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Alan C. Farney

Bio: Alan C. Farney is an academic researcher from Wake Forest University. The author has contributed to research in topics: Transplantation & Kidney transplantation. The author has an hindex of 42, co-authored 144 publications receiving 5747 citations. Previous affiliations of Alan C. Farney include Wake Forest Institute for Regenerative Medicine & University of Maryland, Baltimore.


Papers
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Journal ArticleDOI
TL;DR: Laroscopic donor nephrectomy appears to be safe and decreases morbidity in the renal donor, and allograft function is comparable to that in open neph rectomy series.

400 citations

Journal ArticleDOI
TL;DR: The availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.
Abstract: Objective To examine the impact of laparoscopic nephrectomy and recipient education on the proportion of kidney recipients who could identify a potential live donor, and on the live donor (LD) transplantation rate. Summary Background Data Laparoscopic donor nephrectomy (LDN) results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery than the standard open donor nephrectomy (ODN). The authors hypothesized that the availability of this less invasive surgical technique would enhance the willingness of family and friends to donate. Methods The study population consisted of 3,298 end-stage renal disease patients referred for kidney transplant evaluation between November 1991 and February 2000, divided into three groups. The first group received no formal LD education and had only ODN available. The second group received formal education about the LD process and had only ODN available. The third group had both formal LD education and LDN available. Records were examined to determine what proportion of each group had any potential donors tissue-typed, and the rate at which they received an LD transplant. Results Before LDN availability and formal LD education, only 35.1% of referrals found a potential donor, and only 12.2% received an LD transplant within 3 years. Institution of a formal education program increased the volunteer rate to 39.0%, and 16.5% received an LD transplant. When LDN became available, 50% of patients were able to find at least one potential donor, and within 3 years 24.7% received an LD transplant. Regression analysis indicated that availability of LDN was independently associated with a 1.9 relative risk of receiving an LD transplant. Kaplan-Meier death-censored 1- and 3-year graft survival rates for ODN transplants were 95.8% and 90.6%, versus 97.5% and 94.8% for LDN. Conclusions The availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.

268 citations

Journal ArticleDOI
TL;DR: Pancreatectomy can relieve intractable pain caused by chronic pancreatitis and islet autotransplantation is safe and can prevent long‐term diabetes in more than 33% of patients and should be an adjunct to any pancreatic resection.
Abstract: Background Extensive pancreatic resection for small-duct chronic pancreatitis is often required for pain relief, but the risk of diabetes is a major deterrent. Objective Incidence of pain relief, prevention of diabetes, and identification of factors predictive of success were the goals in this series of 48 patients who underwent pancreatectomy and islet autotransplantation for chronic pancreatitis. Patients and Methods Of the 48 patients, 43 underwent total or near-total (>95%) pancreatectomy and 5 underwent partial pancreatectomy. The resected pancreas was dispersed by either old (n = 26) or new (n = 22) methods of collagenase digestion. Islets were injected into the portal vein of 46 of the 48 patients and under the kidney capsule in the remaining 2. Postoperative morbidity, mortality, pain relief, and need for exogenous insulin were determined, and actuarial probability of postoperative insulin independence was calculated based on several variables. Results One perioperative death occurred. Surgical complications occurred in 12 of the 48 patients (25%) : of these, 3 had a total (n = 27) ; 8, a near-total (n = 16) ; and 1, a partial pancreatectomy (p = 0.02). Most of the 48 patients had a transient increase in portal venous pressure after islet infusion, but no serious sequelae developed. More than 80% of patients experienced significant pain relief after pancreatectomy. Of the 39 patients who underwent total or near-total pancreatectomy, 20 (51%) were initially insulin independent. Between 2 and 10 years after transplantation, 34% were insulin independent, with no grafts failing after 2 years. The main predictor of insulin independence was the number of islets transplanted (of 14 patients who received >300,000 islets, 74% were insulin independent at >2 years after transplantation). In turn, the number of islets recovered correlated with the degree of fibrosis (r = -0.52, p = 0.006) and the dispersion method (p = 0.005). Conclusion Pancreatectomy can relieve intractable pain caused by chronic pancreatitis. Islet autotransplantation is safe and can prevent long-term diabetes in more than 33% of patients and should be an adjunct to any pancreatic resection. A given patient's probability of success can be predicted by the morphologic features of the pancreas.

224 citations

Journal ArticleDOI
TL;DR: Investigations show that pig kidneys can be successfully decellularized to produce renal ECM scaffolds, which maintain their basic components, are biocompatible, and show intact, though thrombosed, vasculature.
Abstract: Background:It is important to identify new sources of transplantable organs because of the critical shortage of donor organs. Tissue engineering holds the potential to address this issue through the implementation of decellularization–recellularization technology.Objective:To produce and examine ace

217 citations

Journal Article
TL;DR: After reduction of immunosuppression, the course of BKAN in most patients followed one of 2 pathways: 1) Clearance of the infection and disappearance of the viral cytopathic changes in biopsies and urine, and 2)Persistence of viral replication with continuous associated tubular damage.
Abstract: The first case of BK virus allograft nephropathy at the University of Maryland Renal Transplant Program was diagnosed in 1997. Since then more than 100 cases have been identified. The incidence of BKAN has increased from 1% for patients transplanted in 1997 to 5.8% for patients transplanted in 2001. BKAN is an important cause of premature kidney graft loss at the University of Maryland Transplant Program. One-third of the patients diagnosed with BKAN since 1997 have already lost graft function, and a third of the remaining patients have creatinine levels over 3 mg/dl. We could not determine that a specific immunosuppressive drug increased the incidence of BKAN. Older patients had an increased risk of developing the disease. The histological diagnosis of BKAN was made at a mean time of 14.4 months after transplantation (range 1.2-53 months). BKAN occurred in 4.3% of all patients biopsied during the period described. The diagnosis of BK allograft nephropathy was based on a combination of renal biopsy to demonstrate viral cytopathic chages, urine cytology and quantitative viral load in plasma. A threshold of >10,000 copies of BK virus per ml of plasma is proposed as an indication of BKAN. Following diagnosis of BKAN, patients on a single immunosuppressve drug (FK506, CsA, sirolimus or MMF) in addition to prednisone had less graft loss and higher viral clearance in comparison to patients on prednisone and 2 immunosuppressant drugs (FK506, CsA or sirolimus and MMF). There was no difference in the rate of acute allograft rejection among different immunosuppression reduction protocols. Three patients who lost their grafts to BKAN were retransplanted. For these patients there has not yet been evidence of recurrence of BKAN. After reduction of immunosuppression, the course of BKAN in most patients followed one of 2 pathways: 1) Clearance of the infection and disappearance of the viral cytopathic changes in biopsies and urine (20%); 2)Persistence of viral replication with continuous associated tubular damage (70%). Renal transplant patients should be routinely screened with urine cytology. The presence of decoy cells in the urine is an indication for quantitative measurement of viral load in plasma. Patients with any evidence of BK viral reactivation should be followed closely. In patients biopsied early due to persistence of BK virus-infected cells in urine, there is a higher rate of conversion from positive to negative urine cytology after reduction of immunosuppression.

185 citations


Cited by
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01 Jan 1980

1,523 citations

Journal ArticleDOI
TL;DR: Recent advances in formulation and delivery strategies, such as the use of microsphere-based controlled-release technologies, protein modification methods that make use of polyethylene glycol and other polymers, and genetic manipulation of biopharmaceutical drugs are highlighted and discussed.
Abstract: The formulation and delivery of biopharmaceutical drugs, such as monoclonal antibodies and recombinant proteins, poses substantial challenges owing to their large size and susceptibility to degradation. In this Review we highlight recent advances in formulation and delivery strategies — such as the use of microsphere-based controlled-release technologies, protein modification methods that make use of polyethylene glycol and other polymers, and genetic manipulation of biopharmaceutical drugs — and discuss their advantages and limitations. We also highlight current and emerging delivery routes that provide an alternative to injection, including transdermal, oral and pulmonary delivery routes. In addition, the potential of targeted and intracellular protein delivery is discussed.

1,274 citations

Journal ArticleDOI
TL;DR: Engineered biomaterials able to mimic the in vivo characteristics of stem cell niche provide suitable in vitro tools for dissecting the different roles exerted by the ECM and its molecular components on stem cell behavior.

1,022 citations

Journal ArticleDOI
TL;DR: This article presents international consensus criteria for and classification of AbAR developed based on discussions held at the Sixth Banff Conference on Allograft Pathology in 2001, to be revisited as additional data accumulate in this important area of renal transplantation.

1,018 citations

Journal ArticleDOI
TL;DR: The continuing risk for lymphoma with time post‐transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma are highlighted.

1,005 citations