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PubMed1992

Changes in cardiac beta 1- and beta 2-adrenoceptor densities after human cardiac transplantation: relation to transplant coronary vasculopathy and pretransplantation disease.

In 100 patients 12 to 60 months after cardiac transplantation, the influence of transplant coronary vasculopathy and of the pretransplantation disease (end-stage heart failure caused by coronary artery disease or dilated cardiomyopathy) on the beta-adrenergic receptor (AR) numbers and beta 1/beta 2-AR ratio of right ventricular biopsies was determined. Patients with coronary vasculopathy (CVP) after cardiac transplantation had lower absolute numbers of beta 1-AR compared with patients without CVP. Since patients with CVP had increased left ventricular (LV) end-diastolic pressure and LV muscle mass, it is suggested that decreased beta 1-AR may be the result of an altered hemodynamic situation of the transplanted heart after development of CVP. Patients with dilated cardiomyopathy (DCM) before cardiac transplantation showed a decrease in total beta-AR and of the beta 1/beta 2-AR ratio as a result of an increase in beta 2-AR and a decrease in beta 1-AR numbers. The decreased beta 1/beta 2-AR ratio in patients with previous DCM may indicate that the beta-AR system of the transplanted heart might be influenced (at least in part) by pathophysiologic factors that are characteristic of the pretransplantation disease ultimately leading to cardiac transplantation and persisting after cardiac transplantation.

Adult↗
PubMed1994

Analysis of airway function of immature whole lung transplants versus mature lobar transplants.

For the pediatric patient with end-stage lung disease in need of transplantation, two potential donor options currently exist: size-matched immature whole lungs or reduced-size mature lobes. To determine which of these options provides superior long-term function, we studied airway mechanics in a chronic porcine model of pediatric lung transplantation. Three groups of animals were studied: the first group underwent left upper lobectomy at 9 +/- 1 weeks of age (innervated left lower lobes). These animals served as controls. A second group of 9-week-old animals received an immature whole left lung allograft from age-matched donors. The third group received a reduced-size mature left lower lobe from 6-month-old donors. Measurements of dynamic airway resistance, pulmonary compliance, and functional residual capacity of the isolated lobes or lungs, and of the nonoperated right lungs, were recorded 12 +/- 1 weeks later, and mean values were calculated for each group. Results showed that transplantation of an immature whole lung resulted in abnormal dynamic airway resistance to airflow, which was not seen in the mature lobar transplants. In addition, compliance was impaired most significantly in the immature whole lung transplants. We conclude that in this experimental model of pediatric lung transplantation, transplantation of a mature lobar segment results in superior long-term airway function when compared with immature whole lung transplants.

Age Factors↗
PubMed1993

Acetylcholine-induced constriction of angiographically normal coronary arteries is not time dependent in transplant recipients. Effects of stepwise infusion at 1, 6, 12 and more than 24 months after transplantation.

OBJECTIVES: The aim of this study was to evaluate whether acetylcholine may be a useful tool for detection of early angiographically undetectable coronary atherosclerosis in heart transplant recipients. BACKGROUND: Coronary artery disease is the main determinant of long-term prognosis in transplant recipients. Acetylcholine-induced constriction of angiographically normal coronary arteries in heart transplant recipients could be due to early atherosclerosis, and acetylcholine has been proposed for early detection of coronary artery disease. METHODS: The responses of large coronary arteries to stepwise intracoronary infusion of acetylcholine (10(-8) to 10(-5) mol/liter) were compared in five control subjects and in four groups of transplant recipients 1, 6, 12 and > 24 months postoperatively (group 1, n = 6; group 2, n = 7; group 3, n = 6; group 4, n = 6, respectively). All patients had normal coronary arteriographic findings. Vessel dimensions were measured in four segments in each patient. RESULTS: In control subjects, acetylcholine increased diameters significantly at 10(-8), 10(-7) and 10(-6) mol/liter (all p < 0.001 vs. basal value). No significant variation was observed at 10(-5) mol/liter. Intracoronary isosorbide dinitrate increased diameters of all segments (p < 0.001). In transplant recipients, vessel diameters did not vary significantly from baseline at 10(-8) and 10(-7) mol/liter concentrations in groups 1 and 3 and at 10(-8) mol/liter in group 4. Vessels constricted significantly in all the other cases. Comparisons of each group with control subjects showed that responses were significantly different for all concentrations but 10(-8) mol/liter in groups 3 and 4. Intracoronary isosorbide dinitrate elicited coronary vasodilation similar to that of control subjects in all groups of transplant recipients. CONCLUSIONS: This study indicates that the acetylcholine response is persistently abnormal in transplant recipients compared with that in normal control subjects and that this abnormality may not be related simply to the presence of atherosclerosis. Thus, acetylcholine may not be a useful tool for early detection of coronary atherosclerosis in heart transplant recipients.

Acetylcholine↗
PubMed1995

Urgent heart transplantation in patients with previous sternotomies. Cardiac Transplant Team.

Critically ill patient status and prior sternotomy have separately been associated with increased risk of mortality and morbidity after heart transplantation. Consequently, the justification of assigning urgent priority for transplantation to critically ill patients with prior sternotomy may be arguable. The authors therefore undertook a retrospective analysis to evaluate the outcome of urgent and elective heart transplantation in 64 patients who had undergone one to four previous sternotomies. Patients in group 1 (n = 23) were critically ill and underwent urgent heart transplantation. Group 2 (n = 41) consisted of more stable patients who received heart transplantation as an elective procedure. Intravenous inotropes or mechanical circulatory support were required by all patients in group 1 but by none in group 2. The mortality rate within 30 days post-transplant was higher in group 1 than in group 2 (22% versus 10%), though the difference was not statistically significant. The 1-year actuarial allograft survival was similar between the two groups (72% versus 74%). In addition, there was no significant difference between groups 1 and 2 in the incidence of postoperative coagulopathy (57% versus 42%), re-exploration (13% versus 15%), early infections (57% versus 49%), renal failure (17% versus 10%) or rejection episodes in the first 3 months (65% versus 78%). The authors' findings suggest that despite higher operative mortality in critically ill patients with previous sternotomies, the intermediate-term outcome of heart transplantation in these patients is similar to that in more stable patients. Critically ill patients with prior sternotomies should therefore continue to be considered for urgent heart transplantation.

Cause of Death↗
PubMed2004

Is severe right ventricular failure in left ventricular assist device recipients a risk factor for unsuccessful bridging to transplant and post-transplant mortality.

BACKGROUND: Bridging to transplant with a left ventricular assist device (LVAD) can be limited by severe right ventricular failure (RVF). The focus of this study was to ascertain whether early implantation (< 24 hours) of a right ventricular assist device (RVAD) in patients with severe RVF improved survival and whether severe RVF adversely affected post-transplant survival. METHODS: We conducted a 10-year review of our bridge to transplant experience using the Heartmate device (Thoratec, Pleasanton, CA, USA), studying patients who required an Abiomed RVAD (Abiomed, Danvers, MA, USA). RESULTS: There were 243 patients who underwent LVAD implantation, of which 17 (7.0%) required an RVAD. Ten patients underwent early RVAD insertion (< 24 hours) while 7 underwent delayed insertion (> 24 hours). Bridging to transplant was successful in 11 (64.7%) RVAD patients versus 163 (72.1%) non-RVAD patients (p = 0.046). Of the 10 patients who underwent early RVAD insertion, 7 (70.0%) were successfully bridged. Of the 7 patients who underwent delayed RVAD insertion, 4 (57.1%) were successfully bridged (p < 0.001). There was no significant difference in post-transplant 1, 5, and 10-year survival between RVAD and non-RVAD patients (71.4%, 71.4%, and 71.4% for RVAD patients, vs 90.5%, 80.4%, and 78.5%, respectively, for non-RVAD patients; p = 0.366). Pretransplant RVAD support was not a risk factor for post-transplant mortality (p = 0.864). CONCLUSIONS: Severe RVF adversely impacted bridging to transplant, although survival was improved with early RVAD insertion. The trend toward worse post-transplant survival in the RVAD cohort raises the possibility that if additional patients were evaluated, a difference in survival might be observed, suggesting the need for a multicenter analysis.

Female↗
PubMed2005

Best single time points as surrogates to the tacrolimus and mycophenolic acid area under the curve in adult liver transplant patients beyond 12 months of transplantation.

BACKGROUND: Tacrolimus and mycophenolate mofetil (MMF) are immunosuppressive agents used for the prevention of allograft rejection in liver transplant recipients. Therapeutic drug monitoring (TDM) of tacrolimus is routinely performed using the trough (predose; time 0) plasma drug concentration (C0). In kidney and heart transplant recipients, TDM of MMF has proved to be effective in preventing acute rejection. Some studies have shown that C0 is a poor predictor of drug exposure (represented by AUC), and that concentrations measured after dosing may have a stronger correlation with AUC. However, routine TDM of MMF has not been widely accepted and dose adjustments are usually performed based on adverse effects. OBJECTIVE: The aim of the present study was to determine whether plasma drug concentrations measured after dosing would be better correlated with the tacrolimus and mycoplasmic acid (MPA) (the active metabolite of MMF) AUC(0-12) values compared with C0 in liver transplant recipients > or = 12 months after transplantation. METHODS: This study was conducted at the Multi-Organ Transplant Program research suite, Royal Victoria Hospital, McGill University Health Center, Montréal, Quebéc, Canada. Liver transplant recipients aged > or = 18 years receiving tacrolimus and MMF > or = 12 months after transplantation were enrolled. The plasma tacrolimus and MPA concentrations were measured before the first morning dose (C0) and at 30 minutes (MPA only) and 1, 2, 3, 4, 6, 8, and 12 hours after the first morning dose (C(30 min), C1, C2, C3, C4, C6, C8, and C12, respectively). RESULTS: The study population consisted of 14 patients (7 women, 7 men; mean [SD] age, 57 [16] years; mean [SD] body weight, 75.4 [20.7] kg [range, 44-107 kg]; mean time posttransplant, 42 [30] months). All postdose concentrations (except C(30 min) [MPA]) were better correlated with AUC(0-12) values for tacrolimus and MPA compared with C0. For tacrolimus, the correlations of C0, C2, C3, and C4 with AUC(0-12) were 0.67, 0.83, 0.84, and 0.88, respectively, and for MPA, they were 0.46, 0.73, 0.69, and 0.68, respectively. For tacrolimus, the concentration best correlated with AUC(0-12) was C4. For MPA, the concentration best correlated with AUC(0-12) was C8. CONCLUSION: This study in adult liver transplant recipients suggests that for both tacrolimus and MPA, C2, C3, and C4 are better surrogates of AUC(0-12) compared with C0.

Enzyme Inhibitors↗
PubMed2004

Characteristics and outcomes of patients bridged to cardiac transplantation on centrifugal ventricular assist devices: a case series of the early experience of one Canadian transplant centre.

BACKGROUND: Centrifugal ventricular assist devices (VADs) have been used successfully to bridge patients in cardiogenic shock to cardiac transplantation, though complications are frequent and often life-threatening. PURPOSE: To describe characteristics and examine outcomes of patients bridged to cardiac transplantation on centrifugal VADs. METHODS: A retrospective health record review was conducted on all adults over a 12 year period (N=20) placed on centrifugal VADs with the intent to bridge to cardiac transplantation at a major Canadian transplant centre. RESULTS: Complications of VAD support necessitated removal of 12 patients from the transplant list; seven (35%) survived to cardiac transplantation. Of the seven recipients, five survived to discharge and four remain alive and well. CONCLUSIONS: Bridging patients on centrifugal VADs to cardiac transplantation requires improvement, including maintaining patient stability during the period of early VAD institution, aggressively managing complications of VAD support, and consideration of long-term pulsatile devices. However, if patients survive to transplantation, good long-term outcomes are expected.

Adult↗
PubMed2006

A new model for limbal transplantation using E-GFP for follow-up of transplant survival.

Limbal transplants in humans show a high rate of rejection even under local and systemic immunotherapy. In order to test immunomodulatory treatments a new limbal transplant model in the rat was developed using enhanced green fluorescent protein (E-GFP) as marker for follow-up. Sixty E-GFP-positive limbal transplants from Sprague-Dawley TgN(act-EGFP)Osb4 rats were transplanted onto 18 wild-type inbred Sprague-Dawley (isografts) rats, six wild-type litter mate Sprague-Dawley (sibling) rats, 18 Fischer 344 (allografts) rats, and 18 Fischer 344 rats depleted from monocytes and macrophages by subconjunctival treatment with clodronate liposomes. All rats were monitored three times a week with fluorescence microscopy, until fluorescence had disappeared. At postoperative days 6, 9, 12, and 15, three rats of all groups were killed for immunohistochemical analysis of infiltrating cells. Using a modified digital fluorescence microscope, we were able to monitor transplant behavior over time without disturbance of the ocular surface. The average days of rejection were 14 days in the isograft group, the sibling group, and the untreated allograft group. However, the average day of rejection in the allogeneic macrophage-depleted group was 27 days. Marked infiltration of macrophages and lymphocytes was seen in the untreated isografts and allografts. In the clodronate liposome-treated allografts infiltration was minor. A successful new limbal transplant model is described. The transplant can be accurately followed up in vivo by E-GFP labeling of the donor tissue without disturbing the corneal surface. Although E-GFP itself proved to be immunogenic, local clodronate liposome injections significantly increased graft survival. So the model seems to be useful for testing immunosuppressive or modulatory agents in limbal transplantation studies.

Animals↗
PubMed2005

Combining transfusion of stem/progenitor cells into the peripheral circulation with localized transplantation in situ at the site of tissue/organ damage: a possible strategy to optimize the efficacy of stem cell transplantation therapy.

Several studies have demonstrated the efficacy of localized in situ transplantation of stem/progenitor cells for tissue/organ regeneration. However, the possible limitations of such an approach have largely been overlooked. This is contrary to the intrinsic physiological process of tissue/organ regeneration in vivo, which is thought to involve the mobilization of stem/progenitor cells resident within the tissue/organ itself, as well as from ectopic sites, in particular the bone marrow. Signaling pathways and other molecular processes within stem/progenitor cells transplanted in situ may not be primed to achieve optimal tissue/organ regeneration, and may even be confused by the sudden rapid transition in the cellular microenvironment encountered during transplantation. To overcome these putative limitations, a possible strategy may be to combine transfusion of stem/progenitor cells into the peripheral circulation with localized transplantation in situ at the site of tissue/organ damage. This could better replicate the natural physiological process of tissue/organ repair in vivo. Possible synergistic interactions between the transplanted stem/progenitor cells in situ with migratory transfused cells from the peripheral circulation may further enhance tissue/organ regeneration. The transfused stem/progenitor cells may be induced to home in on a damaged tissue/organ, via the controlled release of specific cytokines or chemokines (i.e., SDF-1) emanating from that particular tissue/organ. There are a number of possible ways to achieve this. For example, the transplanted cells may be delivered on tissue-engineered scaffolds that are designed for the controlled release of specific homing factors such as SDF-1. Another alternative may be to stimulate or genetically modulate the transplanted cells to copiously secrete homing factors such as SDF-1, to encourage the migration and homing of transfused cells within the peripheral circulation. At the same time, it may also be advantageous to pre-stimulate the transfused cells to strongly express surface receptors specific to homing factors such as SDF-1, in particular CXCR-4. More rigorous investigations should be carried out on the possible strategy of combining in situ transplantation of stem/progenitor cells with transfusion into the peripheral circulation, together with induced homing of the transfused cells to the site of organ/tissue damage. This may possibly result in better efficacy for some, but not all models of tissue/organ regeneration.

Animals↗
PubMed2003

Plasma tissue-type plasminogen activator, fibrinogen, and time on dialysis prior to transplantation are related to carotid intima media thickness in renal transplant recipients.

The majority of deaths among patients after renal transplantation is attributed to cardiovascular disease (CVD). Intima media thickness (IMT) of the common carotid artery is related to coronary and cerebrovascular arterial disease. One of the major causes of death due to CVD is acute coronary syndrome, which is precipitated by coronary plaque rupture and subsequent thrombosis. The aim of the study was to evaluate associations between some fibrinolytic factors: antigens of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), and thrombin-activatable fibrinolysis inhibitor (TAFI), and IMT in a population of renal transplant recipients. The study was performed on 33 Caucasian, clinically stable kidney transplant recipients (11 women, mean age 43 years, range 26 to 62 years). All the patients were on triple immunosuppressive regimen (cyclosporine, prednisone, and azathioprine) and had stable graft function (serum creatinine 1.7 +/- 0.7 mg/dL). The mean time since transplantation was 49.9 months (range 4.1 to 131.8 months). In univariate analysis IMT correlated significantly with age (r =.5; P =.001), pulse pressure (PP) (r =.4; P =.05), time on dialysis prior to transplantation (r =.6; P =.001), fibrinogen (r =.4; P =.02), and t-PA (r =.6; P =.001). Multiple regression analysis showed that t-PA antigen concentration (P =.001), fibrinogen (P <.05), and time on dialysis prior to transplantation (P <.05) were positive independent predictors of IMT. These data support the concept of the coincidence of disturbances in fibrinolysis and arterial remodelling in patients after kidney transplantation. On the other hand the study shows that the duration of dialysis therapy before transplantation is detrimental to the arterial vasculature.

Adult↗
PubMed2004

Exchange kidney transplantation: a good solution in living kidney transplantation.

OBJECTIVES: Kidney transplantation seems to be the best treatment modality for end-stage renal disease patients. But not every patient on the waiting list is able to find a kidney. To increase transplantations, centers have tried to find new options. MATERIAL AND METHODS: In the period of November 1994 through June 2004, among 265 renal transplantations, 182 (68.6%) were from living related donors, namely first- and second-degree relatives, spouses, or parents-in-law of the patients. Four patients, who did not have living related donors, had the opportunity of renal transplantation from living donors by exchanging their donors. RESULTS: All the kidneys functioned immediately. No complications and no acute rejection episodes were observed in the postoperative period up to 12 months. Serum creatinine levels were 1.9, 1.2, 1.6, and 2.4 mg/dL on postoperative day 7; 1.4, 1.0, 1.1, and 1.1 mg/dL at 1 month after transplantation; 1.5 and 1.2 mg/dL at month 6 after transplantation; 1.6 and 1.4 mg/dL at 1 year after transplantation. CONCLUSION: We believe that exchange kidney transplantations represent a good alternative for end-stage renal patients who do not have suitable close living related donors.

Adult↗
PubMed2005

Use of extended right grafts from in situ split livers in adult liver transplantation: a comparison with whole-liver transplants.

INTRODUCTION: We report our experience of in situ split-liver transplantation (SLT) for adult patients and compare the results with those achieved with whole-liver transplantation (WLT). METHOD: From November 1997 to December 2003, 109 liver transplantation were performed in 104 adult patients including 90 WLT (83%) and 19 SLT (17%) grafts. Fifteen extended right grafts (ERG, segments I + IV to VIII) were obtained with in situ split-liver procedures, generating also left lateral segment grafts, which were transplanted at our institution or elsewhere. Four left lobe (LL, segments I to IV) and right lobe (segments V to VIII) grafts were obtained by a modified in situ procedure for adult recipients. UNOS status, percentage of primary or secondary transplantation, and underlying liver disease were similar among patients receiving whole versus split grafts. Donors were older in whole than ERG cohorts (53 vs 26 years, P < .001). Procurement parameters and intraoperative profiles of transplant procedure were comparable among the groups. RESULTS: Median follow-up was 18 months (range: 1 to 73). Four patients with whole (4%) and no patient with ERG underwent retransplantation (P = NS). One- and 3-year patient survivals were 86% and 79% with WLT versus 93% and 93% with ERG (P = NS). One- and 3-year graft survivals were 84% and 75% with WLT versus 93%, and 93% with ERG (P = NS). Incidence of vascular complications was 8% with WLT, 13% with ERG (P = NS). The incidence of biliary complications was 13% in WLT, 27% in ERG (P = NS). CONCLUSIONS: The use of ERG from in situ split livers for adult transplantation allowed us to obtain results comparable or even better than those obtained with WLT. Split-liver transplantation is an effective, safe mechanism to expand the cadaveric donor pool.

Adult↗
PubMedDate not supplied

Donor characteristics can influence transplant activities and the access to transplant for some age groups.

In recent years Italy has experienced a remarkable increase in organ donation and transplant rates for kidney transplantation. The organ donation rate has placed Italy among the European leaders, but a careful comparative evaluation of Italian and international registries data demonstrates that renal transplantations have not shared the same significant growth. In a decisive way donor characteristics have influenced not only the number of renal transplantations, but also the access to transplant for some age groups. We investigated the probability of transplantation from different age groups using the Kaplan-Meier method and the log-rank test. The 7-year probability of transplant was 72% for the 15 to 45 age group, 85.7% for the 46 to 55 age group, and 88.5% for the over 55 years group (P = .0029). Ethical considerations suggest new approaches of innovative promotion of living donor transplants and a revision of organ allocation criteria.

Adolescent↗
PubMed2005

Quality evaluation of solid organ transplant in Italy for the period 2000 to 2002 data from the national transplant center.

BACKGROUND: As part of the increased need for transparency and disclosure of information in health care, the Italian Minister of Health has commissioned the Superior Institute of Health to study health outcomes for several procedures, among which is solid organ transplants. We herein report the results of a quality evaluation of solid organ transplants and on the relationship between hospital volume of activity and outcomes, using the data routinely collected by the National Transplant Center during the period 2000 to 2002. METHODS: We collected and analyzed all the information on solid organ transplants between 2000 and 2002, along with clinical information before and after transplant. Multivariate survival analysis was performed to adjust the follow-up data for the complexity of the cases. Correlation graphs are presented that assess the association between the number of transplants and the adjusted 1-year survival of both the organ and the patient. RESULTS: One-year survival was 92.4% for kidney, 77.8% for liver, and 83.9% for heart. Patient survival was 97.0%, 84.1%, and 83.9%, respectively. A negative correlation was observed between the number of transplants performed by each center and 1-year survival of the organ. CONCLUSIONS: Our study indicated that survival after organ transplants in Italy is good and that hospital quality, indirectly measured through survival, overlaps that observed in other Western countries.

Humans↗
PubMed2006

Varicella zoster virus serostatus before and after kidney transplantation, and vaccination of adult kidney transplant candidates.

In recent years we observed 3 lethal primary varicella infections in adult kidney transplant recipients. Therefore, we wondered how many of our adult renal transplant patients were not protected against varicella zoster virus (VZV), and therefore were at risk for such a primary infection. We also studied the prevalence of VZV seronegativity in the adult patients on our waitlist for kidney transplantation. Finally, we vaccinated these seronegative patients with an attenuated live vaccine. Sera were obtained from 854 transplanted patients, and from 286 candidates on the waitlist for kidney transplantation. We observed that 2.1% of our renal transplant recipients and 3.2% of the patients on the waitlist were seronegative for VZV. We vaccinated 11 seronegative patients on the waitlist twice without side effects. In 7 of 11 patients this resulted in a positive serologic response. In conclusion, the prevalence of VZV seronegativity was low both in renal transplant recipients (2%) and in patients on the waitlist (3%). Vaccination of transplant candidates resulted in a moderate efficiency of 64%.

Adolescent↗
PubMed1999

Transplantation of CD34 human cells into mice with severe combined immunodeficiency results in functional T cells 4 weeks after transplantation.

OBJECTIVE: Our purpose was to determine whether transplantation of fetal human CD34(+) cells into mice with severe combined immunodeficiency results in functional T cells. STUDY DESIGN: The cells used in this study were isolated from fetal human liver tissue obtained after elective termination of normal 18- to 24-week pregnancies. Women with medical conditions that could confound the outcome were excluded. Cells were labeled with fluorochrome-conjugated antibodies that recognized CD34 or other cell surface antigens. The cells were then sorted with the use of a fluorescein-activated cell sorter. The human sorted cells were injected intraperitoneally in mice with severe combined immunodeficiency. Four groups of mice were studied: group 1, injected with 10(5) CD34(+) cells (n = 17); group 2, injected with 10(5) CD34(-) cells (n = 14); group 3, injected with 10(6) unsorted cells (n = 19); and group 4, sham-injected with phosphate-buffered saline solution as controls (n = 14). At 1, 2, and 4 weeks after transplantation, the peripheral blood monocytes of the study mice were analyzed for functional T cells. Aliquots of cells (10(5)) were incubated for 48 hours with 0, 5, 10, and 20 micrograms of phytohemagglutinin. Thereafter the cells were treated with 1 microCi of tritiated thymidine. Subsequently the incorporation of tritiated thymidine was determined by liquid scintillation counting. RESULTS: Cells from mice transplanted with either unsorted cells, sorted CD34(+) cells, or CD34(-) cells showed a response to phytohemagglutinin that varied with time and with the mitogen concentration. Even though unsorted fetal human liver cells had a maximal response at 2 weeks, this posttransplantation response was not statistically significant. CD34(+) cell response to phytohemagglutinin was significant at 4 weeks after transplantation. CD34(-) cells also had a peripheral blood cell response at 4 weeks after transplantation; however, this response was not statistically significant. In addition, all mice transplanted with fetal human liver cells had some functional T cells at 4 weeks; however, this response was statistically significant only for CD34(+) cells. CONCLUSION: Transplantation of either sorted CD34 (positive or negative) cells or unsorted fetal human liver cell preparations into mice with severe combined immunodeficiency results in functional T cells. However, only the mice with transplanted CD34(+) cells demonstrated a statistically significant response.

Animals↗
PubMed2003

Predictors of mortality following heart transplantation: Spanish Registry of Heart Transplantation 1984-2001.

UNLABELLED: Because the number of heart transplants performed at each center is rather low, multicenter registries are designed to analyze a large number of transplants to draw reliable conclusions. OBJECTIVE: To determine the factors associated with early and late mortality following heart transplantation. MATERIALS AND METHODS: All heart transplants performed in Spain since the start of transplant activity (May 1984) to December 31, 2001 were subjected to multivariate test using Cox regression in blocks of variables grouped into donor, recipient, immunosuppression, surgical and follow-up variables (a total of 111 metrics). RESULTS: Among the 3786 transplants early survival at 30 days after transplant was 86%, while survivals at 1, 5, and 10 years were 76%, 63%, and 50%. Variables associated with early mortality included acute graft failure, pulmonary vascular resistance >2.5 Wood Units (WU), prior thoracic surgery, respiratory obstruction, donor treatment with dobutamine, ventricular assistance, hepatic and/or renal dysfunction, hyperuricemia, mechanical ventilation, prior infection, duration of ischemia and/or extracorporeal circulation >4 hours. Variables associated with late mortality were: acute graft failure, graft vascular disease, tumors, rejection, infection, dialysis, and hypertension. CONCLUSIONS: Multicenter records provide reliable information on heart transplants in our country, revealing factors associated with mortality for future solutions.

Cause of Death↗
PubMedDate not supplied

Symptom experiences of lung transplant recipients: comparisons across gender, pretransplantation diagnosis, and type of transplantation.

PURPOSES: To investigate symptom experiences of patients who have single and bilateral-sequential lung transplantation and to determine whether differences exist according to gender, pretransplantation diagnosis, and type of transplantation procedure. DESIGN AND METHODS: In the context of a descriptive, comparative survey design, surviving recipients of single and bilateral-sequential lung transplants (n = 56) were mailed a symptom frequency and distress questionnaire. The response rate was 85.7% (n = 48). The average time since the recipients' lung transplantations was 1.5 +/- 0.7 years. RESULTS: Recipients of lung transplants reported that several symptoms (eg, muscle weakness, shortness of breath with activity, and changed appearance) were both frequently occurring and quite distressing. Other symptoms were identified as being distressing, but not frequently occurring, or vice versa. Significant (P <.05) differences were found for symptom experiences among pretransplant diagnostic groups and between genders and types of transplant procedures. CONCLUSIONS: These findings elucidate the symptom experiences of recipients of lung transplants and suggest that subgroup differences exist. The data provide a basis for strengthening patient and family education and for developing symptom management strategies. Further investigation of the symptom experiences of the recipients of lung transplants is needed, especially in relation to subgroups.

Case-Control Studies↗