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Montali F, Annicchiarico A, Grisales P, Panarese A, Pisani F. Hypothermic Machine Perfusion and Spontaneous Kidney Allograft Rupture: Causation or Correlation? A Case Report and Review of Pertinent Literature. Transplant Proc 2022. [DOI: 10.1016/j.transproceed.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022]
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Szederkényi E, Szenohradszky P, Csajbók E, Lázár G. [History of kidney transplantation in Szeged]. Magy Seb 2022; 75:151-154. [PMID: 35895549 DOI: 10.1556/1046.2022.20009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 01/06/2023]
Abstract
The first Hungarian kidney transplantation was performed in 1962, in Szeged, by András Németh (1924–1999). The first semester at the university in Szeged started in 1921, so this year we celebrate the centenary. This event inspired authors to review the history of kidney transplantation in Szeged, remembering the first one and point of the cornerstones in the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor was healthy, after 50 years, and he encouraged everybody to donate organs. The organized kidney transplant program started more than 10 years later, in 1973, in Budapest. The program was supported by the Ministry of Health. Szeged joined the program in 1979 led by Ernő Csajbók and Pál Szenohradszky. In the Transplant Center in Szeged, developed organizationally as well as professionally, 1701 kidney transplantation has been performed up to the end of the year 2021.
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Affiliation(s)
- Edit Szederkényi
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (igazgató: Prof. Dr. Lázár György)
| | - Pál Szenohradszky
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (igazgató: Prof. Dr. Lázár György)
| | - Ernő Csajbók
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (igazgató: Prof. Dr. Lázár György)
| | - György Lázár
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (igazgató: Prof. Dr. Lázár György)
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Abraham G, Anupama S, Pradeep I, Mathews S, Parthasarathy R, Mathew M, Sundaraja S, Kurien A, Palaniappan N. Clinicopathological correlation of transplant nephrectomies in elusive graft dysfunction - An observational study. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Godara S, Saraf K. Spontaneous renal allograft rupture due to acute rejection in early post-transplant period – A case report. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_141_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Krishna A, Maqbool U, Bansal VK, Prakash O, Kumar S. Spontaneous renal allograft rupture of unknown etiology - A case report. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_69_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Nieto-Ríos JF, Jaramillo Valencia JL, Guzmán-Luna CE, Ocampo Kohn C, Aristizabal Alzate A, Abadía Guzmán H, García Gómez V, Serna-Higuita LM, Zuluaga Valencia G. Tratamiento exitoso de rotura espontánea de injerto renal secundaria a rechazo. Reporte de caso. Rev Urol 2017. [DOI: 10.1016/j.uroco.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ray DS, Thukral S. Spontaneous Renal Allograft Rupture Caused by Acute Tubular Necrosis: A Case Report and Review of the Literature. Case Rep Transplant 2017; 2017:9158237. [PMID: 28808594 PMCID: PMC5541815 DOI: 10.1155/2017/9158237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/12/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. RAR is frequently associated with acute rejection, but other causes like renal vein thrombosis and acute tubular necrosis have also been observed. Most commonly a graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. Herein, we describe a rare case of spontaneous renal allograft rupture in the early posttransplant period due to acute tubular necrosis. A 42-year-old male, living donor renal allograft recipient, experienced RAR on the sixth posttransplant day. Surgical exploration showed two lacerations of 10 cm and 5 cm length at the upper and mid pole of the kidney. Histologically, the graft demonstrated acute tubular injury; no features of humoral or cellular rejection were identified. The successful management of this complication resulted in the salvage of the patient and the graft. This case demonstrates that early diagnosis and prompt treatment of a life-threatening RAR can salvage the graft.
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Affiliation(s)
- Deepak Shankar Ray
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Hospitals, 124 EM Bypass, Mukundapur, Kolkata, India
| | - Sharmila Thukral
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Hospitals, 124 EM Bypass, Mukundapur, Kolkata, India
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Favi E, Iesari S, Cina A, Citterio F. Spontaneous renal allograft rupture complicated by urinary leakage: case report and review of the literature. BMC Urol 2015; 15:114. [PMID: 26581472 PMCID: PMC4650853 DOI: 10.1186/s12894-015-0109-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 11/03/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For more than forty years, graftectomy has been the standard treatment of spontaneous renal transplant rupture. However, recent evidences suggest that graft salvage strategies can be safely pursued, even in difficult cases. CASE PRESENTATION We report on a thirty-nine-year-old woman who received a deceased donor kidney transplant and experienced spontaneous allograft rupture due to acute rejection. The rupture was further complicated by urinary leakage. The kidney and the ureter were successfully repaired. Eight years after transplantation, graft function is still excellent. CONCLUSION Due to the lack of transplantable organs and the long time usually spent on the waiting list, graftectomy should be only considered in case of refractory haemodynamic instability or compromised graft viability.
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Affiliation(s)
- Evaldo Favi
- Transplant Unit, Renal Department, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | - Samuele Iesari
- General Surgery, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Pompeo Spennati, 67100, L'Aquila, Italy.
| | - Alessandro Cina
- Department of Bioimaging, Università Cattolica del "Sacro Cuore", Policlinico Universitario "Agostino Gemelli", Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Franco Citterio
- Renal Transplant Unit, Department of Surgery, Università Cattolica del "Sacro Cuore", Policlinico Universitario "Agostino Gemelli", Largo Agostino Gemelli 8, 00168, Rome, Italy.
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Baker S, Popescu M, Akoh JA. Rupture of renal transplant. Case Rep Transplant 2015; 2015:686584. [PMID: 25685589 DOI: 10.1155/2015/686584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/24/2022] Open
Abstract
Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L). LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.
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Almarastani M, Aloudah N, Hamshow M, Hegab B, Alsaad KO. Salvaging of severely ruptured living-related renal allograft secondary to acute antibody mediated rejection. Int J Surg Case Rep 2014; 5:723-6. [PMID: 25216193 PMCID: PMC4189071 DOI: 10.1016/j.ijscr.2014.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/14/2014] [Accepted: 08/10/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Spontaneous renal allograft rupture (RAR) is a serious and potentially life-threatening complication of kidney transplantation. Debate on the management of RAR has focused on graft nephrectomy versus salvaging in cases where: the allograft rupture site is surgically manageable; the bleeding can be controlled; and/or leaving the renal allograft in situ does not compromise patient survival. PRESENTATION OF CASE A 45-year-old, living-related, female, kidney allograft recipient experienced RAR on the fourth day post transplantation. Surgical exploration showed 12 cm laceration along the convex border of the graft. Histologically the graft demonstrated mild acute kidney injury and linear deposition of C4d along the cortical peritubular capillaries; morphological features for violent humoral or cellular rejection were not identified. The graft was surgically salvaged with excellent clinical and biochemical improvement. DISCUSSION Observations arising from this case are: (1) RAR caused by rejection is still encountered in clinical practice despite effective immunosuppressive management; (2) the severity of the histopathological features of rejection does not necessarily correlate with the extent of graft rupture; and (3) salvaging the graft should be attempted whenever possible as current immunosuppression and advances in surgical techniques may have an impact on long-term graft function and survival, differing from those previously published. CONCLUSION With modern immunosuppression therapy and proven surgical procedures, the efficacy of salvaged renal grafts and graft survival rates may improve substantially.
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Affiliation(s)
- Mohamad Almarastani
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Noura Aloudah
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Hamshow
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bassem Hegab
- Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khaled O Alsaad
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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Szederkényi E, Szenohradszky P, Csajbók E, Perner F, Asztalos L, Kalmár Nagy K, Langer R. 50-year history of kidney transplantation in Hungary. Orv Hetil 2013; 154:846-9. [DOI: 10.1556/oh.2013.29649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The first Hungarian kidney transplantation was performed by András Németh in Szeged in 1962, approximately 50 years ago. A preliminary agreement with Eurotransplant was signed in 2011, and special patient groups gained benefit from this cooperation in 2012, wnich lead to a full membership to Eurotransplant. This event inspired the authors to review the history of Hungarian kidney transplantation of the past 50 years, from the first operation to recent via the specific cornerstones of the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor, is still healthy, after 50 years, and he encourages everybody to donate organs. Organized kidney transplant program started more than 10 years later, such as 1973, in Budapest. The program was supported by the Ministry of Health. New centers joined the program later, Szeged in 1979, Debrecen in 1991 and Pécs in 1993. These four transplant centers work currently in Hungary, and 6611 kidney transplantation has been performed up to the end of year 2012. Orv. Hetil., 2013, 154, 846–849.
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Affiliation(s)
- Edit Szederkényi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged Pécsi u. 6. 6720
| | - Pál Szenohradszky
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged Pécsi u. 6. 6720
| | - Ernő Csajbók
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged Pécsi u. 6. 6720
| | - Ferenc Perner
- Semmelweis Egyetem, Általános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest
| | - László Asztalos
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Károly Kalmár Nagy
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | - Róbert Langer
- Semmelweis Egyetem, Általános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest
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Askandarani S, Aloudah N, Al Enazi H, Alsaad KO, Altamimi A. Late Renal Allograft Rupture Associated with Cessation of Immunosuppression following Graft Failure. Case Rep Transplant 2011; 2011:512893. [PMID: 23198260 DOI: 10.1155/2011/512893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 29-year-old man developed chronic allograft nephropathy 63 months after renal transplantation. He became symptomatic with advanced chronic graft failure; his immunosuppressive medications were reduced and he was commenced on haemodialysis. Two months following the withdrawal of immunosuppression, he presented with abdominal pain, haematuria, and a marked drop in haemoglobin. The patient was taken to the operating room, where the renal allograft was found to be ruptured, and graft nephrectomy was subsequently performed. Histological examination of the graft specimen showed severe haemorrhagic acute vascular cellular rejection in a background of marked chronic allograft vasculopathy. Immunostaining for C4d showed diffuse, strong, linear circumferential staining of the peritubular capillaries, indicating a concurrent antibody-mediated rejection. We report herein an unusual case of spontaneous renal allograft rupture that occurred long time after transplantation due to severe acute rejection following cessation of immunosuppressive medications for advanced chronic allograft failure. To the best of our knowledge, the time interval between transplantation and the rupture of this allograft is the longest of those reported in the literature.
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Abstract
A 5-year-old domestic shorthair cat, that had undergone renal transplantation 3 months earlier, was evaluated after an acute episode of abdominal discomfort. Abdominal ultrasound revealed an enlarged renal allograft (5.5 cm; reference range, 3.2–4.2 cm) with pyelectasia (renal pelvis=3.7 mm; reference range, 1–2 mm). Based on the ultrasonographic appearance of the allograft, primary rule-outs for the renomegaly included hypertrophy and allograft rejection. The ureter and urethra were dilated and a mild amount of abdominal effusion was noted. Thirty-six hours after admission, the cat became acutely hemodynamically unstable and was diagnosed with a hemoabdomen. Review of the original ultrasound revealed a peri-renal hematoma. During emergency laparotomy, ruptures in the cortex of the transplanted kidney were found to be the source of hemorrhage. Immediately following surgery, the cat experienced cardiorespiratory arrest, and resuscitation was not successful. Necropsy and histopathology revealed rupture of the renal allograft. This is the first reported case of renal allograft rupture in a cat, whereas allograft rupture has been reported in human renal transplant patients.
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Sanchez de la Nieta MDG, Sánchez-Fructuoso AI, Alcázar R, Pérez-Contin MJ, Prats D, Grimalt J, Blanco J. Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis. Transplant Proc 2005; 36:3016-8. [PMID: 15686684 DOI: 10.1016/j.transproceed.2004.10.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal allograft rupture is an early postoperative complication threatening graft and patient survival. We reviewed the etiology and prognostic factors for renal allograft rupture. MATERIAL AND METHODS Among 657 renal transplants performed between 1990 and 2001, renal allograft rupture was diagnosed in 10 cases. Statistical analysis by Student t test, ANOVA, and chi-square was performed to assess donor and recipient characteristics. Multivariate logistic regression to predict renal allograft rupture used variables with P <.15 in the univariate analysis. RESULTS Patients with renal allograft rupture were mainly men and young. Renal allograft rupture incidence was higher among allografts from non-heart-beating donors, kidneys with delayed graft function, or patients with a high antibody titer. Histopathological findings revealed that six renal allograft ruptures were secondary to acute rejection, three to acute tubular rejection and one to allograft infarction. Only one of six renal allograft ruptures (17.7%) secondary to rejection was resolved by surgery; two of the three patients (66.7%) with acute tubular necrosis were successfully operated and a nephrectomy was performed for the patient with allograft infarction. By multivariate logistic regression analysis, factors shown to be predictive for renal allograft rupture were: delayed graft function, age of recipient, peak panel-reactive antibody >25%, and initial immunosuppressive treatment without antithymocyte globulin. CONCLUSIONS Higher graft salvage rates are possible in cases of graft rupture associated with acute tubular necrosis.
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Zakir AH, Woodside KJ, Feliberti EC, Rajaraman S, Gugliuzza KK, Daller JA. Late renal allograft rupture in a patient with small vessel vasculitis following discontinuation of immunosuppression. Transpl Int 2003. [PMID: 12827233 DOI: 10.1111/j.1432-2277.2003.tb00237.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report the case of a 21-year-old man with antineutrophil cytoplasmic antibody (ANCA)--associated vasculitis who experienced spontaneous renal allograft rupture 21 months after engraftment. Because of chronic allograft nephropathy, the patient's immunosuppressive regimen had been discontinued approximately 3 weeks prior to his presentation with abdominal pain and evidence of internal hemorrhage. He was emergently taken to the operating room, where a ruptured allograft was found and transplant nephrectomy was performed. Postoperatively, the cause of rupture was determined to have been acute cellular rejection. This case may be the longest interval reported between renal transplant and spontaneous allograft rupture.
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Affiliation(s)
- Ali H Zakir
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
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Affiliation(s)
- B Ringe
- Klinik für Transplantationschirurgie, Georg-August-Universität Göttingen, Göttingen, Germany
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