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Tissue typing for HLA class II antigens is routinely performed by serological, and/or DNA-based methods. Accuracy, absence of cross-reactivity and controllable level of resolution are striking advantages of molecular methods. However, a disadvantage of molecular typing, compared to serological methods, is the identification of unexpressed alleles. Whereas serology allows a more or less direct insight into antigen presence, molecular biology is an indirect method and results must also be interpreted by considering the biological pathways of protein expression. We believe that identification of nonexpressed MHC alleles is of importance for transplantation, since nonexpressed MHC allele positive individuals could give rise to antibody formation against the respective expressed MHC product in donor tissue. Usually, the nonexpressed DRB4*0103102N is encountered in association with DRB1*0701-DQB1*03032, which facilitates correct DNA typing. Here we describe the unusual association of this unexpressed DRB4*0103102N, with DRB1*0402-DQB1*0302 in a sample of Austrian patients. [ABSTRACT FROM AUTHOR]

We report here on a newborn with end‐stage renal failure due to autosomal recessive polycystic kidney disease, also causing ventilation‐requiring respiratory distress. Peritoneal dialysis was able to keep the newborn alive but not wean it from the respirator. After removal of both huge kidneys, dialysis became more effective and allowed the neonate to be extubated only 5 days later. It was decided to register the baby for a pediatric cadaveric kidney transplant when it reached 6 kg/body wt or to perform a living related transplant if no such kidney became available and the baby grew to 7 kg/body wt. At the age of 9 months and a weight of 6 kg a cadaveric kidney from a 20‐month‐old donor became available and was transplanted extraperitoneally. Prophylactic immunosuppression included cyclosporin, mycophenolate mofetil and steroids. Pneumonia on post‐operative day 10 required respiratory care for several days and acute rejection requiring peritoneal dialysis. Both complications were controlled with antibiotics and conversion from cyclosporin to tacrolimus and a temporary increase in steroids. Thirteen months later the child is alive and well with a serum creatinine of 0.6 mg%. From this experience we would recommend early removal of both polycystic kidneys causing end‐stage renal failure and respiratory insufficiency, starting peritoneal dialysis and performing a renal transplant as soon as possible. This therapeutic strategy seems appropriate for this complex situation. [ABSTRACT FROM AUTHOR]

There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation. [ABSTRACT FROM AUTHOR]

Abstract: Rotavirus (RV) is the most common cause of diarrheal illness in children. We report three solid-organ-transplanted patients in whom RV infection caused increased trough levels of the immunosuppressive macrolide tacrolimus (TAC) by mechanisms that are still under investigation. The virus was detected for longer in the feces of these patients than in infants not receiving immunosuppressive therapy. In association with short-term monitoring of blood trough levels of TAC, the dosage should be reduced early if symptoms of an acute gastroenteritis are present. [ABSTRACT FROM AUTHOR]

Abstract: The combination of tacrolimus (TAC) and mycophenolate mofetil (MMF) is frequently used for immunosuppression after organ transplantation (Tx), but the pharmacokinetics and interactions between the two drugs are poorly elucidated. We describe here the increase of TAC trough levels during MMF-induced diarrhea in a 8-yr-old boy after kidney Tx. Early dose reduction of TAC, together with short-term monitoring of TAC trough levels in the presence of diarrhea, is recommended. [ABSTRACT FROM AUTHOR]

Objectives In several large epidemiological studies CF patients report equal levels of anxiety and depression compared to healthy controls. They seem to cope particularly well considering their uncertainty and restrictions in living. (1) “Resilience” (the “bouncing back from adversity”) and (2) “Intolerance of uncertainty” (IU, a vulnerability factor) have been investigated in their predictive power on CF quality of life. Research on resilience and IU in CF is hardly existent yet. Methods Adult patients treated at the CF centre in Innsbruck (n = 57) were assessed at their routine medical check-up. Resilience (assessed with the Resilience Scale – RS; Wagnild & Young, 1993) and IU (assessed with the Intolerance of Uncertainty Scale – IUS; Freeston et al., 1994) were explored as predictors on CF quality of life (assessed with the CFQ-R) in multiple regression analyses. Results CF patients had comparably excellent medical status and reported significantly higher levels of resilience compared to healthy controls, but equal levels of IU. The constructs explained up to 54% of variance in CFQ-R subscales. None of the IUS subscales retained their predictive power when resilience was included in the regression model and lung function was controlled for. Of the two RS subscales “personal competence” had strong predictive power whereas “acceptance” with its purported beneficial effect had a substantial number of negative associations with QoL. Conclusions Data support the notion that the majority of CF patients in our sample rather successfully regulate than suppress negative emotions. Perceived personal coping competence has been confirmed as a major focus for intervention. [ABSTRACT FROM AUTHOR]

Objectives Although several psychological studies on coping and quality of life suggested high levels of resilience in CF patients, empirical data on resilience in CF are barely existent. Thus, the purpose of the study was to investigate resilience in adult CF patients and its impact on quality of life. Methods 57 adult CF patients (18–59 years) participated in the study at their routine medical check-up. In addition to their regular psychological assessment including the Cystic Fibrosis Questionnaire – Revised (CFQ-R), the Resilience Scale (RS) was administered. The constructs were also correlated with physical parameters (age, gender and lung function). Results Patients reported high levels of resilience and overall good quality of life in all domains. Patient's resilience was significantly higher compared to the large healthy reference group (t[2086] = 4.7510, p = 0.0001) and was independent of gender (t[55] = 0.826, p = 0.412), age (r = 0.076, p = 0.573) and lung function (FEV1%, r = 0.165, p = 0.220). Significant associations between resilience and CFQ-R domains could be confirmed. Conclusion Our study is one of the first attempts to explicitely test resilience in CF patients and could demonstrate high levels of resilience in these patient group and positive correlations with quality of life. These results suggest that resilience could be seen as an important factor on quality of life and coping with CF. Therefore fostering resilience early in patient's life should be encouraged. [ABSTRACT FROM AUTHOR]