Transplantation proceedings
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Primary graft failure (PGF) is a severe complication responsible for 42% of the in-hospital mortality after heart transplantation. It has been postulated that once 30-day survival is achieved, patients with PGF have no increased risk of death. Levosimendan increases the 30-day survival among patients with PGF. Herein we have reported a 3-year follow-up at a single center of a patient cohort including PGF cases treated with levosimendan. ⋯ Although treatment of PGF with levosimendan increased the 30-day survival, the 1 year and 3-year rates were reduced among this cohort of patients. PGF was associated with poor long-term outcomes, which may be a consequence of systemic malperfusion during the stage of cardiac low-output after transplantation.
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Viral, bacterial, parasitic, prion, and fungal infections, although uncommon, have been transmitted via organ and tissue allografts. Improved screening techniques for infectious diseases in organ donors have helped to reduce disease transmission. Reports of clusters of donor-derived infections illustrate the need to improve the screening of tissue and organ donors. ⋯ Nucleic acid testing may reduce the risk of disease transmission by detecting early-stage infection, including those from human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in the "window" period before antibody seroconversion can be documented. Screening of organ donors for potential pathogens cannot completely exclude the risk of disease transmission. The process of donor screening must continue to evolve with advances in diagnostic technologies for infectious diseases.
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Unlike other areas in renal transplantation, delayed graft function (DGF) remains an apparently unavoidable complication owing to the characteristics of current donors. The aim of this study was to analyze risk factors for DGF in relation to graft and patient survivals. We retrospectively analyzed 507 renal transplant recipients with a median follow-up of 74.83 ± 45.06 months. ⋯ Graft (81% vs 88%; P = .00) and patient (89% vs 95%; P = .00) survivals at 5 years were lower among the DGF group. In conclusion, DGF which was associated with factors related to the donor, the recipient, and the surgical times, produced worse graft and patient survivals. Shortening the cold ischemia time seems to be a modifiable variable to reduce DGF.
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Central pontine myelinolysis (CPM) may be more prevalent after liver transplantation (OLT). Central pontine and extrapontine myelinolysis (CPEM) is rare. ⋯ No abnormalities were detected in immunosuppressive drug blood levels. The aim of this paper was to report our experience with CPEM among LT patients.
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High levels of lactate are associated with tissue hypoperfusion during cardiac surgery resulting in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass (CBP). Our goal was to evaluate the change in lactate levels during CBP for their possible predictive value for complications after heart transplant surgery. ⋯ Hyperlactemia above certain levels occurring during CPB serve as a biomarker to identify early postoperative morbidity and mortality.