Transplantation
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Comparative Study
Opening of mitochondrial potassium channels: a new target for graft preservation strategies?
This study was designed to assess the protective effects of the mitochondrial adenosine triphosphate-sensitive potassium channel (KATP) opener diazoxide as an additive to heart preservation solution. ⋯ Pharmacologic activation of mitochondrial KATP channels seems to be an effective means of improving preservation of cold-stored hearts, which is consistent with the presumed role of these channels as end effectors of the cardioprotective preconditioning pathway.
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Clinical Trial
Azathioprine withdrawal in stable lung and heart/lung recipients receiving cyclosporine-based immunosuppression.
Chronic rejection is the leading cause of graft failure after (heart-) lung transplantation. Therefore, many centers maintain a triple immunosuppressive cyclosporine-based regimen including azathioprine (AZA) during the long-term course after lung transplantation. However, an increased risk of malignancies has been attributed to prolonged immunosuppression, and there is evidence that less intensive immunosuppressive regimens are feasible in the long-term course after other solid organ transplantation. Therefore, we investigated the effects of AZA withdrawal in stable lung transplant recipients. ⋯ Our data reinforce the importance of a potent immunosuppressive regimen for the maintenance of stable graft function after lung transplantation.
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Case Reports
Use of aerosolized inhaled epoprostenol in the treatment of portopulmonary hypertension.
Portopulmonary hypertension is a known complication in the liver transplant candidate. Intravenous epoprostenol has been demonstrated to decrease pulmonary artery pressures and possibly remodel right ventricle geometry. ⋯ The inhaled route of delivery of epoprostenol is potential alternative for the acute therapy of portpulmonary hypertension.
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Graft-versus-host disease (GVHD) is a major and sometimes fatal complication of allogeneic bone marrow transplantation (BMT). The prediction of GVHD remains an important issue in preventing morbidity and mortality after allogeneic BMT. In the past 10 years, there has been great interest in using the frequency analysis of alloreactive helper and cytotoxic T lymphocyte precursors (HTLp and CTLp) to detect recipient-specific alloreactivity and thus predict GVHD in HLA-matched related and unrelated BMT. However, the results remain controversial. The intention of the present study was to investigate whether alloreactive HTLp and CTLp frequencies measured in donor peripheral blood before BMT would be a useful predictor for the occurrence of acute GVHD after HLA-matched sibling BMT. ⋯ Host-reactive HTLp and CTLp frequency analysis did not provide informative prediction for the occurrence of acute GVHD after HLA-matched sibling BMT.
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For better management of brain-dead donors, we developed a small animal model of brain death. We investigated how three catecholamines commonly used for the management of donors affected the cardiac function, hemodynamics, and tissue blood flow in the endocardium and renal cortex. ⋯ Dopamine and norepinephrine impaired renal perfusion and may reduce the viability of renal grafts before retrieval. Epinephrine improved circulatory collapse and pump dysfunction after brain death, while simultaneously maintaining renal perfusion. We conclude that epinephrine should be selected as the catecholamine of choice for the management of brain-dead donors.