Hypothermic Machine Perfusion in Kidney Transplantation: Back to the Future?

Static cold storage is currently the most used method of organ preservation worldwide. However, cutting edge technology and dramatic changes in the donor pattern have lately renewed the interest toward hypothermic machine perfusion.

Marginal and cardiac death donors show higher rates of primary non function and delayed graft function compared to standard criteria donors. In this setting, machine perfusion may offer several theoretical advantages such as improved organ preservation, continuous graft evaluation, and ex-vivo conditioning of the graft before implantation.

These topics have been recently reassessed by several studies. In particular, perfusion characteristics and perfusate biomarker concentrations (lactate dehydrogenase, aspartate aminotransferase, heart-type fatty acid binding protein, and IL-18) during machine preservation, proved to be reliable tools to rule out graft viability and predict outcomes after transplantation.

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Standard Formulae in Predicting Liver Volumes: A South East Asian Series of Adult Living Donors

Historically Urata et al. first described a formula, based on donor biometrics, to predict total liver volumes. Many centres have shown that such formulae have different accuracy based on the population studied. To date, no such study has been carried out in a South East Asian population.

Our primary aim was to study the accuracy of seven internationally recognized formula. Secondarily we aimed to derive a formula for caluculating the weight of a liver graft using CT derived volume.

A prospectively held database of adult living donor liver transplants between July 1996 and January 2015 was interrogated. Only entries with complete data were included. Donors’ biometrics were tabulated with corresponding CT based volumetry and actual graft volumes and weight, using seven well recognized formulae derived from international centres. The accuracy of these formulae was compared to the CT generated volume.

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Problems and Possibilities in Tissue Engineering

Organ and tissue transplantation in developed countries is in steady increase. We are living in fast changing world with path-breaking technological advancements as a norm of the day. Development of the field of organ and tissue transplantation has accelerated remarkably since the human major histocompatibility complex (MHC) was discovered.

The major histocompatibility complex (MHC) contains a set of cell surface molecules responsible for binding peptide fragments derived from pathogens and display them on the cell surface for recognition by the appropriate T cells.

They are located on chromosome 6 having more than 200 genes in human controlling major part of the immune system responsible for tolerance and rejection of grafts and in graft against host diseases with a decisive role in vertibrates with the help of antibodies, antigen presenting cells, helper and cytotoxic T cell subsets, immune cell surface molecules, signaling mechanisms and cytokines that they release.

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Role of Tissue Dissociation Enzymes on Human Islet Yield Intended for Clinical Islet Cell Transplantation

Clinical islet transplantation is a well-established and a relatively safe procedure for diabetic patients, whereas autologous islet transplantation is performed as an adjunctive therapy following a total or partial pancreatectomy from patients with chronic pancreatitis.

Successful clinical human allo or auto-islet transplantation requires recovery of a suٹcient number of functional islets from cadaveric or chronic pancreatitis pancreata. During the last two decades, significDnt progress has been made in the islet isolation procedures and in the use of tissue dissociation enzymes.

However, it is still challenging to recover all available islets from pancreas. In many centers, about 50% of the islet isolations do not generate a suٹcient number of islets for single donor transplants. Poor islet recovery remains, a critical issue which must be addressed as to achieve widespread adoption of islet transplantation.

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Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique

Various ureteroneocystostomy techniques for kidney transplant have been described with Lich-Gregoir (LG) being widely employed. However, even with multiple modifications on this technique, urine leakage and ureteric stenosis remain as most common complications. This study aims to evaluate urological complications by using our modified LG technique after kidney transplant.

From 26th January 2010 to 30th May 2014, 206 consecutive kidney transplants were performed at our institute. 124 were deceased-donor and 69 were live-donor kidney transplants; 13 patients received a small tumour excised kidney graft.

All transplants except one were done by conventional open surgery. The modification involves an additional stitch placed at proximal part of bladder muscular incision with peri ureteric tissue at the entrance of ureter to bladder. Urological complications were defined as urine leakage or ureteral stricture. The patients were followed-up from 12 to 64 months.

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Problems and Possibilities in Tissue Engineering

Organ and tissue transplantation in developed countries is in steady increase. We are living in fast changing world with path-breaking technological advancements as a norm of the day.

Development of the field of organ and tissue transplantation has accelerated remarkably since the human major histocompatibility complex (MHC) was discovered. The major histocompatibility complex (MHC) contains a set of cell surface molecules responsible for binding peptide fragments derived from pathogens and display them on the cell surface for recognition by the appropriate T cells.

They are located on chromosome 6 having more than 200 genes in human controlling major part of the immune system responsible for tolerance and rejection of grafts and in graft against host diseases with a decisive role in vertibrates with the help of antibodies, antigen presenting cells, helper and cytotoxic T cell subsets, immune cell surface molecules, signaling mechanisms and cytokines that they release.

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PTEN and ERG Molecular Networks in Prostate Cancer

Prostate cancer (PCa) represents a common malignancy among elder males and one of the leading causes of cancer mortality. It may present with a variety of clinical behavior, including tumors of very low clinical significance but also highly aggressive tumors with increased risk of relapse after initial treatment.

Nowadays, many tumors traditionally treated either by radical prostatectomy or by external beam radiation therapy are considered of low clinical significance and such patients are placed under active surveillance protocols with purpose to reduce overtreatment.

As a result, in the “active surveillance” era, there is a need of establishing strong prognostic markers identifying aggressive tumors as well as clinical significant tumors even among these initially characterized of low or intermediate risk.

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RIGHT VERSUS LEFT LAPAROSCOPIC DONOR NEPHRECTOMY: INITIAL 3 YEAR EXPERIENCE FROM A SINGLE CENTRE TRANSPLANT PROGRAM

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers. Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes.

The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.

There were 56 left-sided and 16 right-sided donors. There was no significant difference in surgical outcomes or complication rates. Similarly, the recipient surgery complication rates and allograft outcomes were no different between kidneys procured laparoscopically from the left or the right.

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Pin Worm Causing Acute Appendicitis

The vermiform appendix is a tubular structure found just below the ileoceacal junction on the ceacum. It has got an immune function and is no longer a vestigial organ. Most important implication of the appendix is acute appendicitis which is the most common surgical emergency worldwide.

The inflammation of appendix is generally secondary to obstruction of the lumen of the appendix. Most commonly it is caused by lymphoid hyperplasia, Fecoliths, foreign bodies, tumors or parasites. Among the parasites most common is Enterobius vermicularis.

Mostly it is seen in children however no age is immune to this infection. Enterobius vermicularis can lead to acute appendicitis rarely but it is mostly diagnosed after surgery. Whether Enterobius vermicularis is responsible for acute appendicitis is not definitely clear but Enterobius vermicularis infestation can mimic the features of acute appendicitis. A course of antihelminthic treatment is required to get rid of the parasite from the alimentary tract after appendicectomy

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Evaluation on the Effectiveness of the Different Modes of Publicity for Tissue Donation

In Singapore, the donation of tissues is governed by the Medical (Therapy, Education and Research) Act. For past years, our tissue banks have engaged in various publicity methods. The objective of this study is to evaluate the effectiveness of our publicity strategies among healthcare professionals.

Method: A 6-questions survey was conducted among doctors, nurses, allied health and support services staff from Singapore General Hospital and National Heart Centre Singapore. Sample size was calculated in accordance to the occupation ratio. Results: Of the 450 respondents who completed the survey, most did not see, read or heard about tissue donation. Newspaper articles were their main source of information amongst those who encountered tissue donation message.

All categories of staff concurred that presentations by tissue banking experts is the best way to convey the message. All occupations except doctors, reported that information on how tissue donation improved a recipient’s life will interest them. On contrary, statistics and facts will interest doctors more.

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Function Based Donor/Recipient Matching in ECD Kidney Transplantation Using the Creatinine Clearance Match Ratio

Expanded criteria donor kidneys (ECD) have the potential to greatly increase the number of kidneys available for transplantation; however utilization is limited by poorer outcomes.

One strategy to improve outcomes and secondarily utilization is improved matching of kidneys based on recipient factors such as surface area, kidney graft size to recipient weight and kidney weight to recipient weight.

Recently our group developed the creatinine clearance match ratio (CCMR) as an improved matching technique. The CCMR is calculated using a manipulation of the Cockcroft-Gault equation estimating the creatinine clearance required by the recipient at a serum creatinine level of 1.0 thereby producing an estimated value for an individual’s creatinine production and in intellectual shorthand, “nephron need”.

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Lumbar Artery Embolization for Control of Bleeding after Percutaneous Renal Biopsy

Renal biopsy is an important investigation for suspected renal parenchymal disease and is frequently required in clinical practice. Use of ultrasound and automated spring loaded device has reduced the rate of complications associated with the procedure.

However, occasionally dramatic situations of hemodynamic instability arise due to bleeding after renal biopsy. Only four cases of lumbar artery injury following renal biopsy have been reported in literature.

We report a case of severe hemorrhage due to first lumbar artery injury after native renal biopsy in a patient with functional platelet disorder which was managed with embolization and subsequent surgical exploration.

Management of Adult Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the adult population. The management of traumatic brain injury depends on its severity. It must be recognized that almost all forms of treatment for TBI are geared towards the minimization of secondary injury, as it is assumed that primary injury is irreversible.

The discussion here represents much of what is known up-to-date concerning TBI management, but its treatment continues to evolve once new mechanisms of injury are discovered and those that we know of now are refined.

The treating staffs are encouraged to keep up with the current state of the literature to stay informed.