International Journal of Organ Transplantation Medicine
Volume:6 Issue: 4, Autumn 2015

There are over 250 kidney transplant programs in the USA. To determine if highly competitive regions, defined as regions with a higher number of transplant centers, will approve and wait-list more end-stage renal disease (ESRD) candidates for transplant despite consistent incidence and prevalence of ESRD nationwide. ESRD Network and OPTN data completed in 2011 were obtained from all transplant centers including listing data, market saturation, market share, organs transplanted, and ESRD prevalence. Herfindahl- Hirschman Index (HHI) was used to measure the size of firms in relation to the industry to determine the amount of competition. States were separated into 3 groups (HHI<1000 considered competitive; HHI 1000–1800 considered moderate competition; and HHI>1800 considered highly concentrated). The percentage of ESRD patients listed in competitive, moderate, and highly concentrated regions were 19.73%, 17.02%, and 13.75%, respectively. The ESRD listing difference between competitive versus highly concentrated was significant (p<0.05). When there is strong competition without a dominant center as defined by the HHI, the entire state tends to list more patients for transplant to drive up their own center’s market share. Our analysis of the available national data suggests a discrepancy in access for ESRD patient to transplantation due to transplant center competition.

Induction therapy regimens classified as conventional immunosuppressive agents and lower doses of conventional agents combined with antibodies against T-cell antigens have been purposed to prevent acute rejection after renal transplantation. Various induction agents with different doses and durations have been suggested based on the risk profile of patients. To assess the acute rejection rate (total rate and based on the type of induction therapy regimen) during the first year after kidney transplantation, the type of acute rejection based on Banff classification and to determine the associations between rate of acute rejection, type of the rejection and induction therapy regimen. 249 kidney transplant candidates were divided into two groups—low-risk patients (n=208) who received conventional immunosuppressive agents, and high-risk patients (n=41) who received alemtuzumab—and followed for one year to detect acute rejection first diagnosed clinically, and confirmed by percutaneous kidney biopsy based on Banff criteria. The total incidence of acute rejection was 19.6% (20.7% of the low-risk and 14.4% of the highrisk patients). The most prevalent types of the acute rejection in patients treated with conventional immunosuppressive agents and patients received alemtuzumab as induction therapy were grade IB and grade IA, respectively. The incidence of acute rejection among recipients received a kidney from a deceased donor was 20.6% and grade IA was the most prevalent type (6.9%) whereas the most prevalent grade of acute rejection in patients who received living donor grafts was IB (8.3%). Despite the expected greater risk for acute rejection among high-risk patients, no significant difference was observed between low- and high-risk patients, which may be justified by the greater efficacy of alemtuzumab compared with standard triple induction therapy in reducing the rate of acute rejection.

It is believed that religious leaders’ positive attitude towards organ donation can be an effective factor in Muslims’ inclination to donate organs. To assess the knowledge of freshmen students in Mashhad University of Medical Sciences about religious leaders’ fatwa on organ donation and its effect on their willingness to donate organs. This cross-sectional study was conducted in 2013 on 400 freshmen of various medical disciplines, selected using a simple random sampling in Mashhad, Iran. Data were collected by a valid and reliable researcher-made questionnaire. Data were analyzed by multiple logistic regression analysis. 41.5% of the students were aware of religious authorities’ views on organ donation and 55.6% were willing to donate organs. Participants’ main reasons for lack of willingness to donate organs included the fear of organ donation before the brain death is confirmed (52%), unwillingness to disfigure their body (51%), and belief in the burial of organs (50%). The willingness to organ donation for students who were aware of religious leaders opinion was more than twice more than those who were not (OR: 2.56, 95% CI: 1.75–4.52). Also, female gender, the Shia religion and awareness of the correct definition of brain death were associated factors affecting the desire to donate organs, although their effects were not statistically significant on regression model. A considerable proportion of students were not aware of the religious leaders’ fatwa on organ donation. The most important factor for the desire to donate organs was the awareness of religious leaders’ fatwa. Therefore, it seems necessary that religious leaders’ fatwa be known to all by appropriate methods.

Articular cartilage defect can lead to degradation of subchondral bone and osteoarthritis (OA). To determine the healing effect of transplantation of adipose-derived mesenchymal stem cells (Ad-MSCs) in full-thickness femoral articular cartilage defects in rabbit. 12 rabbits were equally divided into cell-treated and control groups. In cell-treated group, 2×106 cells of third passage suspended in 1 mL of DMEM was injected into articular defect. The control group just received 1 mL of DMEM. Dulbecco’s modified Eagles medium (DMEM) supplemented with 10% fetal bovine serum (FBS), 1% penicillin and streptomycin and 2 mM L-glutamine were used for cell culture. To induce cartilage defect, 4 mm articular cartilage full-thickness defect was created in the knee. For histological evaluation in each group (H&E, safranin-O and toluidine blue), 3 rabbits were sacrificed 4 weeks and 3 animals, 8 weeks after cell transplantation. In cell therapy group post-transplantation, no abnormal gross findings were noticed. Neo-formed tissues in cell-treated groups were translucent with a smooth and intact surface and less irregularity. In cell-treated group after 8 weeks post-transplantation, the overall healing score of experimental knees were superior when compared to other groups. We showed that Ad-MSCs, as an available and non-invasive produced source of cells, could be safely administered in knee osteochondral defects.

Conventional dentoalveolar osseous reconstruction often involves the use of graft materials with or without barrier membranes. To evaluate the efficacy of bone induction by bone matrix gelatin (BMG), delivered on an absorbable collagen sponge (ACS), compared to a placebo (ACS alone) in human alveolar socket defects. 20 alveolar sockets from 10 healthy adults were studied. In all cases, both the mandibular premolar area and the contralateral premolar area (as the control site) were involved. In each of the 10 patients, the extraction sites were filled randomly with BMG and ACS. The repair response was examined on day 90. Qualitative histological and quantitative histometric analysis, including the percentage of newformed bone fill and density were done. Assessment of the alveolar bone indicated that patients treated with BMG had significantly (p<0.05) better bone quality and quantity compared to the controls. In addition, bone density and histology revealed no differences between the newly induced and native bone. The data from this single-blind clinical trial demonstrated that the novel combination of BMG had a striking effect on de novo osseous formation for the bone regeneration.

The kidney transplantation surgery requires left nephrectomy because of the anatomical disadvantages. But hydroureteronephrosis is the most significant renal functional alteration of pregnancy, accounted for by both hormonal and mechanical factors. Dilatation of the ureters and renal pelvis is more prominent on the right side than the left side and is seen in up to 80% of pregnant women. A 23-year-old woman who become pregnant after 4 months from left kidney donation was admitted to our emergency department with acute right kidney injury during her 39th week of pregnancy. She did not response to conservative treatment and required emergency delivery because of the progressive increase in her serum creatinine levels. After delivery, progressive decrease at creatinine level had been observed and in one month, it had reached the normal level. Mother candidates should be advised they donate their kidneys after completing their childbearing if possible, or undergo right nephrectomy.

Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg+ man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the backtable procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.