प्रत्यारोपण प्रौद्योगिकी एवं अनुसंधान

Kidney replacement is the best option for treatment of chronic renal failure patient. This treatment sometimes associates with some complications including: immunologic, vascular and urologic. The vascular complication is a dangerous complication which sometimes may result in losing allograft kidney. The vascular complications including: thrombosis and stricture. These complications can be induced by rejection or by technical fault. The technical fault including: the handling of the vessel and suturing of the vessel. One of the preventable faults is pursiness which may predispose the vessel to the stenosis. We studied the making expansion space between the vessel and first knotting of stitching for prevention of the pursiness of the vessel post anastomosis.

Material and methods: One hundred chronic kidney disease patients 51 males and 49 females with age between 15-67 have been operated for kidney transplant surgery at Imam Reza hospital (teaching hospital) since 2008 -2011. All of the patients have received allograft kidney from live unrelated donors. During surgery after preparation place for allograft kidney at retroperitoneal at fosse of iliac the internal iliac artery (hypogasteric artery) have been selected for renal artery anastomosis and external iliac vein have been selected for renal vein anastomosis. During vessel anastomosis between vessel and first knotting of stitching (continue suture with single thread) 5mm distance have been made as expansion space. After removing the clamp from the vessel bleeding has been controlled, post operation the kidney has been followed by color Doppler ultrasound.

Results: Post declamping the vessel, the expansion space was vanished and the hemeostasis was nearly complete without any significant bleeding and also without detecting any stenosis at anastomosing site with follow up with color Doppler ultrasound at least for 6 months post operation.

Conclusions: making expansion space between the first knot of stitching and the vessel at the anastomosing site for prevention of the pursiness of the vessel and stenosis is safe.

Purpose: To evaluate whether the use of a sealant combined with interrupted suture would provide better visual outcomes and better post-operative recovery to keratoconic patients compared to interrupt and running sutures without the use of sealants using femtosecond laser assisted keratoplasty.

Methods: A prospective, randomized study of 12 patients (12 eyes) with keratoconus was conducted, randomized into two treatment groups. The no glue group (6 eyes) underwent penetrated keratoplasty (PK) with femtosecond laser assisted keratoplasty shaped (mushroom) and combined suture (8 interrupted suture and 8 running sutures) while the glue group (6 eyes) underwent the same procedure but their incisions were closed with 8 interrupted sutures and sealant.

Results: The no glue group had a mean BCVA of 0.2 (LogMar). The glue group had a mean BCVA of 0. (LogMar). p=0.028 Transplants with glue were well positioned showing good healing but presented more inflammation in the first week post-surgery. Regarding refractive outcomes, there was no difference between the groups.

Conclusions: There were no statistical difference between the two groups regarding BCVA and refractive errors. The use of sealants produced more inflammation. Further studies with a larger number of patients and longer follow up would be needed to confirm these findings.

Background: A recent study indicated that FR276457, a pan-histone deacetylase inhibitor, prevented allograft rejection in an ACI-to-Lewis rat heart transplant model, seemingly without affecting cellular infiltration into the transplanted heart. In this report, we investigated alterations in infiltrating cells in allografts by treatment of FR276457.

Materials and Methods: Heterotopic cardiac allografts which were removed from August Copenhagen Irish rats were transplanted into the necks of Lewis rats. FR276457 40 mg/kg or vehicle was subsequently administered orally for 5 consecutive days beginning on the operation day after recovery from anesthesia (Day 0). The allograft recipients were sacrificed under anesthesia on Day 5 after transplantation. At first, we identified infiltrating cells into the allografts by the histopathological analysis. In addition, we isolated the infiltrating cells from allografts, sorted CD8 positive (CD8+) T cells, and then investigated cytotoxicity of CD8+ T cells against spleen cells from an August Copenhagen Irish rat.

Results: Histopathological analysis of allografts on Day 5 after the heart transplant showed that infiltration of T cells was not suppressed in FR276457-treated allograft recipients, compared with those in vehicle-treated allograft recipients, although the infiltration of ED1 positive cells was tended to decrease. Ex vivo analysis revealed that alloantigen-specific cytotoxicity of CD8+ T cells, isolated from allografts in FR276457-treated allograft recipients, against ACI rat splenocytes was much lower than that in vehicle-treated allograft recipients.

Conclusion: FR276457 treatment suppressed the alloantigen-specific cytotoxicity of CD8+ T cells infiltrated into the allograft.

Background and Aims: Treatment with autologous, bone marrow mononuclear stem cells has shown effects in patients with chronic limb ischaemia. The aim of the study was to test the potential effect of stem cell treatment in a strict defined group of patients with non reconstructable critical limb ischaemia (CLI).

Material: Twenty patients with non recontructable CLI of the lower extremities, who received medical treatment in the form of prostavasine.

Methods: Bone marrow cells were harvested from the patient’s iliac crest and, after separation, injected into the calf muscles of the affected leg. Outcome was evaluated by digital subtraction angiography (DSA), visual analogue scale (VAO) one patient was amputated two months after cell injection. Two patients reported relief of pain after four months.

Conclusion: This method seems to be a safe option for treating patients with non reconstructable CLI.