Transplantation proceedings
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There is an increasing demand for lung transplantation in patients in advanced respiratory failure. Although many of these patients do not require mechanical ventilation or extracorporeal membrane oxygenation, an increasing number are critically ill. In this single-center study, we have analyzed our experience with lung transplantation in subjects who were inpatients at the time of their transplant and not expected to survive to discharge. ⋯ Lung transplantation in critically ill inpatients, although associated with a survival advantage compared to not transplanting them, does give poorer survival results compared to postoperative survival in outpatient patients.
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In areas with longer liver transplantation (LT) wait times, liver resection (LR) offers an appropriate alternative in selected patients with hepatocellular carcinoma (HCC). We identified adults with HCC undergoing LT or LR from the United States Nationwide Inpatient Sample from 1998-2008. United Network for Organ Sharing regions were assigned lower rank indicating shorter wait time for patients with Model for End-Stage Liver Disease (MELD) scores of 19-24 or ≥ 25. ⋯ When ranked by wait times for MELD 19-24, the 3rd, 8th, and 11th ranked regions had decreased odds of LR versus LT (region 3: odds ratio [OR] 0.3, 95% confidence interval [CI] 0.2-0.6; region 8: OR 0.5, 95% CI 0.3-0.9; region 5: OR 0.3, 95% CI 0.2-0.6), whereas the 10th ranked region had increased odds (region 1: OR 1.9, 95% CI 1.1-3.4) compared with the region with the shortest wait time, region 10. When ranked by wait times for MELD ≥25, all regions except the 10th ranked region (region 5) had increased odds compared with the region with the shortest wait time, region 3 (OR 1.6-5.6; P < .001). Regional variations of LT versus LR are not completely explained by transplant wait times.
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Coronary artery disease (CAD) is a common cause of morbidity and mortality in liver transplant (LT) recipients. To date there is no consensus on the preferred screening tests to detect CAD in the pre-LT population. Therefore the aim of this study was to: 1) evaluate the utility of a noninvasive tool (cardiac computerized tomography [CT] scan); and 2) determine the prevalence of CAD in low-risk LT candidates. ⋯ Prevalence of asymptomatic CAD in this low-risk population is relatively high. Cardiac CT is well tolerated and is a useful noninvasive screening tool in LT candidates. Future studies to determine its utility as a prognostic tool after LT will be invaluable.
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Adult respiratory distress syndrome is a severe respiratory failure due to noncardiogenic pulmonary edema with high mortality rates (50-70%). The most common etiology of respiratory distress is sepsis, but it may also be caused by several of the immunosuppressants prescribed in transplantation. In the last year, influenza H1N1 virus infection has become more relevant. ⋯ Empirical treatment was started with 3 doses of 6-methylprednisolone (250 mg), with a favorable response. After 7 days, we received the results of the reverse-transcriptase polymerase chain reaction of a nasal smear and blood culture, which were positive for H1N1 virus. In our knowledge, this is the first reported case of a patient with simultaneous pancreas-kidney transplantation and respiratory distress secondary to H1N1 virus infection who showed a favorable response to corticosteroid therapy.
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Salvage liver transplantation (SLT) has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. However, the survival outcomes and recurrence rates of SLT versus primary liver transplantation (PLT) for HCC remain controversial. Here we sought to compare the short- and long-term outcomes after SLT and PLT, by conducting a quantitative meta-analysis. ⋯ The current study demonstrates SLT for recurrent HCC is feasible and it can achieve the same short- and long-term outcomes as PLT. Therefore, SLT may be accepted as the treatment of choice for patients with recurrent HCC.