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duminică, 5 august 2012

The Impact Of Obesity On Donor Acceptability In Pediatric Liver Transplant Recipients

Children undergoing liver transplantation are at greater risk of graft loss and death from adult organ donors who are severely obese according to research published in the August issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases. The study, funded in part by a grant from the National Institutes of Health (NIH), found that pediatric donor body mass index (BMI) did not increase mortality risk in this pediatric population.

Obesity is a global health concern. A 2008 report from the World Health Organization (WHO) estimates that 1.4 billion adults were overweight, and of these 200 million men and 300 million women were classified as obese. WHO also reports that more than 40 million children under the age of five were overweight in 2010. In the U.S., rates of being overweight or obese have risen in children and now exceed 30% say experts.

Prior research shows the prevalence of overweight and obese donors to adult liver transplant recipients has increased during the last two decades. "Donor BMI is associated with post-transplant obesity, but not survival rates of adult liver recipients," explains lead author Dr. Philip Rosenthal, from the University of California, San Francisco's Benioff Children's Hospital. "Our study is the first to evaluate the impact of donor BMI on pediatric liver transplant recipients."

Using data from the United Network for Organ Sharing (UNOS), researchers identified 3788 pediatric liver transplants between 2004 and 2010. Analysis indicates that adult donor BMI 25-35 kg/m2 was not associated with graft loss or mortality in pediatric liver recipients. However, adult donors with a BMI greater than 35 kg/m2 increased the risk of graft loss and death in children receiving livers, after adjusting for other recipient, donor, and transplant risk factors. The authors found that pediatric donor BMI was not associated with graft or patient survival.

"While we found it common for adult donors to be overweight or obese, our analysis suggests that BMI in the 25 to 35 range should not deter liver donation," concludes Dr. Rosenthal. The authors note that causes of graft loss, death, and donor steatosis could not be determined due to lack of donor biopsies. Rosenthal added, "Further research is needed to understand the impact of obesity on donor acceptability and how this affects pediatric liver transplant patients."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our transplants / organ donations section for the latest news on this subject. Full citation: "An Evaluation of the Impact of Donor BMI on Survival and Post-Transplant Obesity in Pediatric Liver Transplant Recipients." Emily Rothbaum Perito, Sue Rhee, Dave Glidden, John Paul Roberts, Philip Rosenthal. Liver Transplantation; Published Online: July 24, 2012 (DOI: 10.1002/lt.23438) Print Issue Date: August, 2012. URL: http://onlinelibrary.wiley.com/doi/10.1002/lt.23438/abstract
About the Author: Dr. Philip Rosenthal is with the University of California, San Francisco's Benioff Children's Hospital.
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'The Impact Of Obesity On Donor Acceptability In Pediatric Liver Transplant Recipients'

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marți, 13 decembrie 2011

Therapy Improves Stem Cell Engraftment In Umbilical Cord Blood Transplant Recipients

Main Category: Stem Cell Research
Also Included In: Transplants / Organ Donations
Article Date: 13 Dec 2011 - 1:00 PST

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A therapy involving a natural compound may improve the ability of stem cells from umbilical cord blood to engraft in patients receiving a stem cell transplant for cancer or other diseases, a phase I clinical trial led by Dana-Farber Cancer Institute scientists indicates.

Details of the trial (abstract 653), which involved 12 patients who underwent reduced-intensity chemotherapy and then received a transplant of cord blood stem cells treated with the compound FT1050, will be presented at the American Society of Hematology's 2011 annual meeting on Monday, Dec. 12, at 2:45 p.m. PST.

FT1050-treated blood-forming stem cells are being tested as a possible solution to one of the major shortcomings of transplants involving stem cells from umbilical cord blood: the relatively small number of stem cells infused in such procedures often take longer to engraft or take root in patients than do the more numerous stem cells involved in transplants from adult donors. The delay can leave patients susceptible to dangerous infections and other complications.

"There is a significant need to improve the speed and quality of engraftment of cord-derived stem cells," says trial leader Corey Cutler, MD, MPH, of Dana-Farber and Brigham and Women's Hospital. "FT1050 has shown the ability in preclinical research to activate hematopoetic [blood-forming] stem cells so they engraft more quickly and with a higher degree of success."

Umbilical cord stem cell transplants are an option for patients who do not have a closely-matched adult donor. Because the current pool of potential donors is smaller for non-Caucasians than for Caucasians, members of ethnic minorities tend to receive transplants from cord blood at a higher rate than Caucasians do.

The goal of the phase I trial was to assess the safety of FT1050-treated cord blood cells in adult patients receiving umbilical cord blood stem cell transplants, and determine if the treated cells accelerate engraftment. In the 12 patients who participated in the trial, engraftment occurred approximately three to four days faster than happens with standard cord blood cells. Levels of white blood cells known as neutrophils returned to normal in the patients after a median of 17.5 days, similar to the rate in standard stem cell transplants. Side effects of the FT1050-treated cord blood cells were minimal. In none of the study patients did the stem cells fail to engraft.

The phase I trial was sponsored by Fate Therapeutics, Inc., of San Diego, Calif., which is developing ProHema, a biologic product consisting of hematopoietic stem cells treated with FT1050 for patients undergoing stem cell transplantation. FT1050 was identified by Leonard Zon, MD, a hematologist and director of the Stem Cell Program at Children's Hospital Boston, using chemical screens conducted in zebrafish, and is the first potential therapeutic derived from a zebrafish model to make into clinical trials.

"We're encouraged by the results of this study for patients receiving umbilical cord stem cell transplants after reduced-intensity chemotherapy treatment," Cutler says. "Further studies are planned to test FT1050-treated hematopoietic stem cells in a larger group of these patients."

Article adapted by Medical News Today from original press release. Source: Dana-Farber Cancer Institute
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Can Transplant Recipients Be Weaned Off Their Immunosuppresive Drugs?

Main Category: Transplants / Organ Donations
Also Included In: Immune System / Vaccines; Liver Disease / Hepatitis
Article Date: 13 Dec 2011 - 1:00 PST

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Transplant surgeons live in the hope that one day they will be able to wean at least some of their patients off the immunosuppressive drugs that must be taken to prevent rejection of a transplanted organ. A team of researchers led by Alberto Sánchez-Fueyo, at the University of Barcelona, Spain, has now identified markers that might make this possible for liver transplant recipients.

Transplant recipients must take immunosuppressive drugs for the rest of their lives to prevent rejection of their transplanted organ; this has serious negative health consequences. It would be helpful if it were possible to determine what would happen if a patient was weaned from their immunosuppressive drugs: would they reject their transplanted organ or would their immune system be sufficiently tolerant of the transplant that it would not be rejected?

Sánchez-Fueyo and colleagues determined that liver transplant recipients with higher blood levels of proteins involved in handling iron (hepcidin and ferritin) could tolerate weaning from their immunosuppressive drugs. Moreover, measuring expression in the liver of genes involved in handling iron enabled Sánchez-Fueyo and colleagues to predict the outcome of immunosuppressive-drug withdrawal in an independent set of patients. They therefore suggest that they have identified a way to accurately pick out those liver transplant recipients who would be good candidates for drug-weaning protocols.

TITLE: Intra-graft expression of genes involved in iron homeostasis predicts the development of operational tolerance in human liver transplantation

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Journal of Clinical Investigation. "Can Transplant Recipients Be Weaned Off Their Immunosuppresive Drugs?." Medical News Today. MediLexicon, Intl., 13 Dec. 2011. Web.
13 Dec. 2011. APA

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