International Journal of Organ Transplantation Medicine
Volume:4 Issue: 3, Summer 2013

Human skin allograft has been used as wound coverage for a long time; it is one of the most successful and widely used dressings for burn wounds in the world. To prepare a freeze-dried human split-thickness skin allograft and evaluate its cytotoxicity, the structure and physical properties after processing methods and clinical efficacy in burn patients. After ensuring tissue safety, we lyophilized human cadaveric partial thickness skin and exposed it to gamma radiation. Histopathological and immunohistochemical properties, tensile strength and in vitro cytotoxicity were assayed for the skin samples. Then, we tested the samples in 11 patients with deep skin burn. On histological and histopathological examinations, we found a normal skin structure. The tensile strength of the rehydrated freeze-dried human skin allograft was not lesser than the fresh human skin. Cell viability in MTT testing was more than 95%. None of our patients showed any signs of immunological reactions or complications. Gamma-irradiated freeze-dried human split-thickness skin is safe and non-toxic and can be used for the treatment of patients with deep skin burn.

Acute kidney injury (AKI) is a common complication after liver transplantation (LT), and considerably increases the morbidity and mortality of the procedure. The gold standard of measuring the kidney function, the serum creatinine level (sCr), has poor specificity and sensitivity for the early diagnosis of AKI. Novel biomarkers for the prediction or early diagnosis of AKI, would potentially increase the opportunities for therapeutic interventions. To compare the diagnostic value of the standard renal marker, sCr and neutrophil gelatinaseassociated lipocalin (NGAL) to predict AKI within 48 hours of LT. During a 9-month period from 2010 to 2011, NGAL was measured two times in 90 patients who underwent LT from deceased donors—after induction of anesthesia (NGAL1) and 2 hours after reperfusion of the liver graft (NGAL2). Patients were grouped according to the presence of risk factors for developing AKI according to the Acute Kidney Injury Network criteria (increase of ≥0.3 mg/dL in plasma creatinine above the baseline value within 48 hours). 60 men and 30 women with mean±SD age of 40.2±14.2 years were included in this study. The incidence of AKI was 34% (95% CI: 24%–44%). The difference between the NGAL1 and NGAL2 (ΔNGAL) and the baseline NGAL concentration was predictive of AKI in all patients. Receiver operating characteristic (ROC) curve and area under curves (AUCs) of ΔNGAL and sCr levels during the first 48 hours of LT were similar in predicting AKI. The AUCs of the ΔNGAL to predict AKI was 0.64 (95% CI: 0.52–0.76). The development of AKI was significantly correlated with the number of units of fresh frozen plasma transfused intra-operatively (p=0.017) and cold ischemic time (p=0.042). Serum NGAL concentrations obtained during surgery is a predictor of AKI in patients undergoing LT.

Mesenchymal stem cells (MSCs) have a capacity for self-renewal and multi-potential differentiations. These cells are considered powerful sources for cell therapy in regenerative medicine and tissue engineering. The cells can be isolated from various tissues; however, harvesting from human umbilical cord and amniotic membrane is easy and accessible source. To isolate and characterize the MSCs derived from human umbilical cord Wharton’s jelly (WJMSC) and amniotic membrane (AM-MSC) with regard to their morphology, immunophenotype and mesodermal differentiation potential in order to obtain an alternative source of MSC for therapeutic clinical applications. Fetal membranes and umbilical cords (n=3) were retrieved from healthy full-term women by elective cesarean delivery. Amniotic membrane and umbilical cord were separately minced and cultured in DMEM supplemented with 10% FBS. After reaching 80% of confluency, the umbilical cord WJ-MSC and AM-MSC were characterized by expression of cell surface markers with flowcytometry, stem cell gene expression with adipogenic/osteogenic potential. Both WJ-MSC and AM-MSC were spindle-shaped cells, expressed MSC surface markers in flowcytometry and stem cell transcriptional factors (OCT4 and NANOG). After induction, the cells differentiated into adipogenic and osteogenic lineages. MSC were successfully generated from umbilical cord WJ-MSC and AM-MSC with similar mesenchymal markers and properties.

The main purpose of organ transplantation is to prolong and maintain a quality life for patients with organ dysfunction. We tried to evaluate short-term survival rates in lung, liver, heart and pancreas recipients. This longitudinal study was based on the data of national registry of recipients in Ministry of Health and Medical Education (MOHME), Iran. Survival rate after 1 year of transplantation, recipients’ age, gender, ischemic time as well as the number of transplantation units, OP units and identification units were collected from the database for all transplantation done between 2010 and 2011. 407 (223 female, and 184 male) patients were enrolled in the study. 13 (3.2%) patients received lung, 299 (73.5%) liver, 85 (20.9%) heart and 10 (2.5%) received pancreas. Within 1 year of transplantation, 61.5% of lung recipients, 88.3% of liver recipients, 72.9% of heart recipients and 80% of pancreas recipients (overall 85.3%) were functioning. Given the short history of transplantation in Iran, we have achieved great success.

Post-transplntation lymphocele is a well known complication, and lymphatic filariasis (LF) has occasionally been found to present as post-transplantation lymphocele. However, incidentally detected LF during transplantation surgery has not been reported. We present an incidentally detected LF presenting as enlarged lymph node in the right iliac fossa of a recipient during transplantation of donor kidney. He was subsequently treated after transplantation and had stable graft function without any complications after 8 months of follow-up.

Nowadays, hand transplantation is a very challenging procedure for surgeons and researchers worldwide. Despite many problems that may occur after this surgery, some centers continue to practice this highly sophisticated procedure. Herein, we report on a 38-year-old man who received hand transplant from a 24-year-old brain-dead man. This patient had lost his right hand from the lower one-third of forearm six years before after a trauma from a mincing machine. Team members organized pre-operative research, cadaver dissection, legal consultation, religious permission and discussion to patient. This procedure was done by 15 Khordad Plastic Surgery Transplant team on February 27, 2013 for the first time in Iran.