ABSTRACT
Retrograde embolization of atherosclerotic arterial plaque remains a threat at the time of organ perfusion in elderly donors. In order to circumvent this potential procurement complication, we describe a technique with two variations. This technique allows for perfusion with UW solution without having to cannulate through severely atherosclerotic distal aortic walls.
Subject(s)
Aortic Diseases/pathology , Catheterization/methods , Tissue Donors , Tissue and Organ Procurement , Adenosine , Aged , Allopurinol , Aorta, Abdominal , Glutathione , Humans , Insulin , Middle Aged , Organ Preservation Solutions , Perfusion , RaffinoseABSTRACT
Injuries sustained by major vessels during procurement pose a major threat to organ viability. Aortic and inferior vena cava lacerations produce rapid hemorrhage associated with hypoperfusion and ischemic damage. We describe a technique that will prevent such damage in the event of vascular mishaps.
Subject(s)
Aorta, Abdominal/injuries , Catheterization, Peripheral , Intraoperative Complications , Lacerations/therapy , Organ Transplantation/adverse effects , Venae Cavae/injuries , Humans , PerfusionABSTRACT
Piggyback orthotopic liver transplantation (LTx) has permitted the elimination of extra-corporeal venovenous bypass. In some instances, an internal temporary portocaval shunt has to be constructed in order to prevent hemodynamic instability. We describe a technique in which a donor iliac vein graft is used to bridge the distance between the portal vein and vena cava in cases where a direct shunt cannot be constructed. This technique can be applied to liver Tx as well as to liver and small bowel Tx.
Subject(s)
Iliac Vein/transplantation , Intestine, Small/transplantation , Liver Transplantation/methods , Portacaval Shunt, Surgical/methods , HumansSubject(s)
Antihypertensive Agents/therapeutic use , Epoprostenol/therapeutic use , Hypertension, Pulmonary/drug therapy , Liver Failure/surgery , Liver Transplantation/adverse effects , Nitric Oxide/therapeutic use , Vasodilator Agents/therapeutic use , Adult , Feasibility Studies , Humans , Hypertension, Pulmonary/etiology , Liver Failure/complications , Middle AgedSubject(s)
Liver Transplantation/mortality , Adult , Age Distribution , Age Factors , Aged , Cause of Death , Humans , Middle Aged , United States/epidemiologySubject(s)
Liver Transplantation , Lymphoproliferative Disorders , Postoperative Complications , Adolescent , Child , Child, Preschool , Cyclosporine/therapeutic use , Female , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Infant , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/epidemiology , Lymphoproliferative Disorders/therapy , Male , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Tacrolimus/therapeutic use , Treatment OutcomeSubject(s)
Cystic Fibrosis/surgery , Liver Transplantation , Child , Cystic Fibrosis/mortality , Female , Humans , Liver Transplantation/mortality , Male , Prospective StudiesABSTRACT
Post-transplant lymphoproliferative disease remains a complication with a high morbidity and mortality. The present study examined 291 pediatric liver transplants performed in 263 children from October 1984 to December 1999. Post-transplant lymphoproliferative disease has an overall incidence of 12%. Tacrolimus and cyclosporine had a similar incidence of post-transplant lymphoproliferative disease. Fifty-six per cent of patients who developed post-transplant lymphoproliferative disease were Epstein-Barr virus negative at the time of transplantation. Mean time of conversion to Epstein-Barr virus positivity was 1.1 years after liver transplantation. Ten per cent of those who developed post-transplant lymphoproliferative disease never had Epstein-Barr virus detected. Mean time from Epstein-Barr virus positivity to detection of post-transplant lymphoproliferative disease was 2.68 years, and 3.13 years from liver transplantation (OLTx) to post-transplant lymphoproliferative disease. There was a 35% incidence of mortality. Deaths occurred a mean of 0.76 years after diagnosis of post-transplant lymphoproliferative disease. Most cases of post-transplant lymphoproliferative disease had extranodal location. There was one recurrence in 10% of patients, and two in 3%. All recurrent cases were seen in recipients who became Epstein-Barr virus positive after transplantation. There has been a decrease in the incidence of post-transplant lymphoproliferative disease from 15% to 9% to 4%. Post-transplant lymphoproliferative disease should be diagnosed promptly and treated aggressively. The best treatment, however, seems to be prevention, starting in the immediate postoperative period. Survivors should be monitored for both recurrence of post-transplant lymphoproliferative disease and acute cellular rejection.
