Even if a living donor candidate exists, there are some cases that do not result in kidney transplantation (KTx) due to problems on the recipient side. The aim of this study was to clarify causes of ...ineligibility for KTx in these cases, so as to make RTx more applicable for patients.
We targeted 470 patients with end-stage renal disease who applied for the primary kidney KTx from 2010 to 2012. Then we selected those who were not applicable for KTx and investigated recipient causes of ineligibility for KTx or not receiving KTx.
The average age of recipients was 47.6 ± 12.9 (7–82) years. A majority of the 470 patients were male (n = 305, 64.9%). Two hundred ninety-seven patients intended to receive a living donor KTx and the others hoped for a deceased donor KTx. Of the 297 patients, 207 (70.0%) underwent KTx and 9 (1.9%) were being prepared for KTx at the time of the survey. Eighty-three patients (27.9%) did not receive a living KTx, with 59 of these due to recipient-related problems and 30 due to donor-related problems. We further classified the reasons for these 59 recipients not undergoing KTx as follows: (1) unclear reasons (35.6%); (2) insufficient intention to receive transplant (13.6%); (3) heart disease (10.2%); (4) malignancy (8.5%); (5) immunologic risks (5.1%); (6) death during the waiting period (5.1%); (7) cerebrovascular events (5.1%); (8) cardiovascular problems (5.1%); (9) psychiatric disorders (3.4%); and (10) infections (3.4%).
Nearly 50% of the reasons for ineligibility as a recipient were related to their intention to receive KTx, with 94.9% of the nontransplanted cases due to nonimmunologic reasons. Thanks to the recent advances in immunosuppressive therapy, there were only 3 patients who could not undergo KTx due to immunologic risks. Based on these results, transplant surgeons should not only emphasize physical evaluation but should also pay careful attention to the recipient's intention to receive KTx.
•More cases could not receive kidney transplants than we expected, owing to insufficient will for kidney transplantation.•Most medical reasons for cases in which transplants were not undergone were nonimmunologic ones.•A whole body medical evaluation and a medical interview should be done in patients to help reinforce their intention for transplantation.
Restricting-type of anorexia nervosa (AN-R) is a serious disorder affecting adolescents and young adults, and decreases quality of life over long period. Successful weight restoration is an important ...prognostic factor for disease outcome; however, the underlying mechanism of refeeding-resistance, a core psychopathology relevant to 'ambivalent' eating behaviors, remains unclear in this disorder. Obestatin plays an important role in the regulation of growth hormone release, appetite, and energy metabolism. However, the progress of these patients and changes in the levels of obestatin during treatment were not reported. The purpose of this study was to determine the changes in obestatin levels when energy intake increases in AN-R patients. As a result, obestatin was higher in AN-R patients than in control subjects as well as acyl ghrelin and des-acyl ghrelin. An increase in the intake calorie has decreased obestatin as well as des-acyl ghrelin. These findings indicate that the obestatin is an important factor in the diagnosis and treatment of AN-R, similarly to acyl ghrelin and des-acyl ghrelin. In the future, the research on the clinical application of the ghrelin peptide family and the receptor will be expected to progress.
The presence of alloreactive memory T cells is a major barrier for induction of tolerance in primates. In theory, delaying conditioning for tolerance induction until after organ transplantation could ...further decrease the efficacy of the regimen, since preexisting alloreactive memory T cells might be stimulated by the transplanted organ. Here, we show that such “delayed tolerance” can be induced in nonhuman primates through the mixed chimerism approach, if specific modifications to overcome/avoid donor‐specific memory T‐cell responses are provided. These modifications include adequate depletion of CD8+ memory T cells and timing of donor bone marrow administration to minimize levels of proinflammatory cytokines. Using this modified approach, mixed chimerism was induced successfully in 11 of 13 recipients of previously placed renal allografts and long‐term survival without immunosuppression could be achieved in at least 6 of these 11 animals.
The authors report successful development of the conditioning regimen for “delayed tolerance,” in which recipients initially undergo kidney transplantation with conventional immunosuppression and subsequently receive nonmyeloablative conditioning and donor bone marrow transplantation from the original kidney donor.
Abstract Aim We investigated clinical outcomes of patients in Japan with a history of long-term dialysis treatment. Methods We conducted 1171 kidney transplantations between 2000 and 2015. Sixty of ...the patients had undergone dialysis therapy for >20 years before the transplantation. We compared graft and patient survivals between the recipients with >20 years of dialysis (long dialysis group LGD) and those with <20 years (control group CG) in a case-control study, in which sex and age of both donors and recipients, ABO compatibility, and calendar year of transplantation were matched. Results Average age of LDG was 52.8 ± 8.9 years, and that of CG was 54.2 ± 12.6 ( P > .05). Durations of dialysis were 25.4 ± 1.57 vs 5.8 ± 5.8 years, respectively ( P < .05). The graft survival rates were 91.6%, 89.9%, and 81.8% at 3, 5, and 10 years in LDG vs 90.71%, 84.8%, and 78.3% in CG, respectively ( P > .05). The patient survival rates were 96.6%, 93.2%, and 88.6% in LDG vs 94.5%, 91.0%, and 83.9%, respectively ( P > .05). There was no significant difference in mean estimated glomerular filtration rates for post-transplant 10 years between them. Conclusion LDG showed satisfying clinical outcomes comparable to those of CG both in graft and patient survivals and renal function.
Restricting type of anorexia nervosa (AN-R) is a serious disorder affecting adolescents and young adults and decreases quality of life over a long period. Successful weight restoration is an ...important prognostic factor for disease outcome; however, the underlying mechanism of refeeding resistance, a core psychopathology relevant to 'ambivalent' eating behaviors, remains unclear in this disorder. Ghrelin plays an important role in the regulation of growth hormone release, appetite, and energy metabolism. However, the early progress of these patients and changes in the levels of acyl ghrelin and des-acyl ghrelin during treatment were not reported. The purpose of this study was to determine the changes in ghrelin levels (acyl and des-acyl) during early treatment. As a result, des-acyl ghrelin in AN-R patients is higher than in control subjects before the therapy, but it decreases with treatment. The plasma des-acyl ghrelin level in AN-R patients started decreasing more rapidly and in early stage of the hospitalization than ever reported, and after 8 weeks, it is significantly lower than in control subjects. It means that des-acyl ghrelin is sensitive and changeable with their nutrition state. Furthermore, the ratio of the acyl ghrelin to total ghrelin increases with 8 weeks treatment. Eight weeks after, energy intake of the AN-R patients is recovered near the normal range with a daily energy intake of 1 700+/-93.54 kcal. These findings may be valuable for future AN-R treatments in order to increase acyl ghrelin and decrease des-acyl ghrelin, thereby influencing the refeeding outcome.
Variability of tow orientation is unavoidable for biaxial engineering fabrics and their composites. Since the mechanical behaviour of these materials is strongly dependent on the fibre direction, ...variability should be considered and modelled as exactly as possible for more realistic estimation of their forming and infusion behaviour and their final composite mechanical properties. In this study, a numerical code, ‘VariFab’, has been written to model realistic full-field variability of the tow directions across flat sheets of biaxial engineering fabrics and woven textile composites. The algorithm is based on pin-jointed net kinematics and can produce a mesh of arbitrary perimeter shape, suitable for subsequent computational analysis such as finite element forming simulations. While the shear angle in each element is varied, the side-length of all unit cells within the mesh is constant. This simplification ensures that spurious tensile stresses are not generated during deformation of the mesh during forming simulations. Variability is controlled using six parameters that can take on arbitrary values within certain ranges, allowing flexibility in mesh generation. The distribution of tow angles within a pre-consolidated glass–polypropylene composite and self-reinforced polypropylene and glass fabrics has been characterised over various length scales. Reproduction of the same statistical variability of tow orientation as in these experiments is successfully achieved by combining the VariFab code with a simple genetic algorithm.
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