Transplantation proceedings
-
Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information. ⋯ The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information.
-
There is good evidence that long-term graft survival is superior when living donors are used for kidney transplantation. Nevertheless, an assessment of potential risks associated with living donation is of particular interest. ⋯ Living donor nephrectomy appears to be an acceptably safe intervention. Despite a reduction in GFR, the postdonation incidence of hypertension was low and proteinuria was not observed in any donor, even among previously hypertensive patients. Rigorous donor follow-up is recommended to identify persons at risk.
-
Case Reports
Anaphylaxis complicating graft reperfusion during orthotopic liver transplantation: a case report.
Hemodynamic instability may occur during liver transplantation especially following unclamping the portal vein. A period of hypotension (postreperfusion syndrome) is usually responsive to treatment with fluids, calcium, sodium bicarbonate, and vasoactive drugs, but if hypotension persists, other causes must be sought out. In this report, we present a case in which anaphylaxis, most likely due to a component of the University of Wisconsin preservation solution, occurred coincident with liver reperfusion and severely exacerbated reperfusion hemodynamic instability. To our knowledge, this is the first report of anaphylaxis at the time of reperfusion and may provide an explanation for cases of vasoplegic syndrome associated with graft reperfusion.
-
Ischemia-reperfusion injury (I/R) has a negative effect on renal allograft survival. Using a rat model of kidney IR injury, we demonstrated inhibition of Toll-like receptor (TLR) 4 with erotoran may shed new light on I/R therapy. ⋯ These data demonstrated that inhibition of TLR4 with eritoran reduced I/R-related inflammatory responses and improved the course of kidney I/R injury.
-
Age is an established predictor of renal failure among recipients of cadaveric transplants; however, the impact of donor age on recipient glomerular filtration rate (GFR) among living donor kidney (LDK) transplantations is not well established. ⋯ Donor age predicts recipient renal function after living kidney transplantation and needs to be evaluated through a larger prospective investigation.