To propose a grading system for early hepatic graft dysfunction.A retrospective study from a single transplant center. Recipients of liver transplants from deceased donors, transplanted under the MELD system were included. Early graft dysfunction was defined by Olthoff criteria. Multiple cut-off points of post-transplant laboratory tests were used to create a grading system for early graft dysfunction. The primary outcome was 6-months grafts survival.th postoperative day) early allograft dysfunction. Moderate and severe early dysfunctions were independent risk factors for graft loss. Patients with mild early dysfunction presented with graft and patient survival comparable to those without graft dysfunction. However, those with moderate early graft dysfunction showed worse graft survival than those who had no graft dysfunction. Patients with severe early dysfunction had graft and patient survival rates worse than those of any other groups.The peak of aminotransferases during the first postoperative week correlated with graft loss. The recipients were divided into mild ; moderate ; and severe (aminotransferase peak >3,000IU/mL + International Normalized Ratio ≥1.6 and/or bilirubin ≥ 10mg/dL in the 7Early graft dysfunction can be graded by a simple and reliable criteria based on the peak of aminotransferases during the first postoperative week. The severity of the early graft dysfunction is an independent risk factor for allograft loss. Patients with moderate early dysfunction showed worsening of graft survival. Recipients with severe dysfunction had a significantly worse prognosis for graft and patient survival. The modern transplant physician deals not only with extremely sick transplant candidates and non-ideal donors, but also with small financial margins and growing pressure of regulatory agencies that measure transplant outcomes–8. Recently, there has been a growing interest in the development of benchmarks that correlate initial graft function and post-transplant outcomes–13.Advances in surgery, anesthesia, immunosuppression and medical care have contributed to the current success of liver transplantation across the globe–17. Other terms such as “poor initial function” or “graft dysfunction with or without inclusion of primary non-function and vascular complications” have also been proposed,13. Recently, in the MELD era, EAD has been defined in those patients with a substantial elevation of aminotransferases during the first postoperative week, or in those who are significantly jaundiced or have a coagulation disorder on the 7th postoperative day. The criterion chosen was based on prior studies and expert opinions of large transplant centers in United States. Importantly, this criterion highly correlated with 6-month patient and graft survival.Early allograft dysfunction (EAD) is a clinical entity which might reflect donor, recipient and transplant characteristics that impact early graft function and could be utilized as a transplant benchmark. Earlier single-center studies have tried to define EAD in the pre-Model for End-Stage Liver Disease (MELD)–21. One could postulate that PNF might be the most severe grade of EAD.In Brazil, EAD impacts our daily clinical practice. It is our clinical impression that some patients who have EAD recover extremely fast and do well. On the other extreme, EAD might correlate with similar donor, recipient and surgical factors that were described in recipients with primary non-function (PNF)A potential gap in previous studies of EAD is the inability to differentiate the severity of this entity. We hypothesize that patients with EAD could be better characterized in a wide clinical spectrum instead of in a single group that behaves uniformly. We strongly believe that a grading system for EAD could assist the clinician in making prompt decisions regarding graft viability, potential retransplantation and eventually innovative interventions that would allow early graft rescue. We designed this study to create a grading system for EAD.To propose a grading system for early allograft dysfunction.st, 2005 through June 30th, 2010. Data were drawn from the liver transplant database and electronic medical records of our hospital. For the present study, inclusion was restricted to adult patients (≥18 years of age) who were candidates for the first deceased donor liver transplantation. Patients with liver-kidney transplants and partial grafts were included. Those with vascular complications and PNF within the first postoperative week were excluded. PNF was described according to the definition of the United Network for Organ Sharing (UNOS), within 7 days of implantation, as defined by aspartate aminotransferase (AST) ≥3,000 and one or both of the following: International Normalized Ratio (INR) ≥2.5 or acidosis, defined as having an arterial pH ≤7.30 or venous pH of 7.25 and/or lactate ≥4mMol/L.This is a retrospective cohort study that was initially conducted by including data from all recipients of liver transplant performed at Hospital Israelita Albert Einstein (HIAE) from July 1.We defined EAD in patients who had: (1) bilirubin ≥10mg/dL on postoperative day 7; and/or (2) INR ≥1.6 on postoperative day 7; and/or (3) aminotransferase peak  >2,000IU/mL within the first 7 postoperative daysSearching for a valid classification, we first used different cut-off points of these three laboratory tests with and/or without adding other variables such as PNF, encephalopathy, acidosis, and the ability to clear lactic acid. For each quartile of distribution of the results of bilirubin and INR at the 7th day or the peak of aminotransferases in the first week, we performed concordance statistics (c-statistic) with the risk of 6-month allograft loss.,12,23. Relative risks (RRs) with 95% confidence intervals (95%CI) were calculated as the cumulative incidence of mortality within 6 months among those with EAD divided by the incidence of 6-month mortality among those without EAD.A c-statistic between 0.8 and 0.9 was interpreted as having excellent discriminative ability. A test with a c-statistic of 0.65 and higher was interpreted as potentially useful tool. A test with a c-statistic <0.6 was judged not usefulWe constructed the ROC curves with different combinations of levels of aminotransferases, degree of cholestasis, significance of coagulation disorders and the variables here described. We then picked the grading system which had the best c-statistic at the same time that would be easy to use and practical for the clinician at the bedside, who is attempting to calculate the risk of graft loss based on the severity of EAD.th postoperative day) or INR ≥1.6 on 7th postoperative day. Patients who had a peak of aminotransferases ≥3,000IU/mL in the first postoperative week, in association with bilirubin ≥10mg/dL and/or INR≥1.6 by the 7th postoperative day, were included in the severe EAD group.To validate the correlation of EAD severity and post-transplant outcomes, we next divided the study population into four groups: no-EAD, mild EAD, moderate EAD, and severe EAD. Patients who did not have EAD were included in the no-EAD group (reference group). Mild EAD was defined in those who had peaks of aminotransferases during the initial postoperative week >2,000IU/mL but <3,000IU/mL. Those with moderate EAD had a peak of aminotransferases during the initial postoperative week ≥3,000IU/mL, without any severe alteration of bilirubin , blood transfusion and cold ischemiatime (CIT). We utilized definitions of allograft loss and patient death equal to those found in the Organ Procurement and Transplant Network (OPTN) registry. The biological MELD at the time of the transplant (or the last score available) was calculated as previously published. Donation after cardiac death (DCD) is not present in this series. Due to the variety of races in the country, the races of the donors are not reported in the database. To calculate the DRI we set DCD scores to zero and imputed race scores to 0.15 .Covariates included gender, age, race, ethnicity, blood type, height, weight, body mass index (BMI), cause of liver failure , local 2 test to examine qualitative variables and Analysis of Variance (ANOVA) to study quantitative variables. Kaplan-Meier curves were drawn depicting the post-transplant patient and graft survival differences of patients by group. The log-rank test was used to determine if there was a significant difference in the curves. Missing data on the characteristics examined was categorized as “other” or “unknown” or excluded from analysis (in most circumstances), depending on the frequency of missing data for the given characteristic. No imputation technique was used. An alpha level of 0.05 was used for all significance tests. Analyses were performed using SAS v.9.2 .Comparisons between rates for demographic, clinical, and geographic strata for the two eras were performed using the χThis study was approved by the Research Ethics Committee of the Institution under number CAAE 079721129.0000.0071.During the period of study, 458 liver transplants were performed at our unit. After we applied the inclusion and exclusion criteria, 325 patients formed the population of this study.The demographics of the transplant recipients are depicted in Patients with severe EAD were retransplanted more often than all other groups. Most of the retransplants were performed early due to poor function. Patients with EAD had worse graft  and patiDespite of the relationship between EAD and 6-month survival, there is still a need to quickly separate patients with EAD who will rapidly recover from those who do not do well. Therefore, we designed this study to create a grading system for EAD.We initially looked at different cut-off points of the postoperative liver tests. The main finding of our study is the demonstration that the peak of aminotransferases correlates significantly with 6-month patient and graft survival and can, therefore, be utilized to grade EAD. There was a random distribution of INR and a lack of correlation of bilirubin levels with post-transplant outcomes. The inclusion of other variables did not seem to increase the discriminatory ability to predict post-transplant outcomes. At the same time, by adding more variables, we increased subjectivity  or made the grading system complicated for daily clinical use (such as clearance of lactic acid).,12. Indeed, the significance of the problem in our clinical practice was the main reason we assigned a research group to focus on EAD. We have not yet identified the details behind this discrepancy. Most likely there is a correlation with donor quality and management. In Brazil, hospitals and intensive care units still lack resources to properly sustain and manage the brain-dead donor. Moreover, we found DRIs significantly higher on this case selection than in most liver transplant reports, which might signal that the quality of our donor population could indeed be different from that of European and North American transplant centers. Other potential explanations include variability in donor acceptance criteria, organ preservation, surgical and anesthesia techniques that are current areas of research and quality improvement initiatives of our group.One interesting finding of our study is a higher rate of EAD in our population in comparison to prior reports. Thus, our findings refine the most current definition of EAD. We innovate by proposing how to measure EAD. Thus, future clinical and translational studies of EAD will now have two options in measuring EAD. Researchers can opt to utilize EAD as a discrete nominal variable (yes versus no) or as a continuous variable. It will be critical for other groups to validate our findings or to improve EAD measurement methods with better scales or other systems.It is important to highlight that we started with a different question and a hypothesis that was driven by clinical findings in dealing daily with patients with EAD. We were not attempting to create a new definition of EAD or to validate prior studies. In our point of view, the EAD definition is reliable and appropriate,8,9,11. The impact of ischemiareperfusion, immunosuppression, liver regeneration, genomics, proteomics and molecular pathways on EAD should be further investigated, and novel technologies, such as the LiMax assay, should be further explored.Our grading system based mainly on the peak of aminotransferases is intuitive, easily reproducible, and has a good relationship with post-transplant survival. However, we were puzzled by the results found in the group of patients with mild EAD. Kaplan Meier survival curves were slightly superior  than those of patients without EAD. Thus, the grading system allowed us to identify two subpopulations that are at higher risk of poor outcomes. Patients with moderate EAD had a higher risk for graft loss. Those with severe EAD had a significantly higher odds ratio of graft loss and mortality. These two groups need not only better clinical support, but also potential allocation policy changes and quicker decisions regarding retransplantation. Indeed those patients with severe EAD are the main contributors for a poor post-transplant outcome at our center. This subpopulation has a higher retransplantation rate. Our findings corroborate our hypothesis that patients with EAD behave differently, which is probably a combination of the severity of ischemia-reperfusion injury of the new liver graft, associated with the comorbidities and general health status of the recipient and perioperative management. We will now concentrate our efforts on improving future outcomes, selection and management in these patients. New technologies that will allow earlier diagnosis, graft protection, or reversibility of EAD will be paramount in the current environment of liver transplantation of meager (and never sufficient number of) donors, sick recipients and stiff regulations–29. For those factors in which the surgeon can intervene by reducing CIT or blood loss, a concomitant reduction of EAD severity might be possible. However, other important characteristics, such as the MELD score of the recipient, pre-transplant dialysis and donor age have been previously pointed as risk factors for EAD and graft loss, but were not found to be relevant in our analysis.We searched for risk factors for allograft loss and whether different degrees of EAD would increase the risk of allograft loss. The factors that were relevant, such as prolonged CIT and utilization of blood transfusion, have been previously described–33. Most characteristics that were previously included in the ECD definition were not found to be risk factors for allograft loss in our analysis. Thus, we suggest a different approach to address the repercussions of the ECDs in post-transplant outcomes. An initial step might be to separate those recipients who do well from those who will have a poor outcome. For this purpose, classifications, scales and grading systems (in similarity with the EAD grading system) might be important contributions. Prognostic models, economic studies and descriptions of complications related to EAD and ECDs are certainly needed. We hypothesize that EAD in liver transplantation might mirror what has been described in kidney allografts that work poorly but do not survive as well in the long-range as do those with initial good function. Long-term follow-up of our cohort should contribute to answering this question.One major focus of the liver transplant community has spun around the utilization of expanded criteria donors (ECDs),12. Second, we started with a set definition of EAD, created a classification and looked into the outcomes of the cohort. We recognize that this is not ideal, but, based on sample size, it is an initial approach. Finally, the grading system has a c-statistic that is acceptable, but not ideal. This compares with several clinical tools currently in use in liver transplantation and surgery,35–37. It is certainly important that futures studies test and validate this classification.Our study has several limitations. First, those inherent to single-center retrospective studies. There was also a limitation of the size of our population of study, which was certainly less than ideal for a clean statistical analysis, but at the same time was comparable to recent studies of EADIn summary, we created a grading system for EAD. Patients with severe EAD had significantly worse patient and graft survival than any other group of our study. Patients with moderate EAD had worse graft survival when compared to patients without EAD. EAD is an independent risk factor for allograft loss. Future studies should search for early markers of EAD and interventions that could minimize or reverse graft damage and loss.


Romanian medicine has brought the world medicine a contribution that will last forever amongst universal values. George Emil Palade, Nicolae Constantin Paulescu, Ana Aslan, Stefan Odobleja, Thoma Ionescu, Sofia Ionescu, Dimitrie Bagdasar, Gheorghe Marinescu, Ion Cantacuzino, Victor Babes, Carol Davila, Matei Bals, C. C. Iliescu, Al. Trestioreanu, Marius Nasta, C. I. Parhon, N. Gh. Lupu, Mina Minovici, Al. Obregia, D. Hociota, P. Sarbu, Th. Burghele, Stefan S. Nicolau, Eugen Proca, etc., are only few of the Romanian personalities who decisively enriched the medical patrimony. Unfortunately, Academician Laurentiu Mircea Popescu, a brilliant representative of the world medical scientific research, joined them too early.He was born in Campulung, studied and formed in Bucharest, just like his destiny chose, on Prof. Dr. Gh. Marinescu Street, near “Carol Davila” University of Medicine and Pharmacy, which he graduated valedictorian in 1967 and, in which, few years later, in 1972, he became a medical doctor. Moreover, he was also a Teaching assistant (1971), Assistant professor (1979), Associate professor (1990), Professor (1992), Head of Department (1993), Head of specialty department (2001). He was also Vice-dean of “Carol Davila” University of Medicine and Pharmacy between 1990 and 1992 and Rector of “Carol Davila” University of Medicine and Pharmacy between 1992 and 2004. He was President of the Academy of Medical Sciences (2006-2011) and member of the Academy of Sciences in New York. He was also member of the American Society for Cell Biology, honor member of the Academy of Medicine in Poland, member of Albert Schweitzer International Academy in Switzerland, member of the International Academy of Cardiovascular Sciences in USA, honor member of the National Academy of Surgery in Paris, member of the Federation of European Academies of Medicine (FEAM). He was also President of the Department of Medical Sciences of the Romanian Academy (2006-2014) and general manager of “Victor Babes” National Institute in Bucharest (1993-2015). He had a sustained scientific activity, having published over 250 works and almost 300 communications , American Journal of Physiology (USA), Annals of the New York Academy of Sciences (USA), Anatomical Records (USA), Applied Immunohistochemistry & Molecular Morphology (USA), Autophagy (USA), Biochemical and Biophysical Research Communications (USA), Biochemical Pharmacology (Belgium), Biochimica et Biophysica Acta (The Netherlands), BioMolecular Concepts (The Netherlands), Bioscience Reports (UK), Cell and Tissue Research (Germany), Cell Calcium (UK), Cellular Physiology and Biochemistry (USA), Cells Tissues Organs (Switzerland), Experimental Cell Research (Sweden), Histology and Histopathology (Spain), Journal of Neurology Sciences , Neuroscience Letters (The Netherlands), Acta Physiologica Hungarica (Hungary), etc.He was also President of Foundation for Cellular and Molecular Medicine through which he sustained both “Carol Davila” University Press, while he was Rector of the University, and Journal of Cellular and Molecular Medicine from its beginning, being its Executive Editor even after it was taken by Blackwell Publishing. He was a member of the Editorial Board of the following journals: Acta Histochemica and Cytochemica (Japan), Cell Transplantation (USA), Chinese Journal of Clinicians (China), Comments on Molecular and Cellular Biophysics (The Netherlands), International Journal of Translational Medicine (USA), Italian Journal of Anatomy and Embriology , Langenbeck Archives of Surgery (Germany), World Journal of Stem Cells (China), World Journal of Methodology (China).He was awarded many honorary titles such as: Men of Achievement (England), 1986; Dictionary of International Biography (England), 1988; International Cultural Diploma of Honor (USA), 1995; Five Hundred Leader of Influence (USA), 1995; Millennium Hall of Fame (USA), 1998; Men of the Year (USA), 1999; International Man of the Millennium (USA), 2000; “100 Personalities in Health Sciences” - elected, Cambridge, 2010; having a Hirsch Index of 23 (according to Thomson ISI Database).He was also awarded The Order of the “Romanian Star” as a commander in 2009 and “Victor Babes” Prize of the Romanian Academy in 1985. We was Senator in the Romanian Parliament between 2000 and 2004, he was a member of the Commission for Health, Ecology, Youth and Sport, but he was also the main member of the Commission of the Romanian Parliament in the Parliamentary Meeting of the Organization for Security and Cooperation in Europe. As a sign of appreciation of his valuable personality, 13 prestigious universities in the whole world offered him the title “Doctor Honoris Causa”. “Being a brilliant researcher, due to his profession and structure, and also being open to effort and to an unusual perceptiveness, Academician Laurentiu Mircea Popescu represents the most brilliant model in the Romanian Medical research field. Together with his Excellency, his team of researchers in “Victor Babes” National Institute of Pathology has discovered a new type of human cells – the telocytes, which were initially called “Popescu cells” or “Cajal-like” interstitial cells. These cells are seen abroad as the key to the tissue regeneration when combined with the stem cells. With their help, myocardial infarction, the main cause of death in the world, could be treated, declared Prof. Dafin Fior Muresanu, MD, at the beginning of 2015. The late academician was the first Romanian citizen who was offered the “Medal of Merit” in 2012 of the International Academy of Cardiovascular Sciences. This honor is considered a real Nobel Prize for cardiology, by the personalities in the international medicine. “It means a lot to me. To take it by far, this honor is shared with a professor in Harvard University, and, even if we share it, its moral, ideatic and scientific value will count the most. I think it is the most important honor of recognition of the scientific value in the last years, offered to a representative of the Romanian medical school and of the Bucharest medical school, of some traditions in “Victor Babes” Institute. It is, to my mind, an important step in taking the position Romanian research in cardiovascular field deserves on the map of Europe and of a significant part of the whole world”, declared on that occasion, with his well-known modesty, the famous scientist, in an interview offered to a prestigious journal. The importance of such an international appreciation was also recognized by important personalities in Romania. “It is extraordinary, the more so as we know that there are some difficulties in Romania as far as research is concerned. What is important is that perseverance in work, and, I could also say without exaggerating, the geniality in the research field, have all led to this discovery. I am telling you from the experience of my specialty that this only happens where there is a lot of recognition and appreciation for the work performed. In addition, it is a very special moment in our existence as academic, university, research members in Romania”, remarked Acad. Prof. Ioanel Sinescu, MD, Rector of “Carol Davila” University of Medicine and Pharmacy in Bucharest. The discovery of telocytes, an accidental matter, as a result of an endless perseverance and of an effort that cannot be measured, in looking for novelty, which were constantly developed in “Victor Babes” National Institute of Pathology, are confirmed now in at least 68 centers in Europe, in over 20 centers in USA and 10 centers in China. In “Confessions of a young novelist”, Umberto Eco wrote: “The fact is that we rarely define things according to their essence. We most often use lists of characteristics”. To quote one of the most serious and rigorous follower of the famous academician, the one who followed his footsteps and is at present Head of Department, Prof. Mihai Hinescu, “Umberto Eco’s statement can also be extended to the personalities in the scientific world. Academician Laurentiu Popescu had the rare ability of understanding and defining things in their essence. At the same time, he imposed his work, tenacity, and perseverance in completing “the lists of properties” of the cells and tissues, which he dealt with for the rest of all his life. He considered it very important to work with young scientists, to make his work visible, teaching his followers the lesson of creating a scientific journal which “can be truly seen” in the international scientific community. Many generations of students have benefited from the lessons of the mentor, and, only a few people had the opportunity of being his followers. He left them a difficult mission, that of confirming the exploration directions which they took with their mentor, being able this way, to offer identity”.Executive EditorProf. Dr. Eng. Victor Lorin Purcarea


The point is to understand.”—Albert EinsteinJournal of Clinical Medicine (JCM), which has been created to serve as a hub for disseminating new findings and discoveries in clinical medicine to clinicians and medical researchers worldwide. “Why yet another journal?” Because this new journal will be different in that we are not just about new information but about understanding new information. We are online, peer reviewed, with a quick turnaround time from submission to publication and without any limit regarding length! Therefore, I am honored to introduce the JCM is an international, peer-reviewed, open-access journal published online quarterly that will provide a platform for advances in health care/clinical practices, the study of direct observation of patients and general medical research. This multi-disciplinary journal is aimed at a wide audience of medical researchers and healthcare professionals. Each edition of the journal will present original research and ideas as well as reviews, communications, short notes, and book reviews involving all fields of clinical medicine. Because of our on-line format, there is no limit to publication length. We encourage our authors to publish their findings and results in as much detail as needed so that our readership will truly understand how they performed their research or worked up their patient and why. Additionally we will cover a wide spectrum of subject areas including (1) clinical trials in which we will include the design of the trial; details regarding data collection; discussion of the legal, ethical and regulator issues; and quality assurance issues; (2) medical science research; (3) epidemiolgic studies and reviews; (4) bioethic reviews and discussions; (4) in-depth reviews on preventive medicine, translational medicine, occupational health and palliative medicine; and (5) information regarding medical care and research in developing countries. Each article will undergo a rigorous peer-review process that will incorporate strict ethical policies and standards to ensure that the journal is scholarly. To ensure this process we have gathered a prestigious and international group for our editorial board including: Dr. Emmanuel Andrès , Dr. Michael Berk , Dr. David L. Brown, , Dr. Edzard Ernst , Dr. Bronwen A. Evans , Dr. Nuri B. Farber , Dr. Kathleen M. Gillespie , Dr. Michael R. Hamblin , Dr. David T. Harris , Dr. Anthony J. Lembo , Dr. Laxmaiah Manchikanti , Dr. Pier Mannuccio Mannucci , Dr. Hans-Jürgen Möller , Dr. Guido Nikkhah , Dr. Julia Polak , Dr. Parminder Raina , Dr. Russel J. Reiter , Dr. Mark S. Sands , Dr. Evan Y. Snyder , Dr. David F. Wozniak  and Dr. Xiao Yan Zhong .Welcome! We invite you to submit your articles and learn along with us as we undertake this new journal.


Journal of Venomous Animals and Toxins including Tropical Diseases would like to thank all of our reviewers, both external and Editorial Board Members, who have contributed to the journal in Volume 21 (2015) and whose valuable support is fundamental to the success of the journal.The Editor of  Adolfo BorgesVenezuelaAdolfo Rafael de RoodtArgentinaAlice MartinsBrazilAline SilvaBrazilAna RoselinoBrazilAna Carolina VasconcelosBrazilAna Cecília OliveiraBrazilAna Leonor Abrahão NencioniBrazilAndre Lopes FulyBrazilAry JuniorBrazilBenito Soto-BlancoBrazilCarla LimaBrazilCarolina GigekBrazilCaroline MourãoBrazilCeila MalaqueBrazilCesar SilvaBrazilChaturaka RodrigoSri LankaChester JoynerUnited States of AmericaCilmery KurokawaBrazilCleide ConsalesBrazilDaniel HortonUnited KingdomDaniel SaidembergBrazilDaniel PimentaBrazilElaine FitchesUnited KingdomElizabeth RangelBrazilEmanuel Marques da SilvaBrazilEmanuel SilvaBrazilEneas CarvalhoBrazilEnzo IerardiItalyEvanguedes KalapothakisBrazilFabiana MiragliaBrazilFan WenBrazilFernanda AmorimBrazilFrancielle CordeiroBrazilGeoffrey IsbisterAustraliaGerardo CorzoMexicoHiroshi NagaiJapanIda Sano-MartinsBrazilJane MegidBrazilJean-Philippe ChippauxBeninJennifer SmithAustraliaJose Raduan Jaber MohamadSpainJosé Roberto Aparecido dos Santos PintoBrazilJosé-María GutiérrezCosta RicaJuliana ZulianiBrazilKatia DantasBrazilKayena ZaqueoBrazilKelly TudiniBrazilL ChangTaiwanLawan ChanhomeBangladeshLeonardo de SousaVenezuelaLigia RugoloBrazilLucilene Delazari dos SantosBrazilLucy LioniBrazilLuis Alberto Ponce-SotoBrazilLuis Roberto GonçalvesBrazilLuiz Felipe PasseroBrazilLuiz Fernando IzidoroBrazilLuiz Gustavo GardinassiBrazilMarcelo DuarteBrazilMarcelo L SantoroBrazilMarcia LaurentiBrazilMaria PeichotoArgentinaMaria A MariggioItalyMaria Regina SandovalBrazilMarjorie GolimBrazilMarta MonteiroBrazilMatthew GrahamUnited States of AmericaMaurício Ventura MazziBrazilMichael GurevitzIsraelMirian M MendesBrazilNajet Srairi-AbidTunisiaNarumol PakmaneeThailandNorival Santos-FilhoBrazilPalmira CupoBrazilPatrícia BrigatteBrazilPedro PardalBrazilPeter StrongUnited KingdomPierre BougisFranceQiumin LuChinaRenata RodriguesBrazilRenata CostaBrazilRick VetterUnited States of AmericaRodrigo SoaresBrazilRosany BochnerBrazilSalvatore De-SimoneBrazilSara Luz Morales-LázaroMexicoSebastian EstradaColombiaSébastien LarréchéFranceShin Yee FungMalaysiaSilvana MarcussiBrazilSilvio VasconcellosBrazilSimone LucheisBrazilStephen HyslopBrazilSylvia LucasBrazilTatiane PaixãoBrazilThais SilveiraBrazilThiago BelinatoBrazilThomaz Rocha e SilvaBrazilValquiria DorceBrazilVera PetricevichMexicoVictor FetUnited States of AmericaVictor MoraisUruguayVidal Haddad JrBrazilYen-Chia ChenTaiwanZhijian CaoChina


Molecular Biology and Evolution (MBE) in 1983, we had a close contact for about 15 years. He and I also started the Society for Molecular Biology and Evolution (SMBE) in 1992. We had a common interest in the theoretical study of molecular evolution and phylogenetics, and we often met in scientific meetings. In this article, I would like to discuss his contributions to the development of MBE and SMBE as well as a few of his research accomplishments concerning molecular evolution. A more general story of his life and science is written by More than 3 years have passed after Walter Fitch died on March 10, 2011. However, my memory of Walter is still fresh and vivid. From the time when he and I started this journal I met Walter for the first time in a symposium on population genetics and evolution organized by Newton Morton in 1972 at the University of Hawaii in Honolulu. He was still young with dark hair and very energetic. He presented his collaborative study with Chuck Langley concerning a statistical analysis of molecular clocks with protein data . They usScience (Current Contents (1988). In this study, they developed a new statistical method of tree-making using a least-squares criterion. This paper together with He published several papers on molecular clocks, but this was not the subject of his main interest. His main interest was in the construction of phylogenetic trees from molecular data though he published many papers on other subjects of molecular evolution. In fact, the most famous paper written by him is the one published by Fitch and Margoliash in Science . In thisSystematic Zoology  but he was fired from the position in 1980 because he was not a real cladist.His contribution to phylogenetics is not confined to this paper. Later, he developed a basic algorithm for the parsimony method of tree construction using nucleotide sequence data . This alAnother contribution of Walter’s to evolutionary biology was his proposal of new concepts or technical terms that are useful for data analysis. One of them was the distinction between orthologous and paralogous genes when duplicate genes exist . This diJournal of Molecular Evolution was launched by Springer Verlag with the editorship of Emile Zuckerkandl. Walter and I then contributed several papers to this journal. However, we realized that there were some problems with this journal. First, this journal was so expensive that many universities did not subscribe to it. Consequently, the papers published in this journal were not read widely. Second, because the journal was for a relatively small number of investigators, the quality of the papers was not necessarily high, and it took a long time for reviewing process. For these reasons many investigators were not very happy with this journal, and I started to consider the creation of a new journal that would be useful for both molecular biologists and population geneticists.Molecular evolutionary biology was born in the 1950s and 1960s when a small number of molecular biologists started to study the evolutionary changes of amino acid and nucleotide sequences between different species. In the mid-1960s, population geneticists entered into this field by initiating the study of electrophoretic variations of proteins within and between populations. These two lines of study of molecular evolution were conducted almost independently by molecular biologists and population geneticists, respectively, until around 1970. At this stage, a new journal called At this time, I received a letter from a commission editor of the publisher Alan Liss (later merged with John Wiley Publ. Co.), who asked me whether I could edit monographs on various subjects of molecular evolution periodically. It was in early 1982. However, I did not think that publication of such monographs would contribute greatly to the progress of molecular evolutionary biology. Instead, I thought that the creation of a new journal for publishing original papers in an inexpensive way would be more important. Fortunately, the commission editor enthusiastically supported my counter proposal. However, to start a new journal, I had to have agreements from my fellow evolutionists.I therefore called or wrote to a dozen or two of key molecular evolutionists. I then received enthusiastic support from most of them, particularly from Walter Fitch. The next step was to make a list of potential editors and editorial board members. Because I was familiar with both molecular evolution and population genetics, this was not a difficult job. However, I was still unsure whether we could get a sufficient number of papers to launch a new journal. For this purpose, I needed support from young investigators as well as from established scientists. Fortunately, I had a plan to organize an international symposium on “Evolution of Genes and Proteins”  at the SAmerican Naturalist at that time. Some publishers offered an honorarium to the editors, but we rejected these publishers because Walter and I thought we were doing public service and should not have personal gain by serving as editors. On March 5, 1983, we finally signed the contract of the publication of MBE with UCP.After the Stony Brook meeting, Walter and I were very busy deciding the name and purpose of the journal and finding an appropriate publisher of the journal. I felt some obligation for choosing Alan Liss, but Walter said we should not be bought by just one dinner. We then solicited the publication proposal from several publishers and finally chose the University of Chicago Press (UCP). As mentioned earlier, we had already decided that the new journal should be owned by investigators rather than the publishing company. This meant that we could change the publisher when their service is not satisfactory for us. In practice, we did not have any formal society of molecular evolutionists at that time, but we could form a small society consisting of the editors and editorial board members. UCP’s proposal was most appropriate for our purpose. This publisher was also doing well in publishing However, the decision about the publisher was only one of the tasks for starting a new journal. We had to decide the roles of editors and editorial board members and how to attract good papers. We had already decided that Walter and I should jointly control the journal, but I thought I should concentrate more on policy-making of the journal including the appointment of editorial board members and evaluating the performance of the publisher, whereas Walter concentrated on the quality control of published papers. I knew that Walter was energetic and could take care of detailed aspects of manuscript editing and publication. For this reason, Walter became the editor-in-chief and I took the job of managing editor. In practice, however, we did essentially the same work in editing and accepting manuscripts. We also appointed several associate editors who could handle reviewing and accepting of submitted papers. In addition, we appointed a few dozens of editorial board members whose primary job was to review manuscripts assigned by the editors or the associate editors.Our next problem was how to collect high-quality manuscripts. For the first issue of the journal, we were supposed to have manuscripts from the researchers who attended the Stony Brook meeting, but their submission was slow although we promised quick publication. We also wanted to have the first paper of the first issue from a prominent molecular biologist, but his submission was delayed too much to be included in the first issue. Fortunately, Walter unexpectedly received an interesting paper on protein evolution by Max Perutz, a Nobel Laureate. We now decided to publish this as the lead paper of the first issue. This paper undoubtedly enhanced the visibility of the new journal MBE.Nature (Nature.) MBE also received an award (Honorable Mention) for excellence in publishing for 1984 from the Professional and Scholarly Publishing Division, Association of American Publisher. We were pleased with these favorable evaluations.However, we had to make a somewhat unusual decision about publishing the first volume of MBE. In the Stony Brook meeting, we promised that the papers submitted to MBE would be published rapidly and volume 1 would be completed in 1983. However, at the beginning of 1983 it was obvious that we could not do it because we had not received enough manuscripts. Yet, we did not want to disappoint the authors who had submitted their papers in 1982. So, we decided to publish the first issue of volume 1 in December 1983, but the remaining five issues in 1984. The last issue of volume 1 was published in November 1984. In 1985, a favorable review of volume 1 of MBE appeared in Nature . , and all council members agreed with him. He then proposed that we should have a special session for graduate students and give an award of $500 to the student who gave the best presentation and that he would donate the money. The council members said that his donation was not necessary because we had a sufficient amount of money. However he insisted his contribution and pledged that he would continue his donation until his retirement from his university, UCI. To appreciate his generosity, the council decided to call the award the Walter Fitch Prize, and set up an endowment of $10,000 for the prize money in 1995.The first SMBE meeting at UCI did not attract many attendants apparently because the society was not well known at that time. Yet the papers presented were of the first rate and there were foreign delegates and attendants, as expected for an international society. Walter was in charge of almost every aspect of the meeting. The second SMBE meeting was held in Athens, Georgia, in 1994, in conjunction with the meetings of the Society for the Study of Evolution, the Society of American Naturalist, and the Society for Systematic Biology. Partly because of the joint meetings, a large number of people attended this meeting. The first SMBE meeting outside the United States was held in Hayama, Japan, under the auspices of Naoyuki Takahata. This was really the first international meeting for SMBE and was attended by many people from various countries. Here, I should mention that this meeting was partially supported by a binational meeting support grant  from the US National Science Foundation (NSF) for promoting the collaboration between young investigators from the United States and Japan . ActuallGenome Biology and Evolution sponsored by SMBE was launched in 2009 with the editorship of Bill Martin. This journal publishes genomics-related papers, expanding the territory of SMBE enormously.The MBE journal has also grown enormously. It now publishes about 4,000 large-size pages per year, and the rejection rate is as high as 73% . (In theThe Three Failures of Creationism: Logic, Rhetoric, and Science. This book was posthumously published from the University of California Press in April 2012. Unfortunately, I have not had a chance to read it, but I am glad that he could finish the book before he died. I heard that he passed away peacefully in his sleep in the early morning of March 10, 2011. He was a man of creativity, generosity, hard-working, and conscientiousness.After retirement from the SMBE activity, Walter Fitch concentrated on his research project on evolutionary changes of influenza virus genes. In 2000, he published a statistical method for predicting the evolution of human influenza A . In his For his outstanding contributions to evolutionary biology, he received many awards and recognitions including the membership for the National Academy of Sciences, American Academy of Arts and Sciences, American Philosophical Society, and foreign member of Linnean Society of London, and honorary doctorate of North Carolina State University.


In November 2013, CEGMR continued its leading role in genomics and organized its 2nd IGMC. The conference was well received and attended by 505 international and national participants. Among the international participants was Professor Erwin Neher, a Nobel laureate with Bert Sakmann in 1991 in Physiology or Medicine, who gave the keynote talk on the first day of the conference on his discovery of “The function of single ion channels in cells” with notes on their function and role in disease. His presence and talk was an excellent opportunity for junior and senior national researchers in Saudi Arabia to meet and learn from a scientific pioneer.Centre of Excellence in Genomic Medicine Research  , is a lend IGMC scientific committee led by Dr Muhammad Abu-Elmagd worked tirelessly hard and managed, for the first time ever for the conference, to publish 98 IGMC abstracts and more than 24 peer-reviewed full articles in two separate special supplements in a high impact factor (IF) journal in the field, the BMC Genomics (IF: 4.04) [The 2nd IGMC program, Table . Abstracts of all oral presentations are now published in BMC Genomics special supplement [Oral presentation sessions started with a talk given by Dr Abdulaziz Al-Swailem from KCAST who elaborated on Saudi national science, technology and innovation plans towards knowledge based economy. After Dr Al-Swailem’s presentation, the conference participants enjoyed attending a series of 17 two days excellent talks presented by Thomson Reuters’s ranked highly distinguished scientists who came from various institutions around the globe to deliver presentations in different topics. The latter mainly covered five genomics and genomic-related areas including oncogenomics, genomics and environment interactions, systems biology and computational genomics, immunogenomics, and omics of cell signalling and reproductive biology , where we not only enjoyed tasty and spicy Saudi food, but also had a chance to inspect his remarkable facility for keeping desert wildlife.''APC: Adenomatous Polyposis Coli; BMC: BioMed Central; CEGMR: Center of Excellence in Genomic Medicine Research; ChIP-Seq: Chromatin Immuno-precipitation Sequencing; CIPM: Centre of Innovation in Personalized Medicine; CMV: Cytomegalovirus; CRC: Colorectal Cancer; ENCODE: Encyclopedia of DNA Elements; IF: Impact Factor; IGB: Integrated Gulf Biosystem; IGMC: International Genomic Medicine Conference; KAU: King Abdulaziz University; KACST: King Abdulaziz City for Science and Technology; KIFs: Kinesin superfamily proteins; Kras: Kirsten rat sarcoma viral oncogene homolog; KSA: Kingdom of Saudi Arabia; MOH: Ministry Of Higher Education; MTNR1B: Melatonin Receptor 1B; STSs: Sequence-Tagged SitesThe authors disclose no competing interests.


In 2002, the Brazilian Journal of Pulmonology (BJP) was accepted for indexing in the SciELOdatabase. This achievement, which is the result of the determination and efforts of thethen current and previous Editorial Boards, was the basis for the construction of theJournal's image and for the Journal's international exposure. Subsequently, in 2006, theBJP was accepted for indexing in PubMed, which significantly increased the Journal'svisibility. In 2012, after its inclusion in the Institute for Scientific Information (ISI)Web of Knowledge database, the BJP received its first impact factor, which placed theJournal in a very prominent position among the Brazilian scientific journals. This wasextremely important, especially for respiratory researchers, because it meant the existenceof a vehicle, with an international circulation, for communicating research results. Although the Journal remained in the database, and therefore its publicationsand the citations of these publications were computed, the company chose not to publish theJournal's impact factor for that year. Considering that journal impact factors are used forjournal classification by national funding agencies and for the evaluation of graduateprograms, the consequences of such a penalty were huge, making it difficult to assess itsextent. Unfortunately, these effects will still be felt in the coming years, unequivocallyaffecting subsequent impact factors.However, in 2013, because of questionable criteria, Thomson Reuters, which is theinternational company responsible for determining journal impact factors, did not publishthe impact factor of the BJP.Recently, on July 29, the annual Journal Citation Reports was published. The impact factorof the BJP for the 2013 publications was 1.268, which means that the BJP ranks sixth amongthe 107 Brazilian journals included in the ISI database. The return of the BJP to theannual list of the database that calculates impact factors shows, more clearly than do theranking achieved and the impact factor itself, that the path followed by the Journal overthe last few years has always been based on the dissemination of quality respiratoryscience. As previously mentioned, the impact factor of the BJP will still reflect theeffects of that penalty over at least the next two years, because of the mechanism throughwhich impact factors are calculated. Nevertheless, the return of the BJP to that annuallist consolidates its position among the journals that are of greatest importance indisseminating knowledge in respiratory medicine worldwide.In addition, in late July, SCImago cites per document index  was published, and the BJP wasassigned 1.45, reinforcing the Journal's position as one of the most important sciencejournals in Brazil. This strengthens our responsibility with regard to the sustained growthof the BJP in the coming years.To ensure this growth, structural changes have been made. We are in the final stages ofchanging the article submission system. As from September, we will use ScholarOne. This isthe new platform that will be available to our authors, reviewers, and editors. TheScholarOne system is more modern and efficient, as well as being the model used by variousjournals of high international impact. The main goal of this migration is to facilitate andexpedite the process of submission and review of articles, which is essential for extendingthe Journal's presence in the international arena, as well as being an added incentive forthe participation of international authors and reviewers.Another important achievement, which was completed on July 2014, is that the BJP content isnow available through PubMed Central (PMC), which is the U.S. NationalInstitutes of Health/National Library of Medicine (NIH/NLM) digital archive of biomedicaland life sciences journal literature. This tool allows free access to full-text articlesfrom the BJP, which surely increases the visibility of articles published by researchersfrom other countries, contributing to their dissemination. This is only possible becauseall articles published in the Journal are available in English.The major responsibilities at this point, especially for the future Editorial Board of theBJP, are to consolidate our presence in international databases, such as SciELO, PubMed,Thomson Reuters ISI Web of Knowledge, Journal Citation Reports, and SCImago, and tocontinuously improve the quality of the published articles. To achieve these goals, thecontinuous participation of all researchers, reviewers, and editors who have contributed tothe growth of the BJP throughout its history is essential. We hope we can count on thecollaboration of more researchers so that the BJP can not only continue to be an importantjournal for the dissemination of respiratory research in Brazil, but also consolidate andincrease its international exposure. Institute for Scientific Information (ISI) Web ofKnowledge, houve a liberação do seu primeiro Fator de Impacto, dando-nos umaposição de bastante destaque entre os periódicos científicos brasileiros. Esse fato foide extrema importância, especialmente para os pesquisadores da área respiratória, poisindicava a presença de um veículo de circulação internacional para expor o resultado daspesquisas. Em 2002, o Jornal Brasileiro de Pneumologia (JBP) foi indexado na base de dados SciELO.Tal fato, fruto da determinação e esforço do Corpo Editorial da época e dos anteriores,foi a base para a construção da imagem e a inserção internacional de nosso jornal. Apartir daquele passo, em 2006, foi obtida a indexação no PubMed, promovendo uma expansãosignificativa na visibilidade do JBP. Em 2012, após a inclusão do JBP na base de dadosdo  Apesar de nosso periódico ter permanecido na base de dados, sendo portantocomputadas suas publicações e citações, houve a opção pela omissão do índice no referidoano. Considerando-se que o Fator de Impacto de uma revista é o índice utilizado para aclassificação da mesma junto a agências de fomento nacionais e mesmo para a avaliação deprogramas de pós-graduação, as consequências de tal penalidade foram enormes, tornandodifícil a avaliação de sua extensão. Infelizmente, essas repercussões serão aindapercebidas ao longo dos próximos anos, influenciando de forma inequívoca os índicessubsequentes.Entretanto, em 2013, por critérios discutíveis, o Fator de Impacto do JBP não foiliberado pela Thomson Reuters, empresa internacional que é a detentora desseindicador. Journal Citation Reports; fomos informados que a avaliação doJBP, relativa às publicações de 2013, apresentava um Fator de Impacto de 1,268, o sextomaior do Brasil entre os 107 periódicos nacionais incluídos na base de dados ISI. Maisque a posição obtida e o valor do indicador, a volta do JBP ao relatório anual da basede dados geradora do Fator de Impacto demonstra que o caminho trilhado ao longo dosúltimos anos sempre foi pautado pela divulgação da ciência de qualidade na árearespiratória. Conforme mencionado, o Fator de Impacto do JBP, pelo mecanismo através doqual é feito seu cálculo, ainda espelhará o efeito da penalidade sofrida ao longo depelo menos os próximos dois anos; ainda assim, o retorno do JBP consolida sua posiçãodentre as revistas de relevância para a divulgação da área de medicina respiratória nomundo. Recentemente, em 29 de julho, foi liberada a lista anual dos periódicos incluídosnoTambém foi liberado, nas últimas semanas do mês de julho, o índice "cites/document" dabase de dados Scopus (que utiliza o mesmo método de cálculo do Fator de Impacto),liberado pela SCImago, e esse foi 1,45, reforçando a posição do JBP como uma das maisimportantes revistas brasileiras de divulgação científica, fato que reforça nossaresponsabilidade com o crescimento sustentado do JBP ao longo dos próximos anos.ScholarOne. Essa será a nova plataforma que estará disponível paranossos autores, revisores e editores. O sistema ScholarOne é maismoderno e eficiente, e é o modelo utilizado por diversos periódicos de granderepercussão internacional. O principal objetivo dessa migração é facilitar e agilizar oprocesso de submissão e revisão dos artigos, o que é fundamental para ampliar a presençado JBP no cenário internacional, inclusive funcionando como um maior atrativo para aparticipação de autores e revisores internacionais. Para garantir tal crescimento, mudanças estruturais foram realizadas. Estamos na fasefinal de mudança do sistema de submissão de artigos. A partir de setembro, utilizaremoso National Institutes of Health/NationalLibrary of Medicine  dos EUA. A utilização dessa ferramenta permite o acesso livre aosartigos completos do JBP, o que seguramente aumenta a visibilidade dos artigospublicados por pesquisadores de outros países, contribuindo para sua divulgação. Isso sóé possível porque nossos artigos são disponibilizados em língua inglesa.Outro fator de grande relevância que foi concluído em julho de 2014 foi adisponibilização do JBP no PubMed Central(r) (PMC), que é o arquivo livre de periódicosde ciências biomédicas e da vida do ISI Web of Knowledge, Journal CitationReports e SCImago, e a busca contínua pela maior qualificação dos artigospublicados. Para atingir esses objetivos será fundamental a contínua participação detodos os pesquisadores, revisores e editores que contribuíram ao longo de toda ahistória do JBP para seu crescimento. Esperamos contar com a colaboração de novospesquisadores para que possamos não apenas nos manter como um periódico importante paraa divulgação da pesquisa brasileira na área respiratória, como também efetivarmos eampliarmos nossa inserção internacional.As grandes responsabilidades que se impõem nesse momento, especialmente para o futurocorpo editorial do JBP, são consolidar nossa presença nas bases de dados internacionais,tais como SciELO, PubMed, Thomson Reuters


Asia Oceania Journal of Nuclear Medicine and Biology (AOJNMB) is now entering its second year of publication. After the publication of the first issue, we received a great deal of positive feedback from all around the world. The feedback ensured us that AOJNMB publication met a crucial need of the nuclear medicine community in the region and encouraged us to work harder.AOJNMB introduction to a large number of readers was one of the main objectives in the first year of publication. Our enthusiastic editorial board and associate editors introduced this journal to their respective scientific societies. Also, free printed copies of AOJNMB were distributed in the annual meetings of European Association of Nuclear Medicine (EANM) in Lyon, World Association of Radiopharmaceutical & Molecular Therapy (WARMTH) in Manila, and Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM) in Mumbai. This policy will be followed for introducing AOJNMB to a large number of nuclear medicine physicians and scientists. Our editorial board could be of significant help for further introduction of AOJNMB.Visibility and wide availability significantly contribute to the success of a journal. There are many indexing and abstracting services which greatly increase the visibility of the articles and direct the researchers to relevant articles in the field. These services facilitate broader dissemination of the journal among scientists. Timely publication and frequent citation of the published articles in other journals are two main criteria that help indexing a journal in main scientific databases. Indexing in these databases is mandatory for bibliometric analyses which have been used for the assessment of the importance of a journal in the scientific world. Impact factor, SCImago journal rank factor, and Eigenfactor score are among the most common indices used for this purpose .Although these factors have limitations and should be used with caution, they are the current available tools for journal ranking . AOJNMB In the first year of publication, AOJNMB received various manuscripts mainly from Japan, Iran, and Korea; however, scientists from 9 different countries published their works in this volume. The average time from submission of original articles to first decision was 26 days, which demonstrates the commitment of our reviewers to the timely reviewing of the articles. The rejection rate for the original articles was 20% in the first year, which is acceptable for a newly published journal.We sadly lost one of our valued editorial board members (Prof. Ajit Padhy) in the previous year. In the same period, five interested scientists from five different countries joined us in the editorial team. I would like to thank the editorial board, associate editors, and our reviewers for their invaluable comments, which play a key role in the success of our journal. Success depends on constancy of efforts and critical appraisal. We will keep the first and wish to receive your feedback for the second.


In coronary artery bypass surgery, proximal anastomosis between the ascending aorta and an arterial or venous graft may be conducted by side-to-side maneuver (Cabrol-type).We evaluated the long-term clinical outcome and aortocoronary graft patency of Cabrol-type proximal anastomosis in coronary artery bypass grafting (CABG).From 2002 to 2012, 460 patients  underwent CABG using Cabrol technique. The graft configuration included the anastomosis of saphenous vein (SV) to saphenous vein (n = 266), SV to radial artery (RA) (n = 65), RA to SV (n = 108), RA to RA (n = 8), and others (n = 11) . The mean follow-up duration was 50.3 ± 32.3 months. Postoperatively, coronary computed tomography angiography (CTA) was checked in 362 patients (78.7%).The operative mortality was 3.9%. The actuarial rate of the overall survival at 1, 5, and 10 years was 97.7% ± 0.7%, 88.6% ± 1.6%, and 70.4% ± 4.0%, respectively. The actuarial MACCE-free survival at 1, 5, and 10 years was 97.7% ± 0.7%, 89.9% ± 1.6%, and 84.2% ± 2.8%, respectively. Of 301 patients who used LITA (in situ) to LAD anastomosis, 712 grafts  were used in Cabrol-type anastomosis. The 1-, 2-, 5-, and 8-year patency of graft in Cabrol-type anastomosis was 91.4% ± 1.2%, 88.8% ± 1.4%, 80.7% ± 2.2%, and 76.3% ± 3.7%, respectively.This alternative proximal anastomosis technique in CABG demonstrated relatively comparable patency of aortocoronary graft.


The affiliation for the fifth author is incorrect. Michael Sieg is not affiliated with #2. He is only affiliated with #1 Institute of Virology, Faculty of Medicine, University of Leipzig, Leipzig, Germany.


Development of organ transplantation is restricted by the discrepancy between the lack of donors and increasing number of patients. The outcome of pediatric donors transplanted into adult recipients especially with donation after circulatory death (DCD) pattern has not been well studied. The aim of this paper is to describe our experience of 3 successful DCD donor child-to-adult liver transplantations lately.Three DCD donors were separately 7, 5, and 8 years old. The ratio between donor graft weight and recipient body weight was 1.42%, 1.00%, and 1.33%, respectively. Ratio between the volume of donor liver and the expected liver volume was 0.65, 0.46, and 0.60. Splenectomy was undertaken for the second recipient according to the portal vein pressure (PVP) which was observed during the operation.Two out of 3 of the recipients suffered with acute kidney injury and got recovered after renal replacement therapy. The first recipient also went through early allograft dysfunction and upper gastrointestinal bleeding. The hospital course of the third recipient was uneventful. After 1 year of follow-up visit, the first and second recipients maintain good quality of life and liver function. The third patient was followed up for 5 months until now and recovered well.DCD child-to-adult liver transplantation should only be used for comparatively matched donor and recipient. PVP should be monitored during the operation. The short-term efficacy is good, but long-term follow-up and clinical study with large sample evaluation are still needed. The application and efficacy of marginal donor liver as well as reduced-size graft despite significant size mismatch become important topics for liver transplantation.Development of organ transplantation is restricted by the discrepancy between the lack of donors and increasing number of patients. Since 1994, the World Health Organization has encouraged organ donation after circulatory death (DCD) worldwide.2 And as DCD grafts, ineluctable warm ischemia time could cause more postoperative complications such as acute kidney injury (AKI),3 early allograft dysfunction (EAD),4 and more hepatobiliary complications.5 It is a big challenge for the surgeons to choose using such graft rather than discarded it. Here we describe the experience of three successful DCD donor child-to-adult liver transplantations in our center lately.The outcome of pediatric donors transplanted into adult recipients especially with DCD pattern has not been well studied. Weight of pediatric donor liver is considerably less than the standard liver weight of adult patient, the difference comes with excessive portal venous inflow and portal hypertension which could lead to small-for-size syndrome (SFSS).6 The donor grafts were harvested via double in situ perfusion with combined liver and kidney rapid resection technique.The DCD donor grafts were from 3 boys Table . They al2 body surface area (BSA), respectively. The weight and volume of the first donor liver were separately 850 g and 800 ml. The warm ischemia time  was 8 minutes and the cold ischemia time of them was 6 hours.The first donor is 7 years old. The body length (BL) and body weight (BW) were 140 cm and 30 kg with a 1.14 m2). The donor liver weight 600 g and its volume was 560 ml. The warm and cold ischemia time were 10 minutes and 5 hours, respectively.The second donor is 5 years old. His BL and BW were 123 cm and 30 kg (BSA 1.03 m2). The weight and volume of liver were separately 800 g and 730 ml, respectively. The warm ischemia time was 11 minutes and the cold ischemia time of them was 4 hours.The third donor is 8 years old. He was 135 cm tall and weighed 27.5 kg  after surgical intervention and the third patient took cyclosporine (CsA) + MMF. ALL of them underwent anticoagulation treatment using low-molecular-weight heparins followed by warfarin.All the patients accepted the orthotopic liver transplantation (OLT) and the second recipient received splenectomy at the same time. Hepatic artery anastomosis was performed between the common hepatic artery of donor and the bifurcation of gastroduodenal-proper hepatic artery with 7-0 Prolene suture. Duct-to-duct anastomosis was used to reconstruct the bile duct with a T-tube indwelled for biliary drainage. Portal vein pressure (PVP) was monitored as reported before.2 BSA, respectively. The expected liver volume (ELV) which is calculated with the formula (ELV = 613 × BSA + 162.8) was 1229.4 cm3.8 The ratio between the volume of donor liver and ELV was 0.65. The ratio between donor graft weight and recipient BW were 1.42%. The anhepatic phase of the first recipient lasted 49 minutes. The PVP before and early after transplantation were separately 32 and 28 cmH2O. The operation time was 5.25 hours and the amount of intraoperative bleeding was 1000 ml.The first recipient is a 41-years-old male. His primary disease was hepatitis B cirrhosis. He once underwent upper gastrointestinal bleeding and splenectomy, and the model for end-stage liver disease (MELD) score and Child-Pugh score were separately 8 and 7. The BL and BW were 173 cm and 60 kg with a 1.74 m2). His ELV was 1204.9 cm3. The ratio between the volume of donor liver and ELV was 0.46. And the ratio between donor graft weight and recipient BW was 1.05%. The anhepatic phase of the second recipient was 67 minutes. The PVP before transplantation was 25 cmH2O (decreased from 35 cmH2O before splenectomy) and the early postoperative PVP was 20 cmH2O. The operation time was 8.75 hours and the amount of intraoperative bleeding was 3500 ml.The second recipient is also a 41-years-old male and his primary disease was hepatitis B cirrhosis as well. With hepatic encephalopathy , the MELD score and Child-Pugh score for the second recipient were 19 and 12, respectively. His BL and BW were 174 cm and 57 kg (BSA 1.70 m2). Her ELV was 1149.7 cm3. The ratio between the volume of donor liver and ELV was 0.63. And the ratio between donor graft weight and recipient BW was 1.54%. The anhepatic phase of the third recipient was 56 minutes. The PVP before transplantation was 20 cmH2O and the early postoperative PVP was 18 cmH2O. The operation time was 7 hours and the amount of intraoperative bleeding was 4200 ml.The third recipient is a 64-years-old female whose primary disease was autoimmune hepatitis-related cirrhosis. The third recipient got the MELD score and Child-Pugh score of 16 and 11, respectively. She was 169 cm tall and weighed 52 kg  DNA test shown positive result and he received Valcyte treatment for a month till the test result turned negative.The hospital course was uneventful for the third recipient.After 1 year of follow-up visit, the first and second recipients maintain good quality of life and liver function. T-tube was removed 2 months post-OLT and no vascular or biliary complication was found. The third patient was followed up for 5 months until now and she recovered well. The case report was approved of the Ethical Committee of the First Affiliated Hospital of Xi’an Jiaotong University and approved of the patients consent.11 To reach such standard, we carefully choose recipients with low BW when allocated the liver. To our certain knowledge, the second boy in this paper is the youngest DCD donor whose liver is successfully transplanted to an adult. But even the 3 cases in this report are all well match with the standard mentioned above, EAD still occurred in the first recipient. We believe that plasma exchange and molecular adsorbent recirculating system could be useful in such situation and help the grafts to recover.13Decades after liver transplantation been widely studied, organ shortage remains the main problem which restricts the qualitative advancement of this treatment. To save more patients on the waiting list, surgeons usually have to take chances to use organs from the expanded donor pool. As the proportion of adult recipients is much larger than that of pediatric recipients, donors from the pediatric age group are becoming more likely to be directed to adult recipients. As a small-for-size liver for an adult, the most important potential risk is SFSS. It is reported by previous studies that grafts must be greater than 0.8% of the recipient BW or >40% of ELV to avoid postoperation SFSS.14 Zhou et al7 found the improvement in esophageal varices could be observed in the whole liver transplantation group 2 weeks post-OLT, whereas no change was observed in the living donor liver transplantation group. This may explain the upper gastrointestinal bleeding for the first recipient. The following report by Feng et al shown the advantage of splenectomy which could prevent the occurrence of SFSS by leading a decrease in the portal flow and PVP and a significant increase in the arterial flow.16 Nevertheless, there is also considerable increase of surgical risk and infection for splenectomy.18 On the other hand, recent studies suggest spleen plays an important role in regulating the immune system, metabolism, and endocrine function.19 But the main reason which increases the morbidity and mortality in asplenia or postsplenectomy states comes from immunological and infectious complications.20 We recommend intraoperative monitoring of PVP and splenectomy which is necessary only if the patient has portal hypertension to protect the donor graft and prevent postoperative gastrointestinal bleeding. Long-term risk of overwhelming post-splenectomy infections should be aware and immediate medical attention is needed in response to every febrile episode.21Another reason which may cause the EAD for the first recipient is relatively high PVP after transplantation. Yagi et al found a poor outcome for the graft early postoperative PVP elevation to 20 mmHg.23 They both considered the discrepancies in the size of the donor as compared with the recipient might be the main reason caused the bad prognosis. Size mismatch is not only the risk for hyper-perfusion injury but also causes blood stream slow at the first hepatic portal which could induce thrombosis. They suggested using donor-to-recipient BSA ratio to be the evaluation criteria before OLT. Based on above reasons, they both suggested anticoagulation therapy to the recipient to prevent vascular complications, especially hepatic artery thrombosis. We applied an anticoagulation protocol with short-term low molecular weight heparin right after transplantation followed by warfarin for about half a year and no vascular complication has been found yet. However, long-term following-up is still needed.The outcomes of the Child-to-Adult liver transplantation have not being well studied. But both Ruud and Emre research suggested a greater incidence of vascular complications and worse 1-year graft survival.24 The main challenge of current DCD practice is prolonged warm ischemia time which could lead to a series of post-OLT disorders, such as AKI and hepatobiliary complications.25 Two out of 3 of our patients suffered with AKI and needed CRRT treatment. Leithead et al3 reported that DCD liver transplantation is associated with an increased frequency of AKI. There is no evidence that AKI is related to pediatric or size mismatched grafts. CRRT could help renal function recovery, maintaining a stable blood volume and removing inflammation factors.26 Although usage of T-tube to prevent biliary complication remains controversial, it is recommended when the bile duct diameter is less than 7 mm.28 In the size mismatch situation of Child-to-Adult liver transplantation, T-tubes are used in the duct-to-duct anastomosis biliary tract reconstruction in all 3 cases of this study with good outcomes. We also believe that the ischemia time and donor graft injury could be minimized with rational intensive care unit management and lead to a good recovery for the recipient.29These 2 papers above found a relationship between ischemia time and vascular complications. Both cold and warm ischemia time have significant impact on the prognosis post-OLT. In this study, we first report DCD Child-to-Adult liver transplantation with a good short-term efficacy. Since March 2010 when the Chinese organ donation system been developed, the ratio of DCD liver transplantation have stepwise become dominate.In conclusion, we suggest DCD pediatric donor liver could only be used for comparatively matched adult recipient. PVP should be monitored during the operation. The short-term efficacy is good, but long-term follow-up and clinical study with large sample evaluation are still needed.


We investigated the levels of radio frequency electromagnetic fields (RF EMFs) emitted from marine ship transmitters. In this study, we recorded the radio frequency (RF) electric field (EF) levels emitted from transmitters from a marine vessel focusing on the areas normally occupied by crew members and passengers. Previous studies considered radiation hazard safety assessment for marine vessels with a limited number of transmitters, such as very high-frequency (VHF) transceivers, radar and communication transmitters. In our investigation, EF levels from seven radio transmitters were measured, including: VHF, medium frequency/high frequency (MF/HF), satellite communication (Sat-Com C), AISnavigation, radar X-band and radar S-band. Measurements were carried out in a 40 m-long, three-level ship  at 12 different locations. We developed a new data-collection protocol and performed it under 11 different scenarios to observe and measure the radiation emissions from all of the transmitters. In total, 528 EF field measurements were collected and averaged over all three levels of the marine ship with RF transmitters: the measured electric fields were the lowest on the upper deck (0.82–0.86 V/m), the highest on the bridge roof (2.15–3.70 V/m) and in between on the bridge deck (0.47–1.15 V/m). The measured EF levels were then assessed for compliance with the occupational and general public reference levels of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) standards. The ICNIRP and the ARPANSA limits for the general public were exceeded on the bridge roof; nevertheless, the occupational limits were respected everywhere. The measured EF levels, hence, complied with the ICNIRP guidelines and the ARPANSA standards. In this paper, we provide a new data collection model for future surveys, which could be conducted with larger samples to verify our observations. Furthermore, this new method could be useful as a reference for researchers and industry professionals without direct access to the necessary equipment. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) is an independent scientific organization that offers regulations and recommendations about the health and environmental effects of non-ionizing radiation exposure . The expThere are countless man-made sources of electromagnetic radiation (EMR), such as mobile phones ,6,7,8, rThe aim of this study was to measure and analyse the radio frequency radiation emitted from transmitters aboard a marine vessel, focused on areas normally occupied by crew members and passengers; and to observe whether the measured electric field (EF) levels comply with the ICNIRP and the ARPANSA limits. In this analysis, we used transmitters: VHF band fixed (156–157.42 MHz), MF/HF transceiver (1605 KHz–30 MHz), satellite communication (Sat-Com C) (6006) , shipborne Automatic Identification System (AIS) navigation (156–163 MHz), radar X-band (9410 MHz) and radar S-band .The levels of electric field were recorded in all areas where crew members and passengers gather in all three levels of the ship: (i) the upper deck, Level 1 (the area where the passengers spend some of their time); (ii) the bridge deck, Level 2 ; and (iii) the bridge roof, Level 3 , as in All electric field measurements were recorded under similar conditions with (i) a NARDA NBM 520 with probe (EF 1891), frequency range 3 MHz–18 GHz and sensitivity 0.8–1,000 V/m, and (ii) a NARDA NBM 550 with probe (EF 0391), frequency range 100 kHz–3 GHz, sensitivity 0.2 V/m for the electric field and a detection range 0.2–320 V/m , to measure the electric field levels in this study. Both broadband and narrowband (frequency selective) instruments can be used for measuring RF fields. In our study, the NARDA meters provide the broadband measurements, and the electric field probes provide isotropic  measurements.The data acquisition time of the NARDA meters is 2 s–5 min. Each position undertook two types of measurements, “spot measurements” and “continuous measurements”. Each set of electric field measurements was taken for 6 minutes at each position until a steady-state value was obtained; average values were then recorded. All probes were oriented vertically during the data collection, and the auto-zeroing function was used to exclude the effects of temperature on the results. Since the field distribution is not homogeneous, the spatial averaging function was used in both meters. The transmission directions of directional antennas did not change during the data collection period.Electric field measurements were then taken while the ship was not moving (in the “standing” position), with the engine turned off. Around each of the locations, the meters were moved slowly along the whole area to identify the typical and highest electric field (EF) levels, as well as the location of the high electric fields. Because the likelihood of peaks and nulls in the fields was very high in the confines of the metal ship, the spot measurements were conducted to identify sources of EF. Then, the continuous measurements were taken from the identified locations. Please note that the EF measurements were taken during the weekend to minimise the impact of external disturbances.Firstly, all of the transmitters and antennas that were installed on the bridge roof were turned off to measure the background electric field levels. Secondly, spot and continuous measurements were recorded in a 40 m-long ship  . The shiUnder a normal operation condition, the ship will have the two radars (X-band and S-band), the AIS and the Sat Comm C; all transmitting continuously. The VHF and the MF/HF radios operate intermittently, in addition to the other navigation equipment transmitting continuously. By considering all of these situations, we developed a data collection protocol and performed various scenarios to observe and measure the radiation emissions from all of the transmitters. The protocol and reasons for the various scenarios are described in First, we analysed the environment or background EF levels, where all of the transmitters and antennas that were installed on the bridge roof were turned off at each measurement point. As the EF levels were not measured on the same day for all transmitters, the background fields were measured on each day. On average, those values were observed ranging from 0.000 to 0.003 V/m. The background electric field values at different locations were subtracted from all of the other measured data, and negative numbers were rounded to zero.N = 176, the bridge deck N = 264 and the upper deck N = 88. For each set of measurements (one location at one data collection protocol), we calculated the mean and the standard deviation of each dataset. The geometric mean is more applicable than the arithmetic mean (AM) for explaining the relative progress of the EF level values. Therefore, we computed the geometric mean (GM) of each dataset to estimate the population. Nevertheless, the percentage of measurements equal to or greater than 14 V/m (50% of the ICNIRP exposure limit) and 28 V/m (the ICNIRP exposure limit) were calculated.The probability distribution of the EF levels was observed in order to test the normality of the distribution. The sample sizes used were: for the bridge roof The interquartile range (IQR) is a vital estimate of the spread of the data, as changes in the upper and lower 25% of the data do not affect it. As an estimate, the IQR is more representative than the standard deviation of the spread of the data, if there are outliers. When the data are from a normal distribution, the IQR is less efficient than the standard deviation; however, we found that our data did not have a normal distribution. Therefore, we analysed the interquartile range of the datasets to perceive how data spread over the 25th (first quartile) and 75th (third quartile) percentiles.The EF measurements were analysed and compared in all 3 levels of the ship  and the operating conditions of the vessels’ transmitters and antennas. For comparison, we used box-and-whiskers plots to show these values. Then, we compared the exposure values with the general public exposure levels of the ICNIRP and the ARPANSA limits in order to quantify the effects. All analyses were carried out using MATLAB  R2014b on a computer with an Intel Core Intel Core i7 CPU.The regulation and recommendations about the health and environmental effects on all aspects of non-ionizing radiation exposure was given by the independent scientific organization, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) . In AustThe measured electric fields were then assessed for compliance with the occupational and general public reference levels of the ICNIRP guidelines  and the ±11%. Nonetheless, we observed that the effect for crew members and passengers from marine vessel transmitters is minimised from the measurements that were carried out under 11 different scenarios and at 12 different locations on the vessel. Our results demonstrated that the electric field levels measured complied with the international (ICNIRP) [Repeated measurements resulted in average electric field levels that differed from each other by about (ICNIRP)  and were(ICNIRP) . Neverth(ICNIRP) . For lowLarger surveys are desired to verify our findings and to provide reliable knowledge on radio hazard safety assessment for marine ship transmitters and the electromagnetic compatibility (EMC). As indicated in , the senIn this investigation, we performed measurements and analysed radio frequency radiation emitted by the transmitters aboard a marine vessel, focusing on areas normally occupied by crew members and passengers. In total, 528 electric field measurements were taken. Additionally, we developed a new data collection protocol and performed various scenarios to accurately measure the radiation from all transmitters. Under the normal operating conditions, there were a few marine ship transmitters and antennas transmitting continuously, and other radios operate intermittently. By considering this, for the first time, we report measuring the electric field from each transmitter condition, which is insignificant, and this must be carefully taken into account for future studies. Our results show that the electric field levels were highest on the bridge roof and the lowest in the upper deck, and the measured values were within a range of 0.001–39.46 V/m. The limits for the general public were exceeded on the bridge roof; nonetheless, the occupational limits were respected everywhere. Hence, this complies with the occupational and general public reference levels of the ICNIRP guidelines and the ARPANSA standards. Some further conclusions that can be drawn from this paper are: (i) electric field levels were high with the VHF fixed (Sailor 6006) transmitter; and (ii) high frequency electric field levels that are radiated from the vessels’ transmitters on the bridge roof will not have much impact for crew members and passengers. Nevertheless, this study should be useful as a reference for many researchers and industry professionals without direct access to the necessary equipment. Further research is desired to determine the electric field levels for a larger amount of ships using the proposed protocol in this paper. Such research would provide a basis for establishing safety distances and support the development of guidelines by suitable authorities.


Regarding the increasingly diverse topics in the field of biomedical physics and engineering, the editorial team of the JBPE had decided to publish “topic issue” from the beginning of 2014. Publishing topic issues involves several challenges such as publication delays. However, JBPE managed to solve this problem through Online First section. Accordingly, editor-in-chief and publishing office of the JBPE pursued a successful endeavor and published the Online First section to reduce the publication delays. A previously ignored point revealed itself after through and conclusive inspections of the results. Topic issues in e-journals are not as beneficial as they are in printed journals. In fact, we believe that there should be a new perspective on the philosophy of e-journals. E-journal readers do not find their desired papers based on the topic of the issue; they search, find and select articles solely based on the keywords and their own research interests. Therefore, the rest of the articles that are being published along with a specific article in a topic issue journal, will not benefit our readers. In other words, cohesion of the papers in a specific topic issue seems to be unnecessary.Meanwhile, the importance of the Online First section of the journal has emphasized in the editorial of the JBPE and we will strengthen this section further in the subsequent issues. The second topic that had been pursued in the past three years at JBPE was the fast track. In the fast track, articles that are derived from graduate theses will be verified through their supervisor’s cover letter and enter a fast track review process which will take less than four weeks. The restriction in the number of the reviewers had prevented JBPE to officially declare this policy in the journal’s website in the past three years. However, by joining new editors to the editorial board of the JBPE and the registration of the journal in new indexings, the journal will officially implement its fast track policy from the beginning of 2016. Since the editorial management of the articles in fast track will be financially demanding, fast track process include partial payment of the review and the editorial expenses. Meanwhile, with the help of the JBPE’s generous sponsors, we will maintain our commitment to the open access and free of charge submission policies of the journal. Based on the editorial board’s approval and by considering different restrictions that exist for researchers and scientists of the developing countries, JBPE will keep its policy to waive all or most of the revision expenses.Last but not least, regarding the international scope of the JBPE, our journal willingly encourages researchers in the field of biomedical physics and engineering to contact the editorial office for paper review, submission of solicited papers and membership in the editorial board. The world had experienced several sad events at the end of the 2015 but I wish a happy, peaceful and prosperous 2016 for all.


Publications in therapeutic ultrasound have been growing exponentially for the past four decades, n = 2 exp((t-1970)/6), R² = 0.965, and reached approximately 1440 papers in 2011. Adoption of new International Electrotechnical Commission standards by regulatory agencies such as the United States Food and Drug Administration will enable more rapid approval of devices and therefore more clinical applications. Thus the exponential growth is likely to continue with a predicted output of 3600 papers by 2015. In order to serve this growing demand, the Journal of Therapeutic Ultrasound (JTU) has been launched. JTU is an online, open access journal designed to accelerate the adoption of focused ultrasound.http://www.JTUltrasound.com] is currently accepting manuscripts of research articles, case reports, reviews, meeting reports, and study protocols. Appropriate topics include translational and clinical research in all areas of therapeutic ultrasound, including stimulation, inhibition, destruction, or modification of tissue function or structure via focused ultrasound. As an online journal, color images and supplemental materials such as audio and video files are readily accepted and publication rapidly follows review. As an open access journal, authors retain full rights to their papers through the Creative Commons license, and papers will be freely available and thus easily accessible to developing countries and the popular press.The journal website [JTU serves as the official journal of the Focused Ultrasound Foundation and the International Society for Therapeutic Ultrasound. Our distinguished editorial board of twenty-six members represents ten countries. Author fees are waived through 2014.


Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal. Thrombosis of an aortobifemoral bypass (ABFB) graft is a common complication that may occur in about 10–15% of the cases within the first five years after surgery .Here, we report the case of a patient presenting a complete occlusion of the arterial bypass in which renal graft perfusion was partially maintained by retrograde flow from collateral arteries in the distal end of the aortobifemoral bypass. Early diagnosis and preemptive treatment with local fibrinolysis allowed the resolution of thrombosis and complete recovery of kidney graft function.A 48-year-old woman with a previous history of chronic kidney disease secondary to type IV lupus nephritis (negative lupus anticoagulant and negative antiphospholipid antibodies) was diagnosed with Leriche syndrome in July 2012. Thus, a 14 mm × 7 mm expanded polytetrafluoroethylene (ePTFE) ABFB graft was successfully implanted and the patient was later discharged with antiplatelet therapy .Four months later, the patient received a kidney transplant from a deceased donor. An end-to-side arterial anastomosis to the left branch of the ABFB was performed and an end-to-side venous anastomosis to the external iliac vein with no significant complications was performed. The patient was started on tacrolimus, mycophenolic acid, and steroids, reaching normal renal graft function over the next months (mean serum creatinine of 1 mg/dL).9/L; serum tacrolimus concentration 4.6 ng/mL (reference range: 4–8 ng/mL). Urinalysis showed a sodium concentration of 55 mmol/L, with negative proteinuria and normal urinary sediment.Nine months later, the patient presented to the emergency room complaining of pain and coldness in the left lower limb and progressive decrease of diuresis in the last two days. Blood pressure was 185/105 mmHg, and physical examination revealed absence of popliteal and pedal pulses in the left lower limb and normal peripheral perfusion of the contralateral leg. Initial laboratory data revealed a serum creatinine of 4.1 mg/dL; lactate dehydrogenase 228 U/L ; creatine kinase 44 IU/L ; hemoglobin 9.3 g/dL; leukocyte count 4.9 per 10She was admitted to the hospital and an abdominal angiography performed through the right humeral artery revealed a complete thrombosis of the proximal left branch of the ABFB , along wThe patient was discharged 14 days after admission under treatment with oral anticoagulation (acenocoumarol), with a complete resolution of ABFB thrombosis and recovery of kidney graft function (serum creatinine concentration of 1.2 mg/dL).This case report highlights the risk of development of acute renal allograft failure in kidneys transplanted over vascular grafts. A myriad of case reports documenting the recovery of renal function after thrombolysis have been published; however, to the best of our knowledge, this is the first case of a kidney allograft implanted on a vascular bypass graft.Kidney transplantation on prosthetic vascular grafts was described first by Sterioff in 1974 , 3.The etiology of vascular graft thrombosis may be related to progressive fibrosis and development of stenosis or aneurysms at the site of implantation which could eventually lead to abnormal vascularization –4.Clinically, the presence of coldness and/or lower limb pain with no peripheral pulses in patients with ABFB suggests a thrombosis of the bypass graft. In our patient, the coexistence of reduced urine output pointed out that the perfusion of the kidney graft could also be compromised.Peripheral arterial occlusions are usually associated with increased leukocyte count and increased serum levels of lactate dehydrogenase , althougIn our case, the patient had severe renal impairment and oliguria at presentation, but retrograde filling of the distal vascular graft permitted a partial perfusion of the transplanted kidney. This was probably the result of a high blood pressure in collateral arteries and relatively low intra-arterial resistance in renal graft with respect to the limb, and we believe that this phenomenon played a pivotal role in the allograft viability.Finally, early recognition and initiation of thrombolytic therapy restore the circulation. We initiated therapy with rtPA due to the low side-effect profile and ease of use. Moreover, it is less aggressive than surgical thrombectomy, and it is associated with a lower average length of stay in hospital –9.In conclusion, thrombosis of an ABFB with an implanted kidney allograft may not result in graft loss if early diagnosed and treated. The presence of collateral circulation together with retrograde filling of the vascular prosthesis played an important role in maintaining the viability of the organ.