Dataset Information

Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome.

ABSTRACT: BACKGROUND:Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation. METHODS:Consecutive adult cardiac transplantations (2005-2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4-8°C). In 2008, 100?ml crystalloid cardioplegic solution was added and administered immediately before implantation. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome. RESULTS:A total of 81 patients, 44 standard ("Cardio(-)") vs. 37 with additional cardioplegia ("Cardio(+)") were analyzed. Recipients and donors were comparable in both groups. Cardio(+) patients demonstrated a reduced need for defibrillation (24 vs. 48%, p?=?0.03), post-operative ratio of CK-MB/CK (10.1?±?3.9 vs. 13.3?±?4.2%, p?=?0.001), intubation time (2.0?±?1.6 vs. 7.2?±?11.5?days, p?=?0.05), and ICU stay (3.9?±?2.1 vs. 8.5?±?7.8?days, p?=?0.001). Actuarial survival was reduced when graft ischemic time was >180?min in Cardio(-) but not in Cardio(+) patients (p?=?0.033). Organ ischemic time >180?min (OR: 5.48, CI: 1.08-27.75), donor female gender (OR: 5.84, CI: 1.13-33.01), and recipient/donor age >60 (OR: 6.33, CI: 0.86-46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure. CONCLUSION:An additional dose of cardioplegia administered immediately before implantation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia. A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.

SUBMITTER: Tevaearai Stahel HT

PROVIDER: S-EPMC4286961 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome.

Tevaearai Stahel Hendrik T HT Unger Darja D Schmidli Juerg J Gahl Brigitta B Englberger Lars L Kadner Alexander A Eberle Balthasar B Mohacsi Paul P Carrel Thierry P TP

Frontiers in surgery 20141128

<h4>Background</h4>Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation.<h4>Methods</h4>Consecutive adult cardiac transplantations (2005-2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4-8°C). In 2008, 100 ml crystalloid cardioplegic ...[more]

PMID: 25593970

Similar Datasets

Project description:Aim of the study:Living donor liver transplantation (LDLT) is regularly performed in small-sized infants. Computed tomography (CT)-based donor liver volumetry is used to estimate the graft size. The aim of our study was to assess the results of CT liver volumetry and their impact on the clinical outcome after LDLT in extremely small-sized infants. Patients and methods:In this study, we included all patients with a body weight of ?10 kg who underwent living related liver transplantation at our centre between January 2004 and December 2014. In all cases of LDLT, a preoperative CT scan of the donor liver was performed, and the total liver and graft volumes were calculated. The graft shape was estimated by measuring the ventro-dorsal (thickness), cranio-caudal, and transversal (width) diameter of segment II/III. We assessed the impact of CT donor liver volumetry and other risk factors on the outcome, defined as patient and graft survival. Results:In the study period, a total of 48 living related liver transplantations were performed at our centre in infants ?10 kg [20 male (42%), 28 female (58%)]. The mean weight was 7.3 kg (range 4.4-10 kg). Among the recipients, 33 (69%) received primary abdominal closure and 15 (31%) had temporary abdominal closure. The patient and graft survival rates were 85% and 81%, respectively. In CT volumetry, the mean estimated graft volume was 255 mL (range 140-485 mL) and the actual measured mean graft weight was 307 g (range 127-463 g). The mean ventro-dorsal diameter of segment II/III was 6.9 cm (range 4.3-11.2 cm), the mean cranio-caudal diameter was 9 cm (range 5-14 cm), and the mean width was 10.5 cm (range 6-14.7 cm). The mean graft-body weight ratio (GBWR) was 4.38% (range 1.41-8.04%). A high graft weight, a GBWR >4%, and a large ventro-dorsal diameter of segment II/III were risk factors for poorer patient survival. Conclusion:Preoperative assessment of the graft size is a crucial investigation before LDLT. For extremely small-sized recipients, not only the graft weight but also the graft shape seems to affect the outcome.

Project description:BackgroundManagement of patients with oncohaematological disorders such as monoclonal gammopathy of undetermined significance (MGUS) is a frequent problem in pre-transplant work-up. Insights on disease progression and long-term functional outcomes are still lacking in this setting.MethodsThis was a retrospective analysis on all patients with MGUS who underwent kidney transplant (KT) at our centre between 1 January 2000 and 31 December 2017 (cases, n = 65). Patients were matched with a control group (KTs with similar characteristics but without history of haematological disease, controls, n = 1079). Primary endpoints were graft and patient survival; secondary endpoints were causes of graft failure, patient death, occurrence of allograft rejection, post-transplant neoplasia (not correlated to previous disorder) and/or infectious episodes.ResultsThe MGUS and control groups had a similar mean age [60 (29-79) versus 55.2 (19.3-79.5) years, respectively] and percentage of males (69.2% versus 64.6%, respectively). Median follow-up time since KT was 3.5 years (0-14) in cases and 8.3 years (0-14.9) in controls. All MGUS patients underwent KT following extensive multidiscliplinary investigations. No differences were found between cases and controls regarding patient and graft survival or post-transplant complications except for lower incidence of infections (58.7% versus 69.8%, P = 0.019) and increased use of mTOR inhbitors (30.3% versus 14.7%, P = 0.001) in MGUS. MGUS isotype did not influence graft and patient survival. The absence of difference in patients and graft survival was also confirmed in an adjunctive analysis where MGUS were compared with controls (ratio 1:2) matched for recipient age, gender, number of transplantations and transplant period.ConclusionPatients with MGUS may undergo KT without significantly increased risks of complications, provided that appropriate diagnostic procedures are carefully followed. Multidiscipline-based studies are crucial for establishing well designed pre- and post-transplant protocols for the best management of patients with coexisting MGUS and end-stage renal disease.

Dataset Information

Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome.

Publications

Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets