Rapid growth of scalp melanoma in a pediatric patient

The Journal of Dermatology, EarlyView.


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Clinical Relevance of a Balance Training Program on Liver Transplant Patients. A Randomized Controlled Trial

Background Although some studies have reported significant improvements in physical function and strength after training programs on Liver Transplant (LT) recipients, there is a lack of knowledge on how it affects in static and dynamic balance, being an important part of these participants' tasks development. The aim of the study was to determine the effects of a 6-month multicomponent circuit training program on static and dynamic balance in LT participants. Methods 54 participants were randomized at 6 months after LT into 2 groups: exercise group (EXER) and control group (CONTROL), with repeat testing at 6 (baseline) and 12 months after LT. The intervention consisted in a multicomponent training, including balance, strength, endurance and flexibility training, with exercises arranged in a circuit setup and a moderate intensity with high perceived exertion. Training sessions were performed in the hospital facilities with qualified trainers. To determine differences overtime between EXER and CONTROL, mixed regression linear models with subject variable as random factor and variables of treatment duration, type and interaction as predictors were used. Results EXER showed significant differences (p<.05 compared to control in all variables of static and dynamic balance hip strength vs agility flexibility adherence the intervention was participants continued voluntarily training after months. conclusions this study demonstrated that a multicomponent circuit program at moderate intensity with high perceived exertion could reduce probability injuries because improves on lt recipients. author correspondence: juan c. colado phd department physical education sports universityof valencia c oliag spain. email: juan.colado authorship diego moya-n contributed design preparation recruitment instruction data acquisition collection tests interpretation drafting manuscript. moya-herraiz revising pedro gargallo helped draft revise joaqu calatayud javier escrig performed statistical analysis interpretation. supervision project authors read approved final disclosure declare no conflicts interest. funding didn receive any funds. copyright wolters kluwer health inc. rights reserved.>

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Blocking CD40/CD40L for Chimerism-Based Tolerance: Lost in Translation?

No abstract available

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Addition of Anti-CD40 Monoclonal Antibody to Nonmyeloablative Conditioning With Belatacept Abrogated Allograft Tolerance Despite Induction of Mixed Chimerism

BACKGROUND We recently reported anti-CD40 monoclonal antibody and rapamycin (aCD40/rapa) to be a reliable, nontoxic, immunosuppressive regimen for combined islet and kidney transplantation (CIKTx) in nonhuman primates (NHPs). In the current study, we attempted to induce allograft tolerance through the mixed chimerism approach using a conditioning regimen with aCD40 and belatacept (Bela). METHODS Five CIKTx or kidney transplant (KTx) recipients were treated with aCD40/rapa for 4 months. All recipients then received a conditioning regimen including horse anti-thymocyte globulin (hATG) and aCD40/Bela. The results were compared with previous reports of recipients treated with Bela-based regimens. RESULTS All 3 CIKTx recipients developed mixed chimerism, which was significantly superior to that observed in the previous Bela-based studies. Nevertheless, all CIKTx recipients in this study lost their islet and renal allografts as a result of cellular and humoral rejection on days 140, 89, and 84. The 2 KTx-alone recipients were treated with the same conditioning regimen and suffered rejection on days 127 and 116, despite the development of excellent chimerism. B lymphocyte reconstitution dominated by memory phenotypes was associated with early development of donor-specific antibodies in 4/5 recipients. In vitro assays showed no donor-specific regulatory T cell (Treg) expansion, which has been consistently observed in tolerant recipients with our mixed chimerism approach. CONCLUSION Despite displaying excellent immunosuppressive efficacy, costimulatory blockade with anti-CD40 mAb (2C10R4) may inhibit the induction of renal or islet allograft tolerance via a mixed chimerism approach. Correspondence information: Tatsuo Kawai, MD, PhD, Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, Phone: 617-817-3270, Fax: 617-724-3471, Email: tkawai@mgh.harvard.edu AUTHORSHIP: TO: Research design, writing the paper, performance of the research, data analysis KH: Performance of the research IR: Performance of the research AD: Performance of the research KK: Performance of the research HL: Data analysis BC: Research design, writing the paper TK: Research design, writing the paper, data analysis DISCLOSURE The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. This manuscript was also not prepared or funded by any commercial organization. Founding sources: This work was supported by NIH grant U19 AI102405-01. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Safety of Islet Autotransplantation Following Pancreatectomy for Adenocarcinoma

Background total pancreatectomy with intraportal islet autotransplantation (TPIAT) rather than partial pancreatectomy could represent a major shift in the management of patients with resectable pancreatic ductal adenocarcinoma (PDAC) when risks of postoperative pancreatic fistula are well identified. This approach provides a theoretical risk of tumor cell dissemination when islet cells are transplanted into the portal vein. Our objective was to demonstrate the safety of TPIAT in PDAC in a mouse preclinical model of subcutaneous xenotransplantation of human cells isolated from pancreatic specimen during partial pancreatectomy performed for PDAC. Methods patients requiring pancreatectomy for PDAC were prospectively included. Immunocompromized mice were transplanted with pancreatic cells isolated from the nonmalignant part of the surgical specimen (experimental group). Results were compared to pancreatic tumor implants (control group). Pancreatic grafts were explanted at 6 weeks for histological analyses. Results 9 patients were included and 31 mice were transplanted. In the experimental group, explants were microscopically devoid of tumor cell and no metastasis was observed. In the control group, all explants were composed of tumor. Conclusions we report in a preclinical model the absence of local and distant spreading of malignant cells following pancreatic islets xenograft isolated from PDAC patients. These data supports the oncological safety of TPIAT as valuable alternative to partial pancreatectomy for PDAC patients with a high risk of postoperative pancreatic fistula. *The authors contributed equally to this work Corresponding author: François Pattou, Université de Lille, Inserm, UMR 1190, Translational Research for Diabetes, European Genomic Institute for Diabetes, 1 place de Verdun 59045, Lille, France, Tel: (+33)3 20 62 69 63; francois.pattou@univ-lille.fr Conflicts of interest: The authors have no conflict of interest to disclose. Funding: SIRIC ONCO Lille and European Genomic Institute for Diabetes (ANR-10-LABX-46). Authorship page Florence Renaud: research design, writing of the paper, performance of the research, data analysis Mikael Chetboun: research design, writing of the paper, performance of the research, data analysis Julien Thevenet: performance of the research, data analysis Nathalie Delalleau: performance of the research, data analysis Valery Gmyr: research design, writing of the paper, data analysis Thomas Hubert: writing of the paper, data analysis, critical revision Caroline Bonner: writing of the paper, critical revision Mathieu Messager: research design, performance of the research, data analysis Emmanuelle Leteurtre: research design, writing of the paper, performance of the research, data analysis, critical revision Christophe Mariette†: research design, writing of the paper, performance of the research, data analysis, critical revision Julie Kerr-Conte: research design, writing of the paper, performance of the research, data analysis Guillaume Piessen: research design, writing of the paper, performance of the research, data analysis, critical revision François Pattou: research design, writing of the paper, performance of the research, data analysis, critical revision Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intraabdominal Complications Following Pediatric Kidney Transplantation: Incidence and Risk Factors

Background The incidence and types of intraabdominal complications following pediatric transplantation are not well established and specific risk groups have not been clearly identified. Methods A retrospective chart review of all pediatric transplant recipients, between 1995 and 2016 was undertaken. Intraabdominal complications were grouped into 4 categories: fluid collections, gastrointestinal, vascular and urogenital. Donor, recipient, and transplant characteristics were evaluated using univariate and multivariate logistic regression. Results There were 146 transplants meeting the inclusion criteria. The mean follow up time was 4.6 ± 3.7 years (range, 0.3-18). The mean weight at transplantation was 31.5 ±16.5kg (range, 9-78), with 24(16%) recipients being

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Protocol Duodenal Graft Biopsies Aid Pancreas Graft Surveillance

Background Histological evaluation of the pancreas graft is usually done on demand resulting in significant delays. This analysis reports on endoscopic protocol duodenal graft biopsies at regular intervals to determine feasibility, safety and monitoring benefits. Methods Protocol duodenal graft biopsies in 27 18 consecutive pancreas transplants (10 simultaneous pancreas kidney [SPK], 17 pancreas after kidney [PAK]) with a follow-up of a minimum of 12 months were performed at days 14, 30, 90, 180, 360, 430. UPMC classification for intestinal rejection was used. C4d staining was performed when antibody mediated rejection was suspected. Results Overall patient and pancreas graft survival was 100% and 93% at a mean follow-up of 2.8 years. 167 endoscopic biopsy procedures were performed in 27 grafts without any complication. Biopsies revealed rejection in 3 (30%) SPK recipients and in 15 (82%) of PAK recipients as early as 14 days posttransplant. Two patients underwent PAK retransplantation diagnosed with acute rejection at day 180. All except 1 recipient being treated for rejection, showed histological improvement following antirejection treatment. Following transient treatment success, a total of 3 pancreas grafts were lost for immunological reason. One loss was immediate despite antirejection treatment, 1 secondary to nonresolving rejection at 7 months and the third due to recurrent rejection 15 months posttransplantation. Additionally, biopsies detected vascular (venous thrombosis) and overimmunosuppression (CMV infection) complications. Conclusions Protocol graft duodenal biopsies detect complications following whole organ pancreas transplantation, are useful in guiding therapy and carry potential for improving outcome. Disclosure statement: The authors have nothing to disclose. Corresponding author: Privatdozent Dr. med. Jens Gunther Brockmann, Director Pancreas & Intestinal Transplant Program, Section Head Kidney & Pancreas Transplantation, Department of Surgery and Organ Transplant Centre, King Faisal Specialist Hospital & Research Centre, P.O. Box 33554, Riyadh, 11211, MBC 37, Kingdom of Saudi Arabia JGB: Designed the research, wrote the paper, performed surgery and follow-up, and participated in data analysis. AB: Participated in research design, the writing of the paper, the performance of the research (endoscopies) and participated in data analysis. HAH: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. HAM: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. KAS: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. MA: Participated in the performance of the research (HLA analysis, follow-up). DCB: Participated in research design. TA: Participated in the writing of the paper, the performance of the research (follow- up), and participated in data analysis. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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