Incident and Emergency Centre of the IAEA.

The Incident and Emergency Centre of the International Atomic Emergency Agency is the global focal point for preparedness, event reporting, and response to nuclear and radiological incidents and emergencies irrespective of their cause. The Centre continuously works to develop standards and guidance for strengthening Member States' preparedness; develops practical tools and training programs to assist Member States in promptly applying the standards and guidance; and organizes a variety of training events and exercises. The Centre evaluates national plans and assists in their development; facilitates effective communication between countries; develops response procedures; and supports national exercises. The Centre provides access to multiple information resources; assesses trends that may influence crisis and consequence management plans and response; and develops and continuously enhances methodology for identifying conditions needed for early warning and response. The Centre provides around-the-clock assistance to Member States in dealing with nuclear and radiological events, including security related events through timely and efficient services and the provision of a coordinated international response to such emergencies.

Donor total lung capacity predicts recipient total lung capacity after size-reduced lung transplantation.

BACKGROUND: Size-reduced lung transplantation has only recently undergone widespread use, especially in highly urgent cases. However, it is still not considered standard procedure at most centers. It has the potential to alleviate the donor organ shortage by allowing the use of oversized grafts for small and pediatric recipients. Limited data exist on pre-operative parameters predicting functional outcome after lung transplantation in general, especially after size-reduced lung transplantation. METHODS: All 98 patients undergoing primary lung transplantation during a 2-year period, including 27 size-reduced lung transplantations, were analyzed retrospectively. Pre-operative functional parameters were-after correction of estimated values according to the amount of size reduction-correlated with post-operative functional assessment. Actual and predicted total lung capacity (TLC) of transplant recipients and predicted TLC of donors was compared with the best post-operative TLC achieved within 12 months after transplantation. RESULTS: Size-reduced lung transplantation was performed in 27 cases. Downsizing was achieved by lobar transplantation (n = 9), split-lung transplantation (n = 2) or peripheral segmental resection (n = 16). There was a statistically highly significant (p < 0.01) correlation between donor TLC and best recipient TLC achieved after transplantation (Pearson's correlation coefficient = 0.675). No statistically significant correlation was seen between pre-operative recipient actual TLC and best post-operative TLC (p = 0.87; Pearson's correlation coefficient = 0.415). In standard lung transplant recipients post-operative TLC was correlated with both donor predicted TLC (p < 0.01; Pearson's correlation coefficient = 0.509) and actual pre-operative recipient TLC (p < 0.01; Pearson's correlation coefficient = 0.667). CONCLUSIONS: Post-operative recipient TLC in size-reduced lung transplantation can be predicted by donor TLC rather than pre-operative recipient TLC.

Initial experience with oral valganciclovir for pre-emptive cytomegalovirus therapy after lung transplantation.

BACKGROUND: The most common opportunistic viral pathogen after lung transplantation is cytomegalovirus (CMV). Oral valganciclovir, a prodrug of ganciclovir, has been introduced as a potential drug for prophylaxis and treatment of CMV infection and disease in lung transplantation. The goal of this study was to describe our initial experience with oral valganciclovir for pre-emptive treatment of CMV infections after lung transplantation. METHODS AND PATIENTS: We summarize our experience with 19 patients who underwent lung transplantation and received pre-emptive oral valganciclovir therapy in the situation of positive CMV polymerase chain reaction (PCR) in either plasma or bronchoalveolar lavage. None of the patients presented with manifest CMV disease. Treatment dosage of valganciclovir was 450 mg to 1800 mg daily, depending on renal function and white blood count. Treatment was continued until the CMV PCR became negative, in any case for a period of at least 14 days. RESULTS: Three patients received two courses of pre-emptive oral valganciclovir; 16 patients were treated once. Eleven patients (57.9%) were treated because of a positive plasma CMV PCR; in eight patients (42.1%) the PCR was positive only in bronchoalveolar lavage. Therapy was initiated 896 +/- 1186 days (range, 108-3911) after transplantation with a mean CMV PCR of 45,536 +/- 149,294 copies (range, 426-706,000). In all cases the PCR fell below detectability (<400 copies) after a period of 22 +/- 10 days of treatment (range, 7-50 days). Mild to moderate leucopenia was observed in seven patients (36.8%) during treatment. None of the patients developed new onset of other potentially drug-related disorders such as neutropenia, anemia, deterioration of renal function or gastrointestinal disorder. CONCLUSIONS: Pre-emptive therapy with oral valganciclovir for CMV infections detected by PCR in either plasma or bronchoalveolar lavage after lung transplantation seems to be efficacious and safe. However, regular blood counts should be performed to detect developing leucopenia.

Extended donor criteria for lung transplantation--a clinical reality.

OBJECTIVE: Standard lung donor criteria have been established on opinions and individual experiences rather than on existing evidence. Since the scarcity of donor organs is one of the major limitations to lung transplantation, extension of donor lung criteria might considerably increase the donor pool. This study therefore evaluates the outcome, achieved with the use of extended donors versus standard donors and aims to redefine lung donor criteria. METHODS: We performed a retrospective analysis of 98 consecutive primary lung transplantations from 94 donors from 1/2001 to 12/2002. Donors were classified as extended if they fulfilled at least one criteria: age >55 years, PaO(2) at FiO(2)/PEEP 5 <300mmHg, tobacco history >20 pack years, inhalative drug abuse, presence of infiltration on chest X-ray or purulent secretions at bronchoscopy. Recipients were stratified in two groups according to whether they received a 'standard' or 'extended' organ. Postoperative complications, extubation time, ICU and hospital stay and survival were compared. RESULTS: Twenty-three (24.5%) donors were extended. Twenty-six recipients (26.55%) received organs from extended donors. Differences in intubation times (12+/-2 days standard vs. 14+/-5 days extended, P=0.70), ICU stay (16+/-2 days standard vs. 18+/-5 days extended, P=0.74) and hospital stay (38+/-4 days standard vs. 40+/-6 days extended, P=0.71) were not statistically significant. Postoperative bleeding rates were comparable (n=14 standard vs. n=3 extended) as well as bronchial anastomotic complications (n=7 standard vs. n=3 extended). Three months survival was 88.89% in the standard group vs. 92.31% in the extended group. One year survival is comparable as well with 81.94 vs. 84.62%, respectively. CONCLUSIONS: The use of lung donors who fail to meet standard criteria does not impair short and medium term results compared to standard lung donors. The impact on long term development of BOS has yet to be evaluated. The strict application of standard lung donor criteria excludes a considerable number of lungs potentially suitable for transplantation, thus liberalisation of donor criteria might help to overcome donor shortage.