Transplantation proceedings
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Comparative Study
Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support.
The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support. ⋯ In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients.
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During the two last decades remarkable progress has been made among transplantations in Greece. However, organ donation remains a controversial issue. ⋯ Despite knowledge and willingness regarding organ donation, only a small percentage of Greeks are actually registered to be donors.
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Brain death (BD) is defined as the total irreversible loss of brain stem function. According to the Greek legislation, BD diagnosis is based on clinical criteria that test brain stem function. Bispectral Index Scale (BIS), a parameter derived from a mathematical analysis of the electroengephalogram depicts brain activity. The aim of our study was to record BIS alterations in brain-dead patients. ⋯ BIS is a noninvasive, easily interpreted method to monitor cerebral activity. According to our results, BIS could be helpful in BD confirmation but cannot replace the valid clinical tests, which are consistent with Greek legislation for this diagnosis.
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The postoperative period following lung transplantation remains critical because of several complications. Infection, primary graft failure, acute rejection, and surgical complications are risk factors for mortality and morbidity. The recognition and early treatment of these complications is important to optimize outcomes. ⋯ CB data were biased because we selected the worst case patients. Donor age and high inotrope requirements in the ICU have been reported previously to be prognostic factors for poor graft function. We believe that control of these variables may improve outcomes.
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Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. ⋯ Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted.