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At least 217 records · Page 12Linked to original sources
PubMed2002

Effects of traction, distension, and joint position on distraction of the hip joint: an experimental study in cadavers.

PURPOSE: To quantify the effects of traction alone and in combination with distension of air in different joint positions in order to find out the conditions for adequate distraction of the hip joint with minimal traction force. TYPE OF STUDY: Experimental cadaver study. METHODS: Eight cadaver hip joints were studied. The cadavers were placed supine on a fracture table and traction was applied in different joint positions for flexion and abduction with and without distension using air. For the measurement, the joint space between the acetabulum and femoral head was separated by 4 different lines characterizing the lateral margin of the acetabulum, the superior portions of the lunate cartilage, and the acetabular fossa. RESULTS: At all measurement lines, distraction of the hip was significantly better when traction and distension were combined. At traction forces from 250 to 300 N, traction plus distension resulted in a 1.59- to 2.25-fold increase of joint distraction compared to traction alone. The maximum effect of distension was achieved between 200 and 250 N. Up to traction forces of 250 N, the joint vacuum force counted for more than half of the total resistance. The effects of flexion and abduction on distraction of the hip were smaller. A trend for better distraction was found for 20 degrees of flexion and a significantly better distraction by avoiding abduction. CONCLUSIONS: High traction forces by breakage of the joint seal can be avoided by distension using air. The passive resistance of the soft tissues increases at higher traction forces. Slight flexion without abduction showed further increase of joint distraction. Reducing the amount of traction may possibly reduce the risk of soft tissue perineal and neurologic injuries.

Adult↗
PubMed2000

Quantitative benefits provided by acute tissue expansion: a biomechanical study in human cadavers.

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded cutaneous flaps to quantitatively assess the efficacy of intraoperative tissue expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (15 x 8 cm), proximally based flap was designed on each side of the body, in three different locations: lateral arm, anterior thorax, anterior thigh. In each cadaver, one randomly selected flap per each body region underwent acute-intermittent expansion, whereas the contralateral flap served as control. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. The obtained data showed that the biomechanical benefits provided by acute tissue expansion were statistically different (P< 0.05) from those obtained by simple subcutaneous undermining. While no changes of length have been observed in the acutely expanded skin flaps as compared to control cutaneous flaps, a statistically significant gain in the compliance of the former has been recorded as compared to the biomechanical behaviour of the latter.

Adult↗
PubMed2000

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation.

STUDY OBJECTIVE: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. METHODS: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. RESULTS: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. CONCLUSION: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear.

Cadaver↗
PubMedDate not supplied

Cadaver studies and their impact on the understanding of human adiposity.

The skinfold thickness is a much-used measurement for monitoring adiposity in a wide range of medical, health, occupational and sport science disciplines. Misconceptions abound, however, in its use, particularly that of purportedly predicting body 'fat' as opposed to 'adipose tissue'. To obtain data to investigate body composition and the extent to which anthropometry can be justifiably used to predict whole-body adiposity, an extensive dissection study was undertaken on 34 cadavers. In addition, to pre-empt questions on the applicability of cadaver data to living subjects, 40 elderly in vivo subjects of the same age range were compared with the cadaver population. No significant macro-morphological differences were found between males or females in the morbid and in vivo groups. Significant findings affect our previous understanding of the predictability of whole-body 'fat'. Skinfold compressibility was by no means constant; skin thickness varied with location in both sexes, females having thinner skin than males; there were significant sex differences in adipose tissue patterning. An identical thickness of adipose tissue did not necessarily contain the same concentrations of fat. Despite this variability, a relationship was demonstrated between aggregate skinfold measures and subcutaneous adipose tissue mass (as opposed to subcutaneous fat), this relationship being more evident in men. A strong relationship was found between subcutaneous adiposity and whole-body adiposity, and between direct skinfold depth measures and whole-body adiposity. The amount of visceral adipose tissue was the same in men and women, but in the men this represented a greater proportion of their total body adiposity. Further, the use of waist-to-hip girth ratio (WHR) was identified as an important predictor of health risk. These findings demonstrate that it is not sustainable to introduce a non-quantifiable error by transforming anthropometric values (skinfolds) into predictions of percentage body fat. If subcutaneous adiposity can be predicted, then an excellent indication of overall adiposity could be obtained. Currently, skinfold measurement can yield a reasonable indication of comparative subcutaneous adiposity (better in men than in women). In neither gender is this prediction completely reliable due to both inter- and intra-individual differences in the skinfold measurement procedure.

Adipose Tissue↗
PubMed2000

Cadaver donor screening for infectious agents in solid organ transplantation.

The transmission of infection by a cadaver donor organ can result not only in loss of the allograft but also in death of the immunosuppressed recipient. Despite the shortage of cadaver organ donors, every donor must be evaluated thoroughly for the potential transmission of infectious disease, because the consequences of the organ donor events can have a profound effect on the transplant outcome. This review summarizes current knowledge about serological screening of organ donors to determine the suitability of organs from cadaver donors for transplantation.

Cadaver↗
PubMed2005

Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers.

BACKGROUND: Percutaneous cricothyroidotomy is a lifesaving procedure for airway obstruction in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed. METHODS: The purpose of this study was to examine whether there is a training effect using Seldinger technique emergency cricothyroidotomy (group 1; Arndt Emergency Cricothyroidotomy Catheter Set; Cook Critical Care, Bloomington, IN) versus standard surgical cricothyroidotomy (group 2). Twenty emergency physicians performed five cricothyroidotomies with each method in a total of 200 human cadavers, comparing efficacy and safety (speed, success rate, and injuries). RESULTS: Seven attempts in group 1 and six in group 2 had to be aborted. Time intervals from the start of the procedure to location of the cricothyroid membrane were not significantly different between the groups. However, time to tracheal puncture (P < 0.01) and time to first ventilation (P < 0.001) were significantly longer in group 2. No time effect could be observed in both groups. The airway was accurately placed into the trachea through the cricothyroid membrane in 88.2% (82 of 93) of the cadavers in group 1 and in 84.0% (79 of 94) in group 2 (not significant). No injuries were observed in group 1, whereas there were six punctures of the thyroid vessels in group 2 (P < 0.05). CONCLUSIONS: With respect to time needed for the procedure, the participants performed Seldinger technique emergency cricothyroidotomy significantly faster as compared with standard surgical cricothyroidotomy. Even if no training effect had been observed, the authors believe that it is important to train residents in different methods of cricothyroidotomy in cadavers in addition to training in mannequins to achieve a higher level of efficacy in real-life situations. The shorter time to first ventilation and the fact that no injuries could be observed favor the Seldinger technique.

Adult↗
PubMed2002

Bioabsorbable ciprofloxacin-containing and plain self-reinforced polylactide-polyglycolide 80/20 screws: pullout strength properties in human cadaver parietal bones.

The aim of this study was to compare the pullout forces of recently developed bioabsorbable ciprofloxacin-containing and plain self-reinforced polylactide/polyglycolide (SR-PLGA) miniscrews in human cadaver parietal bones. Parietal bone pieces (approximately 6 x 20 cm) were collected from five human male cadavers (44-75 years of age). Fifty plain SR-PLGA 80/20 miniscrews (diameter = 1.5 mm, length = 4.0 mm) and 50 ciprofloxacin-containing SR-PLGA 80/20 miniscrews (diameter = 1.5 mm, length = 4.0 mm) were used in this study. The force needed to pull the screws from human parietal cadaver bones was measured using a tensile strength-testing machine. The screw pullout speed was 10 mm/min. Means and SDs were calculated and analyzed using the Student t test (SPSS version 10.0 for Windows). The pullout forces of the ciprofloxacin-containing and plain miniscrews were 66.8 +/- 4.9 N and 96.3 +/- 9.3 N (significant difference, P < 0.001), respectively. The most common cause of failure was screw-shaft breakage (60% in the case of ciprofloxacin-containing screws and 52% in the case of plain SR-PLGA screws). Scanning electron microscopy showed that the fibrillar strip-like microstructure of plain SR-PLGA miniscrews turns into a coarse, uniaxial, platelet-like morphology in antibiotic SR-PLGA miniscrews as a result of the addition of ciprofloxacin. Ciprofloxacin-containing SR-PLGA screws consequently have a lower pullout strength than corresponding plain conventional SR-PLGA screws. Nevertheless, it is evident that the ciprofloxacin-containing screws can be applied in craniomaxillofacial surgery in nonload-bearing or slightly load-bearing applications.

Absorbable Implants↗
PubMed1994

The composition of bone marrow for a dual-energy quantitative computed tomography technique. A cadaver and computer simulation study.

RATIONALE AND OBJECTIVES: The authors have been developing a dual-energy quantitative computed tomography (DE-QCT) technique that requires calibration standards that mimic the x-ray attenuation properties of bone, red marrow, and yellow marrow. To resolve questions regarding the compositions of red and yellow marrow that appear in the literature, the authors performed chemical analyses of bone marrow samples. The newly derived compositions were used in a simulation study to test the accuracy of the DEQCT technique. METHODS: Red marrow samples were extruded from the vertebrae of cadavers of young boys. Yellow marrow samples were removed directly from the femurs of cadavers of elderly women. The fat, protein, water, and mineral contents of these samples were determined. The compositions of 12 mixed marrow samples extruded from cadaver vertebrae also were measured. A computer simulation study was performed in which calibration standards with the new compositions were employed to estimate the fat and bone contents of spongiosas containing the 12 mixed marrows. RESULTS AND CONCLUSIONS: The red marrow samples contained 3% to 6% fat, 6% to 8% protein, 82% to 86% water, and 0.5% to 1% mineral. The yellow marrow samples contained 71% to 92% fat, 1% to 2% protein, 7% to 26% water, and 0.2% to 0.4% mineral. The simulation study yielded good results in three cases and mediocre to poor results in nine cases. An alternative approach was tried in which an average fat-free marrow was derived from the compositions of the 12 mixed marrows, and this substance, fat, and bone were used as the calibration standards. The DEQCT technique with these standards was applied to simulated spongiosas containing the 12 original mixed marrows plus nine additional mixed marrows. All of the estimates were in good agreement with the true compositions. The rms error of the mass fractions of fat was 0.03, and the rms error of the bone concentrations was 3.7 mg/mL.

Aged↗
PubMed1985

Anatomic observations of the carpal tunnel in cadavers with a report of unusual thickening of the perineurium of the median nerve.

The carpal tunnel of 50 cadavers (100 hands) was dissected. Macroscopic finding included 14 median nerves with pressure signs (in 4 cadavers, unilaterally and 5 bilaterally). In three cadavers, marked synovitis was seen around the tendons and the nerve; in one, lipoma was evident; and in the rest, thickening of the volar carpal ligament was seen. Microscopic examination of the compressed nerves showed concentric thickening of the perineurium, thrombosis of veins, and intrafascicular fibrosis. In one nerve, the thickening of the perineurium was not concentric, but only at that part of the fascicle adjacent to the volar carpal ligament in an "onion peel" form.

Adult↗
PubMedDate not supplied

Gas-sterilized cadaver bone grafts for spinal fusion operations. A simplified bone bank.

Cadaver bone for spinal fusion operations is as safe as autografts. The author's 35 years' experience using cadaver bone for interbody spinal fusion operations has led to the development of a simplified bone bank method. Unsterile bone removed from young, fresh cadavers is cut into appropriate sizes and shapes, washed clean, packaged and sterilized with ethylene oxide gas, then aerated and stored at room temperature. The results of spinal fusion, both cervical and lumbar, using 187 gas-sterilized bone grafts in 58 patients operated on over the past year and half, were reviewed and compared with fusions using autografts or banked bone from proven methods. The rate and percentage of fusion of gas-sterilized bone was comparable to other bone grafts with no untoward complications.

Bone Transplantation↗
PubMed1988

The use of single pediatric cadaver kidneys for transplantation.

We have reviewed our experience with 126 single pediatric cadaver kidneys (donor ages 9 months to 16 years) transplanted over a 10-year period. There were 17 donors aged 0-2 years, 55 donors aged 0-6 years, 34 donors aged 7-12 years, and 37 donors aged 13-16 years. One-year patient and graft survival was 88.2%/76.5%, 91%/74%,88.3%/69.1%, and 94.4%/80.6% for the respective groups. One-year patient and graft survival for an adult donor control group was 93%/69%. The percentage of recipients requiring dialysis in the early posttransplant period was 70.6%, 54.5%, 52.9%, 51.4%, and 52.4% for all groups, respectively. The time to reach a nadir creatinine was similar in all groups (24-30 days). While the functional outcome was comparable to cadaver transplantation utilizing adult donor kidneys, a higher incidence of infections and technical complications were encountered in the young-donor-age groups. Overall, there were 12 ureteral complications (8 fistulas, 4 stenoses), 3 bladder fistulas, and 4 renal artery stenoses. The urologic complication rate in kidneys from donors 0-2 years of age was 23.5% (all ureteral fistulas) versus 5% in the kidneys from adult donors. Only one graft was lost due to a technical complication. We conclude that, while cadaver kidneys from donors in the young age groups may be utilized successfully for transplantation, a higher incidence of urologic complications may be associated with their use. Careful harvesting and intraoperative techniques may minimize complications when utilizing kidneys from these donors.

Adolescent↗
PubMed1988

Significance of delayed graft function in cyclosporine-treated recipients of cadaver kidney transplants.

Many transplant teams are reluctant to initiate cyclosporine immunosuppression in recipients of cadaver kidney grafts with delayed graft function (DGF). The renal function of cadaver kidney grafts in cyclosporine-treated recipients was compared in 47 recipients with DGF and 57 without DGF. Regardless of initial renal function, all recipients received prednisone, azathioprine, and oral cyclosporine 5 mg/kg/day or its intravenous equivalent. All kidneys were flushed with ice-cold intracellular electrolyte solution and cold-stored for 15-54 hr (mean of 31 hr) prior to transplantation at our hospital between April 10, 1985 and November 30, 1986. Rejection crises were treated with high-dose steroids or OKT3. Cyclosporine was discontinued during courses of OKT3. Recipients with DGF had significantly higher one-month serum creatinine nadirs (2.6 +/- 1.8 mg/dl vs. 1.5 +/- 0.5 mg/dl). Actuarial graft survivals were not significantly different at one year (82.2 +/- 5.5% vs. 82.6 +/- 6.4%, all graft losses included). Mean serum creatinine levels at six months and twelve months after grafting were not significantly different (1.7 +/- 0.4 mg/dl vs. 1.8 +/- 1.2 mg/dl and 2.0 +/- 0.5 vs. 1.7 +/- 0.7 mg/dl, respectively). Delayed graft function following cadaver kidney transplantation does not adversely affect intermediate term function of kidney grafts flushed with intracellular electrolyte solution and cold-stored until transplantation when a low-dose cyclosporine induction protocol is used and cyclosporine is discontinued during OKT3 administration.

Cadaver↗
PubMed1990

An approach to organ salvage from non-heartbeating cadaver donors under existing legal and ethical requirements for transplantation.

Effective utilization of nonheartbeating cadaver donor organs is limited by the time required to obtain the necessary family consent prior to organ retrieval (a delay of at least 4-6 hr); this exceeds by far the maximum tolerance of kidneys to warm ischemia. Measures that could theoretically permit use of such organs include: (1) rapid in situ flush cooling; (2) continued in situ kidney cooling until permission for donation is secured; and (3) cell-membrane stabilization of vital organs, with only minimal invasion of the donor body. These measures were tested experimentally in dogs. Hemorrhagic shock was produced in mongrel dogs. One hour after cessation of heartbeat, a rapid perfusion tube was placed into the femoral artery; it was advanced, and its balloon was inflated in the aorta above the renal vessels. The kidneys were then flushed in situ with 1000 cc of cold preservation solution containing a calmodulin inhibitor, trifluoperazine. Two other catheters were inserted percutaneously into the peritoneal cavity for continuous intraperitoneal cold perfusion. Core temperatures of 4 degrees C were maintained in situ in the kidneys for 5 hr. Six hours after cardiac arrest, the kidneys were removed and preserved ex vivo at 4 degrees C for 24 hr, and were then transplanted into their respective hosts (n = 11), where they sustained life uneventfully. This method requires a 2-inch incision in the groin of the prospective donor, and two small stab wounds of the abdomen; i.e., semi-invasive procedures which are commonly performed in emergency rooms. The perfused body could then be released to the family if donation is denied. The recently documented increased willingness of the public to donate organs when the termination of life support is not an issue, and court decisions that have authorized the performance of nondeforming diagnostic procedures in cadavers without consent, suggest that the salvage of transplantable semi-invasive procedures described in this study may be useful in helping to alleviate the current shortage of transplantable organs. This technique can provide the time needed for families to consider the option of organ donation from nonheartbeating cadaver donors in an unhurried and unpressured manner, while preserving the viability of vital organs during the decision-making process.

Animal Experimentation↗
PubMed1994

Induction immunosuppression with antilymphocyte globulin or OKT3 in cadaver kidney transplantation. Results of a single institution prospective randomized trial.

Improved cadaver kidney allograft survival rates, shorter duration of acute tubular necrosis, and a reduction in the incidence of rejection have been achieved using "quadruple sequential therapy"--AZA, prednisone, and antilymphocyte globulin (ALG) induction followed by the delayed addition of CsA. OKT3 has been shown to be effective in preventing and treating rejection, including steroid- and ALG-resistant rejection episodes. A single institution prospective randomized trial comparing ALG and OKT3 prophylaxis in first cadaver kidney allograft recipients was performed to assess their relative advantages and disadvantages. First cadaver kidney allograft recipients were prospectively randomized to receive 7 days of either ALG (n = 58) or OKT3 (n = 59) as part of a quadruple therapy protocol that included AZA, prednisone, and oral CsA. Patient characteristics, patient survival and causes of death, graft survival and causes of graft loss, incidence of and time to rejection and response to treatment, incidence of infections and their type, renal function, and antibody formation to ALG and OKT3 were examined. The 1-, 2-, and 3-year actuarial patient survival rates were 96% in the ALG group and 98% in the OKT3 group. The graft survival rates were 81.1%, 78.4%, and 78.4% in the ALG group and 84.1%, 78.7%, and 78.7% in the OKT3 group. In ALG-treated patients, 63% never had rejection, compared with 49% in the OKT3 patients (P = NS). In the ALG group 31% had a single rejection, 6% had 2 rejections, and none had 3 rejections, compared with 37%, 12%, and 2% in the OKT3 group. In the ALG group, 43% were steroid responsive compared with 65% in the OKT3 group (P = 0.08). There were 1.44 infections per patient in the ALG group compared with 0.76 in the OKT3 group (P = 0.0004). In the ALG group, 37% of patients developed CMV disease compared with 10% in the OKT3 group (P = 0.001). In donor-positive/recipient-negative patients, 8/10 (80%) in the ALG group developed CMV infection, of which 6 (75%) had severe or moderate CMV disease, compared with 2/15 (13%) patients in the OKT3 group (P = 0.002), of whom only one (6.7%) developed moderate disease. In donor-positive/recipient-positive patients, 8/23 (35%) in the ALG group developed CMV infection, of whom 5/8 (62.5%) developed severe or moderate disease compared with 1/21 (4.8%) in the OKT3 group (P = 0.02). Antibody formation to ALG and OKT3 occurred in 11% and 8% of patients, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

The impact of the quality of initial graft function on cadaver kidney transplants.

Living unrelated donor (LURD) transplants have immunologic barriers similar to cadaver transplants, yet the outcome is better (1-year graft survival = 96%). One advantage of LURD transplants is that, with the extremely short preservation time, the kidney functions immediately. We studied whether the quality of initial renal function affects the outcome of primary cadaver transplants. We divided 301 non-6-antigen-matched recipients transplanted between 1/1/86 and 8/1/92--who had no graft loss due to hyperacute rejection, primary nonfunction, or technical reasons--into 5 groups based on the quality of initial renal function (serum creatinine level in the first week). We determined patient and graft survival rates for each group. We found that the quality of initial function had a significant effect on patient and graft survival rates. Recipients whose serum creatinine level was < 3 mg/dl on posttransplant day 5 (groups 1 and 2) had better patient and graft survival than either those whose serum creatinine level was > 3 mg/dl on day 7 (group 4) or those who required dialysis (group 5). Because some early dysfunction may be immunologic, we reanalyzed the data excluding patients with percent reactive antibody > or = 15; the quality of initial function in this group had a significant impact on outcome. Similarly, when patients with graft loss due to "death with function" were excluded, the quality of initial function had a significant impact on survival rates. We conclude that the quality of early posttransplant function is an important predictor of long-term outcome. Cadaver recipients with immediate good function have outcomes similar to living donor recipients. Our data suggest that increased effort should be made to improve immediate posttransplant function.

Adult↗
PubMed1997

GB hepatitis agent in cadaver organ donors and their recipients.

BACKGROUND: The cloning of yet another hepatitis virus, GB virus-C (GBV-C), has provided the opportunity to study the prevalence, and clinical and laboratory characteristics, associated with GBV-C infection among cadaver organ donors and recipients of organs from infected donors. METHODS: Stored sera from a cohort of cadaver organ donors from eight organ procurement organizations, representing different geographic regions of the United States previously screened for hepatitis C virus (HCV) infection, were tested for GBV-C RNA by polymerase chain reaction using degenerate primers derived from the NS3 helicase and 5'-untranslated regions of the GBV-C genome. Pre- and posttransplantation clinical data, and prevalence of GBV-C RNA among recipients of organs from GBV-C RNA-positive and -negative donors, were studied at one of the organ procurement organizations. RESULTS: Twenty-one of 76 (27.6%) anti-HCV ELISA1-positive donors tested positive for GBV-C RNA compared with 6 of 82 (7.3%) ELISA1-negative donors (P=0.001). The prevalence of GBV-C RNA, extrapolated to all cadaver organ donors, was 8.3% (95% confidence interval [CI]: 5.6-11.1%) and was higher than the prevalence of HCV RNA (2.4%). Among ELISA1-positive donors, GBV-C RNA was present in 13 of 35 (37%) donors with HCV RNA, compared with 8 of 41 (20%) donors without HCV RNA (odds ratio [OR]=2.44, P=0.09). Blood alcohol level of more than 100 mg/dl (OR=9.43, P=0.05) and a positive anti-HCV ELISA2 (OR=4.58, P=0.001) were significantly associated with GBV-C infection. In addition, there was a trend toward an association between history of drug abuse (OR=5.23, P=0.06) and younger age (OR=0.97/year, P=0.06) with GBV-C infection. Organs from four GBVC-positive donors and 47 GBV-C-negative donors procured by the New England Organ Bank (Newton, MA) were transplanted into 6 and 79 recipients, respectively. Among recipients of organs from GBV-C RNA. positive donors, the posttransplantation prevalence of GBV-C RNA (25%) was not significantly higher than among recipients of organs from GBV-C RNA-negative donors (23%). Among recipients in whom both pre- and posttransplantation sera were available, one of three (33%) recipients of kidneys from GBV-C RNA-positive donors acquired GBV-C RNA after transplantation, compared with 4 of 40 (10%) recipients of kidneys from GBV-C RNA-negative donors. After a median follow up of 6 years, the posttransplantation prevalence of liver disease, and graft and patient survival, were not significantly different between recipients of organs from GBV-C RNA-positive and -negative donors. CONCLUSIONS: Although GBV-C could be transmitted by organ transplantation, the results of this study preclude definitive conclusions. Further studies are required to determine the risk of transmission of GBV-C by organ transplantation and its role in posttransplantation liver disease.

Adolescent↗
PubMed1997

HLA and cross-reactive antigen group matching for cadaver kidney allocation.

BACKGROUND: Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African-American and other hard to match populations. Consequently, matching has been proposed of deduced amino acid residues of the individual HLA molecules shared by cross-reactive antigen groups (CREGs). We have examined the circumstances under which compatibility with either method impacted graft survival. METHODS: Using Cox proportional hazards regression modeling, we studied the relationship between levels of conventional HLA mismatch and other donor and recipient factors on primary cadaver kidney survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 (n=31,291). The results were compared with those obtained by the matching of amino acid residues that identified CREG-compatible cases with as many as four (but not five and six) HLA mismatches. RESULTS: With more than one HLA mismatch (> 85% of patients in both series), most of the survival advantage of a zero mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched recipients (35.3%) had better graft survival than the remaining 64.7%, who were CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA incompatibility tiers. Better graft survival with tacrolimus was observed in both the Pittsburgh and UNOS series. CONCLUSIONS: Obligatory national sharing of cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The potential value of CREG matching observed in the one-HLA-mismatched recipients of the UNOS (but not the Pittsburgh) experience deserves further study.

Adolescent↗
PubMed2002

Intrathoracic cooling of cadavers before lung transplantation using cold air: an experimental study.

OBJECTIVE: In an attempt to identify an effective method of harvesting adequately functioning donor lungs from a cadaver, we devised an intrathoracic cooling method utilizing cold air that resulted in successful experimental lung transplantation. METHODS: The lungs of donor mongrel dogs were inflated with 100% oxygen after death. The animals in group I (n=5) were left at room temperature for 2 hr, whereas those in group II (n=5) were left for 2 hr with their left thoraces filled with cold air cooled by dry ice. The lungs were subsequently flushed with cold Euro-Collins solution, harvested, and stored inflated in a cold saline solution for a further 2 hr. Left lung allotransplantation was then performed. Transplanted left lung function was examined by inducing occlusion of the native right bronchus and pulmonary artery for 10 min while the left lung was ventilated with 100% oxygen. RESULTS: There was a slow decline in intrathoracic, lung surface, and endobronchial temperatures toward room temperature in group I. In contrast, all three temperatures dropped to approximately 10 degrees C within 30 min in group II. In group I, all recipient dogs died immediately after occlusion was induced, whereas four of the five dogs in group II survived to show satisfactory lung function. CONCLUSIONS: (1) Intrathoracic topical cooling of a cadaver by cold air is efficacious in decreasing lung temperature and thus preserving lung tissue function. (2) Transplantation of cadaver lungs harvested using this novel method might be clinically feasible.

Animals↗