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| 1 | Immunobiology of hepatocarcinogenesis: Ways to go or almost there?显示文摘Hepatocellular carcinoma is on the rise and occurs in the setting of chronic liver disease and cirrhosis.Though treatment modalities are available,mortality from this cancer remains high.Medical therapy with the utilization of biologic compounds such as the Food and Drug Administration approved sorafenib might be the only option that can increase survival.Immunotherapy,with modern pharmacologic developments,is a new frontier in cancer therapy and therefore the immunobiology of hepatocarcinogenesis is under investigation.This review will discuss current concepts of immunobiology in hepatocarcinogenesis along with current treatment modalities employing immunotherapy.The tumor microenvironment along with a variety of immune cells coexists and interplays to lead to tumorigenesis.Tumor infiltrating lymphocytes including CD8+ T cells,CD4+ T cells along with regulatory T cells,tumor associated macrophages,tumor associated neutrophils,myeloid derived suppressor cells,and natural killer cells interact to actively provide anti-tumor or pro-tumor effects.Furthermore,oncogenic pathways such as Raf/mitogenactivated protein kinase/extracellular-signal-regulated kinase pathway,phosphatidyl-3-kinase/AKT/mammalian target or rapamycin,Wnt/β-catenin,nuclear factor-κB and signal transducers and activators of transcription 3 may lead to activation and proliferation of tumor cells and are also considered cornerstones in tumorigenesis.Immunotherapy directed at this complex milieu of cells has been showned to be successful in cancer treatment.The use of vaccines,adoptive cell therapy and immune checkpoint inhibitor modulation are current options for therapy.Further translational research will shed light to concepts such as anti-tumor immunity which can add another alternative in the therapeutic armamentarium. | Pavan Patel Steven E Schutzer Nikolaos Pyrsopoulos | 2016 | World Journal of Gastrointestinal Pathophysiology2016，7，3： | 3 |
| 2 | Past, present and future of kidney paired donation transplantation in India显示文摘One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, nonsimultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool.In absence of national kidney paired donation program,a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries. | Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Manisha P Modi Priya S Shah Umesh T Varyani Pavan S Wakhare Saiprasad G Shinde Vijay A Ghodela Minaxi H Patel Varsha B Trivedi Hargovind L Trivedi | 2017 | World Journal of Transplantation2017，7，2： | 0 |
| 3 | International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India显示文摘AIM To report the first international living related two way kidney paired donation(KPD) transplantation from India which occurred on 17 th February 2015 after legal per-mission from authorization committee. METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-matchand donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD. RESULTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/d L on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.CONCLUSION International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India. | Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Priya S Shah Pavan S Wakhare Saiprasad G Shinde Vijay A Ghodela Umesh T Varyani Minaxi H Patel Varsha B Trivedi Hargovind L Trivedi | 2017 | World Journal of Transplantation2017，7，1： | 0 |
| 4 | Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States显示文摘BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,P<0.001).Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals(4 d vs 5 d,P<0.001).A higher proportion of non-white patients were managed in teaching hospitals.As far as procedures in nonteaching vs teaching hospitals,portosystemic shunt insertion(3.1%vs 6.9%,P<0.001)and balloon tamponade(0.6%vs 1.2%)were done more often in teaching hospitals while blood transfusions(64.2%vs 59.9%,P=0.001)were given more in nonteaching hospitals.Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality,LOS and cost in teaching hospitals remained higher.CONCLUSION In patients admitted for esophageal variceal bleeding,mortality,length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors. | Pavan Patel Laura Rotundo Evan Orosz Faiz Afridi Nikolaos Pyrsopoulos | 2020 | World Journal of Hepatology2020，12，6： | 0 |
| 5 | Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India显示文摘AIM To avoid desensitization protocols and ABO incompatible kidney transplantation(KT) due to high costs and increased risk of infections from intense immunosuppression.METHODS We present institutional ethical review board- approved study of single center 6-way kidney exchange transplantation. The participants comprised ABO incompatibility(n = 1); positive cross-match and/or presence of donor specific antibody(n = 5). The average time required from registration in kidney paired donation(KPD) registry to find suitable donors was 45 d and time required to perform transplants after legal permission was 2 mo. RESULTS Graft and patient survival were 100%, and 100%, respectively. One patient had biopsy-proven acute borderline T cell rejection(Banff update 2013, type 3). Mean serum creatinine was 0.8 mg/dL at 9 mo followup. The waiting time in KPD was short as compared to deceased donor KT. CONCLUSION We report first non-simultaneous, single center, 6-way kidney exchange transplantation from India. Our experience will encourage other centers in India to undertake this practice. | Vivek B Kute Himanshu V Patel Umesh T Varyani Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Priya S Shah Pavan S Wakhare Vijay A Ghodela Saiprasad G Shinde Varsha B Trivedi Minaxi H Patel Hargovind L Trivedi | 2016 | World Journal of Nephrology2016，5，6： | 0 |
| 6 | Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report显示文摘The combination of kidney paired donation(KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation(LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT. | Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Manisha P Modi Priya S Shah Umesh T Varyani Pavan S Wakhare Saiprasad G Shinde Viajay A Ghodela Minaxi H Patel Varsha B Trivedi Hargovind L Trivedi | 2016 | World Journal of Clinical Cases2016，4，10： | 0 |
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