Background. Survival after liver transplantation for fulminant hepatic failure has been reported to be less favorable than survival for patients with chronic liver diseases. Methods. We have studied all patients (n=229) undergoing highly urgent liver transplantation from 1990 to 2001 in the Nordic countries. The impact of patient and donor characteristics, with emphasis on donor-recipient ABO matching (identical, compatible, incompatible), has been studied. Results. One-year and 3-year patient survival rates were 73% and 70% for the total period and 86% and 78% for the last 4-year period. Patients receiving an ABO-compatible liver allograft had significantly lower patient survival rates than those receiving an ABO-identical donor organ (1-year patient survival rates 66% of vs. 79%, P=0.03). Graft survival rates varied less (1-year graft survival rates of 64% vs. 74%, P=0.09). Patients receiving an ABO-incompatible liver allograft had patient survival rates of 70% at 1 year and 60% at 3 years but low graft survival rates (40% and 30% at 1 and 3 years). In a multiple regression analysis, significant independent predictors of poor patient survival were early year of transplantation, ABO-compatible donor, high donor age, and waiting time more than 3 days and less than 9 days. Conclusion. Survival after highly urgent liver transplantation has improved and is comparable to that observed in patients receiving a liver allograft because of chronic liver disease. Patients receiving an ABO-identical donor organ had significantly higher patient survival rates compared with those receiving an ABO-compatible donor liver.

Highly urgent liver transplantation: possible impact of donor-recipient Abo matching on the outcome after transplantation

Regionwide sharing for status 1 liver patients--beneficial impact on waiting time and pre- and posttransplant survival.

Any organ which is allocated to one individual represents a missed opportunity for someone else. Given the important repercussions which organ allocation policies inevitably have for certain people, any prioritization policy should rest on a solid argumentative basis. In this study, we analyze the widespread practice of prioritizing pediatric patients in the allocation of kidneys. While official policy documents offer no arguments in support of pediatric priority, such arguments can be found in the academic literature on pediatric renal transplantation. Our study is the first to bring together and critically analyze these. We identify five commonly cited arguments and show that none of these succeeds in justifying pediatric priority policies. We argue that the legitimacy of such policies may be further undermined by their potential adverse effects on both adults and children.

Pediatric priority in kidney allocation: challenging its acceptability.

Armulik, A. 2000. Studies on the transmembrane signaling of β1 integrins. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 963. 92 pp. Uppsala. ISBN 91-544-4832-1. Integrins are heterodimeric cell surface receptors, composed of an α and a β subunit, mainly for binding extracellular matrix proteins. Integrin subunit β1 can combine with at least 12 α subunits and thus form the biggest subfamily within the integrin family. In this thesis, functional properties of the splice variant β1B, and the effects of several mutations in the cytoplasmic tail of integrin subunit β1A were studied. In addition, the border between the transmembrane and cytoplasmic domains of several integrin subunits was determined. The β1B splice variant has been reported to have a dominant negative effect on functions of β1A integrins. In this study, it was studied if the expression of β1B had similar negative effects on the αvβ3 integrin functions since the β3 subunit is structurally similar to β1A. The β1B subunit was expressed in an integrin β1-deficient cell line and it was found that the presence of β1B does not interfere with adhesion or signaling of endogenous αvβ3. The border between the cytoplasmic domain and the C-terminal end of the transmembrane domain of integrin α and β subunits has been unclear. This question was experimentally addressed for integrin subunits β1, β2, α2 and α5. It was found that integrin subunits contain a positively charged lysine, which is embedded in the membrane in the absence of interacting proteins. The functional importance of the lysine in integrin transmembrane domains was investigated by mutating this amino acid to leucine in β1A. The mutation affected cell spreading and tyrosine phosphorylation of the adapter protein CAS. The activation of focal adhesion kinase and tyrosine phosphorylation of paxillin was not affected. Furthermore, the mutation of two tyrosines to phenylalanines in the β1A cytoplasmic tail was found to reduce the capability of β1A integrins to mediate cell spreading and migration. Activation of focal adhesion kinase in response to the later β1A mutant was shown to be impaired as well as tyrosine phosphorylation of adapter proteins paxillin and tensin, whereas overall tyrosine phosphorylation of CAS was unaffected. These data suggest the presence of focal adhesion kinase-dependent and -independent pathways for tyrosine phosphorylation of CAS after integrin β1A-mediated adhesion.

Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1211

Aim: € The€ aim€ of€ this€ study€ was€ to€ evaluate€ gastrointestinal€ (GI)€ complications€ afterkidney€ transplantation€ in€ the€ Finnish€ population€ with€ a€ special€ focus€ in€ uppergastroduodenal€ ulcer€ development,€ gallstone€ disease€ and€ biliary€ complications,pancreatitis,€colon€perforations€and€GI€malignancies. Patients: The€adult€patients€included€in€these€studies€underwent€kidney€transplantation€atHelsinki€University€Central€Hospital€in€Finland€in€1990­2000. Methods: € Data€ on€ severe€ GI€ complications€ were€ collected€ from€ the€ Finnish€ KidneyTransplantation€Registry€and€patient€records.€Questionnaires€about€upper€gastroduodenaland€gallstone€complaints€were€sent€to€a€subgroup€of€patients. Helicobacter€pylori IgG€andIgA€antibodies€were€measured€from€500€patients€before€kidney€transplantation€and€after€amedian€6.8­year€follow€up,€when€also€CagA€antibodies€were€determined.€For€studies€ofgastroduodenal€ cytomegalovirus€ (CMV)€ infection€ oesophagogastroduodenoscopy(OEGD)€ with€ biopsies€ was€ performed€on€ 46€ kidney€ transplantation€ patients€sufferingfrom€ gastroduodenal€ symptoms€ and€ 43€ dyspeptic€ controls.€ To€ determine€ the€ risk€ ofgallstone€ formation€ after€ the€ transplantation€ ultrasound€ (US)€ examination€ of€ thegallbladder€ was€ performed€ on€ 304€ patients€ after€ a€ median€ of€ 7.4€ years€ posttransplantation.€In€addition€to€this,€data€from€these€304€patients€were€collected€on€serumlipids,€body€mass€index€(BMI)€and€the€use€of€statin€medication.

/pdf/gastrointestinal-complications-after-kidney-transplantation-5d1y02y5dl.pdf

Gastrointestinal complications after kidney transplantation

Organ donation, allocation, and transplantation in the Nordic countries: Scandiatransplant 1999.

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries—Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.

Selected Activities in Scandiatransplant

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Organ donation, allocation, and transplantation in the Nordic countries: Scandiatransplant 1999.

Selected Activities in Scandiatransplant