The Journal of heart transplantation
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Distant procurement of organs for transplantation requires satisfactory preservation to reduce injury during ischemia and the initial phase of reperfusion. We have studied the mechanism of reimplantation injury after unilateral lung transplantation in isogeneic Fisher rats. The heart and lungs were removed en bloc from donor rats and preserved at 4 degrees C. ⋯ In seven other rats we measured BAL neutrophil activity with stimulated luminol chemoluminescence from transplanted left and nontransplanted right lungs 24 hours after unilateral left lung transplantation. Results (expressed as millivolt X 10(3) neutrophil +/- SD) showed significantly greater activity from transplanted (2.8 +/- 1.7) compared with nontransplanted (0.72 +/- 0.6) lungs. Reimplantation injury of the lung is characterized by pulmonary sequestration of neutrophils, and these cells may play a primary role in mediating vascular damage.
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A review of the world experience with the implantation of total artificial hearts has been carried out. Thirteen centers throughout the world have implanted 27 total artificial hearts in 26 patients. ⋯ Of the other twenty-one patients, three patients died while on a total artificial heart, seven patients died following transplantation, two patients are waiting for transplant, and nine patients have successfully been transplanted and are presently alive. Various clinical preoperative and postoperative parameters are analyzed in this investigation.
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Experimental animal work has shown that thyroid hormone levels become undetectable 9 hours after brain death. It is unknown whether such an acutely hypothyroid state contributes to the hemodynamic instability of brain-dead donors or whether these donors should be resuscitated with thyroid hormone. No previous clinical study has examined thyroid hormone levels in human brain-dead organ donors. ⋯ Donors with a closed-head injury plus multiple injuries had statistically lower thyroxine values than donors with only a closed-head injury. For the heart donors, no correlation was found between thyroid hormone levels and the duration or dose of dopamine required for the heart allograft recipients after transplant. The incidence of acute tubular necrosis in the kidney transplants did not correlate with the donor thyroid hormone levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Enoximone (MDL 17,043), a phosphodiesterase inhibitor, in the treatment of advanced, unstable chronic heart failure.
Patients with advanced heart failure may be candidates for mechanical circulatory support, heart transplantation, or both. Optimal medical therapy in such patients, who are frequently unstable clinically, is focused on traditional and newer methods of inotropic support. Accordingly, the response to intravenous and oral enoximone, an experimental compound with phosphodiesterase inhibitory properties, was examined in 25 patients with unstable, severe chronic heart failure as a result of ischemic or myopathic heart disease. ⋯ Thus enoximone, a compound with inotropic and vasodilator properties, was useful in the acute and short-term management of unstable, chronic heart failure and had an additive hemodynamic benefit to dobutamine, dopamine, or both. Enoximone may therefore be a useful adjunct to stabilizing these patients before mechanical circulatory support or transplantation. The advanced degree of myocardial failure in these patients, however, precludes enoximone together with standard medical therapy from having a more favorable impact on clinical outcome in these patients.
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Comparative Study
Flush perfusion using Euro-Collins solution vs cooling by means of extracorporeal circulation in heart-lung preservation.
Single-flush perfusion using modified Euro-Collins solution and donor cooling by extracorporeal circulation represent two concepts of lung preservation currently in use for on-site heart-lung transplantation. The question of which technique is better for safe clinical application of heart-lung transplantation, including extended periods of ischemia and distant organ procurement, currently remains undetermined. Eighteen mongrel dogs, divided in three groups, underwent left lung, heterotopic heart transplantation, leaving the right lung and heart of the recipient in place. ⋯ By contrast, groups II and III showed a slight decrease of oxygenation within acceptable limits. We therefore conclude that both methods of cardiopulmonary preservation evaluated may allow for an extended ischemic time of up to 6 hours before heart-lung transplantation. Pulmonary vascular resistance was significantly lower in the group preserved by extracorporeal circulation, possibly reflecting superior preservation of lung function by this method.