No abstract

The current liver allocation system, introduced in 2002, decreased the importance of waiting time for allocation priorities; the number of active wait‐listed candidates and median waiting times were immediately reduced. However, the total number of adult wait‐listed candidates has increased since 2002, and median waiting time has increased since 2006. Pretransplant mortality rates have been stable, but the number of candidates withdrawn from the list as being too sick to undergo transplant nearly doubled between 2009 and 2011. Deceased donation rates have remained stable, with an increasing proportion of expanded criteria donors. Living donation has decreased over the past 10 years. Transplant outcomes remain robust, with continuously improving graft survival rates for deceased donor, living donor, and donation after circulatory death livers. Numbers of new and prevalent pediatric candidates on the waiting list have decreased. Pediatric pretransplant mortality has decreased, most dramatically for candidates aged less than 1 year. The transplant rate has increased since 2002, and is highest in candidates aged less than 1 year. Graft survival continues to improve for pediatric recipients of deceased donor and living donor livers. Incidence of acute rejections increases with time after transplant. Posttransplant lymphoproliferative disorder remains an important concern in pediatric recipients.

We investigated whether differences in IL-6 and IL-1␤ expression could be detected in monoclonal plasma cells from patients with MGUS or MM. Expression of IL-6 and IL-1␤ in bone marrow cells was determined using cell sorting to enrich for plasma cells followed by reverse transcriptase/polymerase chain reaction (RT/PCR). Nineteen patients (six MGUS, two primary amyloid (AL), 11 MM) were studied. IL-6 mRNA expression was detectable in the sorted CD38 ؉ /CD45 ؊ plasma cell populations from 0/6 MGUS, 0/2 AL and 5/11 MM patients. All five MM patients with autocrine IL-6 expression demonstrated an elevated plasma cell labeling index. IL-1␤ mRNA was detectable in the sorted CD38 ؉ /CD45 ؊ plasma cell populations from 1/6 MGUS, 0/2 AL and 10/11 MM patients. In situ hybridization (ISH) confirmed that the IL-1␤ producing cells were plasma cells. In conclusion, autocrine production of IL-6 parallels a high labeling index and aberrant expression of IL-1␤ correlates with the diagnosis of MM. Follow-up of IL-1␤-positive MGUS patients will determine whether aberrant expression of IL-1␤ will predict those MGUS patients that will eventually progress to MM.

Early experiences with both liver and kidney donation after cardiac (DCD) allografts showed outcomes that were inferior to those for donation after brain death (DBD) donors. Concerns specific to DCD kidney allografts included prolonged delayed graft function (DGF), ischemia-reperfusion injury leading to allograft fibrosis, and primary nonfunction (PNF). 1-4 Similarly, decreased survival