Transplantation proceedings
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The development of pulmonary hypertension before heart transplantation increases the risk for postoperative right ventricular failure. Reversibility of pulmonary vascular resistance (PVR), which indicates the feasibility of heart transplantation, can be tested with the use of intravenous vasodilators, such as sodium nitroprusside (NaNTP) or prostacyclin. However, the drawback of these drugs is the development of systemic hypotension. The aim of this study was to evaluate the safely and feasibility of inhaled nitric oxide (iNO) compared with sodium nitroprusside to test PVR reversibility, while avoiding systemic hypotension. ⋯ We observed a reduction in PVR and mPAP with administration of either iNO and NaNTP. A better effect of NaNTP was attributed to reducted post-load of the left ventricle. However, the main advantage of iNO was the absence of systemic hypotension and its selectivity for pulmonary vascular system, as underscored by TPG reduction.
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Lung transplantation (OLT) is a viable option for end-stage pulmonary diseases in selected patients with satisfactory long-term results. However, the paucity of available donors engenders a prolonged stay on the waiting list with progressive decline of lung function. In cases of sudden respiratory failure, admission to an intensive care unit with institution of extracorporeal membrane oxygenation (ECMO) may be an option while a waiting an emergency OLT. ⋯ The mean weaning time from ECMO after OLT was 2.14 days. No patient died in the perioperative period and 1-year survival was 85.7%. ECMO represents a valid option as a bridge to urgent OLT for selected candidates.
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Antibodies directed against platelet-surface antigen cause immune thrombocytopenia. Transplantation from a donor with immune thrombocytopenia has rarely been reported in the literature and never with a platelet count of 1 × 10(9)/L. We report one liver transplant recipient and one kidney transplant recipient who received organs from a donor with immune thrombocytopenia dying from intracranial hemorrhage. ⋯ However, in the liver recipient, the platelet count nadired at 4 × 10(9)/L and normalized within 3 months. Transplantation of a liver from a donor suffering from immune thrombocytopenia must be considered with great caution. Other organs are suitable for transplantation; however, recipients of these organs must be followed carefully for evidence of immune thrombocytopenia and treatment offered accordingly.