Zonal allocation for thoracic organs in the united kingdom: Has it been successful? A single-center view

AbstractObjectives: The purpose of this study was to analyze the impact of the zonal allocation system for thoracic organs on the outcome of our transplant activity. Methods: We analyzed the results of thoracic transplants performed between 1987 and 1998. The transplants were divided into 3 groups: local donors retrieved by our team (171 hearts and 61 lungs; DL group); distant donors retrieved by our team (58 hearts and 35 lungs; DD group); and distant donors retrieved by other teams (51 hearts and 41 lungs; DX group). Results: No significant differences were observed among the groups in early postoperative events for either heart or lung transplantation. Heart transplants: Cardiac index was 2.6 ± 0.4 L/m2 for the DL group, 2.7 ± 0.6 L/m2 for the DD group, and 2.5 ± 0.7 L/m2 for the DX group (P = .4). The 30-day mortalities were 9.1%, 9.1%, and 8.3% ( P = .5) and the 1-year survivals 83%, 80%, and 82% ( P = .4) for the DL, DD, and DX groups, respectively. Lung transplants: Alveolar-arterial oxygen gradient was 358 ± 19 mm Hg for the DL group, 345 ± 17 mm Hg for the DD group, and 329 ± 21 mm Hg for the DX group (P = .07). The 30-day mortalities were 9.9%, 10.5%, and 12.8% (P = .2) and the 1-year survivals 79%, 75%, and 77% (P = .3) for the DL, DD, and DX groups, respectively. Conclusion: Zonal allocation for thoracic organs has been successfully applied to our program. Using donor organs retrieved by other teams, we have achieved equivalent outcomes for both heart and lung transplantation. (J Thorac Cardiovasc Surg 1999;118: 733-9

Interleukin-4 C-590T polymorphism has no role in coronary artery bypass surgery

Interleukin-4 exerts anti-inflammatory effects through decreased macrophage production of tumor necrosis factor-α and interleukin-1ß. We investigated genetic predisposition in the interleukin-4 response to coronary revascularization and studied the association between C-590T polymorphism, interleukin-4 levels, and outcome of surgery. DNA was obtained from 96 consecutive patients undergoing elective coronary revascularization. Patients were genotyped for interleukin-4 C-590T polymorphism using a sequence-specific primer polymerase chain reaction. Interleukin-4 levels were measured using an enzyme-linked immunosorbent assay in serum samples taken 3 hr postoperatively. The frequency of interleukin-4 C-590T genotypes CC, CT, and TT was 33.3%, 27.1%, and 39.6%, respectively. Patients with the TT genotype had significantly higher circulating levels of interleukin-4 (3.4 ± 4.6 pg·mL−1) postoperatively compared to CC (2.5 ± 0.1 pg·mL−1) and CT (2.7 ± 0.5 pg·mL−1) genotypes. Interleukin-4 C-590T polymorphism is the main determinant of postoperative interleukin-4 levels. The TT genotype is the highest producer of interleukin-4. Neither the genotype nor the serum levels seem to play any role in recovery from coronary artery bypass surgery. </jats:p