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Much progress has been made in the recent era to significantly decrease the incidence of cardiac allograft rejection. However, the incidence of cardiac allograft vasculopathy (CAV) persists, affecting 50% of patients by 10 years post heart transplantation. CAV in these patients is a common cause of chronic graft dysfunction, often resulting in graft failure and death. As only a small number of patients with CAV are candidates for redo heart transplantation, addressing this complication continues to be a priority for the heart transplant community. Predicting the development of CAV, with a view to early intervention, remains a challenge due to diverse...
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OK – this is the first non-Parmjeet Blog entry in the Diagnostics COP, so I decided to touch on a topic close to his heart. One of the diagnostic challenges that I and my colleagues in our renal pathology group struggle with is biopsies from patients with recent or resolving BK polyomavirus nephropathy (PVN). Early in my career, I found polyomavirus nephropathy to be an easy diagnosis. Patients presented with graft dysfunction, and biopsies showed fulminant plasma cell rich inflammation, viral cytopathologic effect, and widespread unequivocal immunohistochemical staining for the large T antigen. I still see these cases occasionally, but practice patterns...
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The last two COP business meetings at the ATC have featured difficult cases brought to us by COP members for a collective consultative opinion. These cases will be achived on the COP website. The first case has been posted in the Library section. It describes an interesting case of Denovo Minimal Change Disease occurring in a kidney transplant patient with recurrent Pseudomonas necrotizing fascitis. Enjoy!
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Who is “too big” for a liver transplant? Nearly one-third of people living in the United States today are obese, and almost 7% are morbidly obese. Because of this increasing epidemic, more morbidly obese patients are undergoing liver transplant evaluation. Although organizations such as the AASLD have suggested restrictions on the transplantation of morbidly obese patients, there remains great variation in clinical practices among different institutions. This is in part due to conflicting literature about LT outcomes in morbidly obese patients. Perez Protto et al. reported equivalent long-term outcomes in morbidly obese and lean LT patients at their...
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