Current opinion in organ transplantation
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Bridging to lung transplantation remains a controversy. Individually, it may be a life-saving therapy to use ventilation and extracorporeal means for gas exchange to keep a patient alive until lung transplantation. Collectively, this may lead to a selection of patients with the worst outcome. New technologies have become available to minimize the adverse events of extracorporeal devices. This may have an impact on the indication and use of such devices and also on the outcome. ⋯ Bridging to lung transplantation changes to concepts avoiding the sequels mechanical ventilation and thereby offers improvement of lung recipients prior to the transplant procedure.
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Curr Opin Organ Transplant · Aug 2011
ReviewUtilization of kidneys from donation after circulatory determination of death.
The present review describes the recent experience with kidney transplantation using donation after circulatory determination of death (DCDD) including efforts to expand the potential pool of DCDD donors. ⋯ DCDD kidneys continue to demonstrate increased rates of delayed graft function and primary nonfunction when compared with kidneys recovered after donation after brain death (DBD) likely due to increased warm ischemic time during recovery. Despite early complications, DCDD kidneys show comparable function and survival after the immediate postoperative period and have been demonstrated to provide a survival benefit to recipients over waiting for DBD kidneys. The effect of machine perfusion on DCDD kidneys may decrease delayed graft function but has no effect on long-term function. Despite concerns, the increasing number of DCDD donors does not appear to be directly responsible for decreased numbers of DBD donors.
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To summarize the pulmonary complications seen in cirrhosis. ⋯ Cirrhosis may be complicated by one of two pulmonary vascular complications, portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS). POPH is a syndrome of increased vascular resistance, initiated by pulmonary vascular spasm. HPS is caused by intrapulmonary arteriovenous shunting with resultant hypoxemia. Both conditions are associated with portal hypertension, but are unrelated to the degree of portal hypertension, the nature or severity of the liver disease, and are associated with mortality in excess of the model for end-stage liver disease score. POPH is usually responsive to vasodilators, while HPS remains resistant to therapeutic agents. Both conditions are improved or cured by liver transplantation.
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The Jehovah's Witness religion is a Christian movement, founded in the USA in the 1870s, with 6 million members worldwide (150,000 in the UK). Members of this faith have strong beliefs based upon passages from the Bible that are interpreted as prohibiting the 'consumption' of blood. Their beliefs prevent them from accepting transfusion of whole blood or its primary components. They also believe that blood that has been removed from the body is 'unclean' and should be disposed of. The use of procedures that involve the removal and storage of their own blood is often unacceptable. ⋯ In summary, major surgery can be performed safely in the Jehovah's Witness who refuses blood transfusion by utilizing preoperative and intraoperative techniques that decrease surgical blood loss, decrease oxygen consumption, and increase oxygen delivery. Even if significant intraoperative blood loss occurs, successful postoperative management is possible by utilizing techniques that minimize oxygen consumption and maximize oxygen delivery.
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Curr Opin Organ Transplant · Oct 2010
ReviewThe contribution of airway ischemia and vascular remodelling to the pathophysiology of bronchiolitis obliterans syndrome and chronic lung allograft dysfunction.
Chronic allograft dysfunction continues to limit the enduring success of lung transplantation. Increasingly it is recognized that events very early post-transplant such as primary graft dysfunction can be linked to poor clinical outcomes at much later time points. In this article we review a number of the different processes that predispose the allograft to ischemia early post-transplant and explore how these events may contribute to obliterative bronchiolitis, the histological correlate of chronic lung allograft dysfunction. ⋯ Whilst the published literature for vascular remodelling in post-transplant obliterative bronchiolitis is not as extensive as that for asthma, a disease also characterized by airway pathology, there are clear parallels and shared pathophysiological pathways between the two diseases. An understanding of the complex interaction between ischemia, vascular remodelling and chronic lung allograft dysfunction may lead to the future development of therapeutic strategies that can unravel this association.