Current opinion in organ transplantation
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The scarcity of suitable donor organs continues to limit lung transplantation, resulting in long waiting times and significant mortality for those patients listed for transplant. Strategies to expand the donor pool can substantially lift donor lung utilization rates from historically low levels of less than 20% to rates greater than 50%. This article reviews recent developments in the selection, assessment and management of the potential lung donor that aim to increase donor organ use. ⋯ Optimal donor management should aim to maximize lung donation through aggressive donor management and consideration of the complete and expanded donor pool. However, long-term studies are required to validate such an approach and to confirm that long-term outcomes are not being compromised by the use of both traditional and nontraditional organ donors.
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Recent outcome data, ongoing organ shortage and proposed changes in allocation policies are driving the need to review current practices and possible future course of kidney transplantation in the elderly patients. ⋯ Despite improved outcomes, there remain significant challenges to kidney transplantation in the elderly, including organ shortage, poor transplant rate, evolving allocation policies, high wait-list mortality and nonstandardized immunosuppression. Prospective studies are needed to evaluate the strategies to meet these challenges and to study the impact of proposed new allocation system.
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Curr Opin Organ Transplant · Aug 2009
ReviewThe role of the histocompatibility laboratory in desensitization for transplantation.
The ability of histocompatibility laboratories to define and monitor human leukocyte antigen (HLA)-specific antibodies via highly sensitive immunoassays has been a major contributing factor in the development of desensitization protocols for HLA-incompatible transplants. This review will focus on the laboratory's role in desensitization and the types of tests needed for determining the specificity and strength of antibodies to donor HLA pretransplant, during treatment, and after transplant. ⋯ Histocompatibility laboratories are essential components of desensitization programs. Thorough antibody characterization and serial monitoring of changes in antibody status are needed pretreatment, during treatment and after transplant. Because clinical decisions rely heavily on changes in antibody specificity and strength, desensitization should not be undertaken without access to appropriate histocompatibility testing.
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Curr Opin Organ Transplant · Jun 2009
ReviewQuality improvement: ultrasonography-guided venous catheterization in organ transplantation.
Central venous catheterization (CVC) is a procedure, not exempt of risk. Transplantation patients represent by themselves a high-risk group for CVC. Ultrasonography provides us of the exact localization of the target vein and its relationship with artery and nerve structures, detecting anatomic variations and thromboses of vessels. A description of technical skills, a review of the clinical evidence of ultrasonography-guided CVC and basic training guidelines are presented. ⋯ Ultrasonography-guided venous catheterization is an easily learned technique for internal jugular vein insertion, with significant improvements in overall success in those patients in whom a difficult vein access can be anticipated.