ABSTRACT
The cornea is the outermost tissue of the eye and must be transparent to maintain good visual function. Diseases with loss of corneal transparency (ie, corneal blindness) account for 10% of blindness worldwide. The treatment of this condition is only possible with corneal transplant from corneal tissue obtained from deceased donors. More than 10 million people worldwide have corneal blindness, but the annual number of available corneal transplants is only 185 000. Accordingly, it is obvious that the quantity of available donor tissue does not meet the need, with nearly 70 candidates on the wait list for each available corneal transplant. Rapid identification of appropriate recipients has become a crucial element in the field of corneal transplantation. There is a similar urgency (and scarcity) in other solid-organ donation programs, most of which have an established set of selection parameters (such as blood enzyme levels) that are easily defined and measurable. However, in the case of corneal transplant, there is presently no worldwide consensus on such selection criteria. The corneal transplant wait lists are long. The selection of appropriate recipients from these wait list candidates is managed by a designated authority (the authorized recipient selection operator) informed by the literature and the characteristics of the recipient within a framework of generally accepted, but variable, guidelines. The decision process is encumbered to a degree proportionate to the length of the wait list. In this review, we focus on solutions documented in the literature for selection of appropriate corneal recipients from transplant wait lists.
ABSTRACT
OBJECTIVE: Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. BACKGROUND: The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality. METHOD: Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR. RESULTS: The mean age was 30.5 ± 5.6 years, and the mean LVEF was 28.2% ± 6.7%. In 13(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3 ± 10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9 ± 35.4, 86.4 ± 7.5, p = .003; 86.8 ± 34.6, 52.6 ± 7.6, p = .006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free 1-year survival was 88.9% (event rate 11.1%), and 5-year survival was 75.7% (event rate 24.3%). CONCLUSION: In a retrospective cohort of PPCM patients, 35.7% of patients' LVEF recovered, and the primary end-point of free-5-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.
