M S Cattral

University Health Network, Toronto, Ontario, Canada

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Publications (151)580.36 Total impact

  • Transplantation 07/2014; · 3.78 Impact Factor
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    ABSTRACT: Background Pancreas transplant recipient obesity has been associated with increased risk of peri-operative complications, graft failure and death. Cardiovascular co-morbidity is the key risk for the obese candidate. Methods We compared the outcomes of pancreas transplant recipients with body mass index (BMI) >30kg/m 2(n=60) to those with BMI <30kg/m 2 (n=308) between 1996 and 2013. All patients were assessed by a cardiologist prior to, and annually after transplantation. There was a low threshold for cardiovascular intervention both pre- and post-operatively. Results There were no differences in the pre-transplant recipient or donor characteristics apart from BMI. There was an increased incidence of surgical site infections in the BMI>30 group compared to the BMI<30 group (12% vs 3.2% respectively; p=0.03). Despite this, the median length of hospital stay was shorter in the BMI>30 group (9 days vs. 10 days in the BMI<30 group; p=0.02). There were no other significant differences in the complications in the first three post-operative months. The BMI>30 group were more likely to suffer a rejection episode (43% vs 29%; p=0.03) compared to the BMI<30 group, and the median time to first rejection was also shorter (1 vs. 6 months; p=0.04) in the BMI>30 group. There was no difference in the rate of patient survival, pancreas or kidney graft survival or difference in graft function between the two groups. Conclusion Although there was an increased risk of rejection and wound infection in the obese group, there was no difference in the rate of patient or graft survival. This finding, when compared with previous reports, may be related to stringent recipient selection and post-transplant care particularly with respect to cardiovascular disease.
    The World Transplant Congress, San Francisco; 06/2014
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    ABSTRACT: Background:Steroids are known to be associated with several adverse metabolic and cardiovascular (CV) side effects. Given the increase in risk of CV disease in patients with diabetes, pancreas transplant recipients may benefit from steroid withdrawal after transplant. However, the impact of steroid withdrawal on acute rejection and graft survival is controversial. Methods:A retrospective cohort study was conducted at our institution. Simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplant recipients between Feb 1997 and May 2005 were included in the study and followed until April 2010. Exposure to steroids was modeled as a time-varying exposure. Cox proportional hazards models were used to examine the relation between steroid withdrawal and acute rejection as well as graft survival. Traditional CV risk factors were evaluated using parametric and non-parametric methods as appropriate. Results:141 SPK and PAK transplant recipients were included in the cohort, of which 42 underwent steroid withdrawal. 41 patients experienced acute rejection, with 17 episodes occurring in the steroid withdrawal group (36%) compared to 24 occurring in the non-steroid withdrawal group (25%). Withdrawal of steroids was associated with an increased risk of acute rejection (HR 4.74, [95% CI 1.9, 11.8], p value 0.001) but was not associated with an increased risk of graft failure (HR 1.42, [95% CI 0.64, 3.16], p value 0.4). There were no clinically significant differences in lipid profile, blood pressure and glucose tolerance at 1 year after steroid withdrawal. Conclusion:In a cohort of SPK and PAK transplant recipients at our institution, steroid withdrawal was associated with a significantly increased risk of acute rejection but no clinically meaningful changes in traditional CV risk factors. Further study is needed to determine whether steroid withdrawal may be beneficial in a subgroup of carefully selected patients.
    The World Transplant Congress, San Francisco, California; 06/2014
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    ABSTRACT: Background Evaluation for pancreas transplantation in this centre requires routine cardiovascular consultation with a low threshold for intervention. We hypothesized that the requirement for pre-operative cardiovascular intervention (PCVI) may be associated with an adverse impact on outcome after pancreas transplantation. Methods Retrospective analysis of a prospectively collected database was undertaken, including 366 consecutive primary pancreas transplants performed between 1995 and 2013. Outcomes including postoperative complications, rejection, as well as graft and patient survival were compared between recipients who had undergone PCVI (n=48) and those who had not (n=318). Results The recipients undergoing PCVI were older than those not undergoing PCVI (47.6yrs (+/- 7.9) vs. 41.9yrs (+/- 7.6) respectively, p<0.0001) and the cohort included more males (73% vs. 62% respectively, p=0.02). There was a higher rate of post-operative cardiovascular events or interventions in the PCVI group (11.9% vs. 2.2% respectively, p=0.02). In the long term, there were no difference in the rate of death with graft function (p=0.77) or rejection (p=0.17). There were no statistically significant differences between the groups with respect to patient (p=0.54), kidney (p=0.76), or pancreas (p=0.63) graft survival. Conclusion PCVI is a risk factor for short term peri-operative cardiovascular events. However, the long-term transplant outcomes are equivalent to patients not requiring PCVI. The requirement for PCVI by itself should not be considered a contraindication for pancreas transplantation, but should raise awareness of increased peri-operative risk.
    The World Transplant Congress, San Francisco, California; 06/2014
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    ABSTRACT: Background Although commonly applied in many centers, there are limited data to validate age alone as a selection criterion for pancreas transplantation. We analyzed the impact of recipient age ( ≥55yrs) on outcome of pancreas transplantation. Methods Retrospective analysis of a prospectively collected database was undertaken, including 382 consecutive pancreas transplants performed between 1995 and 2013. Outcomes including postoperative complications, rejection, as well as graft and patient survival were compared between recipients ≥55years (n=30) and <55 yrs (n=352). Results The recipients ≥55years had a significantly higher rate of pre-operative cardiac intervention (46% vs. 13%, p=<0.001) than those <55years. However, there were no differences in the incidence of infectious and non-infectious post-operative complications between the groups. The rate of rejection in the first three months after transplant of recipients ≥55yrs was significantly lower (13% vs. 33%, p=0.02) than recipients <55years. There were no differences in kidney or pancreas graft function. There were no statistically significant differences between the groups with respect to patient (p=0.25), kidney (p=0.71), or pancreas (p=0.14) graft survival. Conclusion Pancreas transplantation in carefully selected recipients ≥55yrs of age can yield equivalent outcomes to transplantation of recipients of a younger age. Advanced recipient age by itself should not be considered a contraindication for pancreas transplantation.
    The World Transplant Congress, San Francisco, California; 06/2014
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    ABSTRACT: There is a paucity of contemporary data describing the results of pancreas retransplantation (PRT). As a measure of utility, we wished to determine whether PRT could produce equivalent short-term and long-term recipient outcomes to primary pancreas after kidney (PAK) transplantation.
    Transplantation 06/2014; · 3.78 Impact Factor
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    ABSTRACT: Abstract Bacterial infections are major cause of early morbidity and mortality after liver transplantation (LT). Selective digestive decontamination (SDD) can be used pre-operatively for living donor LT (LD-LT), but its role in this setting remains controversial. To evaluate this strategy, we retrospectively analyzed a cohort of consecutive LD-LTs performed in our center from March 2007 to February 2011 and compared the incidence and nature of early infectious complications, length of intensive care unit stay and hospitalization, antibiotic use, and emergence of resistant bacteria in patients with or without SDD prophylaxis. Of 148 LD-LTs in the study period, 111 received SDD prophylaxis while 37 did not. In a multivariate model, the independent factors associated with an increased risk of early post-transplant infections were length of post-operative mechanical ventilation (for every additional day OR=2.37, 95% CI 1.4-; p=0.002), and choledochojejunostomy (OR=4.14.5, 95% CI 1.95-; p=<0.0001). Use of SDD did not affect the rate or distribution of infectious complications, duration of hospitalization, antibiotic use or acquisition of resistant bacteria (OR=33.52, 95% CI; p=0.68376). In conclusion, the use of SDD prophylaxis in LD-LT was not beneficial and should be avoided, as it offers no advantage and could potentiate the emergence of multidrug resistant organisms.
    Transplant Infectious Disease 05/2014; · 1.98 Impact Factor
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    ABSTRACT: BACKGROUND: Cytomegalovirus (CMV) is a major pathogen affecting solid organ transplant (SOT) recipients. Prophylactic strategies have decreased the rate of CMV infection/disease among SOT. However, data on the effect of current prophylactic strategies for simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) transplant remain limited. We report our experience of CMV prophylaxis in SPK/PAK recipients. METHODS: A total of 130 post-SPK/PAK patients were analyzed retrospectively for the rate of CMV and the risk factors associated with the acquisition of CMV. All patients received antiviral prophylaxis. The follow-up period was one yr post-transplant or until death. RESULTS: The rate of CMV post-SPK/PAK transplant was 24%, 44%, and 8.2% among the whole cohort, the D+/R- and the R+ groups, respectively. Median time of prophylaxis was 49 (0-254) d. In the whole cohort, risk factors for CMV infection/diseases were D+/R- CMV status (odds ratio [OR] = 16.075), preceding non-CMV (infection caused by bacteria or fungi and other viruses) infection (OR = 6.362) and the duration of prophylaxis (OR = 0.984). Among the CMV D+/R- group, non-CMV infection was the only risk factor for CMV disease (OR = 10.7). CONCLUSIONS: Forty-four per cent (25/57) of the D+/R- recipients developed CMV infection/disease despite CMV prophylaxis. Current CMV prophylaxis failed to prevent CMV infection/disease in this group of patients.
    Clinical Transplantation 06/2013; · 1.63 Impact Factor
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    ABSTRACT: Background: Evidence indicates that pre-transplant donor specific antibody (DSA) in kidney transplantation recipients worsens graft survival significantly. The impact of pre-transplant DSA on pancreas transplant outcome in patients with negative T-cell cytotoxicity cross-matches remains unclear. Methods: We performed a retrospective analysis of 69 consecutive pancreas transplants (40 kidney-pancreas, 29 pancreas after kidney) performed at a single institution from Jan 2010 to May 2012. The presence of DSA before transplantation was detected by Luminex single-antigen assays. All recipients received prednisone/tacrolimus/mycophenlate mofetil–based immunosuppression. Recipients with DSA also received IVIG (1g/Kg preoperatively). Results: Pre-transplant DSA was detected in 20 (29%) recipients. Demographics of the No-DSA and DSA groups were similar with respect to male sex (70% vs. 90%), recipient age (43+9 vs. 42+9 yrs., p=0.7), donor age (26+10 vs. 25+10 yrs., p=0.6), donor weight (74.5+21.2 vs. 75.7+29.9 kg, p=0.86), pancreas cold ischemic Time (CIT) (9h17m+2h10m vs. 10h6m+2h6m, p=0.2), kidney CIT (7h32m+2h vs. 9h33m+4h6m, p=0.07), pancreas warm ischemic time (WIT) (30.5+7 vs. 34.4+12 m, p=0.12), kidney WIT (31.5+7 vs. 32.3+6.5 m, p=0.9). Rejection occurred in 8 (16%) and 5 (25%) patients in the No-DSA and DSA groups (p=0.5). The median (range) time of first rejection was similar in both groups (No-DSA, 27 days (11-224); DSA, 33 days (25-124) p=0.9). Severe rejection (Banff 2a,b) occurred in 2 patients in the No-DSA group and 1 in the DSA group (p=0.68). Two pancreas grafts were lost from acute rejection in the NO-DSA group, both from non-compliance. The other causes of graft loss in the No-DSA group were duodenal leak (3), pancreatitis (3), thrombosis (1) and death (1); causes in the DSA group were leak, pancreatitis, thrombosis, and death (1 of each). Pancreas graft survival was comparable in the No-DSA and DSA groups at 3, 6, and 12 mo (92% vs. 100%, 85% vs. 94%, and 83% vs. 94% respectively). Kidney graft survival at 12 mo in the No-DSA and DSA groups was also similar at 96% vs. 92%. Conclusion: The presence of pre-transplant DSA is not associated with reduced survival of pancreas allografts during short-term follow-up. Further studies are needed to clarify the effect of IVIG therapy and impact of DSA on long-term graft survival.
    American Transplant Congress; 05/2013
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    ABSTRACT: Improved outcomes and graft survival in pancreas transplantation has increased the number of pancreas re-transplants performed. However, pancreas retransplantation presents significant surgical and medical management challenges. Aim: To compare the outcomes of pancreas retransplants and primary pancreas after kidney transplants at a single center. Methods: Between January 2003 and May 2012, 70 pancreas after kidney transplantations have been performed at our institution. Of those, 56 (80%) were primary pancreas transplants, while 14 (20%) received a retransplant graft. All patients received identical maintenance therapy. Pancreas graft function was determined by fasting blood glucose levels (FBG), HbA1c, and annual oral glucose tolerance testing. Serum creatinine was used to assess kidney graft function. Graft survival, and patient survival were calculated by log rank analysis. Results: 14 First graft failures were retransplanted for rejection (7), duodenal leaks (4), thrombotic episodes (3). First grafts had similar pre-transplant characteristics to retransplants with respect to male sex (55% vs. 78% p=0.14), donor age (23.7±13.1 vs. 21.8±9.4 p=0.62 ), recipient age (44.4±7.9 vs. 40.4±6.2 yrs p=0.09). Donor and recipient weight were comparable (p=0.11, p=0.19). Pancreas warm ischemic time (26.76 vs. 31 min p=0.51), cold ischemic time (7.75 vs. 8.25 h p=0.76), and Total length of hospital stay (12.7±11.3 vs. 10.7±6.6 days p=0.54) were also comparable. Retransplants had shorter graft follow-up (49.7±29.4 vs. 35.3±26.1 months p=0.13). There was no difference in the rate of post-operative complications in the first 6 months, except for duodenal leaks (p=0.03). Graft function 1, and 3 years were comparable (p=NS). Pancreas graft survival at 1 and 3 year was similar between first grafts and re-transplant at 91% vs. 100% and 88% vs. 100% respectively. Creatinine levels were higher in the primary grafts at 1 and 3 years (p=0.07 and p=0.06). Conclusion: Despite technical and immunological challenges, pancreas retransplantation has excellent short term results. More detailed studies are required to better assess the effect on long term kidney graft function.
    05/2013;
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    ABSTRACT: Informed consent for living donor liver transplantation (LDLT) requires that patients are provided with accurate information on the relative benefits and risks of this procedure compared with deceased donor liver transplantation (DDLT). There is strong evidence to suggest that LDLT facilitates timely transplantation to patients; however, information on the relative morbidity and death risks after LDLT as compared with DDLT is limited. A matched cohort comparison was performed matching recipients for age, MELD, date of transplant, gender, primary diagnosis, and recipient surgeon. A total of 145 LDLT were matched with 145 DDLT. LDLT had a higher overall rate of perioperative surgical complications (P = 0.009). Most of this difference was caused by a higher rate of biliary complications. However, the complications that occurred in the DDLT group tended to be more serious (P = 0.037), and these complications were strongly associated with graft loss in multivariate analysis. The 3- and 5-year graft and patient survivals were similar. In conclusion, DDLT and LDLT have different complication profiles, but comparable hospital stays and survival rates. In areas of deceased donor organ shortages, LDLT offers an excellent alternative to DDLT because it facilitates access to a liver transplant without compromising short- or medium-term recipient outcomes.
    Transplant International 05/2013; · 3.16 Impact Factor
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    ABSTRACT: Impaired counterregulation during hypoglycemia in type-1 diabetes (T1D) is in part due to inadequate glucagon secretion. Intra-islet somatostatin suppression of hypoglycemia-stimulated alpha-cell glucagon release plays an important role. We hypothesized that hypoglycemia can be prevented in autoimmune T1D by somatostatin receptor type-2 (SSTR2) antagonism of alpha-cells, which relieve SSTR2 inhibition, thereby increasing glucagon secretion. Diabetic (D) Biobreeding diabetes-prone (BBDP) rats mimic insulin-dependent human autoimmune T1D, whereas non-diabetic (N) BBDP rats mimic prediabetes. D and N rats underwent a 3-h infusion of vehicle vs SSTR2 antagonist (SSTR2a) during insulin-induced hypoglycemia clamped at 3±0.5 mmol/L. D, treated with SSTR2a, needed little or no glucose infusion compared to untreated rats. We attribute this effect to SSTR2a restoration of the attenuated glucagon response. Direct effects of SSTR2a on alpha-cells was assessed by resecting the pancreas, cut into fine slices and subjected to perifusion to monitor glucagon release. SSTR2a treatment enhanced low glucose-stimulated glucagon and corticosterone secretion to normal in D. SSTR2a had similar effects in vivo on N, and promoted glucagon secretion from N and human pancreas slices. We conclude that somatostatin contributes to impaired glucagon responsiveness to hypoglycemia in autoimmune T1D. SSTR2a treatment can fully restore hypoglycemia-stimulated glucagon release sufficient to attain normoglycemia in both diabetic and prediabetic stages.
    Diabetes 04/2013; · 7.90 Impact Factor
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    ABSTRACT: Improved outcomes and graft survival in pancreas transplantation has increased the number of pancreas re-transplants performed. However, pancreas retransplantation presents significant surgical and medical management challenges. Aim: To compare the outcomes of pancreas retransplants and primary pancreas after kidney transplants at a single center. Methods: Between January 2003 and May 2012, 70 pancreas after kidney transplantations have been performed at our institution. Of those, 56 (80%) were primary pancreas transplants, while 14 (20%) received a retransplant graft. All patients received identical maintenance therapy. Pancreas graft function was determined by fasting blood glucose levels (FBG), HbA1c, and annual oral glucose tolerance testing. Serum creatinine was used to assess kidney graft function. Graft survival, and patient survival were calculated by log rank analysis. Results: 14 First graft failures were retransplanted for rejection (7), duodenal leaks (4), thrombotic episodes (3). First grafts had similar pre-transplant characteristics to retransplants with respect to male sex (55% vs. 78% p=0.14), donor age (23.7±13.1 vs. 21.8±9.4 p=0.62 ), recipient age (44.4±7.9 vs. 40.4±6.2 yrs p=0.09). Donor and recipient weight were comparable (p=0.11, p=0.19). Pancreas warm ischemic time (26.76 vs. 31 min p=0.51), cold ischemic time (7.75 vs. 8.25 h p=0.76), and Total length of hospital stay (12.7±11.3 vs. 10.7±6.6 days p=0.54) were also comparable. Retransplants had shorter graft follow-up (49.7±29.4 vs. 35.3±26.1 months p=0.13). There was no difference in the rate of post-operative complications in the first 6 months, except for duodenal leaks (p=0.03). Graft function 1, and 3 years were comparable (p=NS). Pancreas graft survival at 1 and 3 year was similar between first grafts and re-transplant at 91% vs. 100% and 88% vs. 100% respectively. Creatinine levels were higher in the primary grafts at 1 and 3 years (p=0.07 and p=0.06). Conclusion: Despite technical and immunological challenges, pancreas retransplantation has excellent short term results. More detailed studies are required to better assess the effect on long term kidney graft function.
    Canadian Society of Transplantation 2013; 03/2013
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    ABSTRACT: Management of chronic disease such as end stage liver disease and subsequent liver transplantation may only be available in large urban areas. Rural residence poses significant challenges for the patient seeking care, as well as the transplant centre providing the care. Research studies have suggested that barriers for rural residents can have a negative impact in outcomes and quality of care. Aim: To determine the impact of place of residence on post liver transplantation outcomes and complications. Methods: We performed a retrospective review of 1411 liver transplants performed at a single institution from Jan. 2000 to Dec. 2011. 1033 deceased donor grafts recipients and 378 live donor liver transplants . Survival was calculated using Log-Rank, while clinical data was analyzed using Chi-square, and Student[apos]s t-test or Mann-Whitney U-test. Rural residence was determined using the Canada Post Conversion file and a cut-off point of less than 1000 inhabitants for rural qualification. Linear distance to transplant center was calculated using Google maps. Results: 9.3% (131) transplants were from rural recipients (RR) vs. 90.7% (1280) urban recipient (UR). Linear distance from place of residence to transplant center is not significantly different between RR and UR. Demographics were similar between the groups in terms of age (59.0±11.9 vs. 51.3±12.1 years), gender (69.2% vs. 68.8% male), and most underlying liver disease (Hep C, Hep B, Fulminant Hepatitis, Alcohol, HCC and other). Only autoinmmune hepatitis was significantly higher in rural recipients 8.4% vs 3.8% (p=0.02). Donor demographics were comparable in for RR and UR terms of age, as well as cold and warm ischemic times. Total length of stay (23 vs. 24 days RR vs. UR) and post-transplant ICU stay (3.3 vs. 4.5 respectively) were comparable. No difference in mediate or immediate transplant complications were observed between the two groups in terms of type, or degree of severity in the complications (Clavien score). Retransplant rate was similar between RR and UR at 4.5% vs 5.1%. (p=0.16). Graft survival at 1, 3, and 5 years was 90% vs 90%, 86% vs. 82%, and 80% vs 78% for RR and UR respectively (p=0.79), patient survival was also comparable at 93% vs 92%, 83% vs. 85% and 81% vs. 79% respectively (p=0.76). No change in the RR to UR ratio was observed over 10 years time. Conclusion: Etiology for end-stage liver disease may significantly vary according to place of residence beyond autoimmune hepatitis. Rural recipients have remained steadily below 10% of our transplant population over the last decade despite excellent outcomes and similar complication rates.
    CST (Canadian Society of Transplantation) 2013; 03/2013
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    ABSTRACT: BACKGROUND: Controversy persists over the safety and efficacy of pancreas transplantation in patients with insulin-dependent diabetes mellitus who have received a prior kidney transplant. METHODS: We compared the outcomes of recipients who received either Synchronous-Pancreas Kidney-Transplantation (SPK, n=123) or Pancreas-After-Kidney-Transplants(n=49)at our institution between August 2002 to January 2010. RESULTS: Donor and recipient demographics were similar. Time interval between kidney and pancreas transplantation was 5.9 ± 3.8 (4.8 [1.6-12.2]) years. The majority of kidney-recipients in PAK group were transplanted at outside institutions and referred to us for PAK. Most patients received thymoglobulin induction and were maintained on tacrolimus, MMF, and prednisone. For SPK versus PAK recipients, there was no difference in median of length of hospital stay or incidence of overall complications. All PAK recipients are alive with functioning kidney grafts, whereas the 1-, 3-, and 5-year SPK patient survival rates were 98%,96%,and 94%, P=0.09. The 1-,3-, and 5-yr uncensored pancreas survival rates for SPK versus PAK were 93% vs. 90%, 90% vs. 90%, and 82% versus 85%, respectively (P=0.4). CONCLUSION: Glycemic control and intermediate survival outcomes were similar in both groups. Pancreas-graft outcomes in SPK and PAK were equivalent in our study, but our specific population entailed among other factors a long K to PAK time interval; PAK could be a comparable option to SPK for patients with access to kidney grafts.
    Transplantation 11/2012; · 3.78 Impact Factor
  • American Transplant Congress; 06/2012
  • American Transplant Congress; 06/2012
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    ABSTRACT: Routine induction therapy in living donor liver transplantation (LDLT) has not been well described. We reviewed outcomes of induction therapy with rabbit antithymocyte globulin (rATG) or basiliximab within 1 year of LDLT. Between 2002 and 2007, 184 adults underwent LDLT and received induction therapy in addition to standard immunosuppression. Acute cellular rejection (ACR) developed in 17 of 130 patients (13.1%) who received rATG and 13 of 54 patients (24.1%) who received basiliximab (P = .066). The interval between transplantation and rejection as well as rejection severity was similar in patients who received rATG and those who received basiliximab. Hepatitis C (HCV) recurrence requiring initiation of antiviral therapy was more common in patients who received rATG compared with basiliximab (34.5% vs 8.7%; P = .021), and in those who received induction combined with tacrolimus as opposed to cyclosporine (38.5% vs 3.9%; P = .001). rATG and basiliximab were associated with excellent patient and graft survivals well as low rates of opportunistic infections and malignancies. Induction with rATG or basiliximab was well tolerated and highly effective at preventing ACR within 1 year of LDLT, but may be associated with a higher risk of clinically significant HCV recurrence in some patients.
    Transplantation Proceedings 06/2012; 44(5):1351-6. · 0.95 Impact Factor
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    ABSTRACT: Dendritic cell (DC) homeostasis in peripheral tissues reflect a balance between DC generation, migration, and death. The current model of DC ontogeny indicates that pre-cDCs are committed to become terminal conventional DCs (cDCs). Here, we report the unexpected finding that proliferating immunostimulatory CD11c(+) MHC class II(+) cDCs derived from pre-cDCs can lose their DC identity and generate progeny that exhibit morphologic, phenotypic, and functional characteristics of regulatory macrophages. DC-derived-macrophages (DC-d-Ms) potently suppress T-cell responses through the production of immunosuppressive molecules including nitric oxide, arginase, and IL-10. Relative deficiency of granulocyte-macrophage colony stimulating factor (GM-CSF) provided a permissive signal for DC-d-M generation. Using a transgenic mouse model that allows tracking of CD11c(+) cells in vivo, we found that DC-d-M development occurs commonly in cancer, but not in lymphoid or nonlymphoid tissues under steady-state conditions. We propose that this developmental pathway serves as an alternative mechanism of regulating DC homeostasis during inflammatory processes.
    Blood 04/2012; 119(21):4919-27. · 9.78 Impact Factor
  • 01/2012; 94:815.

Publication Stats

3k Citations
580.36 Total Impact Points

Institutions

  • 2000–2012
    • University Health Network
      • Department of Surgery
      Toronto, Ontario, Canada
  • 1994–2012
    • University of Toronto
      • Department of Surgery
      Toronto, Ontario, Canada
  • 2001–2006
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2005
    • The University of Calgary
      • Department of Surgery
      Calgary, Alberta, Canada
  • 2004
    • National and Kapodistrian University of Athens
      • Division of Surgery V
      Athens, Attiki, Greece
  • 2003
    • The University of Western Ontario
      • Department of Surgery
      London, Ontario, Canada
  • 1999
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1996
    • SickKids
      Toronto, Ontario, Canada
  • 1995–1996
    • University of Nebraska Medical Center
      • Department of Pathology and Microbiology
      Omaha, Nebraska, United States
  • 1993–1994
    • University of Nebraska at Omaha
      • Department of Surgery
      Omaha, NE, United States