Clinical transplantation
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Clinical transplantation · Feb 1999
Increased early morbidity and mortality with acceptable long-term function in severely obese patients undergoing liver transplantation.
The effect of obesity on outcomes following liver transplantation remains unclear. We reviewed our experience with 302 liver transplants in 277 patients from September 1989 to September 1996 to determine the effect of body mass on outcome. Two-hundred and seventeen transplants were performed in patients with a body mass index (BMI) < 30 kg/m2, 55 in patients with a BMI of 30-34 kg/m2 (obese), and 30 in patients with a BMI > 35 kg/m2 (severely obese). ⋯ Post-operatively, severely obese patients had a higher rate of wound infection (20 versus 4%, p = 0.0001) and death attributed to multisystem organ failure (15 versus 2%, p = 0.0001), although overall mortality prior to discharge and total complications were not different between groups. Actual 1-yr graft survival showed a negative trend in the severely obese group (67 versus 81% for non-obese, p = 0.07), but both 3-yr graft survival and patient survival were similar to non-obese patients (p = 0.12 and 0.17, respectively by the Cox-Mantel test). Liver transplantation in severely obese patients is associated with wound infection and early death from multisystem organ failure, but has similar long-term outcomes when compared to non-obese controls.
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Clinical transplantation · Dec 1998
Giving and taking--to whom and from whom? People's attitudes toward transplantation of organs and tissue from different sources.
The aims of the study were: 1) to describe the willingness of the public to receive material of different origins in one's own body; 2) to compare the willingness to donate and receive body material; 3) to compare the willingness to donate while alive and after death; 4) to compare the willingness to donate to a next-of-kin and unknown recipients. A random sample of 1500 inhabitants, 18 to 70 yr old, in the county of Uppsala, Sweden, were sent a questionnaire asking about their opinion on transplantation and transfusion issues. The response rate was 71%. ⋯ Thirty-one percent, more often women than men, had signed a donor card and/or registered with the Swedish Organ Donation Registry. The results with regard to receiving organs and tissue are discussed in terms of two different sets of explanations, which can be seen as different sides of the same coin, and mutually strengthening the reactions. The great readiness to donate to a family member as well as the discrepancy between giving in life and after death is commented upon.
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Clinical transplantation · Jun 1998
Effects of low-dose dopamine on urine output in oliguric, critically ill, renal transplant patients.
Low-dose dopamine (LD-DA) has been used extensively to increase urine output (UO) in critically ill patients. These effects have recently been documented in patients with normal and mildly abnormal renal function. The purpose of this study was to quantitate the effects of LD-DA on UO and urineNa (UNa) excretion in renal transplant (RT) patients, and thereby evaluate the effects of LD-DA on the denervated kidney. ⋯ LD-DA increases UO, but not UNa excretion, in RT patients with oliguria, comparably to controls. These data suggest that this effect is predominantly mediated by dopaminergic receptors, since the transplanted kidney is denervated and there were no significant associated changes in hemodynamic parameters during the study.
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Clinical transplantation · Jun 1998
Case ReportsLiver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis.
Patients awaiting liver transplantation may suffer from severe hyponatremia. It has been suggested that hyponatremia or its treatment might be associated with central pontine myelinolysis (CPM), a serious complication that can be seen after orthotopic liver transplantation (OLT). We undertook this study to assess the outcome of hyponatremic patients after OLT and to evaluate the risk factors in the development of CPM. ⋯ No other risk factor could be identified in the development of CPM. It is concluded that prognosis of hyponatremic patients after OLT is poor if they develop CPM. Slow correction of hyponatremia perioperatively may be critical in preventing this devastating complication.
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Clinical transplantation · Jun 1998
Infection and associated risk factors in the immediate postoperative period of pediatric liver transplantation: a study of 176 transplants.
To describe the characteristics of infections occurring in the immediate postoperative period of orthotopic liver transplantation (OLT) in children in a pediatric intensive care unit (PICU) and the associated risk factors. ⋯ Infection in the immediate postoperative period of pediatric OLT was related with a high morbidity but was not related significantly with increased mortality. The main risk factors for infection in the postoperative period of OLT were related essentially with small recipient size and the inherent complexity of the operation. Routine oropharyngeal decontamination is recommended, as well as early administration of oral nystatin in preoperative intestinal decontamination. The risk of infection increased 2.38 times with partial grafts and 1.1 times with the transfusion of every 20 ml of packed RBC.