RESUMO
Mesenchymal stem cells (MSCs) from human adipose tissue have a great potential for use in cell therapy due to their ease of isolation, expansion, and differentiation, besides the relative acceptance from the ethical point of view. Our intention was to isolate and promote in vitro expansion and differentiation of MSCs from human adipose tissue into cells with a pancreatic endocrine phenotype. Human adipose tissue obtained from patients undergoing abdominal dermolipectomy was digested with type I collagenase. MSCs isolated by plastic adherence and characterized by cytochemistry and FACS were expanded in vitro. MSC differentiation into an endocrine phenotype was induced over 2 to 4 months with high glucose (25 mmol/L) media containing nicotinamide, exendin-4, and 2-mercaptoethanol. Insulin and glucagon expressions were analyzed by immunofluorescence. Cells isolated from human adipose tissue and expanded in vitro expressed MSC markers as confirmed by FACS and cytochemistry. Insulin but not glucagon production by differentiated cells was demonstrated by immunofluorescence. MSCs isolated from human adipose tissue were induced to differentiate in vitro into an endocrine phenotype that expressed insulin.
Assuntos
Gordura Abdominal/citologia , Diferenciação Celular , Insulina/metabolismo , Ilhotas Pancreáticas/metabolismo , Células-Tronco Mesenquimais/metabolismo , Biomarcadores/metabolismo , Adesão Celular , Proliferação de Células , Separação Celular/métodos , Citometria de Fluxo , Imunofluorescência , Regulação da Expressão Gênica , Glucose/metabolismo , Humanos , Insulina/genética , Fenótipo , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life-threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine. METHODS: A questionnaire was sent to all associated doctors to the Brazilian Organ Transplantation Association through its website, calling for reports of organ transplanted patients who have been vaccinated against YF. RESULTS: Twelve doctors reported 19 cases. None had important side effects. Only one had slight reaction at the site of YFV injection. Eleven patients were male. Organs received were 14 kidneys, 3 hearts, and 2 livers. Twelve patients received organs from deceased donors. Mean age at YFV was 45.6 ± 13.6 years old (range 11-69); creatinine: 1.46 ± 0.62 mg/dL (range 0.8-3.4); post-transplant time: 65 ± 83.9 months (range 3-340); and time from YFV at the time of survey: 45 ± 51 months (range 3-241). Immunosuppression varied widely with different drug combinations: azathioprine (7 patients), cyclosporine (8), deflazacort (1), mycophenolate (10), prednisone (11), sirolimus (3), and tacrolimus (4). CONCLUSIONS: YFV showed no important side effects in this cohort of solid organ transplanted patients. However, owing to the small number of studied patients, it is not possible to extend these findings to the rest of the transplanted population, assuring safety. Therefore, these data are not strong enough to safely recommend YFV in organ transplanted recipients, as severe, even life-threatening side effects may occur.
Assuntos
Transplante de Órgãos , Vacina contra Febre Amarela/administração & dosagem , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Inquéritos e Questionários , Vacinação/métodosRESUMO
Laparoscopic donor nephrectomy (LN) offers less postoperative pain and early recovery in living kidney donors, but graft kidney function in the recipients can be delayed due to prolonged warm ischemic time (WIT) and adverse effects of pneumoperitoneum. We compared the early function of the grafted kidney and the complications in kidney recipients after LN versus open nephrectomy (ON). We analyzed 109 kidney recipients from living donors, including 60 LN and 49 ON, comparing immediate diuresis after surgery, glomerular filtration rate (GFR) by MDRD formula (modification of diet in renal disease) at day 5, and complications. The recipient age among the LN group was 20 to 73 years with 51% men among whom 95% of patients had immediate diuresis with GFR at day 5 varying from 4.85 to 99.45 mL/min/1.73 m(2) by MDRD Surgical complications were renal artery stenosis (5%) and urinary leakage (5%). The recipient among age ON cases varied from 18 to 63 years with 63% men and immediate diuresis observed in 87% and GFR at day 5 varied from 4.75 to 101.1 mL/min/1.73 m(2) by MDRD. Renal artery stenosis was observed in 8.16%. The WIT was longer (P < .05) among the LN (1.4 to 11 minutes) compared with the ON group (1 to 4 minutes). GFR at day 5 showed no difference between the two groups. In conclusion, WIT was higher among LN compared with ON but did not seem to influence early function of the grafted kidney.
Assuntos
Transplante de Rim/fisiologia , Laparoscopia , Doadores Vivos , Nefrectomia , Adolescente , Adulto , Idoso , Diurese , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos RetrospectivosRESUMO
Hand-assisted laparoscopic surgery is assumed to be easier to learn than the standard approach and simplifies intact kidney removal. Herein we have presented our experience performing hand-assisted laparoscopic donor nephrectomy (HALDN) compared with contemporary pure laparoscopic donor nephrectomy (LDN). We retrospectively analyzed 55 patients who underwent LDN. Among the procedures, 21 were HALDN and 34 were pure LDN. We compared the two groups with regard to operative time, warm ischemic time (WIT), estimated blood loss, conversion rate, postoperative stay, and complications. For the HALDN group, the mean operative time was 191 minutes, WIT varied from 2 to 11 minutes, and bleeding estimates varied from 100 to 4000 mL. The overall complication rate of 28.6% included: vessel injury, urinary leakage, and paralytic ileus. In the LDN group, the mean operative time was 184 minutes, WIT varied from 2 to 10 minutes, and bleeding estimated varied 100 to 3000 mL. Three patients (8.8%) had complications including ureteral obstruction (n = 1) and vessel injury (n = 2). There was no significant difference between the two groups about the procedure and the complications. Our series suggested that HALDN and LDN were similar, with a tendency toward better results in LDN group, which also shows lower costs.
Assuntos
Laparoscopia/métodos , Doadores Vivos , Nefrectomia/métodos , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de TempoRESUMO
Diabetes is an emerging epidemic throughout the world. In our city alone, there are approximately 25,000 known diabetics (5% to 10% type 1) among a total population of 1.7 million inhabitants, and the incidence is increasing among all age groups. Islet transplantation is a potential treatment for type 1 diabetes mellitus. For this reason, we intended to establish an islet transplantation program. This required competent and well-trained professionals, a specially planned facility adhering to rigid regulations regarding safety and sterility, and a detailed study of the ethical laws and rules involving transplantation. In this article, we describe the process including any difficulties or barriers encountered due to limited resources in a developing country. We also describe all stages of personnel training and the necessary equipment and work area of a similar specialized center following the guidelines of the Brazilian National Agency for Health Care. Finally, we discuss our expectations for the initial phase of our islet transplantation program.