International Journal of Organ Transplantation Medicine
Year:2018 | Volume:9 | Issue:2|Papers Count:6

Background: According to the basic ethical principle of non-maleficence, organ procurement systems need to be accountable to donor families. As organ donation can be potentially traumatic, donor families are at risk of developing psychological damage. Appropriate measurement tools are needed to diagnose such disorders and develop appropriate treatment measures.Objective: To examine the appropriateness of measurement tools and approaches used in previous studies for assessing donor families’ psychological well-being.Methods: A structured online search was conducted in electronic databases namely Science Direct, PubMed, ProQuest, Scopus, Ovid, and Web of Science. The main inclusion criterion was the use of psychological assessment tools for data collection.Results: 10 studies were included in which different tools had been used for measuring donor families’ psychological well-being in the following 5 dimensions: stress, depression, grief, general health, and positive legacy of trauma. The major pitfalls of the reviewed studies were failure to specifically assess complicated grief and differentiating it from other psychological disorders, diversity of the tools used for psychological well-being assessment, and lack of clear definitions of donor families’ psychological well-being and its dimensions.Conclusion: Donor families’ psychological well-being is a complex and multidimensional concept and the existing measurement tools cannot accurately assess it. Therefore, the concept needs to be clearly explored and defined. Developing a comprehensive measurement tool or a set of scales is necessary for the early diagnosis of any impairment in donor families’ psychological well-being.

Background: Liver function indices and anti-viral immune regulatory markers can both improve graft outcomes, which lead to better post-transplantation management and increase the possibility of surveillance in liver transplant recipients with chronic hepatitis B virus (HBV) infection.Objective: To determine the association between the interferon regulatory factor 1 (IRF1) mRNA levels and liver enzymes in HBV-infected liver transplant recipients with and without experience of rejection.Methods: A total of 46 chronic HBV-infected patients who had undergone liver transplant surgery was divided into 2 groups of recipients "with rejection" and "without rejection.". Blood samples were collected form each patient on days 1, 4, and 7 post-transplantation. A SYBER GREEN real-time PCR was used to evaluate the expression level of IRF1 in liver recipients. Liver enzyme activities were also measured in all patients.Results: The expression of IRF1 in the patients with rejection was up-regulated at all 3 follow-up days compared with those without rejection. The serum levels of ALT and AST were more than normal levels at 3 follow-up times in both study groups. Significant differences were found in IRF1 gene expression levels and also serum ALT levels between those with and without rejection after 7 days post-transplantation.Conclusion: The IRF1 expression and serum ALT levels were increased significantly in patient with rejection compared to those without rejection. IRF1, an inflammatory factor, may also intensify induction of inflammatory pathways in engrafted liver and promote liver inflammation and injuries leading to liver enzymes elevation in patients with graft rejection.

Background: Generating hepatocytes with complete liver functions is still a challenge and developing more functional hepatocytes is needed.Objective: To compare various differentiation factors and protocols and introducing a preferable protocol to differentiate human-induced pluripotent stem cells (hiPSCs) into hepatocyte-like cells (HLCs).Methods: After 3 days of the endoderm differentiation of hiPSCs, the cells were incubated with 5 hepatocyte differentiation culture media, protocols (P), for 14 days—P1: hepatocyte growth factor and fibroblast growth factor-4 (FGF-4) for the first week and oncostatin-M and dexamethasone for the second week, P2: similar to P1 but FGF4 was used in both the first and second weeks, P3: similar to P1 but FGF-4 was not used, P4: similar to P1 but FGF-4 and dexamethasone were not used, and P5: similar to P1 but FGF-4 and oncostatin-M were not used. After 17 days, characterization was done by qRT-PCR, immunofluorescence and ELISA.Results: The mRNA expression levels of hepatocyte markers (albumin, cytokeratin-18, tyrosine aminotransferase, hepatocyte nuclear factor-4a, cytochrome-P450 7A1) increased significantly (p<0.05) in the differentiated cells by 5 different protocols. Furthermore, significant protein expression and secretion of albumin were detected in the differentiated cells by 5 different protocols. In P3, the differentiated cells had the highest exhibit of hepatocyte characteristics and in P4 they had the lowest. Moreover, in P1 and P2 similar results were observed.Conclusion: Since P3 gave us the best results among all protocols, we recommend it as an efficient protocol to differentiate the functional HLCs from hiPSCs, which can improve cell therapies

Background: After organ transplantation, many patients have diverse experiences; they face many changes in the physical and emotional aspects of their life. Patients’ understandings of the post-transplantation period influence their adaptation to the changes. There is a need to improving the knowledge of patients’ unique experiences of post-transplantation period and the changes occur in their life.Objective: To explore the experiences of organ recipients in the post-transplantation period.Methods: In a qualitative research using a hermeneutical phenomenological approach, data were collected from April 2015 to June 2016. Participants were consisted of 15 patients who received organ chosen using a purposive sampling method. In-depth semi-structured interviews were held with them. The collected data were analyzed using Diekelmann’s hermeneutical analysis approach.Results: The data analyses led to the development of 3 main themes and 17 subthemes as "back from the grave" with the subthemes of "organ as the God’s deposit, " "God as the source of life, " and "new life"; "chapter of prosperity" with the subthemes of "the spring of the body, " "recovery, " "peace and joy, " "benevolent and good behavior, " "renewal, " "opportunity of being together again, " "golden age, " "positive perspective, " "the sense of normality, " "the return of health, " and "spiritual evolution"; and "the fall" with the subthemes of "a lack of energy, " "the mirage of transplantation, " and "hell on the earth." Conclusion: The patients had diverse experiences of the post-transplantation period, which varied from the feeling of exhilaration and youth to losing energy and the wish for not undertaking organ transplantation.

Direct oral anticoagulants have suggested a favorable profile compared with vitamin K antagonists. However, the lack of treatment to reverse the effect of direct oral anticoagulants has limited its use in some patients who require rapid reversal of anticoagulation, as those included in the transplant waiting list. Idarucizumab is a recently approved drug to reverse the anticoagulant effect of dabigatran. However, the clinical experience when using this drug is scarce. Herein, we present a clinical case on anticoagulation reversal with idarucizumab to perform heart and lung transplantation in a patient with Eisenmenger syndrome.

Massive post-transplantation ascites is a rare but serious condition following liver transplantation. Although, many etiologies are suggested as the cause of this complication, in some cases the definitive etiology remains unknown. Drug-induced post-transplantation ascites is one of the possible etiologies. In this study we present a case of ascites caused by tacrolimus in the post-liver transplantation period. A 49-year-old man with hepatitis B virus cirrhosis underwent liver transplantation and received tacrolimus, mycophenolate and prednisolone, as the immunosuppressive regimen. Progressive ascites developed after 10 days, in spite of a normal liver function. Various studies, including liver biopsy, were performed but we could not find any etiology for this complication. The tacrolimus was switched to rapamune. Ascites was completely disappeared and up to the last follow-up visit, the patient remained asymptomatic for more than two years. We concluded that after ruling out other etiologies, tacrolimus as a rare cause of post-transplantation ascites should be taken into account. The treatment is discontinuation of the drug.