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Posters
GST 2016
Page 33 Vijaya Kumar et al., J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Functional endometrial preservation in cervicovaginal or vaginal agenesis: A medical versus cultural perspective in a developing country Vijaya Kumar Kasturba Medical College, India
Aim: Congenital agenesis of the uterine cervix and vagina in the presence of a functional endometrium is an extremely rare Mullerian anomaly presenting with painful cryptomenorrhea. Our subset of women in this group wishes to conserve their uterus for social and cultural reason of the region. We report 15 cases of functional endometrial preservation with restoration utero-vaginal continuity for menstrual function. Material & Methods: All the girls (13-26 years) presented with cyclical painful cryptomenorrhea. Magnetic resonance imaging (MRI) confirmed hematometra and distal cervicovaginal or vaginal agenesis. The patient counselling revealed that girls were very keen to conserve their uterus for social and cultural reasons but want to get relieved of painful cyclical cryptomenorrhea. A sigmoid colon conduit was planned as neo-vagina and anastomosed to the uterus through posterior uterine wall in 12 girls with cervicovaginal agenesis. It was anastomosed to upper vaginal pouch in three girls with vaginal agenesis. Three patients also underwent anterior sagittal anorectoplasty as there was no space available between the urethra and anal opening to accommodate the neo-vagina because of the anterior ectopic anal opening. A circular portion of the posterior uterine wall needs to be excised for wide colo-uterine anastomoses. Results: Recovery of painless menstrual activity was possible in all the cases. Two patients had stenosis of perineal neo-vaginal orifice, out of which one responded for dilatation and the other for Y-V plasty of the orifice. One patient developed obstruction at colo-uterine anastomosis and managed by redoing the anastomosis. Neo vaginal prolapse seen in one patient underwent excision of prolapsed portion of the neo vagina. Four girls got married and reports satisfactory intercourse. Conclusion: The surgical technique described herein creates a conduit for sexual function and also allows an egress for regular painless menstruation. We believe that this is an important achievement in a young woman, helping her to acquire psychological fulfillment as a woman. However, they should be cautioned against pregnancy in cases of cervicovaginal agenesis and against vaginal delivery if they have vaginal agenesis.
Biography Vijaya Kumar is a Professor and Head in Department of Pediatric Surgery, Kasturba Medical College, Manipal, India. His area of interest includes Pediatric Urology and Pediatric Gynecology. He has attended more than 40 national and international conferences, workshops and presented more than 60 scientific papers. He has published 49 publications in both national and international journals. He is actively involved with the research activities at the university level and completed three international funded projects.
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J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
Page 34 Joshua A Cuoco et al., J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Reproductive quandaries pertaining to human head transplantation Joshua A Cuoco & George W Koutsouras New York Institute of Technology College of Osteopathic Medicine, USA
ecently, plans have been proposed to perform the first human head transplantation procedure within the next few years. However, Rthere are significant ethical ramifications of such a procedure, particularly with regard to the ethics of sexual reproduction. First, a recipient (i.e., the head of the individual being transplanted onto a donor body) will never truly have the capacity to reproduce; rather, the donor body will reproduce upon the will of the recipient. This begs the question - would it be ethical for the recipient to use the donor’s reproductive organs to have a child when the donor is legally deceased? Undoubtedly, it would be a challenge for the recipient to inform their child that the child’s natural mother/father had died prior to the child’s conception. Furthermore, it would be difficult for the recipient to explain to their child that the child’s biological mother/father donated their body to the recipient. Second, biologic differences (e.g., sex, age, fertility and genetics) between the recipient and donor should be addressed. Would it be ethical for a fertile individual to recieve an infertile body or an infertile individual to receive a fertile body? Lastly, we ought to consider where the first successful human head transplantation may lead us in the future. If same-sex head transplantation one day becomes common practice then why not to pursue opposite-sex head transplantation? Although neurochemically improbable procedure can theoretically allow an individual to transition to the opposite sex and participate in the reproductive activities associated with this sex.
Biography Joshua A. Cuoco completed his MS at the age of 22 years from Johns Hopkins University. He is currently a second-year medical student at NYIT-COM. He studies the anatomic and functional neuronal diversity in the brain during brain development and in brain pathologies. He has published several papers in the field of neuroscience.
George W. Koutsouras completed his MPH in 2012 from SUNY Downstate Medical Center School of Public Health. He is currently a third-year medical student at NYIT-COM. He studies central nervous system invasion and biofilm formation by Cryptococcus neoformans. He has published in the field of public health.
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Page 35 Shi-Feng Li et al., J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Successful combined liver-kidney transplantation for methylmalonic acidemia Shi-Feng Li, Hawxby A M and Sebastian A Oklahoma Transplant Center, USA
o evaluate the emerging role of combined liver-kidney transplantation (CLKT) for methylmalonic acidemia (MMA) with Tassociated renal failure, we report a case and review the literature on outcomes of this treatment. Following successful CLKT, during the four year follow-up, our 16 year old patient demonstrated a marked reduction in serum methylmalonic acid level from a pre-transplant level of 3204.86 µmol/L to 236.46 µmol/L and complete independence from dialysis. Our patient has normal protein intake, growing normally without any further neurologic complication. The patient has graduated from a high school and is ready to study at a college. In our retrospective literature review of 10 patients undergoing CLKT for MMA, all patients were alive with adequate liver function at a mean of 15 months following CLKT. One patient did experience worsening renal function due to non- adherence with medication and restricted diet following CLKT; the other nine patients demonstrated satisfactory renal function. One patient suffered metabolic decompensation with cerebellar infarct 10 months after CLKT. Even though CLKT is not curative for MMA, the patients often gain freedom from dietary protein restriction, normal growth curve, muscular strength and avoidance of metabolic crises with overall improvement in quality of life. In conclusion, CLKT should be considered for those patients with MMA and renal failure who continue to experience episodes of metabolic decompensation in spite of optimal medical therapy. Adequate dietary protein restriction following CLKT should also be considered if serum methylmalonic acid is too high in order to minimize potential late neurologic complications.
Biography Shi-Feng Li completed his Medical Degree and Surgery Residency from West China University of Medical Sciences. He also completed a Transplant Surgical Fellowship at Integris Health. He has authored numerous peer review articles, as well as medical textbooks. He is serving as a Liver, Kidney and Pancreas Transplant Surgeon at Oklahoma Transplant Center.
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Page 36 conferenceseries.com 715th Conference
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Accepted Abstracts
GST 2016
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Its about time: Raising awareness of organ donation within the Pakistani/Indian Muslim community Angela Ditchfield East Lancashire Hospitals NHS, UK
rgan transplants save and improve lives of people with end stage organ failure. The demand for organ transplants outweigh Othe supply in the UK and this shortage is more acute within the Black and Minority Ethnic (BAME) groups. There are nearly a quarter of people from BAME groups waiting for a kidney transplant although fewer than 2% of those who have joined the organ donor register to pledge their organs for transplantation after their death are from BAME groups. There is a significant shortage of donors from the BAME population. The UK can and must do more to save and improve lives through organ donation and transplantation and aim to change the current situation. The most successful transplant will come when best matched. Blood group and tissue typing are test which are carried out to find the best possible match and organ matching is likely to be closer when the ethnicity of the donor and the recipient are same. The project aimed to raise awareness of organ donation within the Pakistani Muslim community in Blackburn Lancashire. 30 questionnaires were distributed amongst the community. The questionnaire enquired about the participants understanding of organ donation and how the participants accessed media platforms to gain information. Three focus groups were held within the community of Blackburn. The participants ages ranged from 16-65 years. The focus groups were transcribed and analysed using a thematic approach.
The associations of endocannabinoids and metabolites of adipose tissue in kidney transplant recipients Daria Salata, Malgorzata Marchelek Mysliwiec, Tomasz Janus, Andrzej Ciechanowicz, Wojciech Brzoska, Natalia Marczuk, Elzbieta Cecerska-Heryc and Barbara Dolegowska Pomeranian Medical University, Poland
ndocannabinoids (EKB) influence the function of endocrine, nervous and immune system, as well as may modify metabolism of Elipids, carbohydrates and adipose tissue. EKB may also participate in the development of inflammation, in adhesion, migration and apoptosis of inflammatory cells. The most well-known EKB are anandamide and 2-arachidonylglycerol. They are closely associated with abnormalities in the glucose/lipid metabolism which is deregulated in patients after transplantation.On the other hand, action of these lipids on immune or endothelial cells may play a crucial role in determination of allograft survival. EKB may inhibit migration of immune cells to the site of transplanted allograft. EKB seem to be a promising target of research, potentially leading to improvement of both -early- and long-term outcome of transplanted kidney allograft. Our study included 35 patients after kidney transplantation from Nephrology, Transplantology and Internal Diseases Departments of Pomeranian Medical University and 40 healthy-individuals as control. Blood were collected directly before and at 5-7 day after transplantation and plasma concentration of anandamide and 2-arachidonylglyceroland adipocytokines: adiponectin, leptin were analyzed. We also examined serum biochemical parametersand lipid profile. Serum NGAL, creatinine and eGFR were evaluated as well as marked the renal function. Our study i) supports the significance of selected endocannabinoids in the in kidney transplant recipients ii) highlights associations between endocannabinoids and adipocytokines in kidney transplant recipients iii) preliminarily characterizes the diagnostic potential of EKBin kidney transplantation. This study was supported by a grant awarded by the Polish National Science Center.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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Intestinal transplantation: The anesthesia perspective Aparna Dalal Icahn School of Medicine at Mount Sinai, USA
ntestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for Ithose patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/ duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access may be common due to prolonged parenteral nutrition and/or hypercoagulability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors may be used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks and thrombosis of grafts etc. Asepsis, drug interactions between anesthetic and immunosuppressive agents and venous access are some of the anesthetic considerations for this group.
Stem cell transplantation: Emerging hope for sickle cell disease patients Olusogo Busari University College Hospital, Nigeria
ickle cell disease remains a disease of public health importance particularly in West Africa with 2-3% of the Nigerian population Sliving with the disease and 25% being carriers of sickle cell trait. Despite the advocacy programme on prevention, the prevalence of sickle cell disease does not seem to have changed. Early detection through prenatal and neonatal screening and novel therapies such as chronic transfusion and use of hydroxyurea have helped in preventing complications and thus prolonged the life span of patients with sickle cell disease. Stem cell transplantation is a potential cure for patients with sickle cell disease and our institution has over 2000 adult and 800 paediatric sickle cells patients and many more are still joining the pool. My focus on transplantation medicine is linked to the large cohort of these patients who might be able to lead a normal life if successfully transplanted. Currently, very few of the patients who can afford the transplant are referred to abroad. We intend to establish a sickle cell centre which will incorporate the transplant centre. I have a short exposure/training locally in bone marrow transplant in sickle cell. The recent success reported by National Institute of Health (NIH) will offer the opportunity to our adult sickle cell patients to lead a normal life. Therefore, I look forward to available cutting edge science and opportunities in the field of transplantation during the conference.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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Prioritization of surgical patients Samira Abbasgholizadeh Rahimi Université Laval, Canada
tatement of the problem: Access to healthcare services and long waiting time is one of the main issues in most of the countries including SCanada and United States. Healthcare organizations can’t increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best use the scarce resources. Some challenging aspects in patients’ prioritization problem are: Considering multiple conflicting criteria; incomplete and imprecise data; associated risks that threaten patients on waiting lists; uncertainties in clinicians’ decisions; involving group of decision makers’ opinions and; system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in healthcare delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this study, we propose novel hybrid frameworks to prioritize surgical patients by addressing a number of main shortcomings of introduced/used prioritization methods in the literature and in practice. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC), clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework can be adopted easily and effectively in other healthcare organizations as well. In brief the results of this study could be beneficial for healthcare professionals to: Evaluate surgical patients’ priority more accurately and easily; determine policies and guidelines for patients’ prioritization and scheduling; manage waiting lists properly; decrease the time required for surgical patients’ prioritization; increase equity and justice among surgical patients; diminish risks that threaten surgical patients during waiting time; consider group of decision makers’ opinions in the prioritization procedure to prevent possible biases in decision-making; involve surgical patients and their families in the prioritization procedure to increase their satisfaction; handle uncertainties in the decision-making procedure and; increase quality of care.
Introducing analytical hierarchy process into shared decision making in surgery Samira Abbasgholizadeh Rahimi Université Laval, Canada
sually there are different associated risks, complications and side effects in surgeries. An effective communication among Usurgeons and patients, and patients’ active involvement could result in taking better decisions for treatment and high quality patient care. Shared Decision Making (SDM) could make both surgeon and patient feel comfortable about the procedures, decisions and any possible future complications. However, for effective implementation of SDM in surgery setting having a decision aids that could simplify and accelerate the procedure for patients and surgeons is essential. This study highlights: The importance of the SDM in surgery, the need for an appropriate decision aid, introduces Analytical Hierarchy Process (AHP) as an effective tool to promote SDM in surgery and to enhance surgeon-patient communication. AHP is well known and well developed method which is successfully applied in different medical decision makings. Although AHP has the potential to improve quality of SDM in surgery and overcome current barriers in this area, further researches are needed to determine its effectiveness in practice.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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European liver transplant registry: A 30-year model of international scientific collaboration Vincent Hassan Karam Paul Brousse Hospital, France
he European Liver Transplant Registry (ELTR) is a voluntary collaboration of 161centers in 31 European countries established in T1985. For ELTR, a pre-specified set of variables is collected from every liver transplant (LT) patient at the point of transplantation. Moreover, follow up data are updated by contributing centers at each visit so that re-transplantations as well as deaths can be recorded. The ELTR has established partnerships to exchange data with key European Organ Sharing Organizations (NHS Blood and Transplant- UK, Organización Nacional de Transplantes- Spain, Agence de la Biomedicine- France, Stichting Nederlandse Transplantatie- Netherlands) and European Organ Exchange Organizations (Scandiatransplant and Eurotransplant Foundation). Coverage of LT in Europe within ELTR has been shown to be as high as 97% in 2013; data obtained from the ELTR database can thus be described as highly representative of Europe. Data are collected prospectively by an EDC standardized questionnaire, which is regularly updated by a scientific committee, and subject to strict internal and external quality control to ensure the accuracy and consistency of the information. Annual audits of randomly selected centers are continuously performed, which have confirmed that data from the ELTR are a reliable and credible representation of LT practice in Europe. As such, data from the ELTR has also formed the foundation for the development of risk models for LT outcomes. The ELTR has currently worked on implementing a platform by combining traditional data management and analytics roles to effectively evaluate LT data in real-time by utilizing the appropriate data IT solutions.
Use of a new laser for prostate surgery Tawfik A Zein St. Joseph's Hospital of Buckhannon, USA
0 patients were evaluated in our clinic for symptoms of bladder outlet obstruction and were scheduled for laser ablation of the 5prostate utilizing the ProTouch 1470 laser. All patients failed medical treatment, five presented with urine retention. Preoperative evaluation included ultrasound, cystoscopy, flow rate and the BPH scoring system. Operative time was markedly shorter than the gold standard TURP. Time of resection ranged from 10 minutes to 45 minutes depending on the size of the prostate. The glands ranged in size between 30 g and 120 g. No intraoperative complications took place and no postoperative bleeding was noted. No postoperative fluid absorption was verified by postoperative blood work and no patient demonstrated an altered mental status while being observed at the hospital. All patients ate on the same day of surgery and were ambulated when spinal anesthesia worn off. Most patients had spinal anesthesia unless contraindicated or refused by the patient. All patients left the hospital following an overnight stay. The Foley catheter was removed on the second morning before discharge except in two patients; no manual bladder irrigation was needed. No patient presented to emergency department after discharge with bleeding or other complications. The technology used for these procedures was the ProTouch 1470 Diode Laser, which is manufactured by Convergent Laser Technologies located in Alameda, CA. The ProTouch operates on the 1470 wavelength. The wattage ranged from 85 to 100, the recommended setting is 90 watts. A setting of 45 watts in super pulse mode was found to be optimal for the resection of bladder tumors. This laser can be used in any operating room that has a standard 110 V line. It reduces hospital expenses through decreased intraoperative times and reduced lengths of stay for patients.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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Islet transplantation: Input of biomaterials for islet survival Elisa Maillard University of Strasbourg, France
slet transplantation is a promising and minimally invasive therapy to restore normoglycaemia in brittle type 1 diabetic patients. IHowever, the procedure is pancreas consuming since two to three pancreases are needed for a single patient. Therefore, efforts in research are focusing on improvement of islet survival during the process to decrease pancreas requirement. The stressful event of islet/exocrine separation deprives cells from extracellular matrix contact and oxygen supply which are two of the major reasons of the loss of approximately 60% of islets. Interest has risen over the last couple of years in biomaterials in islet transplantation regarding transplantation but also for the culture steps. The uses of biomaterials to create an artificial environment for islets post isolation increase their survival and improve transplantation outcome. In the same way, oxygen provider arouses enthusiasm of the community, and numerous teams tested the beneficial effect of oxygen supply from the pancreas retrieval to islet implantation step. The combination of both agents showed a real benefit for islet viability and function in vitro, providing more robust islet for sustaining the transplantation event. In vivo study highlighted several problems with transplantation sites, the liver. Indeed depending upon the material used, the inflammatory reaction is triggered. Therefore, alternative sites are investigated with in particular the omental pouch which gives the opportunity to keep matrices post implantation
Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children Hisham Hussein Mohamed Ahmed Benha University, Egypt
Introduction: Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. Objectives: The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. Methods: A total of 40 children were enrolled into this prospective study; they were aged ≥6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3 mm 30° telescope. Another 3 mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. Result: The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. [email protected]
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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Acute and chronic graft versus host disease of the gastrointestinal tract - Clinical symptoms and current management Gerhard C Hildebrandt University of Kentucky, USA
he gastrointestinal tract is a critical target organ of both acute and chronic graft versus host disease (GVHD). Clinical signs Tand symptoms are often non-specific and can be attributed to a variety of other medical conditions, which are frequently seen in the allogeneic HCT recipient as well. GI involvement during either acute or chronic GVHD significantly affects overall non- relapse mortality and overall survival and early identification and adequate treatment is critical. Therefore, patients should undergo a thorough work as soon as possible, including extensive infectious work up plus upper and lower GI tract endoscopy to obtain histologic proof of GVHD and/or identification/exclusion of other or concurrent underlying causes. The diagnostic role of standard imaging techniques, such as abdominal XR, CT, MRI and conventional ultrasound is rather limited, yet PET/CT and wireless video- capsule endoscopy may aid in diagnostic management and are currently under investigation. Treatment is usually initiated once the diagnosis of acute GI-GVHD is either confirmed or if clinical symptoms suggest the possibility of GVHD and other causes have been ruled out. Initial treatment of acute GI-GVHD usually consists of systemic methylprednisolone. Non-(little-) absorbable steroids, such as budesonide or beclomethasone di-proprionate can be considered to augment topical steroid delivery and to potentially spare systemic steroid exposure. In chronic GI-GVHD, systemic immunosuppression with steroids plus/minus calcineurin inhibitor are commonly initiated and optimized when clinical symptoms develop or worsen. Mechanic dilation and enzyme replacement therapy are utilized for esophageal structures and pancreatic insufficiency, respectively. The role for non-absorbable steroids in chronic GI- GVHD is not well defined and in both acute and chronic GI-GVHD, switching to second/third line immunosuppressive strategies often will be required.
Impact of immunosuppression minimization and withdrawal in long-term hepatitis C virus liver transplant recipients Giuseppe Tisone University of Tor Vergata, Italy
HCV-related disease is the most common indication for liver transplantation (LT). HCV recurrence, which is almost universal, has a significant impact on patient and graft survival after LT and still represents a great unsolved issue for the liver transplant community. Since Interferon and Ribavirin have limited efficacy and can be administrated only in selected transplant recipients and considering the lack of long-term results of the new direct acting antiviral agents on HCV-LT recipients, the achievement of immunosuppression minimization and when possible, the immunosuppression-free state, still play a central role in the avoidance of rapid HCV recurrence. On this regard, the antimetabolite use (namely Micophenolate) in the mid-term LT recipients seems to favorably impact the natural history of HCV recurrence. It is likely that the avoidance of IS in LT recipients should be the main purpose in order to restore the immunity and contrast the HCV disease. Literature reports 21 cases of HCV-LT recipients who successfully achieve a sustainable IS-free state but in most of them the long-term histological finding was not reported. Only our group published a long-term HCV- transplanted series on more than 300 yearly consecutive liver biopsies in which a lower fibrosis progression rate was showed in those recipients who were off any immunosuppressant agents. In conclusion, the long term LT recipients should always be considered for withdrawal. In those who require immunosuppression, the use of anti-metabolites should be considered in spite of calcineurin inhibitors. [email protected]
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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Survival outcomes after combined heart-kidney transplantation compared to kidney transplantation alone Konstantinos A Zorbas, Sunil Karhadkar, Kelvin Kwan N Lau and Antonio Di Carlo Temple University Hospital, USA
Introduction: The first successful combined heart-kidney transplantation (HKTx) underwent in 1986 and since then the prevalence of this procedure has increased dramatically. Survival outcomes in HKTx seem to be similar to those for kidney transplantations alone (KTx). Aim: Aim of this study is to examine whether combined HKTx have the same survival outcomes or not, compared with those of kidney transplantation in the first two years. Methods: Temple University Hospital Database was queried from 1990-2015 for patients with heart and renal failure, who underwent HKTx and we found 20 cases. Data were extracted with reference to age (at transplantation), gender, race, weight (BMI), diabetes mellitus status, coronary artery disease status, hypertension status and date of transplantation. A control group of solitary KTx recipients was selected from the same database that underwent transplantation during the same time period. The control group was matched with HKTx for age at transplantation (±2 years), gender and race. Kaplan-Meier method was used to identify the first two years survival outcomes in these two cohorts. Results: Out of 20 patients who underwent HKTx, seven died during the first year after transplantation and from the cohort of solitary KTx only one patient died, particularly during the second year. Mortality in the HKTx group was higher in comparison with the mortality in solitary KTx cohort, particularly with statistically significant difference (.012). Conclusions: Combined heart-kidney transplantations have higher incidence of mortality during the first year after transplantation. Additional studies are needed to determine the long-term mortality and which patients are suitable for HKTx.
Stimulation of islet revascularization modulating HIF-1α expression using siPHD3 A Langlois, E Maillard-Pedracini, M Prinz, R Beaurepère, W Bietiger, C Sookhareea, C Mura, N Jeandidier, M Pinget and S Sigrist University of Strasbourg, France
eleterious events for islet engraftment are related to insufficient islets revascularisation inducing β cells death. HIF-1α is involved Din various survival molecular pathways like cell proliferation and angiogenesis whereas for a chronic stabilization, it induces apoptosis. Prolyl-hydroxylase 3 (PHD3) mediates the degradation of HIF1α under normal oxygen conditions. It could be interesting to find the best level of HIF-1α expression in islets inhibiting PHD3 to induce angiogenesis while limiting apoptosis. The aim of this work was to realize a proof of concept of a new strategy of angiogenesis stimulation inhibiting PHD3 expression using siRNA on β-cell lines. RINm5F β-cells were lipofected (Lipofectamine RNAiMax) or not with 50 µM of siPHD3. Apoptosis was determined using Apo-ONE® Homogeneous Caspase-3/7 Assay, PHD3 expression by western blotting and VEGF secretion using Elisa kit 48 and 72 hours after lipofection. Caspase 3/7 activity is reduced with siPHD3, 48h (Control: 450±18 RFU; siPHD3: 155±12 RFU, p<0.001) and 72h post lipofection (Control: 689±10 RFU; siPHD3: 213±21 RFU, p<0.001). A significant decrease of PHD3 protein expression was observed using siPHD3 validating the efficiency of our approach (Control 48h: 0.48±0.15 and siPHD3: 0.14±0.03 PHD3 protein expression/β-actin; p<0.01). Finally, siPHD3 shown a significant pro-angiogenic effect increasing VEGF secretion 72h post lipofection (Control: 9837±470 and siPHD3: 17306±2118 pg/mg of protein; p<0.05). Inhibition of PHD3 using siRNA, decreases apoptosis and increases VEGF secretion in RINm5F cells. Thus, modulation of HIF-1α expression using lipofection of siRNA could increase islet vascularization and could be a realistic approach to improve graft survival.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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How ex vivo lung perfusion could play a significant role to decrease the incidence of renal injuries after lung transplantation? Mohamed Shehata Essen University Hospital, Germany
ung transplantation is indicated for terminal stage lung diseases such as chronic obstructive pulmonary disease, idiopathic Lpulmonary fibrosis, cystic fibrosis, pulmonary hypertension and sarcoidosis, which have a significant impact on the pulmonary vasculature and may affect the function of the right ventricle and cardiac output. Accordingly, right ventricular and correspondingly the left ventricular parameters and functions have been reported to improve after lung transplantation. However, improved cardiac index, echocardiography and other cardiovascular parameters are not the only indicators of good prognosis. Renal functions may, in addition, provide more reliable clinical prognostic evaluation. When the cardiac output is improved, following lung transplantation, renal perfusion and the urine output would correspondingly improve. However, if renal injury develops, urine output would not be able to reflect the improvement of the cardiac functions and the cardiovascular system may instead be affected secondary to the renal injury. High rates of incidence of acute and chronic kidney injuries have been reported following lung transplantation; with complete recovery from the acute kidney injury did not decrease the risk for the development of chronic kidney disease or long term mortality. Though renal injury following lung transplantation depends on many risk factors, including the original status of the patient's kidneys and the effects of the immuno-suppression, especially calcineurin inhibitor therapy, the increased production of inflammatory cytokines due to the ischemic reperfusion injury and the donor-recipient contact can be propagated to significant levels that lead to renal and other organs injury, dysfunction and or failure. In addition, reducing the pro-inflammatory stimuli associated with lung transplantation, may affect the long term immuno-suppression regime. Hence, effective EVLP might, to some degree, affect the risk of acute and or chronic kidney injuries following lung transplantation. Taking these concepts into consideration, a non- randomized retrospective study has been recently reported by the Toronto team to compare 52 standard lung transplants to 13 EVLP transplants regarding the incidence of acute kidney injury following transplantation. The results showed no significant differences.
Dual system of ex vivo lung perfusion: Describing Shehata model Mohamed Shehata Essen University Hospital, Germany
ue to the increased incidence of end stage lung diseases, lung transplantation has become a frequent intervention that constitutes Dthe sole therapeutic strategy. Unfortunately, up to 80% of the available lung grafts could not be considered for transplantation. The introduction of ex vivo lung perfusion (EVLP) technique allowed the reconditioning of the otherwise declined grafts, which had a significant impact on the clinical outcome and the mortality within the waiting lists of the patients. Moreover, the value of reconstruction of the bronchial arteries during lung transplantation was previously documented, where it was found to protect the pulmonary endothelium and type II pneumocytes in the early phase after transplantation. The bronchial blood flow was also found to be important for the vitality of the airways, the fluid balance of pulmonary tissue and the metabolic functions of the lungs. Accordingly, the inclusion of the bronchial arteries in the ex vivo lung graft perfusion has been suggested to provide a significant functional improvement. Currently, there are only two dual EVLP systems that have been described; an experimental dual- EVLP system, which was designed for the ex vivo perfusion of rat heart-lung blocks and the Shehata- described model. The results of the experimental study confirmed the expected significant impact on the graft physiology and histology, including the attenuation of the cytokine production. The other (Shehata) model differs from the experimental model in the technique of the inclusion of bronchial arteries in the perfusion circuit.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
Page 45 J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Laparoscopic treatment of hydatid cyst of the liver in children (62 cysts) Muataz Abduljawad Alani Central Child Teaching Hospital, Iraq
Introduction: Appropriate surgical intervention to obtain the best results with the lowest rate of recurrence and minimal morbidity is mandatory for the management of hepatic hydatid disease. Aim: Aim of this study is to evaluate the safety and efficacy of laparoscopically treated liver hydatid cysts in children. Patients & Methods: From September 2009 to September 2014, 62 hydatid cysts of the liver underwent laparoscopic treatment in pediatric surgery center in Al Khansaa Teaching Hospital, Iraq. Umbilical 5 mm port, another two 5 mm ports inserted and used as working site. The procedure were the same as in open surgery, puncture, aspiration, injection of scolicidal agent, reaspiration, removal of proligerous membrane and resection of the dome. All patients received antiparasitic drugs. Results: The patients' mean average age was five years and seven months (range three to seven years). The number of cysts ranged from one to two with a diameter of 60 to 150 mm (mean diameter, 85.5 mm). Three patients had a mesenteric associated hydatid cyst, another two had pelvic hydatid cyst. The average operating time was 65 minutes (45 min-95 min). The average length of hospital stay was three days (range, 2-4 days). No complications were reported, apart from port site infection in three patients with infected hydrated cyst. At 5 to 49 months follow-up, no recurrence has been reported. Conclusion: Laparoscopy represents a safe approach for the treatment of hydatid cyst of the liver in children.
NOD2/CARD15 gene polymorphisms are associated with increased risk of extensive chronic and steroid- resistant graft versus host disease after hematopoietic stem cell transplantation Victoria Lavrinenko, Kira Takun, Nina Minakovskaya, Dmitriy Prudnikov and Olga Aleinikova National Research Center for Pediatric Oncology, Hematology and Immunology, Belarus
vHD (graft versus host disease) is a major cause of non-relapse mortality and morbidity after allogenic hematopoietic stem cell Gtransplantation (HSCT). Polymorphisms of non-HLA genes including NOD2/CARD15 that influence on immune responses and inflamation may play a role in GvHD development. The aim of this study was to evaluate the influence of NOD2/CARD15 gene polymorphisms on the outcome of HSCT. 80 patients at the age of 0.5-29 (median, 9) years with malignant and non-malignant diseases after allogenic HSCT were included in the study. SNP8, SNP12 and SNP13 alleles of NOD2 had a frequency of 3.5%, 2.5% and 7.5%, respectively. Among donor/recipient pairs, no SNPs were detected in 64%, SNPs only in the recipient were in 9%, SNPs only in the donor were in 15%, SNPs both in the donor and the recipient were in 12%. The presense or absence of NOD2 polymorphisms in the donor and/or the recipient had no impact on OS, TRM, relapse incidence and acute GvHD. Extensive chronic GvHD was associated with the presence of NOD2 polymorphisms only in the donor compared to the group of patients without SNPs (50% vs. 15.8%, p=0.009). In the groups with SNPs only in the recipient or with SNPs both in the donor and the recipient, CI of extensive cGvHD was 13.3% and 14.3%, respectively. CI of steroid-resistant form was higher in the group with NOD2 SNPs only in the donor compared to the group of patients without polymorphisms (50% vs. 17.1%, p=0.009). In groups with SNPs only in recipient or with SNPs both in the donor and the recipient were 25% and 14.3%, respectively. SNPs of the NOD2 gene in donor and/or recipient are associated with a higher rate of infections during the first year after HSCT (93.1% vs. 72.6%, p=0.040). In conclusion, we found the evidence that NOD2/CARD15 polymorphisms in the donor influence on chronic and steroid-resistance GvHD and NOD2/CARD15 typing might help in donor selection.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
Page 46 J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Differentiation of bone marrow derived mesenchymal stem cells into hepatocyte-like cells Reham A Afify, Nesrien M Al Ghrbawy, Nehal Dyaaand Asmaa A El Saye Cairo University, Egypt
Cirrhosis is the end-stage liver fibrosis, whereby normal liver architecture is disrupted by fibrotic bands, parenchymal nodules and vascular distortion. Portal hypertension and hepatocyte dysfunction are the end results and give rise to major systemic complications and premature death. Mesenchymal stem cells (MSC) have the capacity of self-renew and to give rise to cells of various lineages, so MSC can be isolated from bone marrow (BM) and induced to differentiate into hepatocyte-like cells. MSC were induced to differentiate into hepatocyte-like cells by hepatotic growth factor (HGF) and fibroblast growth factor-4 (FGF-4). Differentiated cells were examined for the expression of hepatocyte-specific markers and hepatocyte functions. MSC were isolated. Flow cytometry analysis showed that they expressed the MSC-specific markers, reverse transcriptase–polymerase chain reaction (RT-PCR) demonstrated that MSC expressed the hepatocyte-specific marker cytokeratin 18 (CK-18) following hepatocyte induction. This study demonstrates that BM- derived - MSC can differentiate into functional hepatocyte-like cells following the induction of HGF and FGF-4. MSC can serve as a favorable cell source for tissue-engineering in the treatment of liver disease.
Renal transplantation in HIV-infected patients: The first Portuguese review Sara Querido Hospital de Santa Cruz, Portugal
Introduction: With the introduction of combination antiretroviral therapy (cART), prognosis of HIV infection has been improved and kidney transplantation (KT) in HIV positive patients became possible. Methods: We reviewed the demographic, clinical, laboratorial and therapeutic data of all the HIV-infected patients who underwent KT prior between 2009 (first KT in Portugal in a HIV-infected patient) and May 2014. Case accrual was through all Portuguese KT centers where KT in a HIV-infected patient was performed. Patients were transplanted following the American and Spanish guideline recommendations that included maintenance on cART, undetectable plasma HIV RNA copies and absolute CD4 count of at least 200cells/µl in the last 6 months. Results: Fourteen KT were performed on men, 3 KT on women. The mean age of patients at the time of transplantation was 49.9±11.7 years. HIV status was known for 12±5 years. Eight patients had AIDS in the past and all patients received grafts from deceased donors. Twelve patients (64.7%) received induction therapy with basiliximab and two patients had early graft loss. In 2 patients humoral rejection was diagnosed and in 3 patients, cellular rejection. Two patients died and one additional patient had early graft loss. Conclusion: KT is a possible, but challenging, renal replacement therapy in selected HIV patients. Even in those with AIDS criteria in the past, when the disease is controlled and after the reconstitution of the immune system with cART, KT can be performed. Nevertheless, the risk-benefit ratio for each patient needs to be taken in consideration.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
Page 47 J Transplant Technol Res 2016, 6:4 (Suppl) conferenceseries.com http://dx.doi.org/10.4172/2161-0991.C1.003 4th Global Surgery and Transplantation Congress October 03-04, 2016 Atlanta, USA
Overcoming blood group and antibody barriers by kidney paired donation Shafi Malik University Hospital of Wales, UK
pproximately one third of kidney transplant candidates has medically acceptable living donors but is unable to receive transplants Adue to donor - recipient incompatibilities. Kidney Paired Donation (KPD) is a strategy that matches incompatible pairs in order to find compatible matches, thus increasing living donor transplantation. Significant strides have been made since the idea was first conceptualised. However, the technique remains under utilized. This lecture is intended to highlight the current advances, types of paired donation programs, registries, world-wide experience, outcomes, barriers and limitations.
miRNA-200b inhibits epithelial-mesenchymal transition in TGF-β1 induced human bronchial epithelial cells Shameem S Ladak, Chris Ward and Simi Ali Newcastle University, UK
Introduction: The role of TGF-β1 in mediating extracellular matrix remodeling during the pathogenesis of lung fibrosis has been well defined. Dysregulated expression of miRNA is increasingly implicated in various pathological processes and may play an important role in progressive loss of lung function. Material & Methods: The differential expression of miRNAs was assayed using NanoStringTM in untreated and 1, 4 and 24 hours TGF-β1 treated BEAS-2B (immortalized human bronchial epithelial cells) cells. BEAS-2B and PBECs were transfected with miR- 200b mimics to study expression of EMT markers at mRNA and protein level. MiRNA targets were identified and validated using multiple computational tools and qRT-PCR respectively. In situ hybridization allowed detection of miR-200b in tissues samples at cellular level. Results: NanoStringTM allowed identification of differentially expressed miRNAs post TGF-β1 treatment. MiR-200b mimic transfection followed by TGF-β1 treatment demonstrated a significant increase in E-cadherin (p≤0.05, p≤0.001) and a significant decrease in fibronectin (p≤0.001, p≤0.01) in BEAS-2B cells and PBECs. Protein studies suggested a similar trend in both the cells. MiR-200b significantly reduced the expression of its targets ZNF532 (p≤0.01) and ZEB2 (p≤0.001) in BEAS-2B cells and ZNF532 (p≤0.01) in PBECs post TGF-β1 treatment. Furthermore, In situ hybridization allowed localization of miR-200b in airway epithelium of normal human lung sections. Conclusion: The findings suggest that ectopic expression of miR-200b restore TGF-β1 induced EMT in BEAS-2B cells and PBECs. The outcomes from this study may offer new insights into mir-200b regulation in fibrosis and have potential for therapeutic application in progressive airway diseases.
J Transplant Technol Res 2016 Volume 6, Issue 4 (Suppl) ISSN:2161-0991 JTTR, an open access journal GST 2016 October 03-04, 2016
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