Donor heart selection: the outcome of "unacceptable" donors

BACKGROUND: The decline in the number of suitable donor hearts has led to an increasing interest in the use of previously unacceptable donors. In the United Kingdom, if one centre declines a donor heart on medical grounds it may be offered to other centres. This multi-centre study aimed to evaluate the outcome of recipients of donor hearts considered medically unsuitable for transplantation by one centre that were used in other centres. METHODS: Between April 1998 and March 2003, ninety-three donor hearts (group A) were transplanted, after being considered medically unsuitable for transplantation by another centre. During the same period, 723 hearts (group B) were transplanted in the UK using donors not previously rejected. Data on the donors and recipients was obtained from the UK transplant database. Comparative analysis on the two groups was performed using SPSS 11.5 for Windows. RESULTS: The characteristics of recipients were similar in both groups. The main reasons for refusal of hearts are listed below. In most cases there was more than one reason for refusing the donor heart. We did not find significant differences in the post-operative mortality (up to 30 days), ICU and hospital stay and cardiac cause of death between the two groups. Kaplan-Meier survival curves showed no significant difference in the long-term survival, with Log Rank test = 0.30. CONCLUSION: This study demonstrates that some hearts declined on medical grounds by one centre can safely be transplanted and should be offered out nationally. The use of these hearts was useful to expand the scarce donor pool and there does not seem to be a justification for denying recipients this extra source of organs

Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult.</p> <p>Case presentation</p> <p>A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14^thpost-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO) support. Subsequently his recovery was uneventful.</p> <p>Conclusion</p> <p>The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.</p

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