Role of plasmapheresis as liver support for early graft dysfunction following adult living donor liver transplantation

Background

Severe early graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). We have assessed the effectiveness of plasmapheresis (PP) as liver support for LDLT recipients with severe early graft dysfunction.

Methods

Of the 789 adult LDLTs performed between January 2007 and December 2009, 50 patients (6.3%) underwent PP as a supportive measure during the first month.

Results

The mean time from LDLT to start of plasmapheresis was 11.2 ± 6.8 days (range 2-28). The 50 patients underwent 517 sessions of PP, or a mean of 10.3 ± 6.8 sessions per patient, over a mean 21.6 ± 9.4 days. Thirty-four patients (68%) required concurrent hemodiafiltration. Mean serum total bilirubin concentration before PP was 16.2 ± 6.7 mg/dL, peaking at 20.3 ± 7.9 mg/dL during PP, and decreasing to 13.4 ± 5.4 mg/dL 1 week after completion of PP (P < .001 compared with before PP). Except for prothrombin time, no other biochemical parameter was significantly altered by PP. There were no serious complications related to PP. Of the 50 patients, 17 (34%) died soon or a few months after PP. The 6-month graft survival rate after completion of PP was 66%; the overall 1-year patient survival rate was 64.0%.

Conclusion

PP appeared to have beneficial effects for LDLT recipients with severe early graft dysfunction, namely total bilirubin concentrations greater than 10 mg/dL.     

Long-term renoprotective effect of candesartan in renal transplant patients

Background

The renoprotective effects of angiotensin II type 1 receptor blockers (ARBs) have been demonstrated in a number of clinical studies, but there are few evaluations of long-term ARB treatment. We measured blood pressure, urine protein, and estimated glomerular filtration rate (eGFR) among patients under long-term (up to 9 years) treatment with candesartan cilexetil to evaluate its safety and effectiveness to protect renal graft function.

Methods

This study of 41 patients (31 male and 10 female) who presented with proteinuria and hypertension (blood pressure >140/90 mm Hg) after receiving a renal graft. Their serum creatinine level at baseline was 1.51 ± 0.53 mg/dL. Cyclosporine or tacrolimus were concomitantly prescribed for 18 (43.9%) and 22 (53.7%) subjects, respectively. The ARB treatment period was ≥12 months (up to 9 years, mean 4.8 years). Combination with other antihypertensive drugs (calcium antagonists) was necessary in 14/41 subjects (34.1%).

Results

Significant declines in blood pressure were observed during the treatment period; blood pressure reduction target (blood pressure <130/80 mm Hg) was met in 56.1% for systolic and 68.3% for diastolic pressure. No significant increase in serum creatinine level or eGFR was observed. Urinary protein was reduced to negative or marginal in 63.4% of the subjects, demonstrating a significant decrease.

Conclusions

Candesartan cilexetil was considered to be safe even for long-term treatment in renal transplant patients, and effective to protect renal graft function.     

Plasmapheresis therapy in renal transplant patients: five-year experience

Introduction

Plasma exchange (PE) and double-filtration plasmapheresis (DFPP) have been used successfully in renal transplant patients as well as those with various other diseases over the last decade. In this retrospective study, we sought to explore the outcomes of plasmapheresis in renal transplant patients.

Patients and methods

We investigated 58 patients who received PE or DFPP therapy between 2005 and 2010. PE was performed using a Fresenius AS.TEC 204 device and DFPP, by an INFOMED HF 440 device. Indications for therapy, biopsy findings, number of PE/DFPP sessions, laboratory data, medications, complications as well as graft and patient survivals were recorded.

Results

Overall mean age of subjects was 34.1 ± 8.8 years and 55% were female. Sixteen patients underwent 95 DFPP sessions and 42 underwent 215 PE sessions. Indications for therapy were acute humoral rejection (n = 39), recurrent focal segmental glomerulosclerosis (FSGS; n = 8), thrombotic microangiopathy (n = 6), and chronic humoral rejection (n = 5). Responses to therapy were 24/39 for acute humoral rejection, 1/5 for chronic rejection, 4/8 for FSGS, and 3/6 for thrombotic microangiography. No complication was observed in any patient.

Conclusion

PE/DFPP is a safe and succesful method for treatment of acute humaral rejection as less so for recurrent FSGS and thrombotic microangiopathy. The outcomes among subjects with chronic humoral rejection were not satisfactory.     

Experimental Model of Isolated Lung Perfusion in Rats: First Brazilian Experience Using the IL-2 Isolated Perfused Rat or Guinea Pig Lung System

Introduction

Lung transplantation has become the mainstay therapy for patients with end-stage lung disease refractory to medical management. However, the number of patients listed for lung transplantation largely exceeds available donors. The study of lung preservation requires accurate, cost-effective small animal models. We have described a model of ex vivo rat lung perfusion using a commercially available system.

Methods

Male Wistar rats weighing 250 g-300 g were anesthetized with intraperitoneal sodium thiopental (50 mg/kg body weight). The surgical technique included heart-lung block extraction, assembly, and preparation for perfusion and data collection. We used an IL-2 Isolated Perfused Rat or Guinea Pig Lung System (Harvard Apparatus, Holliston, Mass, United States; Hugo Sachs Elektronik, Alemanha).

Results

Preliminary results included hemodynamic and pulmonary mechanics data gathered in the experiments.

Conclusion

The isolated rat lung perfusion system is a reliable method to assess lung preservation.     

Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement

Background

Ideal perfusion during ascending aorta-arch surgery should allow easy implementation of antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion in dissections. We report favorable experience with direct axillary artery cannulation.

Methods

Between 1999 and 2003, 284 patients with a mean age of 62.2 years (25 to 85), underwent axillary artery cannulation using a right angle wire-reinforced catheter. During this interval, attempted axillary cannulation was abandoned in only 14 patients because of inadequate backflow or other complications. Eighty-five patients were female. Severe aortic arteriosclerosis or degeneration was present in 209, aortic dissection in 63, and Marfan disease or aortitis in 12. The Bentall procedure was done in 144 patients, arch replacement in 86, the Yacoub procedure in 18, thoracoabdominal aneurysm repair in 16, and coronary artery bypass grafting in 20. Reoperations were at 30.2%.

Results

Adverse outcome (hospital death or permanent stroke) occurred in 6.6% (n = 19). Thirteen patients (4.6%) died before hospital discharge, and 13 patients (4.6%; 9 of whom died) suffered permanent stroke. Transient neurologic dysfunction occurred in 9.2% (n = 26). Mean duration of hypothermic circulatory arrest, used in 246 patients, was 26 ±7 minutes. Mean duration of antegrade cerebral perfusion, used in 139 patients, was 47 ± 23 minutes. In 93%, the right axillary artery was cannulated. Complications included 2 cases (0.7%) of brachial plexus injury (one transient), and 3 (1%) of localized dissection.

Conclusions

Our results suggest that axillary artery cannulation, successful in 95% of patients, may be the optimal technique for reducing perfusion-related morbidity and adverse outcome in operations for acute dissection, atherosclerotic, and degenerative aneurysmal disease. It deserves serious consideration in all patients older than 65 requiring cardiopulmonary bypass.     

Establishment of an Ex Vivo Lung Perfusion Model Using Non-Heart-Beating Large Pigs

Background

Functional evaluation of potentially damaged lungs donated after cardiac death is crucial for widespread clinical transplantation. To date, the mean weight of animals used in studies of ex vivo lung perfusion (EVLP) has been 60 kg; however, in the clinical setting, donor weight may be greater.

Objective

To investigate EVLP using lungs from large pigs (mean weight, 115 kg) to simulate human adult lungs donated after cardiac death.

Materials and Methods

Five heart-lung blocks were obtained at 20 minutes after death at the slaughterhouse. The lungs were flushed and preserved on ice for 6 hours before being connected to an ex vivo lung circuit, and were perfused for at least 2 hours.

Results

In all cases, perfusion was sustained for at least 2 hours. Mean (SEM) final flow rate was 4.9 (0.1) L/min, pulmonary artery pressure was 14.8 (1.7) mm Hg, and oxygen tension/fraction of inspired oxygen was 518.0 (18.0) mm Hg. The shunt fraction was 20.5% (4.0%). Histologic analysis demonstrated no significant pulmonary edema at the end of perfusion.

Conclusion

We successfully completed EVLP using lungs from large pigs.     

Serial Monitoring of Co-stimulating Signals in Double Hand Allograft: A Case Report

Aims

The aim of this study was to evaluate the clinical significance of serial monitoring of co-stimulating signals in double hand transplantation.

Methods

From September 2001 to December 2001, a patient who had double hand transplantation in our hospital was the subject of the experiment. Before the operation, a blood sample was collected before giving an immunodepressant and twice after giving the immunodepressant. A blood sample was also collected before arteriovenous connection during the operation, as well as once a day during the first week after the operation, once every other day in the second week, twice a week in the third and fourth week, followed by once a week for 2 months. The first week after operation was taken as the induction period with the other samples as the maintenance period. Then 2 mL peripheral venous blood collected from a healthy adult was anti-coagulated using EDTA of mass scores of 20 g/L. Flow cytometry was used for serial monitoring of T-cell surface co-stimulating molecules (CD28, CD54, and CD11a).

Results

The changes in the 3 co-stimulating molecules—CD28, CD54, and CD11a—were consistent with each other after double hand transplantation, displaying a decrement during induction compared with preoperatively: 9.84 ± 5.28%, 55.50 ± 3.62%; 71.03 ± 5.33% versus 95.10 ± 1.26%; 9.40 ± 9.17%, 29.70 ± 3.23% with low levels during maintenance 22.54 ± 6.56%, 91.28 ± 8.12%, 11.22 ± 4.08%.

Conclusion

The serial monitoring of the co-stimulating signals in the peripheral blood of limb allograft patients may be beneficial to evaluate postoperative immunologic reactions to guide immunosuppression as well as predict and diagnose postoperative immune rejection.     

The bispectral index, a useful adjunct for the timely diagnosis of brain death in the comatose trauma patient

Background

The bispectral index (BIS) is a processed electroencephalographic value (awake = 100, isoelectric = 0). The relationship of BIS and brain death (BD) is assessed.

Methods

BIS was evaluated in GCS 3 head-injured patients with BD (no brain function including apnea) or near BD (no apnea or negative ancillary test [cerebral perfusion and electroencephalogram]).

Results

In 27 patients, there were 37 BD evaluations (apnea assessment or ancillary test). BD was confirmed in 62% (n = 23). However, 38% (n = 14) showed near BD. BD BIS is 3 ± 5 and near BD BIS is 36 ± 31 (P = .002). In the 23 BD patients, BIS was <20 for 7 hours ± 6 hours before a BD evaluation was performed. Of 14 near BD evaluations, 9 (64%) had BIS ≥20. BIS <20 for predicting BD had a sensitivity of 100% (23/23), a positive predictive value of 84% (23/28), and a negative predictive value of 100% (9/9).

Conclusions

Distinguishing brain death and near brain death in severely comatose trauma patients is complex. By indicating the likelihood of brain death, BIS is an adjunct for efficient evaluation.     

Abdominal wall repair using human acellular dermal matrix: a follow-up study

Background

The role of acellular dermal matrix (ADM) in abdominal wall reconstruction (AWR) is unclear. The aim of this study was to review the management, complications, and long-term outcomes of AWR using ADM in a large surgical cohort.

Methods

Retrospective chart review of patients undergoing AWR using ADM from 2004 to 2007 was performed. Demographic data, comorbidities, complications, and long-term outcomes were collected.

Results

There were 77 cases in 68 patients with mean age of 61.1 ± 1.4 years. The most common indication was infected fascia (n = 19 [25%]). Wound closure was achieved in 75% of the cases via primary (n = 26 [45%]), secondary intention (n = 17 [29%]), or skin graft (n = 15 [26%]). Nonprimary closure was achieved in 5.7 ± .7 months. There were 32 perioperative (39%) and 33 long-term (43%) complications. Over a mean follow-up period of 13.2 ± 1.5 months, the hernia recurrence rate was 27% (n = 21).

Conclusion

Although ADM is a viable option in AWR, the high hernia recurrence rate warrants a continued search for alternative biologic materials to improve outcomes.     

Detrimental effect of aprotinin ban on amount of blood loss during liver transplantation: single-center experience

Background

Aprotinin, a plasmin inhibitor, had been used for reduction of intraoperative bleeding caused by hyperfibrinolysis during extensive surgery. Prophylaxis with aprotinin to limit blood loss during orthotopic liver transplantation (OLT) had been widely applied until the drug was weaned off the therapeutic list for severe complications. We compared the need for blood and blood products transfusion in patients undergoing OLT with and without the use of aprotinin.

Materials and Methods

A retrospective analysis was performed on 150 patients, who underwent OLT between March 2004 and August 2008 and were divided into 2 groups: the APRO group (n = 111) after induction of anesthesia was given a bolus of 500 kIU of aprotinin in a 30-minutes infusion followed by 140 kIU/h till the end of the OLT in which aprotinin was not administered, and the NON-APRO group (n = 39).

Results

Patients from the NON-APRO group needed significantly more units of packed red blood cells (PRBC) than the APRO group (5.53 ± 4.89 vs 3.99 ± 3.58 units; P = .037). Avoidance of aprotinin administration (β = 1.408), Child-Pugh score (β = 0.519), and duration of anhepatic phase (β = 0.03) affected the volume of transfused blood according to multiple regression analysis (P < .05).

Conclusions

Our study confirmed the important prophylactic role aprotinin used to have during OLT in limiting the need for blood transfusions. Further research and progress in methods of blood loss minimization and monitoring of hemostasis are needed to warrant safe liver transplantation.     

Oxidative injury and hepatocyte apoptosis in total parenteral nutrition-associated liver dysfunction

Purpose

The aim of this study was to investigate the impact of oxidative injury and apoptosis on total parenteral nutrition (TPN)-associated hepatic dysfunction.

Methods

Fifty-nine New Zealand rabbits (6-8 days old) were divided into 4 groups: 12 in the control group (maternal fed), 15 in the PN-3 group (TPN for 3 days), 14 in the PN-7 group (TPN for 7 days), and 18 in the PN-10 group (TPN for 10 days). At the end of the experiment, blood biochemistry analysis and histologic examination of the liver were performed; the malondialdehyde content of liver tissues was determined and hepatocyte apoptosis was evaluated by terminal deoxynucleotidyl transferase-mediated nick-end labeling assay.

Results

We found that the serum level of direct bilirubin became higher as PN duration was extended. The light microscopy features in the PN-3 and PN-7 groups included inflammatory cells infiltrated in portal areas and some degeneration changes, whereas in the PN-10 group, cholestasis (proliferation of bile ducts and bile pigments in hepatocytes) or diffuse steatosis was shown. Electron microscopic manifestation in PN groups included reduced numbers of microvilli and some preapoptosis changes. Both the malondialdehyde content and apoptosis index were the highest in the PN-10 group; there were more apoptotic hepatocytes in the groups with longer PN duration.

Conclusions

The longer the TPN duration, the more severe the liver injury. Both oxidative injury and apoptosis may play important roles in the mechanism of TPN-associated hepatic dysfunction.     

The antiproteinuric effects of green tea extract on acute cyclosporine-induced nephrotoxicity in rats

Background

It has been reported that the proteinuria is an early useful marker to detect cyclosporine (CsA) nephrotoxicity. The aim of this study was to investigate the antiproteinuric effects of green tea extract (GTE) on CsA-induced acute renal injury in rats.

Methods

The rats (n = 28) were divided into four groups (n = 7/group); controls intraperitoneally (IP) injected with 0.9% saline; CsA group IP injected CsA (50 mg/kg); inducible nitric oxide synthase (iNOS) inhibitor group administered in addition NG-nitro-L-arginine-methyl ester (12 mmol/L) subcutaneously and CsA-GTE group of CsA IP plus GTE (100 mg/kg) subcutaneously.

Results

The 24-hour urine proteins were significantly increased among the CsA (22.6 ± 3.1 mg/d) compared with the control (7.1 ± 1.5 mg/d) and significantly decreased in the CsA-GTE group (8.2 ± 1.8 mg/d, P < .01). Nitric oxide production induces by CsA treatment was significantly suppressed by GTE and iNOS inhibitor. Renal tissue malondialdehyde level was significantly increased in the CsA compared with controls and significantly decreased in the CsA-GTE group. The antioxidant enzyme activities of superoxide dysmutase and catalase, which were significantly suppressed in the CsA compared with the control group, were restored in the CsA-GTE cohort.

Conclusion

GTE treatment of rats showed meaningful antiproteinuric effects through antioxidative activity in kidneys from CsA-induced acute renal injury.     

Esophageal pathology in patients after treatment for head and neck cancer

Objective

To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA).

Study Design

Case series with planned data collection.

Setting

Academic medical practice.

Subjects and Methods

Subjects comprised HNCA survivors. Esophagoscopy was prospectively performed on 100 patients at least three months after treatment for HNCA. Patient demographics including cancer stage, cancer treatment, use of reflux medications, symptoms surveys, and esophageal findings were prospectively determined.

Results

The mean age of the cohort was 64 (± 10) years; 75 percent were male. The mean time between the end of treatment and endoscopy was 40 (± 51) months. Eighty-one percent of HNCA was advanced stage (3 or 4). The distribution of site of the primary HNCA was as follows: oropharynx (38%), larynx (33%), oral cavity (17%), unknown primary (10%), hypopharynx (1%), and nasopharynx (1%). Treatment modalities included surgery alone (15%), surgery with radiation (34%), radiation alone (6%), chemoradiation alone (24%), and chemoradiation with surgery (20%). The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy.

Conclusion

Esophageal pathology is extremely common in patients treated for HNCA. These findings support routine esophageal screening after HNCA treatment.     

Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes

Background

Caudate lobe of the liver is relatively inaccessible because of its deep location and lying between the major vascular structures. Therefore, isolated caudate lobe resection (ICLR) is a much challengeable operation.

Methods

Review of prospectively collected data from patients who underwent ICLR for hepatic tumor.

Results

Forty-six patients (mean age 46.8 years) underwent ICLR for malignant (39 cases) and benign (7 cases) hepatic tumors. ICLRs were performed by 3 different approaches and in different ways of hepatic vascular control: without any vascular control in 7 patients, under Pringle maneuver in 26 patients, and under sequential inflow and outflow vascular occlusion in 13 patients. There were no perioperative deaths, and the postoperative complication rate was 8.7% (4/46). The mean operative time was 174.5 ± 44.3 minutes and the mean estimated intraoperative blood loss was 504.4 ± 356.2 mL.

Conclusions

ICLR is a technically demanding but safe procedure. Choice of surgical approaches and ways of hepatic vascular control should be based on tumor location and surgeons'experience.     

Intramedullary Cavity as Implantation Site for Bioartifical Pancreas: Preliminary In Vivo Study

Background

The intramedullary cavity is a widely distributed well-vascularized microenvironment capable of sustaining grafts, and is a potential site for islet transplantation. The bone marrow offers sufficient space that may also be suitable for bioartificial pancreas (BAP) implantation.

Objective

To evaluate the feasibility of bone marrow as an implantation site for BAPs.

Materials and Methods

A calcium phosphate cement chamber satisfies the criteria for immunoisolation. Mouse insulinoma cells were suspended with agarose gel and enclosed in a calcium phosphate cement chamber to create a BAP, which was implanted in the intramuscular space in diabetic swine or the intramedullary cavity in diabetic dogs. Blood glucose and C-peptide concentrations were determined perioperatively.

Results

In the swine, the mean ± SD blood glucose concentration decreased from 413 ± 24 mg/dL to 285 ± 47 mg/dL, and was maintained in the range of 285 to 336 mg/dL for 15 days. It increased to 368 to 450 mg/dL after the BAPs were implanted in the intramuscular space. In the dogs, the blood glucose concentration decreased from 422 ± 32 mg/dL to 247 ± 52 mg/dL, and was maintained in the range of 247 to 347 mg/dL after the BAPs were implanted in the intramedullary cavity. The C-peptide concentration increased from 6.1 ± 2.8 pmol/L to 104.7 ± 16.4 pmol/L when the BAPs were implanted in the intramedullary cavity.

Conclusion

This study indicates superior effectiveness of BAPs implanted in the intramedullary cavity compared with the intramuscular space. This observation may be attributed to the greater oxygen tension in the bone marrow. The BAPs in direct contact with the circulatory system receive sufficient blood flow for function and survival. This preliminary study demonstrates that the intramedullary cavity may be an implantation site for BAP transplantation.     

Intrapleural hyperthermic perfusion with chemotherapy increases apoptosis in malignant pleuritis

Background

Previously, we reported on the effectiveness of intrapleural hyperthermic perfusion with chemotherapy, a new treatment we developed for patients with malignant pleuritis. The present study analyzes the mechanism of the effectiveness of this therapy by examining the induction ratio of apoptosis among tumor cells following the perfusion treatment.

Methods

This study included 11 consecutive patients with primary pulmonary adenocarcinoma and accompanying pleural seedlings and pleural effusions containing tumor cells but without distant metastasis. All patients underwent surgical resection of the primary lesion and then received sequential perfusion treatment. Tumor cells collected from the effusion both before and again at 24 hours following the perfusion treatment were subsequently examined using an immunocytochemical stain to determine apoptosis among tumor cells. The percentage of positively stained cells was expressed as the apoptotic index. We compared the survival rate of these 11 patients with the survival rate of a second group of 11 patients with malignant pleuritis who underwent surgical resection of the primary lesion but who did not receive the perfusion treatment (control group).

Results

The ratio of spontaneous apoptosis of untreated tumor cells was 2.8% ± 2.0%. Following the perfusion, apoptosis among tumor cells was 25.2% ± 4.6%, clearly a significant increase. While the median survival time for patients receiving the perfusion treatment was 20 months, the median survival time for the control group was 6 months.

Conclusions

In patients with malignant pleuritis, intrapleural hyperthermic perfusion with chemotherapy induced potent apoptosis of tumor cells in the pleural cavity and also improved the survival rate of these patients as compared with patients who did not receive the perfusion treatment.     

The preliminary study of modified Swenson procedure in Hirschsprung disease

Purpose

We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We hypothesized that (1) omitting anterior wall dissection would not affect postoperative anorectal function, and (2) reduced dissection with better visualization via laparoscopy would reduce operative risks.

Method

Charts of 89 patients with Hirschsprung disease operated on between 1990 through 2005 were retrospectively reviewed. Comparisons between Swen and mSwen, as well as between mSwen and LapmSwen, were analyzed in terms of operating time, blood loss, and complications.

Results

Mean operating times (minutes) were 312 for Swen, 284 for mSwen (P = .152), and 302 for LapmSwen ( mSwen, P = .218). Mean blood loss (mL) were 64.8 for Swen, 60.3 for mSwen (P = .669), and 8.7 for LapmSwen (as compared to mSwen, P = .001). We noted leakage in 7 Swen, 2 mSwen, and no LapmSwen patients. There were no significant differences between Swen and mSwen, or between mSwen and LapmSwen, in the incidence of enterocolitis, constipation, and soiling.

Conclusion

LapmSwen appeared to be comparable to the standard and modified Swenson procedures in most measures. Operative blood loss may be reduced in the LapmSwen approach.     

Importance of Organ Preservation Solution Composition in Reducing Myocardial Edema during Machine Perfusion for Heart Transplantation

Objective

Machine perfusion preservation has been used experimentally to extend the storage interval of donor hearts. We previously demonstrated that machine perfusion with glucose-supplemented Celsior preservation solution led to superior reperfusion function but resulted in increased myocardial edema compared with conventional static preservation. We hypothesized that other solutions that contain an oncotic agent, such as University of Wisconsin Machine Perfusion Solution (UWMPS), might reduce graft edema development while maintaining myocardial oxidative metabolism during long-term storage.

Methods

Canine hearts were stored and perfused in a perfusion preservation device (LifeCradle; Organ Transport Systems) after cardioplegic arrest and donor cardiectomy. Hearts were perfused either with glucose-supplemented Celsior (which lacks an oncotic agent) or UWMPS (which contains hydroxyethyl starch) at 5°C in the perfusion device over 10 hours. Oxygen consumption (MVO₂), lactate accumulation, regional flow distribution, and myocardial water content were measured.

Results

Hearts in both groups continued to extract oxygen over the entire perfusion interval. Lactate accumulation was minimal in both groups. Both solutions delivered perfusate evenly to all regions of myocardium. Heart weight increase (Celsior 31.3 ± 4.3%, UWMPS −3.3 ± 1.9%) and final myocardial water content (Celsior 80.2 ± 1.3%, UWMPS 75.9 ± 0.3%) were higher in the Celsior group (P < .005).

Conclusions

Donor hearts can be supported by a perfusion device over relatively extended storage intervals. These organs continue to undergo oxidative metabolism with little lactate accumulation. An oncotic agent appears to be important in limiting increases in myocardial water content. UWMPS appears to be superior for perfusion preservation of myocardium by reducing edema development during storage.     

Sexual attitudes and behavior of young adults who were burned as children

Objective

Little is known about sexual attitudes and behaviors of adults burned as children. We hypothesized that survivors with large burn scars would have differences in sexual attitudes and behaviors from their unburned counterparts.

Methods

Ninety-two young adults (50 males and 42 females), ages 21.0 ± 2.7 years old, who were burned 30% total body surface area or more as children 14.2 ± 5.4 years earlier, completed the questionnaire “What Young People Believe and Do” by RC Sorenson, 1972. The questionnaire explores sources of sexual information, attitudes toward different sexual behaviors, and experience with different sexual behaviors.

Results

Sixty-five percent of the females and 52% of the males currently had a significant other. Although only 54% women and 60% of men felt they were sexually attractive, 83 and 87%, respectively, endorsed feeling confident about sex. Experience with sexual intercourse was common: 90% of females and 76% of males. Burn severity was not significantly correlated with sexual attitudes and behaviors.

Conclusion

The majority of 92 young adults burned as children described sexual attitudes and behaviors comparable to the general population and the vast majority had significant sexual experience. Females reported more sexual behavior post-burn than males.     

The extent of biliary proliferation in liver biopsies from patients with biliary atresia at portoenterostomy is associated with the postoperative prognosis

Background/Purpose

In biliary atresia (BA), a derangement in the biliary system remains, despite portoenterostomy performance. Many factors can influence the disease progression rate. This study aimed to analyze the association between biliary proliferation extent in biopsies from BA patients and postoperative prognosis.

Methods

Biliary proliferation was evaluated by a morphometric analysis of the cytokeratin 7 positivity percentage (PCK7) in wedge liver biopsies from 47 BA patients. The extent of fibrosis was evaluated by a fibrosis score (FS). The outcome 1-year native liver survival was correlated, using a multivariable regression analysis, with PCK7, FS, and age at portoenterostomy.

Results

The PCK7 ranged between 0.80% and 14.79% (M ± SD = 7.36% ± 4.15%). Patients who died or underwent transplantation had higher PCK7 than survivors with their native livers (P < .001). The area under the receiver operating characteristic curve for PCK7 in relation to the outcome was 0.845 (P < .001). The cutoff point of PCK7 for the maximal effect on postoperative prognosis was 10.18% (sensitivity = 0.71, specificity = 0.88). The PCK7 was the only studied variable associated with 1-year native liver survival, independently of age and FS (P = .002).

Conclusion

The extent of biliary proliferation at portoenterostomy, evaluated by PCK7, was associated with 1-year native liver survival of BA patients.