ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Cardiac failure is an important problem in developed countries with impacts on patient prognosis, quality of life, and economic cost. Although heart transplantation is the only established therapy for advanced heart failure, it is limited by donor organ shortage. Medical therapy should be optimized before transplant assessment, and patients should be offered the option of alternative surgical therapy when possible. Appropriate candidate selection by precise risk stratification and exclusion of patients with unacceptable risk will ensure best utilization of a scarce resource to patients who will derive the most benefit.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

For more than 15 years, immunosuppression after heart transplantation followed a standard protocol that was based on a triple drug regimen (consisting of cyclosporine, azathioprine, and steroids) with or without antibody induction therapy. Lately, intensive pharmacological research has produced a number of new agents with a variety of immunosuppressive actions. Most clinical experience with these compounds has been gained in renal transplant studies. Possible advantages but also likely disadvantages of these agents for the specific setting of cardiac transplantation need to be critically evaluated.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Acute vascular (microvascular) rejection is a term that has been applied to the morphologic appearance of rejection responses involving the allograft vasculature. Recent studies have highlighted the diverse mechanisms that can be responsible for this morphologic appearance. Features of microvascular injury caused by reperfusion injury are related to complement mediated effects that are operative in both reperfusion as well as humorally mediated allograft rejection. Recent work has documented the importance of antibody and complement in mediating antigen-dependent microvascular damage and its relation to cardiac allograft vasculopathy. Strategies to monitor patients with acute vascular rejection include monitoring of serum antibody titers coupled with frozen section immunohistochemistry. Treatment strategies include plasmapheresis and immunosuppressive regimens containing cyclophosphamide or mycophenolate mofetil.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Cardiac allograft vasculopathy remains one of the main causes of morbidity and mortality after heart transplantation, although its impact is becoming somewhat smaller as prophylactic measures are implemented. Consensus is needed on a working definition of the disease as detected by different diagnostic techniques.Advances in the understanding of the molecular and cellular mechanisms involved in the genesis and development of cardiac allograft vasculopathy will undoubtedly create ways for new diagnostic and therapeutic strategies. Currently available tools for anatomic and physiologic diagnosis of the disease have allowed a better understanding of the dynamic interaction between intimal growth “passenger” atherosclerotic plaques and vascular remodeling that integrates cardiac allograft vasculopathy. The emerging concept of vascular compartments may help to explain the time-related differences in anatomic and functional abnormalities found in each vascular segment at different stages of the disease.Successful prophylaxis of the early stages of the disease has been recently demonstrated with the use of newer immunosuppressive agents that will probably be included in future protocols. In patients with severe cardiac allograft vasculopathy and suitable anatomy, newly designed drug-eluting stents or brachytherapy must be tested in an attempt to overcome the known limitations of conventional revascularization strategies. Selected patients with end-stage disease could be candidates for retransplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lung transplantation is a well accepted treatment for end-stage cystic fibrosis. Despite these successes, many cystic fibrosis patients die awaiting lung transplantation, primarily because of the lack of donor organs. As a result, appropriate allocation of donor organs is necessary to maximize the success of transplantation for the CF population. In addition, optimizing potential transplant candidates by identifying and treating multidrug resistant organisms such asBurkholderia cepaciaas well as addressing poor physical condition caused by malnutrition and deconditioning may improve overall outcome after transplantation. Advances in surgical techniques and the continued success of living related donor transplantation have increased the supply of available organs. In this article, we will review the current literature in cystic fibrosis, particularly in regards to transplantation over the past year.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An overview of quality of life studies indicates that lung transplant recipients report a significantly better quality of life than lung transplant candidates. The importance of quality of life is emphasized by the fact that quality of life before lung transplantation independently predicts survival after lung transplantation, even after accounting for severity of illness. Quality of life appears to be greater in patients undergoing double lung transplantation in contrast to single lung transplantation. Quality of life improvement is most evident between 3 and 6 months after transplantation. Increased levels of anxiety coincide with the onset of bronchiolitis obliterans syndrome. This review will summarize recent quality of life studies in lung transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lung transplantation has evolved into the standard treatment for selected patients with severe end-stage pulmonary and pulmonary–vascular disease. In the two decades since the first successful heart–lung transplant in 1981, there has been a substantial improvement in early mortality. Many heart–lung and bilateral lung transplant recipients achieve near normal lung function. Despite a significant improvement in maximal exercise capacity after lung transplantation with VO2peak increasing to the range of 40 to 60% predicted, this remains well below normal values. Ventilatory limitation to exercise does not appear to contribute to impaired exercise capacity in those subjects with normal graft function and generally reflects the presence of complications in the allograft (for example, bronchiolitis obliterans). The evidence points toward a pretransplant injury resulting in impairment of skeletal muscle oxidative capacity with subsequent further injury after transplantation, particularly related to immunosuppressant drugs such as corticosteroids and cyclosporin A, resulting in significant peripheral limitation to exercise.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lung transplantation is a well accepted treatment for patients with advanced lung disease; however, there is a large shortfall in the availability of donor lungs to meet the demand. This has prompted new approaches, including a widening of the criteria to define a suitable donor lung, the use of non–heart-beating donors, and living donor lobar donation. The latter procedure involves the removal of a lower lobe from each of two donors and subsequent transplantation into a child or small adult. This review summarizes issues pertaining to donor and recipient selections, surgery, outcomes, and ethics for this procedure.

ISSN:1087-2418    

出版商:OVID    

年代:2002

数据来源: OVID