Transplantation proceedings
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Delays in diagnosis of brain death have definite consequences for the organ retrieval and transplantation process. It is advisable to use accurate diagnostic methods. Transcranial Doppler sonography is a well-accepted technique for diagnosing cerebral circulatory arrest. ⋯ In 39 patients the usual protocol of insonation (temporal window and foramen magnum window) was sufficient to demonstrate cerebral circulatory arrest. In 10 patients, including all the cases in which it was impossible to use a temporal approach, the carotid siphon was successfully insonated, showing in all the cases the existence of a sonographic pattern compatible with cerebral circulatory arrest. It may be concluded that the use of an orbital window for exploring intracranial circulation by transcranial Doppler sonography can be a useful tool in cases of difficult sonic windows.
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Since cadaveric donation is the main source of organs for transplantation in many countries, the diagnosis of brain death is an important issue. The cessation of cerebral circulation is one phenomenon closely related to brain death. Transcranial Doppler sonography is one of the accepted techniques to establish cessation of cerebral circulation. ⋯ In all the cases the insonation of the arteries of the base of the skull was performed. In supratentorial lesions, the predominant pattern was a reverberating flow, while in infratentorial lesions systolic spikes pattern was most frequent. Our study showed a high sensitivity of transcranial Doppler sonography for the diagnosis of brain death and the existence of different mechanisms of cerebral circulatory arrest depending on the location of the intracranial pressure wedge.
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Improvements in perioperative care, namely, organ preservation solutions, immunosuppression, and increased experience of surgical, anesthetic, and intensive care teams, have contributed to the success of pancreas transplantation. The objective of this study was to present data on anesthesia for pancreas transplantation alone (PTA) or simultaneous with kidney (SPKT), evaluating crystalloid, albumin and blood component infusions, graft ischemic times, and weights and ages of recipient. We evaluated patients undergoing SPKT (n=73), PTA (n=49), or SPKT with kidney living donor (n=8). ⋯ There were no other complications related to anesthesia in any patient. Although it is a high-risk surgery, PTA or SPKT is routine in our practice. Adequate perioperative care is important not only for the safety of the procedure but also for graft viability, contributing to a promising long-term treatment of insulin-dependent diabetic patients.
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As bone marrow transplantation (BMT) increases, the availability of suitable donors becomes critical, especially for African Americans, who require a large donor pool to find a suitable match. Previous studies indicated willingness to donate marrow may be a barrier for achieving a large donor pool. ⋯ Our study suggests reported lack of general willingness does not explain the racial disparities in BMT. Many who expressed willingness to donate were not willing to be contacted to sign up for the registry, especially African Americans. Education and adequate pain control may improve minority recruitment.
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Simultaneous hepatic artery and portal vein thrombosis rarely occurs after liver transplantation. The etiology is unknown. Of 213 patients (72 children and 141 adults) that underwent living donor liver transplantation (LDLT) from January 1996 to March 2003, 4 (2%) developed simultaneous thrombosis at 3 hours to 7 days (median, 4 days) after the operation. ⋯ Portal vein, hepatic artery, and hepatic vein velocity in the liver graft were measured every 12 hours by Doppler ultrasonography for 2 weeks after liver transplantation. These parameters were stable until just before the simultaneous thrombosis. These findings indicate that protocol Doppler ultrasonography can diagnose, but not predict, this fatal complication.