Our single center study showed a relatively higher incidence of mixed rejection compared with that reported for non-HIV transplant recipients. A donor terminal serum creatinine greater than 2.5 mg/dL predicted mixed rejection, which was associated with poor outcomes. Donor selection and optimization of immunosuppression may be critical in these patients.

Over time, an increase in thrombus cellular composition and a linear decrease in fibrin content as a function of thrombus age is observed. However, little else is known regarding the evolution of fibrin based clots. The role of fibrin in mediating cellular coordination, thrombus maturation, and changes of the venous wall also requires further research. This review discusses the current impact of fibrin on thrombus remodeling and addresses the limitations of the work done in this area.

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challenging to treat. The goal of this study was to describe the clinical presentation, associated imaging findings, and operative strategies for these aneurysms.Methods: A retrospective record review was performed of all patients with GDAAs or PDAAs identified through an institutional database by axial imaging between 1994 and 2014. Data on presenting symptoms, comorbid conditions, imaging findings, and outcomes after operative intervention were collected and examined.Results: We identified 11 GDAAs and 25 PDAAs in 35 patients. Mean size of the GDAAs was 31.1 mm (range, 10-60 mm), and mean size of the PDAAs was 19.1 mm (range, 10-48 mm). Fourteen patients (40%) had symptomatic aneurysms and seven patients (20%) presented with rupture. Median size of ruptured aneurysms was 20 mm (range, 10-60 mm). Axial imaging showed 20 of 25 patients (80%) with PDAAs and four of 11 patients (36%) with GDAAs had evidence of severe celiac axis stenosis or occlusion, and 11 patients (31%) had radiographic evidence of median arcuate ligament syndrome. Of 24 patients who underwent aneurysm repair, 18 (75%) were successfully treated with primary endovascular repair (coil embolization, with or without celiac stent). Endovascular therapy failed in 2 patients (8%), who required open repair, Four patients (17%) were treated with primary open repair. Overall 30-day morbidity and mortality after aneurysm repair were 29% and 4%, respectively.Conclusions: GDAAs and PDAAs are uncommon lesions that are often associated with severe celiac axis stenosis/occlusion leading to altered hemodynamics in the pancreaticoduodenal arcade. These aneurysms are prone to rupture regardless of size, and intervention is accordingly recommended for all aneurysms at presentation. Endovascular repair of these aneurysms is highly successful and should be considered as the initial operative approach.