International Journal of Organ Transplantation Medicine
Volume:5 Issue: 4, Autumn 2014

Organ transplantation is not only considered as the last resort therapy but also as the treatment of choice for many patients with end-stage organ damage. Recipient-mediated acute or chronic immune response is the main challenge after transplant surgery. Nonspecific suppression of host immune system is currently the only method used to prevent organ rejection. Lifelong immunosuppression will cause significant side effects such as infections, malignancies, chronic kidney disease, hypertension and diabetes. This is more relevant in children who have a longer life expectancy so may receive longer period of immunosuppressive medications. Efforts to minimize or complete withdrawal of immunosuppression would improve the quality of life and long-term outcome of pediatric transplant recipients.

Cytokines and co-stimulatory molecules are important factors determining the outcome of transplantation. To investigate the effect of IL-18 and CD40 gene polymorphisms on the outcome of liver transplantation. 150 liver transplant recipients were included in this study. Alleles and genotypes frequencies for IL-18 (rs1946519) and CD40 (rs1883832) were determined in 28 acutely rejected (AR group) and 122 non-acutely rejected (non-AR group) liver transplant recipients. IL-18 and CD40 gene polymorphisms were evaluated by PCR-RFLP methods. There were no significant associations between IL-18 and CD40 polymorphism with acute rejection in liver transplant patients. IL-18TT and TG genotypes had a significant association with rejection in women compared to men. After grouping the liver recipients according to living vs cadaver donors, a significant association was found between CC genotype of CD40 and rejection in male living donor recipients. IL-18 TG genotype had a significant association with rejection in female cadaver donor recipients. There is no correlation between all genotype and alleles of IL-80 and CD40 polymorphism and the outcome of liver transplantation. However, gender and type of donor affect the correlation between all genotype and alleles of IL-18 and CD40, and the outcome of liver transplantation.

Patients undergoing renal transplantation consume immunosuppressive drugs to prevent graft rejection. Cardiovascular complications and reduced quality of sleep are among the side effects of these drugs. Studies have indicated that the use of non-therapeutic methods such as exercise is important to reduce these complications. To evaluate the effect of a period of exercise training, as a non-therapeutic method, on quality and quantity of sleep and lipid profile in renal transplant patients. 44 renal transplant recipients were selected to participate in the study and randomized into exercise (n=29) and control (n=15) groups. The exercise group participated in a cumulative exercise program 3 days a week for 10 weeks in 60–90-minute exercise sessions. Control group subjects did not participate in any regular exercise activity during this period. Sleep quality of the subjects was evaluated using Pittsburgh Sleep Quality Index (PSQI) questionnaire; the sleep quantity was assessed by recording the duration of convenient nocturnal sleep of the subjects. Physiological sleep-related variables (serum triglyceride [TG], and total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL] cholesterol) were measured before and after 10 weeks of exercise training. In exercise training group, sleep quality of the subjects was improved by 27%; the sleep quantity was increased by 30 minutes (p<0.05). TG, cholesterol and LDL values were significantly (p<0.05) decreased after 10 weeks of exercise training in the exercise group compared to the control group, however, no change was observed in serum HDL level in exercise group compared to the control. There was also a significant (p=0.05) difference in sleep quality and quantity between control and exercise groups. However, there was no correlation between changing quality and quantity of sleep with sleep-related physiological factors. 10 weeks of exercise activity improved the quality and quantity of sleep as well as a number of sleep-related physiological parameters in renal transplant recipients, and would be an effective approach to treat sleep-related disorders in renal transplant recipients.

Liver fibrosis results from excessive accumulation of extracellular matrix, which affects liver function over time and leads to its failure. In the past, liver transplant was thought to be the only treatment for end-stage liver disease, but due to the shortage of proper donors other medical treatments have been taken into consideration. To evaluate the therapeutic effects of bone marrow derived mesenchymal stem cells (BM-MSC) in CCl4 damaged rats. Liver damage in adult male Wistar rats was induced with carbon tetrachloride (CCl4). The rats were divided into normal control group, receiving CCl4, and those receiving CCl4 + marrow derived-MSC. Human BM-MSC was isolated, cultured, and characterized. The rats were injected with xenograft MSCs into the hepatic lobes of the liver. In the eighth week, blood samples were taken from all groups. Histological examination and biochemical analyses were used to compare the morphological and functional liver regeneration among different groups. Measurement of lipid peroxidation and glutathione transferase activity was also performed. Histopathology and biochemical analyses indicated that local injection of human BM-MSCs was effective in treating liver failure in the rat model. Furthermore, oxidative stress was attenuated by increased level of GSH content after MSC transplantation. Evidence of this animal model approach showed that bone marrow-derived MSCs promote an antioxidant response and support the potential of using MSCs transplantation as an effective treatment modality for liver disease.

De novo esophageal malignancy following liver transplantation is very rare. Esophageal squamous cell carcinoma following liver transplant is closely associated with history of alcohol intake and tobacco chewing. We report on a 45-year-old man, chronic tobacco chewer and alcoholic who underwent liver transplantation for alcoholic cirrhosis and developed esophageal squamous cell carcinoma 23 months following the procedure. He was treated surgically and has had a tumor-free survival after 34 months of regular follow-up.