scholarly journals The Key Role of Warm and Cold Ischemia in Uterus Transplantation: A Review

2019 ◽  
Vol 8 (6) ◽  
pp. 760 ◽  
Author(s):  
Antoine Tardieu ◽  
Ludivine Dion ◽  
Vincent Lavoué ◽  
Pauline Chazelas ◽  
Pierre Marquet ◽  
...  

Introduction: Uterus transplantation (UTx) is a promising treatment for uterine infertility that has resulted in several births since 2014. Ischemia is a key step in organ transplantation because it may lead to changes jeopardizing graft viability. Method: We performed a systematic review of animal and human studies relating to uterine ischemia. Results: We retained 64 studies published since 2000. There were 35 studies in animals, 24 in humans, and five literature reviews. Modest preliminary results in large animals and humans are limited but encouraging. In small animals, pregnancies have been reported to occur after 24 h of cold ischemia (CI). In ewes, uterine contractions have been detected after 24 h of CI. Furthermore, it has been shown in animals that uterine tolerance to CI and to warm ischemia (WI) can be increased by pharmacological products. In women, mean CI time in studies of births from uteri obtained from live donors was between 2 h 47 min and 6 h 20 min from a deceased donor; with only one birth in this case. Muscle contractions have also been demonstrated in myometrial samples from women, after six or more hours of CI. Conclusion: The uterus seems to be able to tolerate a prolonged period of CI, of at least six hours. Studies of the ischemia tolerance of the uterus and ways to improve it are essential for the development of UTx, particularly for procedures using grafts from deceased donors.

2019 ◽  
Vol 13 (5) ◽  
pp. 1405
Author(s):  
Rejane Ecker ◽  
Joice Da Costa Lores ◽  
Susana Cristina Sperandei Lavarda

ABSTRACT Objective: to evaluate the success of renal transplantation in relation to donor and recipient variables, graft type, age, complications, infections and duration of ischemia. Method: this is a quantitative study of the retrospective documentary cohort, evaluating 282 medical records of patients attended by the Renal Therapy Unit, aged over 18 years and the results were presented in the form of tables and figures. Results: it was shown that of the transplants performed, 100 were with live donor kidneys and 182 with deceased donor kidneys; 18 and 37 patients died, respectively, and the mean cold ischemia time was 25.9 hours for organs of deceased donors. Conclusion: the greater number of patients who developed infections and complications of grafts from a deceased donor is shown to be an influencing factor in the success of renal transplantation, showing that the longer the cold ischemia time, the greater it will be the loss of viable tissue from the graft, which causes a greater propensity for infectious events and failure of renal function, therefore, it is extremely important to implement actions and new behaviors, thus favoring bases for the success of renal transplants. Descriptors: Transplantation; Kidney; Tissue Donors; Ischemia; Renal Insufficiency, Chronic; Survival Analysis.RESUMO Objetivo: avaliar o sucesso do transplante renal diante das variáveis de doador e receptor, tipo de enxerto, idade, complicações, infecções e duração do tempo de isquemia. Método: trata-se de estudo quantitativo, do tipo coorte documental retrospectivo, avaliando-se 282 prontuários de pacientes atendidos pela Unidade de Terapia Renal, com idade maior que 18 anos e os resultados apresentaram-se em forma de tabelas e figura. Resultados: mostrou-se que dos transplantes realizados, 100 foram com rins de doador vivo e 182 com rins de doador falecido, sendo que evoluíram para óbito, respectivamente, 18 e 37 pacientes, e o tempo médio de isquemia fria foi de 25,9 horas para os órgãos de doadores falecidos. Conclusão: refere-se o número maior de pacientes que desenvolveram infecções e complicações aos que receberam enxerto advindo de doador falecido, mostrando-se como um fator influenciador no sucesso do transplante renal, evidenciando que, quanto maior for o tempo de isquemia fria, maior será a perda de tecido viável do enxerto, o que acarreta maior propensão a eventos infecciosos e falha de função renal, portanto, é de extrema importância que se implementem ações e novas condutas, favorecendo, assim, bases para o sucesso dos transplantes renais. Descritores: Transplante; Rim; Doadores de Tecidos; Isquemia; Insuficiência Renal Crônica; Análise de Sobrevida. RESUMEN Objetivo: evaluar el éxito del trasplante renal ante las variables de donante y receptor, tipo de injerto, edad, complicaciones, infecciones y duración del tiempo de isquemia. Método: se trata de estudio cuantitativo, del tipo cohorte documental retrospectivo, evaluando 282 prontuarios de pacientes atendidos por la Unidad de Terapia Renal, con edad mayor que 18 años y los resultados se presentaron en forma de tablas y figura. Resultados: se mostró que de los trasplantes realizados, 100 fueron con riñones de donante vivo y 182 con riñones de donante fallecido, siendo que evolucionaron a muerte, respectivamente, 18 y 37 pacientes, y el tiempo promedio de isquemia fría fue de 25,9 horas para los órganos de donantes fallecidos. Conclusión: se refiere al número mayor de pacientes que desarrollaron infecciones y complicaciones a los que recibieron injerto proveniente de donante fallecido, mostrándose como un factor influyente en el éxito del trasplante renal, evidenciando que, cuanto mayor sea el tiempo de isquemia fría, mayor es la pérdida de tejido viable del injerto, lo que acarrea mayor propensión a eventos infecciosos y fallo de función renal, por lo tanto, es de extrema importancia que se implementen acciones y nuevas conductas, favoreciendo así bases para el éxito de los trasplantes renales. Descriptores: Trasplante; Rinón; Donantes de Tejidos; Isquemia; Insuficiencia Renal Crónica; Análisis de Supervivencia.


Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 396
Author(s):  
Kohei Ogawa ◽  
Yasutsugu Takada

Recently, there have been many reports of the usefulness of locoregional therapy such as transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma (HCC) as pretreatment before liver transplantation (LT). Locoregional therapy is performed with curative intent in Japan, where living donor LT constitutes the majority of LT due to the critical shortage of deceased donors. However, in Western countries, where deceased donor LT is the main procedure, LT is indicated for early-stage HCC regardless of liver functional reserve, and locoregional therapy is used for bridging until transplantation to prevent drop-outs from the waiting list or for downstaging to treat patients with advanced HCC who initially exceed the criteria for LT. There are many reports of the effect of bridging and downstaging locoregional therapy before LT, and its indications and efficacy are becoming clear. Responses to locoregional therapy, such as changes in tumor markers, the avidity of FDG-PET, etc., are considered useful for successful bridging and downstaging. In this review, the effects of bridging and downstaging locoregional therapy as a pretransplant treatment on the results of transplantation are clarified, focusing on recent reports.


2021 ◽  
Vol 10 (4) ◽  
pp. 586
Author(s):  
Jiri Fronek ◽  
Jakub Kristek ◽  
Jaroslav Chlupac ◽  
Libor Janousek ◽  
Michael Olausson

Introduction: Uterus transplantation (UTx) is a rapidly evolving treatment of uterine-factor infertility. We report the results of the first 10 UTx procedures performed at our institution. Methods: The program started in April 2016 as a two-arm study comparing the efficacy of UTx from live donors (LD) and deceased donors (DD). Results: Between April 2016 and April 2018, we performed five DD UTx and five LD UTx. Two grafts had to be removed early due to thrombosis. One graft was removed due to chronic rejection and previous herpes simplex infection at month 7. Graft survival is 70% at one year. Recipient survival is 100% at two years. Live donor survival is 100% at three years. Three live-births have been achieved, two from a LD and one from a graft from a nulliparous DD. Vaginal anastomotic stenosis occurred in 63% (5/8) of grafts. Self-expanding stents have shown preliminary suitability for the treatment of vaginal stenosis. Three recipients developed severe acute rejection. Conclusion: The interim results of our study demonstrate mid-term viability in 70% of grafts. The LD UTx produced two live births and the DD UTx produced one live birth. Nulliparous donors should be considered for donation.


2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
N. Bogert ◽  
I. Kanzler ◽  
U.A. Stock ◽  
A. Moritz ◽  
A. Beiras-Fernandez
Keyword(s):  

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 675
Author(s):  
Saartje Uyttebroek ◽  
Jolien Onsea ◽  
Willem-Jan Metsemakers ◽  
Lieven Dupont ◽  
David Devolder ◽  
...  

Chronic rhinosinusitis is a common condition affecting 5–12% of the general population worldwide. In a limited number of cases, the disease is recalcitrant to medical and surgical interventions, causing a major impact on physical, social and emotional well-being and increasing pressure on healthcare systems. Biofilm formation and dysbiosis caused by Staphylococcus aureus and Pseudomonas aeruginosa play a role in the pathogenesis of recalcitrant chronic rhinosinusitis. In these cases, a promising treatment alternative is the application of bacteriophages, which are viruses that infect and lyse bacteria. In this review, we appraise the evidence for the use of bacteriophages in the treatment of recalcitrant chronic rhinosinusitis. Additionally, (dis)advantages of bacteriophages and considerations for implementation of phage therapy in otorhinolaryngology practice will be discussed.


2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Zhaojun Duan ◽  
Yunping Luo

AbstractImmunotherapy is regarded as the most promising treatment for cancers. Various cancer immunotherapies, including adoptive cellular immunotherapy, tumor vaccines, antibodies, immune checkpoint inhibitors, and small-molecule inhibitors, have achieved certain successes. In this review, we summarize the role of macrophages in current immunotherapies and the advantages of targeting macrophages. To better understand and make better use of this type of cell, their development and differentiation characteristics, categories, typical markers, and functions were collated at the beginning of the review. Therapeutic strategies based on or combined with macrophages have the potential to improve the treatment efficacy of cancer therapies.


Author(s):  
Sapna Puri ◽  
Manisha Kohli

Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.


2019 ◽  
Vol 131 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Laura O’Donovan ◽  
Nicola Jane Williams ◽  
Stephen Wilkinson

Abstract Introduction In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide. Sources of data This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx. Areas of agreement There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry. Areas of controversy There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment. Growing points UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide. Areas timely for developing research Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law.


2016 ◽  
Vol 100 (2) ◽  
pp. 422-428 ◽  
Author(s):  
Sussie Shrestha ◽  
Lisa Bradbury ◽  
Matthew Boal ◽  
James P. Blackmur ◽  
Christopher J. E. Watson ◽  
...  

The Lancet ◽  
2018 ◽  
Vol 392 (10165) ◽  
pp. 2657-2658 ◽  
Author(s):  
Cesar Diaz-Garcia ◽  
Antonio Pellicer

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