Analysis of organ donors in the peripartum period.

This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.

Cold ischemia and outcome in 17,937 cadaveric kidney transplants.

To determine if cold preservation time continues to affect renal transplant outcome, prospectively collected data from 17,937 cadaveric renal transplants performed between 1982 and 1991 were analyzed. Cold preservation intervals of 1-16, 16-32, 32-48, and greater than 48 hr were studied by multi- and univariate methods for two time periods: 1982-1989 (n = 13,800) and 1990-1991 (n = 4137). The functional one-year graft survival for kidneys stored over different intervals was significantly different (P < 0.001) only for the 1982-1989 epoch: one-year allograft survival ranged from 76% (1-16), to 72% (16-32 and 32-48) to 74% (> 48) hr. One-year graft survival ranged from 81 to 83% for the four preservation times in 1990 through 1991 (P = NS). Overall actuarial graft survival was 76% (74% prior to 1990, and 82% after 1990). Factors significantly (P < 0.0001) affecting kidney transplant outcome before and after 1990 were delayed graft function (DGF): n = 4232, 65% one-year graft survival; retransplant status: n = 3029, 67% one-year graft survival; and HLA match at three or more loci: n = 6067, 79% one-year graft survival. While DGF occurred more often with prolonged preservation, kidneys with DGF had similar survival regardless of preservation duration. Before 1990, pretransplant transfusion was associated with better and black recipient race with worse outcome; neither transfusion nor recipient race had any effect after 1990. Patients receiving kidneys preserved for longer periods demonstrate one-year graft survival comparable to kidneys preserved for shorter periods. Prolonged cold ischemic time should no longer be a principal reason for considering organ discard.

The optimal treatment of lymphoceles following renal transplantation.

Lymphoceles are well-recognized complications following kidney transplantation. The authors describe their experience with the treatment of eight clinically significant lymphoceles (incidence 2.7%). In seven patients percutaneous needle aspiration was attempted, often repeatedly, both for diagnostic and therapeutic purposes. In all of the patients the lymphocele recurred within days and internal marsupialization was therefore performed, in the last two patients utilizing minimal access surgery through laparoscopy. There were no postoperative complications or signs of a recurrence of the lymphocele. Patients following the laparoscopic marsupialization had a much briefer hospital stay and postoperative convalescence. Our results confirm that internal marsupialization is the procedure of choice for most post-transplant lymphoceles. Internal marsupialization through laparoscopy should be used in patients who meet the standard criteria for laparoscopy.

Transplantation in the military: state of the art--a progress report from the Army-Navy Transplant Program.

The commitment to clinical transplantation services by the Army and Navy is now in its third decade. Located at the Walter Reed Army Medical Center, the Army-Navy Organ Transplant Service has been staffed and led by some of the most prominent transplant surgeons in America. Military beneficiaries are eligible for evaluation and care regardless of their geographic assignment or residence. Principally a renal transplant clinical service, the Organ Transplant Service also gives support to patients with heart, liver, and pancreas grafts. Organs for transplant are largely (85%) from the civilian sector, although the Department of Defense has officially encouraged organ donation. Research, scientific publication, protocol development, teaching, and interaction with reserve components have been major facets of the Organ Transplant Service. Clinical outcome in renal transplantation at the Army-Navy Unit is comparable to that at the best civilian units: 2-year graft and patient survival 81% and 98%, respectively. These superior clinical results and the major roles that the Army-Navy Transplant Service have played make continued support and expansion of military transplantation compelling.

Nonosseous sarcomas in a military hospital.

This is a retrospective review of 67 patients with soft tissue or visceral sarcomas treated during 1973-1982. There were 40 males and 27 females. The mean age was 36 with a range of 1 to 77 years of age. The most common histologic subtypes were rhabdomyosarcoma (19%), malignant fibrohistiocytoma (13%), fibrosarcoma, leiomyosarcoma, dermatofibrosarcoma protuberans (12% each), and liposarcoma (10%). Among the 42 soft tissue sarcomas 33% occurred in the trunk, 35% and 21% in the lower and upper extremities, and 10% in the head and neck region. Among the 25 visceral sarcomas, 16% were in the thorax, 56% involved abdominal or retroperitoneal organs, and 28% were in the head and neck region. Overall, 33 of the 54 patients with early sarcomas were treated by surgical resection alone while 21 others had postoperative adjuvant radiotherapy and/or chemotherapy. Factors influencing survival are presented and patterns of metastasis discussed. Overall, 45% of the patients showed metastatic disease either at diagnosis (15%) or during the follow-up period (30%). The lung was involved in two-thirds of the cases and was the most common site of spread. In patients with rhabdomyosarcoma and malignant fibrohistiocytoma, regional lymph node metastasis was noted in 36% and 17%, respectively.