ABO Incompatible Kidney Transplantation, Michael Casey, MD (W-0007)UF Nephrology
Welcome to the Division of Nephrology, Hypertension, & Renal Transplantation within the Department of Medicine at the University of Florida. The University of Florida is an exciting academic community filled with people passionate in their academic pursuit. The Division of Nephrology, Hypertension, & Renal Transplantation is distinguished by the impact, breadth, and depth of its clinical, training, and research programs. It is the Highest ranked Division of Nephrology within Florida, 13th top program nationally, and is comprised of distinguished faculty, all of whom are involved in patient care, research and education. Our research interests include cutting edge research and collaborations with Departments throughout the University.
For CME Credit, visit our website to register and complete the necessary requirements.
http://nephrology.medicine.ufl.edu
ABO Incompatible Kidney Transplantation- a review with a perspective from a c...mionresearch
ABO incompatible kidney transplantation is performed all over the world in order to increase the donor pool and reduce the waiting time for kidney transplantation. The success of such transplantation depends on the desensitization at the time of transplantation. Although in the immediate post operative period more antibody mediated rejections are seen. The long term outcome is excellent comparable to the regular kidney transplantation. In a country like India, infections are a major problem related to excessive immunosupression. This article describes the present state of art in ABO incompatible kidney transplantations and the experience of a center from South India where 35 patients have undergone such transplantation.
ABO Incompatible Kidney Transplantation, Michael Casey, MD (W-0007)UF Nephrology
Welcome to the Division of Nephrology, Hypertension, & Renal Transplantation within the Department of Medicine at the University of Florida. The University of Florida is an exciting academic community filled with people passionate in their academic pursuit. The Division of Nephrology, Hypertension, & Renal Transplantation is distinguished by the impact, breadth, and depth of its clinical, training, and research programs. It is the Highest ranked Division of Nephrology within Florida, 13th top program nationally, and is comprised of distinguished faculty, all of whom are involved in patient care, research and education. Our research interests include cutting edge research and collaborations with Departments throughout the University.
For CME Credit, visit our website to register and complete the necessary requirements.
http://nephrology.medicine.ufl.edu
ABO Incompatible Kidney Transplantation- a review with a perspective from a c...mionresearch
ABO incompatible kidney transplantation is performed all over the world in order to increase the donor pool and reduce the waiting time for kidney transplantation. The success of such transplantation depends on the desensitization at the time of transplantation. Although in the immediate post operative period more antibody mediated rejections are seen. The long term outcome is excellent comparable to the regular kidney transplantation. In a country like India, infections are a major problem related to excessive immunosupression. This article describes the present state of art in ABO incompatible kidney transplantations and the experience of a center from South India where 35 patients have undergone such transplantation.
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
Basics of kidney_transplant and donor_recepient evaluationJosephN7
This contains basic information on kidney transplant, benefits of transplant , donor_recepient evaluation, immunosuppressive drugs and risk factors
for update on my new presentations follow and leave a comment on any topic.
follow me on social media for related content (IG "mulebajoseph" and Pinterest "Joseph N Muleba" twitter "joseph n muleba"
Newer Oral Anticoagulant in Chronic Kidney DiseaseAbdullah Ansari
Kidney specific mechanisms leading to atrial fibrillation
Possible mechanism of CKD progression in atrial fibrillation
Atherosclerosis Risk in Communities (ARIC) study
Guidelines
Pulmonary embolism & deep vein thrombosis
Nephrotic syndrome
Problems with Vit K antagonists in CKD
Non Vit K oral anticoagulants
Site of action of NOACs and VKAs
Pharmacology of Direct Oral Anticoagulants
Trials for NOACs
Dose NOACs according to renal function
Laboratory monitoring of NOACs
Anticoagulant reversal of NOACs
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
Basics of kidney_transplant and donor_recepient evaluationJosephN7
This contains basic information on kidney transplant, benefits of transplant , donor_recepient evaluation, immunosuppressive drugs and risk factors
for update on my new presentations follow and leave a comment on any topic.
follow me on social media for related content (IG "mulebajoseph" and Pinterest "Joseph N Muleba" twitter "joseph n muleba"
Newer Oral Anticoagulant in Chronic Kidney DiseaseAbdullah Ansari
Kidney specific mechanisms leading to atrial fibrillation
Possible mechanism of CKD progression in atrial fibrillation
Atherosclerosis Risk in Communities (ARIC) study
Guidelines
Pulmonary embolism & deep vein thrombosis
Nephrotic syndrome
Problems with Vit K antagonists in CKD
Non Vit K oral anticoagulants
Site of action of NOACs and VKAs
Pharmacology of Direct Oral Anticoagulants
Trials for NOACs
Dose NOACs according to renal function
Laboratory monitoring of NOACs
Anticoagulant reversal of NOACs
According to the Texas Department of State Health Services, there ar.pdfakashitproduct
According to the Texas Department of State Health Services, there are approximately 17.7
million adults (age 18+) living in Texas, of which 1.47 million have diabetes. In 2010, 341,430
adult Texans were diagnosed with diabetes for the first time.
What is the incidence of diabetes in Texas? Express your answer in units of per 1000 persons
per year.
Solution
191 Patients with hepatocellular carcinoma (HCC) within Milan criteria receive
priority on the liver transplant(LT) waiting list(WL) and compete with non-HCC candidates. We
compared dropout from the WL using a competing risks approach to assess the relative access to
transplant for these two groups. The cohort consists of all candidates listed 4/14/04 - 12/31/2007
with HCC candidates identifi ed via initial exception application. Status 1 and pediatric patients
were excluded. Dropouts included removals for candidate death, too sick, and for other. A
multivariable waiting list analysis was performed using a Cox model of time to dropout and
competing risks model. Results: Non-HCC patients had a signifi cantly higher dropout rate from
the WL compared with HCC patients over one year after listing/exception. This was reproducible
across all regions. Ablation had little infl uence on HCC dropout. Larger tumor size, higher
MELD score and/or AFP were associated with increased dropout. Multivariable analysis with
competing risks showed that MELD, log AFP, max tumor size were of signifi cance in predicting
dropout for HCC patients. % dropout Days after Listing 30 60 90 180 365 Non-HCC All MELD
6.5 9 10.6 13.9 17.9 No Ablation 2.2 4 6 9.2 11.8 Ablation 1.4 3.1 4.7 8 11.2 Non-HCC MELD
<21 1.4 2.9 4.4 8.1 13.1 HCC + MELD < 8 0.6 1.4 1.9 4 6.6 HCC + MELD 8-11 0.9 2.4 3.7 6.1
8.5 HCC + MELD 11-14 1 2.8 4.3 7.8 10.3 HCC + MELD >14 3.9 6.6 9.4 13.9 17.7 Tumor < 2
cm 0.9 2.6 4.9 8.2 11.2 2-2.6 1.8 3.4 5.1 8 10.4 2.6-3.3 2.3 3.8 5.2 8.4 11.1 > 3.3 2 4.4 6.3 10
13.4 AFP < 500 1.7 3.2 4.8 7.5 10.2 500-1000 2.8 6.4 9.2 15.3 18.2 >1000 4 8.3 13 21.8 27.8
Conclusions: HCC patients appear to be advantaged in the current allocation scheme as shown
by lower dropout rates. This advantage is consistent through the UNOS regions. A continuous
score incorporating MELD, AFP and tumor size would help prioritize HCC with non-HCC
patients to help equate dropout rates and equalize the allocation scheme. Abstract# 4 Primary
Outcomes from a Randomized, Phase III Study of Belatacept vs Cyclosporine in Kidney
Transplant Recipients (BENEFIT Study). F. Vincenti,1 J. M. Grinyo,2 B. Charpentier,3 J. D.
Medina-Pestana,4 L. Rostaing,5 Y. Vanrenterghem,6 G. B. Di Russo,7 P. Garg,7 C.-S. Lin,7 C.
Larsen.8 1UCSF; 2Univ Hospital of Bellvitge; 3Hopital Bicetre; 4Hospital do Rim e Hipertensao
Unifesp; 5CHU Ranguell; 6Univ Hospital Kuleuven; 7Bristol-Myers Squibb; 8Emory Univ
School of Medicine. Introduction: Belatacept, a co-stimulation blocker, is being developed as an
immunosuppressant for kidney transplant recipients to avoid the renal and.
Molecular epidemiology of carbapenem resistant Acinetobacter baumannii carryi...Bidur Chaulagain
Molecular Epidemiology of Imipenem Resistant Acinetobacter baumannii carrying the ISAba1–blaOXA-51-like genes
A story of a molecular epidemiological analysis to know :
# Imipenem resistance in A. baumannii
# the cause of outbreak in hospital setting and,
# an intervention to control the outbreak
Presentation at the Glomcon session of March 6th 2023 on microvascular inflammation after kidney transplantation and the potential adaptation of the Banff Classification
In this presentation, given for the ISN-TTS webinar on Antibody-Mediated Rejection after kidney transplantation, I discuss the phenotype of microcirculation inflammation/microvascular rejection/ABMRh in the absence of donor-specific HLA antibodies. Also the potential role of missing self activation of natural killer (NK) cells and non-HLA antibodies.
This is the presentation that I gave in Genua, which discusses the recente studies outlining the prevalence, impact, potential causes and diagnostic features of microvascular rejection after kidney transplantation, when no HLA-DSA are present.
It provides some background literature and insights for discussions on potential updates of the Banff classification of kidney transplant pathology
2018 09-20 biomarkers for post-transplant immune injuryMaarten Naesens
I discuss the paradigm of personalized (precision) medicine, and apply this to the field of kidney transplantation. I discuss risk markers, non-invasive and invasive diagnostic markers, prognostic and predictive markers.
Stockholm Karolinska meeting: Graft histology - a marker of pain and sufferin...Maarten Naesens
In this presentation, I discuss the role for protocol kidney allograft biopsies and biopsies for cause, as opportunity for individualised immunosuppressive regimen and use of targeted therapeutic strategies, in order to prevent chronic allograft dysfunction and improve long-term graft outcome. I discuss how kidney transplant histology is re-emerging as the clinical key parameter for the fate of the graft, and display long-term implications of histological alterations. I finally discuss the value of histology as a surrogate study endpoint, and reiterate the urgent need to identify appropriate surrogate endpoints to improve long-term outcomes.
Banff 2017 meeting presentation - early versus late inflammationMaarten Naesens
My presentation at the Banff 2017 meeting in Barcelona on kidney transplant pathology on the impact of time after transplantation on transplant outcome, and the difference between diagnostic and prognostic use of the Banff scheme for allograft histopathology.
HLA antistoffen en antistof-gemedieerde rejectie zijn de belangrijkste oorzaken van het falen van transplantnieren. In deze presentatie wordt een moeilijk onderwerp eenvoudig uitgelegd.
2014 06-05 Pretransplant Evaluation for Kidney Transplantation - Pretransplan...Maarten Naesens
Short overview of evidence-based decisions for the pre transplant evaluation of kidney transplant recipients. Pretransplantbilan onderzoeken niertransplantatie UZ Leuven.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
ABO incompatible living donor kidney transplantation - REVIEW in living donor congress Padua Italy 09-2014
1. ABO Incompatible Tx
What Are the Best Protocols?
Maarten Naesens, MD PhD
Nephrology and Renal Transplantation
University Hospitals Leuven
7th International Conference: Living Donor Abdominal Organ TX
September 26th 2014 – Padova - Italy
2. Case
o 60-year old female with blood group O with end-stage renal
disease, dialysis start imminent.
o Husband is suitable candidate for kidney donation, but donor
blood group A1.
o Average waiting time in Belgium is 3 years for a deceased
donor kidney transplantation of blood group O.
Options in your center:
- Wait list for deceased transplantation
- Paired exchange program
- ABO-incompatible transplantation
3. 3
Oag
anti A Ab
anti B Ab
AagBag
no Ab
Aag
(A1 ~36%, A2 ~9%)
anti B Ab
Bag
anti A ab
40%
5%
45% 10%
The likelihood that two
unrelated individuals are:
- identical is 37.5%
- compatible is 64.25%
- incompatible is 35.75%
4. First succesfull ABO-incompatible transplant
used minimal immunosuppression!
Starzl et al Surgery 1964
Case 1: B -> A
1 rejection, successfully treated
• Case 2: A -> AB:
OK
• Case 3: A -> O:
death due to
sepsis; graft
biopsy showed
“rejection”
12. Specific or non-specific immunoadsorption:
not different for graft outcome
Morath et al Transplantation 2012
VERY LOW NUMBERS IN SINGLE CENTER
TO MAKE ANY CONCLUSION!!
13. Clinical protocols for ABO-incompatible
transplantation evolved over time
Tacrolimus or cyclosporine
Azathioprine
Methylprednisolone
Tacrolimus
Mycophenolate
Methylprednisolone
Splenectomy Rituximab
Plasmapheresis, double-filtration plasmapheresis, non-specific
immunoadsorption, specific immunoadsorption (pre and post TX)
Intravenous immunoglobulin (IVIG)
1980
Earlier
Trials
1990 2000 2010
preTX
?
14. Current clinical protocol for
ABO-I transplantation in Leuven
Highest
Isoagglutine
titer
Start day IA
(-X)
Number of IA
sessions
1:8 -5 4
1:16 -6 5
1:32 -8 6
1:64 -9 7
1:128 -11 8
1:256 -13 9
1:512 -14 10
non-antigen-specific IA
day -35 -30 -X TX 4
XM
Iso
rituximab <1:16
basiliximab
basiliximab
tacrolimus + mycophenolate + corticosteroids
…
15. ABO-I transplantation has excellent outcome
in routine clinical practice
Opelz et al Transplantation 2014 (in press)
16. ABO-I transplantation has excellent outcome
but higher mortality at 1 year
Opelz et al Transplantation 2014 (in press)
P<0.05
97.0% vs. 98.6%
17. Graft outcome is no longer considered for
choice of therapy in ABO-I transplantation
Side effects
Complications
Logistic issues
Cost Availability
Graft
outcome
20. Cost* of ABO-incompatible transplantation
depends on the specific protocol
€ 0
€10 000
€20 000
€30 000
€40 000
€50 000
€60 000
€70 000
John Hopkins
(plasmapheresis)
Heidelberg
(non-specific IA)
Stockholm
(specific IA)
1 yr of HD
* Belgian context
21. Conclusion
• ABO-incompatible living donor kidney transplantation has equal
outcome as ABO-compatible transplantation (i.e. better than
deceased-donor kidney transplantation).
• There are many different protocols used, and outcome is
excellent in all.
• Due to absence of controlled trials comparing the different
protocols, no best protocol can be put forward.
• The risks associated with intensified immunosuppression
needs to be weighed against the benefit of a pre-emptive living
donor kidney.
• The financial cost of desensitization is low in comparison to
chronic dialysis.