By Niloo M. Edwards, Jonathan M. Chen, Pamela A. Mazzeo
Prime physicians summarize during this easy-to-use and eminently sensible instruction manual the daily administration of transplant donors and recipients at Columbia-Presbyterian scientific middle. themes coated diversity from surgical innovations, pathology, and immunosuppression, to posttransplant administration, pediatric center transplantation, surgical choices, and mechanical circulatory information as a bridge to transplantation. The authors additionally speak about congenital transplant suggestions, cutting-edge perioperative administration suggestions and protocols, and UNOS legislation and nurse coordination.
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Extra info for Cardiac Transplantation (Contemporary Cardiology)
A potential solution is the use of hepatitis C-positive hearts for hepatitis C-positive recipients; however, this generally requires using an alternative list for transplantation, which is discussed later. STRATEGIES TO BROADEN DONOR AVAILABILITY Nonbeating Donors Some enthusiasm has arisen from the liver and kidney procurement literature for organ use from nonbeating donors. Whereas experimental literature suggests that hearts may be harvested as long as 30 min postmortem, this process requires preservation with blood cardioplegia prior to cardiac arrest, the logistics of which in the human condition are unclear (36,37).
Lewandowski and investigators at the University of Michigan compared donor echocardiogram interpretations screened by cardiologists at referring donor hospitals to those of “experts” trained in donor heart selection. In 67 patients, they found poor correlation between two groups: minor abnormalities were 18% sensitive and 75% specific (53% agreement), major abnormalities were 33% sensitive and 94% specific (77% agreement), and the designation “unusable” was 33% sensitive and 96% specific (81% agreement); the recommendation (by the referring cardiologist) to reject a donor based on the echocardiogram was considered inappropriate (by the experts) in two patients (10).
Intravenous immunoglobulin reduces anti-HLA alloreactivity and shortens waiting time to cardiac transplantation in highly sensitized left ventricular assist device recipients. 235. 26. Schuler S, Parnt R, Warnecke H, et al. Extended donor criteria for heart transplantation. J Heart Transplant 1988;7:326–330. 27. Houyel L, Petit J, Nottin R, et al. Adult heart transplantation: adverse role of chronic alcoholism in donors on early graft function. J Heart Lung Transplant 1992;11: 1184–1187. 28. Freimark D, Aleksic I, Trento A, et al.