Background. Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. Methods. We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. Results. Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. Conclusions. While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.

term result of fasciotomy caused by medial tibial syndrome in athletes. Scand J Med Sci Sports 1991: 1: 59-61.Sixty fasciotomies of the deep posterior compartment were performed on 30 patients with longstanding bilateral medial tibial syndrome (mean duration 25 months). The initial symptoms occurred during sports activities in all cases. Only 2 of the athletes were able to continue sports at an ordinary activity level. The diagnosis was based on a typical history of longstanding exertional pain and clinical findings of tenderness at the postero-medial border of the tibia. Radiographs showed no abnormalities. Scintigrams were performed in 12 patients in whom stress fractures could not be excluded by radiographs and clinical examination. Conservative treatment failed to relieve the symptoms. At follow-up 34 months (range 6-85) after surgery, 95% of the men and 73% of the women were free of symptoms or improved compared with prior to surgery. Whereas 68% of the men were totally free of symptoms, the corresponding figure for the women was 36%. Ninety-five percent of the men and 82% of the women returned to sport after surgery. Seventy-four percent of the men and 54% of the women returned to an activity level similar to that prior to injury. We conclude that fasciotomy of the deep posterior compartment gives a good long-term result in patients with medial tibial syndrome when conservative treatment fails. There was no significant difference between the sexes.The medial tibial syndrome is characterized by a history of refractory pain at the posterior-medial border of the tibia during physical activity, despite periods of rest, use of orthotics and proper rehabilitation (2). In contrast to the anterior compartment syndrome (8), the medial tibial syndrome is not associated with an increase in muscle relaxation pressure, ischaernic pain or impaired muscle function. There is a general agreement on the aetiology and diagnostic criteria for surgical treatment of anterior compartment syndrome, whereas the opinion on the aetiology of the medial tibial syndrome deviates. Despite different opinions on the appearance of increased intramuscular pressure in the deep posterior compartment during and after exercise, authors of both opinions (5,lO) present good results after decompression of the deep posterior compartment in patients with medial tibial syndrome.The purpose of this study was to evaluate the long-term functional results of fasciotomy of the deep posterior compartment in 30 patients with bilateral medial tibial syndrome. Material and methodsThirty subjects, 17 competitive and 13 recreational athletes, participated in the study. There were 19 men with a mean age of 25 years (range 15-36) and 11 women with a mean age of 19 years (range 15-28). They were all operated on with fasciotomy caused by bilateral medial tibial syndrome from 1974 to 1986. The diagnosis was based on a thorough history and clinical findings of tenderness at the postero-medial border of the tibia. The patients correspond to the medial tibial stress syn...

Background: More than 500 kidneys from HCV+ deceased donors are discarded each year, even though direct acting antiviral therapies have cure rates exceeding 95%. We performed a pilot trial of transplanting kidneys from HCV+ donors into HCV-recipients (THINKER; NCT02743897; sponsor: Merck). Methods: HCV-patients aged 40-65 years on dialysis, waitlisted for kidney transplant (KT) with ≤548 days of wait time were approached. A three-step process of education and consent was used pre-enrollment. We performed HCV donor genotyping during allocation, and only used kidneys from genotype 1a or 1b donors. We treated recipients with Grazoprevir/Elbasvir when recipient HCV NAT was detected. Results: From 6/1/16-11/11/16, 43 patients were contacted by phone, 22 (51.1%) attended an in-person educational session, 19 (86.4%) consented for screening, and 15 (78.9%) were enrolled. 10 HCV-patients received HCV+ kidneys (median KDPI: 42, IQR: 34-53); 9 were genotype 1a. Median time from activation in UNET for HCV+ donors and KT was 58 days (range 11-130 days). All 10 patients had detectable HCV RNA on post-op day 3, but were undetectable within 4 weeks of starting HCV therapy.

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