Lung transplantation with grafts from elderly donors: a single-center experience.

INTRODUCTION: Use of extended criteria donors is one of the strategies to face the scarcity of donors for lung transplantation. METHODS: Between November 2002 and May 2009, we performed 52 LTs in 50 recipients, 10 of whom (group A) received lungs from donors aged 55 years or older (median, 58.5; range, 56-66 years) for comparison with 28 patients (group B) transplanted with lungs from donors younger than 55 years (median, 25.5; range, 15-54 years). We excluded 9 children and 3 recipients of combined liver plus lung transplantations from the study. RESULTS: Recipient age, gender, and indications for transplantation did not differ significantly between the 2 groups. Neither were there significant differences in PaO2/FiO2 ratios before lung retrieval, or length of the ischemic time The first PaO2/FiO2 on arrival to the intensive care unit (ICU) and the median length of ICU stay were similar. All patients, except 2 who died in the operating theatre, were extubated between 3 and 216 hours after the transplantation. Hospital mortality was similar in both groups: 3 patients in group A and 2 in group B (P = .1). The median portions of the predicted 1-second forced expiratory volume (FEV1) at 6 months after transplantation did not differ in the 2 groups: 62.4% in group A versus 70% in group B (P = .85). CONCLUSION: Lung grafts from donors older than 55 years can be effectively used for transplantation, thus increasing the total organ pool.

The relationship of pain and deformity of the rheumatoid foot to gait and an index of functional ambulation.

We evaluated the relationships among pain, structural deformity of the foot, 4 variables of gait, and an index of functional ambulation in 31 patients with rheumatoid arthritis. We saw significant correlations between the ambulation index and all gait variables (p less than 0.005). For the group as a whole, pain in the foot did not correlate with structural deformity. However, when patients were grouped according to the relative preponderance of pain or deformity and duration of disease, we found correlations between the sites of pain and deformity. Pain in the lower extremity, and the knee or hindfoot separately, showed correlations with functional ambulation. Foot deformity did not correlate with functional ambulation at all. Foot pain correlated well with velocity and especially stride length (p less than 0.005), and not as well with cadence and double stance time. Fewer correlations were seen between foot deformity and gait. In general, hindfoot disease was associated with greater impairment of gait and mobility than forefoot disease.