International Journal of Organ Transplantation Medicine
Volume:5 Issue: 1, Winter 2014

Literature review suggests that adherence to immunosuppressive drugs may be lower in recipients of living than of deceased donor kidney grafts, possibly because of profile differences. To compare the level of immunosuppressive adherence levels between patients with deceased and living (-related; -unrelated) donor grafts in Switzerland. Using data from two similar cross-sectional studies at two transplant centers in Switzerland, the level of adherence between the two groups was compared. Medication adherence was assessed by self-report or electronic monitoring. Possible explanatory factors included age, beliefs regarding immunosuppressive drugs, depressive symptomatology, pre-emptive transplantation, and the number of transplants received, were also considered. Data were analyzed using logistic regression analysis. Unadjusted non-adherence odds were 2 to 3 times higher in living-related than deceased donor transplantation (ORs: 2.09-3.05; p<0.05). Adjustment for confounders showed that these differences were associated most with the younger age of living-related subjects and the belief that immunosuppressive drugs are less important for living-related donations. There is a lower immunosuppressive adherence in recipients of living-related donor kidneys, possibly owing to differences in patient profile (ie, health beliefs regarding their immunosuppressive needs), knowledge of which may enhance adherence if addressed.

Cell-based therapy has been implicated in the treatment of liver diseases. Mesenchymal stem cells from various sources such as bone marrow are available. These cells are one of the major candidates in cell therapy. The production of insulin-like growth factor-I increases in the regenerating organ. The insulin-like growth factor-I in liver regeneration is effective after binding to insulin-like growth factor-I receptor. To test our hypothesis that tumor necrosis factor-α can stimulate mesenchymal stem cells to express insulin-like growth factor-I receptor. Bone marrow was aspirated from normal human donor after taking informed consent. Cells were isolated and cultured. Identification of cells was done by flowcytometry and functional tests. The fourth passage cells were treated with tumor necrosis factor-α at two doses of 1 and 10 ng/mL, and incubated for 2, 10, 24, and 48 hours. Insulin-like growth factor-I receptor gene expression was studied using real-time polymerase chain reaction. Flowcytometry showed that the human bone marrow mesenchymal stem cells were positive for CD90 and negative for CD45 and CD80. The insulin-like growth factor-I receptor gene expression was increased in tumor necrosis factor-α treated in comparison with untreated cells. Treatment of human bone marrow-derived mesenchymal stem cells with tumor necrosis factor-α increases gene expression of insulin-like growth factor-I receptor. This finding may be used for increasing the effectiveness of stem cell therapy in those with acute hepatic failure.

For the treatment of bone defects that exceed the critical size of the injury, several therapies have been investigated. Thermal decomposition method is suggested for extraction of natural hydroxyapatite bioceramic (HA). This technique in comparison with other methods of producing HA, has less complexity and greater economic efficiency. In the present study, a thermal decomposition method is suggested for extraction of natural HA from bovine femur bones. In this experiment, to extract the ceramic material, the bone samples were first de-fatted and ground to particles less than 420 μm, and also 420–500 μm, respectively. Prepared powders were heated at 170 °C for 24 h, and then divided into two groups for 6 h. The first group was heated at 750 °C; the second group was heated at 850 °C. The calcium phosphate compounds were obtained with complete elimination of the organic phase of the bone. These bioceramic compounds were characterized physiochemically by X-ray diffraction (XRD), fourier transform infrared spectroscopy (FTIR), energy dispersive X-ray (EDX), and scanning electron microscopy (SEM). We found that the powder heated at 750 °C in two dimensional scales was rich in carbonated hydroxyapatite, and therefore, eminently suitable for using in hard tissue replacements. However, increasing the temperature up to 850 °C reduced the Ca/P ratio to 1.5 in the powder sample sizes less than 420 μm. Consequently, the obtained composition became rather similar to the chemical formula of tricalcium phosphate (TCP) that is appropriate in tissue engineering and drug delivery applications. The observations affirmed that by eliminating the collagen and other organic materials existing in the bovine bones, the mineral phase of the bone had the potential of transformation to nanoparticles. To investigate the repair of critical-size bone defects and bone augmentation, cylindrical blocks were fabricated by applying different pressures of 150, 160 and 170 MPa. The structure and compressive strength of the pressed samples after sintering at 1200 °C were characterized by SEM and compressive strength test.

An adequate level of tacrolimus in serum should be obtained to prevent acute rejection following liver transplantation. Because of good gastrointestinal absorption of oral tacrolimus, adequate trough levels can be achieved even in patients with short bowel syndrome. Rarely, adequate through levels cannot be obtained by oral administration of the drug for several reasons such as inadequate absorption, having a discordant patient, laboratory error, and/or interactions with other drugs and foods. Here, we described a 16-year-old patient who had undergone massive intestinal resection due to mesenteric torsion 5 years previously and required liver transplantation for cryptogenic cirrhosis. Her remnant small bowel length was 90 cm. After a successful living donor liver transplantation, oral tacrolimus administration resulted in inadequate through levels in some parts of the postoperative period. We checked up all the potential reasons but could not identify any cause. An intravenous tacrolimus including immunosuppressive regimen was temporarily required. She maintained adequate blood levels of tacrolimus by parenteral route for a while; thereafter, oral administration resulted in enough blood drug levels. She was discharged with oral tacrolimus therapy. We concluded that very rarely, adequate blood levels of tacrolimus cannot be achieved by oral administration for unexplained reasons. In such cases, temporary administration of parenteral tacrolimus can be life-saving.