Vivian C McAlister

London Health Sciences Centre, London, Ontario, Canada

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Publications (75)254.38 Total impact

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    ABSTRACT: The use of small pediatric kidneys obtained from very young donors after cardiac death (DCD) has been limited and this remains an underutilized organ source.
    The Journal of urology. 07/2014;
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    ABSTRACT: To determine if there is a reasonable prospect of success of a re-use liver transplantation.
    World journal of hepatology. 06/2014; 6(6):443-7.
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    ABSTRACT: BACKGROUND: Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation but there have been few studies with limited power that have addressed this issue. OBJECTIVE: To review the evidence for the effectiveness of storing kidneys from deceased donors after cardiac death prior to transplantation, using cold static storage solutions or pulsatile hypothermic machine perfusion. DATA SOURCES: Electronic databases were searched in September 2011 for systematic reviews and/or meta-analyses, randomized controlled trials and other study designs that compared delayed graft function and graft survival. Sources included Cochrane Library, PUBMed and EMBASE. Studies excluded from review included those that were unable to discriminate between donation after cardiac death (DCD) and a neurologically deceased donor (NDD). REVIEW METHODS: Our primary outcomes were delayed graft function (DGF) and one year graft survival. Statistical analysis was carried out using the Review Manager software from the Cochrane database. RESULTS: A total of nine studies qualified for review. We found that pulsatile perfusion pumped kidneys from DCD donors had reduced DGF rates compared to kidneys that were placed in cold storage (p = 0.03; odds ratio 0.64, CI 0.43 - 0.95). Although, there was a trend towards improved 1 year graft survival in the pulsatile perfusion group, statistical significance was not reached (p = 0.17; odds ratio 0.74, CI 0.48 - 1.13). CONCLUSION: Pulsatile machine perfusion of DCD kidneys appears to reduce delayed graft function rates. There did not appear to be a benefit in regards to one year graft survival. Due to the great heterogeneity among the trials along with several confounding factors the overall impact upon allograft function and survival requires more study.
    The Journal of urology 12/2012; · 4.02 Impact Factor
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    ABSTRACT: Medical students at the Schulich School of Medicine and Dentistry at The University of Western Ontario in London, Ontario, Canada, learn clinical facts about the hepatobiliary system as transplant surgeon Dr. Vivian McAlister (at the far right) demonstrates Whipple's procedure in the anatomy laboratory. In this issue of ASE, Ullah and colleagues describe an extracurricular student initiative known as the Surgically Oriented Anatomy Program (SOAP), which aims to deliver anatomy teaching from a surgical perspective through the philosophy of "education through recreation".
    Anatomical Sciences Education 05/2012; 5(3).
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    ABSTRACT: Didactic and laboratory anatomical education have seen significant reductions in the medical school curriculum due, in part, to the current shift from basic science to more clinically based teaching in North American medical schools. In order to increase medical student exposure to anatomy, with clinical applicability, a student-run initiative called surgically oriented anatomy prosectors (SOAP) club was created within the extracurricular program at the Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. SOAP invites surgeons and residents from various surgical specialties to demonstrate, on a cadaver, a surgical procedure of their choosing. During the demonstration, the anatomy, as it relates to the surgical procedure, is discussed. The students then break into smaller groups to examine the relevant anatomy on the cadavers, during which time the discussion is broadened. The group continues the conversation in a social environment with refreshments. SOAP is one of the most popular extracurricular clubs with 65% of first and second year medical students registered as members. The high demand for SOAP, along with the positive participant feedback, may be due to its utilization of the principle of education through recreation, which seeks to provide opportunities for learning seamlessly throughout all facets of life. It also demonstrates the desire, amongst certain medical students, to learn applied anatomy, particularly within a surgical context.
    Anatomical Sciences Education 03/2012; 5(3):165-70.
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    Emily Claydon, Vivian C McAlister
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    ABSTRACT: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario. Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his times. A fragmented biography can be assembled from family notes and obituaries with the help of contemporary documents compiled by early 20th century medical school historians. Wishart assisted Abraham Groves in the first reported operation for which aseptic technique was used (1874). He was considered locally to perform pioneering surgery, including an appendectomy in 1886. Wishart was a founding member of the medical faculty at Western University in 1881, initially as Demonstrator of Anatomy and subsequently as its first Professor of Clinical Surgery, which post he held until 1910. Comprehensive notes from his undergraduate lectures demonstrate his teaching style, which mixed organized didacticism with practical advice. The role of the Flexner review in the termination of his professorship is hinted at in minutes of Faculty of Medicine meetings. Wishart was a foundation fellow of the American College of Surgeons and a founding physician of London's Catholic hospital, St. Joseph's, despite his own Protestant background. Wishart's career comprised all the elements of modern academic surgery, including pioneering service, research, and teaching. Surgery at Western owes as much to Wishart as it does to university reorganization in response to the Flexner report.
    World Journal of Surgery 03/2012; 36(3):684-8. · 2.23 Impact Factor
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    Vivian C McAlister
    Canadian journal of surgery. Journal canadien de chirurgie 02/2011; 54(1):7-8. · 1.63 Impact Factor
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    Yves Caumartin, Vivian C McAlister, Patrick P W Luke
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    ABSTRACT: Abraham Groves worked as a general practitioner and surgeon in the small town of Fergus, Ontario, Canada. Several priority claims have been attributed to Groves' life in surgery, including aseptic surgery (1874), appendectomy (1883) and the use of surgical gloves (1885). He was also an early practitioner of urological surgery. The purpose of this paper is to describe and objectively assess his contributions as a pioneer in urological surgery. A systematic search of contemporary journals was made for articles by or about Groves. These articles and his 1934 autobiography were reviewed. The information was assessed not only for priority, but also for the development of organized surgical principles and thought. Groves published frequently throughout his career; up to this point, 36 papers have been identified. Groves' claims are verifiable for aseptic surgery, which were the result of logical surgical thought and was practiced throughout his career. Contemporary publications support his early use of suprapubic lithotomy (1875), prostatotomy (1887), bladder repair (1892), urethral repair (1903), renal decapsulation (1905) and prostatectomy (1911). Despite his isolation, Abraham Groves independently developed a full range of surgical techniques and principles relevant to modern-day urology. His impact was reduced by the nature of the environment in which he worked and by the limited circulation of the journals in which he chose to publish.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 12/2010; 4(6):407-12. · 1.66 Impact Factor
  • Christopher R. Geddes, Vivian C. McAlister
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    ABSTRACT: BACKGROUND: The practice of surgery had changed little over millennia when Abraham Groves and William Osler attended medical school together in Toronto, Ontario. The invention of anesthesia sparked such rapid development that by the time of Groves' and Osler's deaths, surgical practice resembled the current model. Several priority claims have been attributed to Groves' life in surgery, including aseptic surgery (1874), suprapubic lithotomy (1878), appendectomy (1883), surgical gloves (1885) and cancer radiotherapy (1903). These claims arise from an autobiography written by Groves at the age of 87 years in 1934. METHODS: The purpose of this paper is to assess these priority claims from a modern surgical perspective. We did a systematic search of contemporary (1873-1934) and modern journals for articles by or about Groves. We searched relevant archives and museums. We reviewed the 1934 autobiography, notes held by descendants, reminiscences by contemporaries and collateral information. We assessed the information not only for priority but also for the development of organized surgical thought. RESULTS: Groves published frequently throughout his career; thus far we have located 36 papers, almost all of which were published in Canadian journals. He spoke regularly at regional meetings in Ontario. Many medical students apprenticed with him (including his brother, son and grandson), he established a hospital and he founded a school of nursing. His contemporaries published complimentary reminiscences, but no correspondence with his classmate, William Osler, is known. Groves' priority claims for aseptic surgery, suprapubic lithotomy and radiotherapy are supported by contemporary publications. Groves independently developed an organized surgical system that remains valid today. Priority claims for appendectomy and the use of surgical gloves are entirely consistent with that system. CONCLUSION: Although Groves' impact was reduced by his location and the limited circulation of the journals in which he wrote, he demonstrated a systematic understanding of modern surgery well ahead of his contemporaries.
    Canadian journal of surgery. Journal canadien de chirurgie 10/2009; · 1.63 Impact Factor
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    Vivian C McAlister
    Canadian journal of surgery. Journal canadien de chirurgie 07/2009; 52(3):175-6. · 1.63 Impact Factor
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    ABSTRACT: The objective of this study was to determine if clinically important thromboembolic adverse events (TAEs) because of recombinant activated factor VII (rFVIIa) administration are being under-reported. rFVIIa is a potent haemostatic agent with a short half-life of 2.6 h that is increasingly used in 'off-label' situations. Retrospective review of 94 patients who received rFVIIa during 1 January 2003 to 30 June 2007 was carried out at a tertiary care centre. Sixty-nine patients, 32 females and 37 males, mean age 55 years (18-84 years), satisfied study criteria of off-label usage. This was a high-risk population with 33 (48%) deaths. A mean dose of 8.2 mg (2.4-19.2 mg) was administered in two average divided doses. Thirty-six potential TAEs were identified in 29 patients, and of these, 12 patients had TAEs deemed to be rFVIIa related and were identified on average 8.8 days after exposure to rFVIIa. Forty-eight (70%) physician questionnaires were completed; however, no TAEs were reported in these questionnaires or on chart review. Potential clinically significant TAEs are being under-reported by treating physicians. Until further evidence, we suggest the urgent need to develop consensus recommendations for utilization and required follow up to monitor the safety of rFVIIa and that at a minimum, all use of rFVIIa should be regulated through a gate-keeping mechanism that ensures adherence to these policies. Furthermore, prospective registries and trials are necessary to evaluate the efficacy and safety of rFVIIa in off-label settings.
    Transfusion Medicine 01/2009; · 1.26 Impact Factor
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    ABSTRACT: The effect of adding a calcium channel antagonist to kidney allograft perfusate solution was assessed. All renal transplants in which both kidneys from the same donor used for transplantation were studied between November, 2003 and August, 2005 (n=46). The first renal allograft was perfused on the backtable with 1 L of histidine-tryptophan-ketoglurate solution and the second with 1 L of histidine-tryptophan-ketoglurate with 5 mg/L of verapamil. Both organs were transplanted in the usual manner. Baseline demographic parameters were similar between first and second kidney recipients other than BMI and cold ischemic time. At 6 and 12 months, renal function was significantly improved in the verapamil versus control cohort (creatinine clearance 73.8+/-23.5 mL/min vs. 55.8+/-17.0 mL/min, P<0.05 and 87.5+/-28.4 mL/min vs. 59.7+/-21.3 mL/min, P<0.05 respectively). Additionally, rates of hypotension during graft reperfusion and other adverse reactions were similar in both groups. In conclusion, verapamil supplemented perfusate significantly improved renal function posttransplantation.
    Transplantation 12/2008; 86(10):1463-7. · 3.78 Impact Factor
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    Cyrus C Hsia, Ian H Chin-Yee, Vivian C McAlister
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    ABSTRACT: Benefits of recombinant activated factor VII (rFVIIa) in hemorrhage may be lost because of thromboembolic events (TAE). MEDLINE, EMBASE, BIOSIS, CINAHL, Science Citation Index Expanded, clinicaltrials.gov were searched for placebo controlled trials of rFVIIa in patients without hemophilia. Reports of 22 randomized controlled trials were selected for analysis. Results were pooled using random effects models to calculate the odds ratios (OR) with 95% confidence interval (CI). Subgroup analyses were predetermined. Among 3184 participants, 478 (15.0%) died and 249 (7.8%) had TAE. Additional blood transfusion was required in 517 (41.2%) of 1256 subjects. Patients receiving rFVIIa were less likely to need additional blood transfusions (OR, 0.54; 95% CI, 0.34-0.86) than patients receiving placebo. Mortality was not increased but may be reduced (OR, 0.88; 95% CI, 0.71-1.09). Reduction in mortality was more likely if rFVIIa was given therapeutically (OR, 0.87; 95% CI, 0.70-1.09) rather than prophylactically (OR, 1.00; 95% CI, 0.37-2.68). Differences in the pooled analysis of TAE were not statistically significant (OR, 1.17; 95% CI, 0.87-1.58) but the incidence of arterial TAE was likely higher in patients receiving rFVIIa (OR, 1.50; 95% CI, 0.93-2.41) although no differences were seen with respect to venous TAE (OR, 0.76; 95% CI, 0.49-1.15). Use of rFVIIa reduces the need for blood transfusion and it may reduce mortality, especially if the dose of rFVIIa is limited to therapeutic doses of 90 mug/kg. It does not increase the risk of venous thrombosis but it may increase the risk of arterial thrombosis.
    Annals of surgery 08/2008; 248(1):61-8. · 7.90 Impact Factor
  • David A Stanford, Elizabeth M Renouf, Vivian C McAlister
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    ABSTRACT: This study comprises a historical review of liver transplants performed in Canada during 2000--2004, and sensitivity analyses to assess the impact of possible changes in the operation of the waitlists. In the first part, overall statistics are reported, and the notable impact that blood type plays in affecting waiting time is discussed. Waiting times and numbers of transplants are also reported by gender, age, and geographic region (waitlist), and statistical analyses of the patient placement and cadaveric donations processes are performed. These analyses establish that the service times of an appropriate queuing model are closely approximated by an exponential distribution. Consequently, the resulting distribution for the waiting time from placement until transplant is well described by a different exponential distribution. The GI/M/1 queuing model is then used to perform a number of sensitivity analyses. The sensitivity analyses attempt to quantify the impact of no change in policy via a lottery system, and likely increases in cadaveric and/or living donor sources that would be needed to bring stability to the system. The results can be used by relevant authorities, together with information on success rates for publicity campaigns and living donor matching campaigns, to assess where further efforts should be made to reduce waiting times.
    Health Care Management Science 07/2008; 11(2):184-95. · 1.05 Impact Factor
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    ABSTRACT: For years, the reference standard in the evaluation of living donor vascular anatomy has been selective renal angiography (SRA). Because of the potential morbidity associated with SRA, we prospectively evaluated magnetic resonance angiography (MRA) in the assessment of renal donors. All patients had SRA and 53 renal units were prospectively evaluated by MRA. We used SRA supplemented by findings at donor nephrectomy (DN) as our standard. We defined a positive test as the detection of any abnormality in the number of renal arteries. Selective renal angiography yielded a sensitivity of 86%, specificity of 95%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 97% compared with findings at DN. MRA had a sensitivity of 64%, 88% specificity, 58% PPV, and 90% NPV. MRA correctly identified only 7 of 11 renal units with accessory arteries. MRA also incorrectly identified 5 accessory arteries not present on SRA or DN. Two patients diagnosed with fibromuscular dysplasia by SRA were missed using MRA. We have shown that MRA is not capable of replacing SRA as the reference standard in renal donor imaging.
    Urology 04/2008; 71(3):385-9. · 2.42 Impact Factor
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    Vivian Charles McAlister
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    ABSTRACT: Since its inception 50 years ago, the Canadian Journal of Surgery has published articles under the banner "History of Canadian Surgery." Because no comprehensive history of surgery in this country has yet been written, these articles may provide its basis. The Canadian Journal of Surgery was searched from October 1957 to August 2007 for articles on the practice of surgery in Canada before 1957. Articles regarding the development of surgery in provinces, universities, hospitals and surgical specialty societies were included, as well as biographies and obituaries of surgeons. Thirty-six articles dealing with the lives of 57 Canadian surgeons were located. Three periods of Canadian surgery were covered: the French regime (1535-1759), the transition period (1759-1870) and the early modern period (1870-1945). The review shows that persistent efforts were made in Canada to develop surgical education and to regulate the practice of surgery. Isolation forced a spirit of adaptability that led to innovation and progress. The practice of surgery in Canada today can be traced back to contributions made by pioneering surgeons over the entire history of modern Canada. An archive of materials related to the history of surgery in Canada is being created at www.historyofsurgery.ca to facilitate further research.
    Canadian journal of surgery. Journal canadien de chirurgie 11/2007; 50(5):357-63. · 1.63 Impact Factor
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    ABSTRACT: Kidney retransplants carry increased immunologic risk. One possible contributor to this risk may be re-exposure to human leukocyte antigens (HLA) common to a previous donor but foreign to the recipient. Conflicting publications have assessed this risk, so to examine our experience 259 kidney retransplants were analyzed. A retrospective cohort of retransplant patients from 1973 to 2005 with minimum 12 months follow up was examined. Using multivariable modeling, important confounders were controlled for identifying factors significantly affecting graft survival. Re-exposure to HLA class I (HLA-A or B) antigens, peak panel reactive antibodies and donor source were the most important determinants of allograft survival, despite a negative conventional or anti-human globulin-augmented T cell crossmatch. We failed to demonstrate that recipient re-exposure to HLA class II (HLA-DR) or positive B cell crossmatch were associated with adverse outcomes. Sample size and molecular versus serologic methods may have influenced the former, while inability to determine antibody specificities may have influenced the latter. Controlling for other variables, the adjusted risk of graft loss associated with re-exposure to HLA class I increased by 71% (P=0.006) and occurred early, consistent with recall of memory cytotoxic T lymphocyte or antibody responses. Kidney recipients re-exposed to mismatched HLA class I antigens appear to be at heightened risk of early graft loss. Such patients may benefit from pretransplant identification of donor specific antibodies using solid phase methods and heightened vigilance for acute rejection. Future studies may indicate whether more intensive immunosuppression for these patients is warranted.
    Transplantation 10/2007; 84(6):722-8. · 3.78 Impact Factor
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    ABSTRACT: Cardiac and cerebral vascular diseases are leading causes of morbidity and death in solid organ transplant recipients. Immunosuppressant drugs are associated with dyslipidemia, hypertension, and hyperglycemia, which along with obesity are the main features of metabolic syndrome. In the nontransplant population, metabolic syndrome is associated with increased risk for major vascular complications. We postulated that metabolic syndrome is common post-liver transplantation and plays a significant role leading to cardiac and cerebrovascular events. Our Multi-Organ Transplant Program database was reviewed for all liver transplant recipients between January 1998 and June 2004 with follow-up until December 2005. We adapted the 2001 National Cholesterol Education Program-Adult Treatment Panel III Guidelines to define posttransplantation metabolic syndrome (PTMS) as the presence at least 3 of the following: 1) obesity (body mass index>30 kg/m2); 2) serum triglyceride level>or=1.7 mmol/L; 3) high density lipoprotein level<1 mmol/L in men and <1.3 mmol/L in women; 4) hypertension; and 5) fasting plasma glucose>or=5.6 mmol/L. A total of 118 patients were included. Among them, 69 patients (58%) had PTMS. The mean (+/-standard deviation) time from transplant was 59+/-21 months (no significant difference in patients with or without metabolic syndrome). Overall, patients with metabolic syndrome had a significantly higher average age, posttransplantation body mass index, fasting glucose, high-density lipoprotein levels, and serum triglycerides. There was no difference in creatinine, hemoglobin, or prednisone average dose between the 2 groups. There were 25 major vascular events affecting 21% of patients. There were significantly more vascular events in patients with metabolic syndrome posttransplantation than in those without (30% vs. 8%; P=0.003) during the study period. In conclusion, the prevalence of metabolic syndrome post-liver transplant is significantly higher than that estimated in the general population. Metabolic syndrome appears to be associated with an increased risk of major vascular events in our liver transplant population.
    Liver Transplantation 08/2007; 13(8):1109-14. · 3.94 Impact Factor
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    ABSTRACT: Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery. The panel undertook a literature review of the use of rFVIIa in both cardiac and non-cardiac surgery. Appropriateness, timing, and dosage considerations were addressed for three cardiac surgery indications: prophylactic, routine, and rescue uses. Recommendations were based on evidence from the literature and derived by consensus following recognized grading procedures. The panel recommended against prophylactic or routine use of rFVIIa, as there is no evidence at this time that the benefits of rFVIIa outweigh its potential risks compared with standard hemostatic therapies. On the other hand, the panel made a weak recommendation (grade 2C) for the use of rFVIIa (one to two doses of 35-70 microg.kg(-1)) as rescue therapy for blood loss that is refractory to standard hemostatic therapies, despite the lack of randomized controlled trial data for this indication. In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients.
    Canadian Journal of Anaesthesia 08/2007; 54(7):573-82. · 2.13 Impact Factor
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    A Y Alemdar, D Sadi, V McAlister, I Mendez
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    ABSTRACT: Immunosuppression remains a key issue in neural transplantation. Systemic administration of cyclosporin-A is currently widely used but has many severe adverse side effects. Newer immunosuppressive agents, such as tacrolimus (TAC) and rapamycin (RAPA), have been investigated for their neuroprotective properties on dopaminergic neurons. These drugs have been formulated into liposomal preparations [liposomal tacrolimus (LTAC) and liposomal rapamycin (LRAPA)] which retain these neuroprotective properties. Due to the slower release of the drugs from the liposomes, we hypothesized that co-transplantation of either LTAC or LRAPA within a xenogeneic cell suspension would increase cell survival and decrease graft rejection in the hemiparkinsonian rat, and that a combination of the two drugs may have a synergistic effect. 6-hydroxydopamine-lesioned rats were divided to four groups which received intra-striatal transplants of the following: 1) a cell suspension containing 400,000 fetal mouse ventral mesencephalic cells; 2) the cell suspension containing 0.63 microM LRAPA; 3) the cell suspension containing a dose of 2.0 microM LTAC; 4) the cell suspension containing 2.0 microM LTAC and 0.63 microM LRAPA. Functional recovery was assessed by amphetamine-induced rotational behavior. Animals were killed at 4 days or 6 weeks post-transplantation, and immunohistochemistry was performed to look at the expression of tyrosine hydroxylase and major histocompatibility complex classes I and II. Only the group receiving LTAC had a decrease in rotational behavior. This observation correlated well with significantly more surviving tyrosine hydroxylase immunoreactive cells compared with the other groups and significantly lower levels of immunorejection as assessed by major histocompatibility complex class I and II staining. This study has shown the feasibility of using local immunosuppression in xenotransplantation. These findings may be useful in optimizing immunosuppression in experimental neural transplantation in the laboratory and its translation into the clinical setting.
    Neuroscience 05/2007; 146(1):213-24. · 3.12 Impact Factor

Publication Stats

662 Citations
254.38 Total Impact Points

Institutions

  • 2004–2014
    • London Health Sciences Centre
      • • Department of Medicine
      • • Department of Surgery
      London, Ontario, Canada
  • 2009–2012
    • University of Toronto
      • Department of Surgery
      Toronto, Ontario, Canada
  • 1993–2012
    • The University of Western Ontario
      • • Schulich School of Medicine and Dentistry
      • • Department of Surgery
      • • Department of Statistical and Actuarial Sciences
      London, Ontario, Canada
  • 2002–2004
    • Nova Scotia Agricultural College
      Truro, Nova Scotia, Canada
    • Dalhousie University
      Halifax, Nova Scotia, Canada