Transplantation proceedings
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Comparative Study
Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction.
The decision to perform aortic valve replacement (AVR) or heart transplantation (HTx) for aortic stenosis (AS) with severe left ventricular dysfunction is difficult and may be affected by prior myocardial infarction (MI) and coronary artery disease (CAD). ⋯ In severe AS and LVEF <30% with no concomitant CAD or with CAD requiring one to two bypass grafts, AVR has a survival equal to or exceeding that of HTx. In patients with CAD requiring more than two bypass grafts, survival is significantly reduced, and HTx can be considered.
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Several recent reports demonstrated the usefulness of new biomarkers in early prediction of delayed graft function (DGF) and graft recovery after kidney transplantation (KT). It is unknown, however, whether these biomarkers would predict long-term graft outcome. In this study, we examined whether the biomarkers including neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding protein (L-FABP) can predict 1-year graft outcome as well as short-term graft function especially in patients with early graft function (EGF). ⋯ This study demonstrates the possibility that u-NGAL might be useful in predicting adverse 1-year outcome as well as short-term graft function even in EGF patients.
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Despite an increase in patients with end-stage heart failure, the acceptance rate has been going down in recent years owing to a change in donor demographics. Furthermore, the rate of emergency heart transplantation has progressively increased. The result is an increase in the time awaiting heart transplantation in elective patients and therefore in the risk of sudden death in this population. Implantable cardioverter defibrillators (ICDs) could be a preventive option in these cases. However, indications for the implantation in this population are not well established. ⋯ This study suggests that ICD could reduce the risk of sudden death in patients with LVEF ≤ 30% while awaiting heart transplantation. However, more studies are needed to confirm these results.
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Observational Study
Outcomes in renal transplantation with expanded-criteria donors.
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. In recent years donor criteria have changed to increase the percentage of expanded-criteria donors (ECDs). The aim of this study was to analyze transplants from ECDs obtained at our institution from. 2010 to 2012. We studied the comorbidity of ECD, preimplantation histologic study, renal function, and survival of transplanted grafts. ⋯ We found no differences in graft survival from ECD compared with the control group of standard-criteria donors. The evaluation of grafts from ECD may be a strategy to increase the number of kidney transplants.
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Approaches to preserve renal function after liver transplantation (OLT), such as the delayed use of calcineurin inhibitors (CNI), may reduce the need for postoperative renal replacement therapy (RRT) or simultaneous liver-kidney transplantation (SLK). ⋯ This noninduction, RS protocol is effective in patients not on pre-OLT RRT. Patients on RRT pre-OLT should be considered for more aggressive renal sparing approaches (induction therapy with more delayed CNI initiation or SLK).