1
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Blitzer D, Baran DA, Lirette S, Copeland JG, Copeland H. Does donor treatment with inotropes and/or vasopressors impact post-transplant outcomes? Clin Transplant 2023; 37:e14912. [PMID: 36650699 DOI: 10.1111/ctr.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/07/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose was to evaluate the effects of the most commonly used cardiac donor inotropes/vasopressors on subsequent post-heart transplant survival. METHODS Adult heart transplant recipients from January 2000 to June 2022 were identified in the United Network for Organ Sharing (UNOS) database. Exclusion criteria included: multiorgan transplants, donor age < 15, and recipient age < 18. Donors receiving vasoactive medications at the time of procurement were compared to donors not receiving these medications. Those on vasoactive medications were stratified by medication: phenylephrine, dopamine, dobutamine, norepinephrine and epinephrine, the combination of these agents, and the concomitant administration of vasopressin with any single agent alone or in combination. The primary area of interest was short-and-long-term survival. Survival at 30 days, 1 year, and long-term (Median = 13.6 years) was compared using logistic and Cox models to quantify survival endpoints. RESULTS A total of 45,198 donors met inclusion criteria and had data on the use of vasoactive agents available. Mean donor age was 32.3 years with 71% male. Vasoactive medications and potential combinations included phenylephrine in 8156 donors (18.0%), dopamine in 9550 (21.1%), dobutamine in 718 (1.6%), epinephrine in 332 (.73%), and norepinephrine in 4854 (10.7%). A total of 25,856 donors (57.2%) were receiving vasopressin at the time of procurement. There was no impact of donor inotropes on 30-day survival. Donors receiving one inotrope and no vasopressin were associated with increased 1 year mortality (OR 1.14; p = .021), as were donors receiving 2+ inotropes and no vasopressin (OR 1.26; p = .006). For individual agents, 1 year mortality was increased for dopamine (OR 1.11; p = .042) and epinephrine (OR 1.59; p = .004). CONCLUSIONS There is no difference in heart transplant recipient survival at 30 days when the donor is receiving inotropes without vasopressin at the time of procurement. Inotropic support without vasopressin is associated with greater 1 year mortality. The impact of donor inotropic support on long term heart transplant survival, and the interaction with vasopressin warrants further study.
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Affiliation(s)
- David Blitzer
- Columbia University, Department of Surgery, Division of Cardiovascular Surgery, New York, New York, USA
| | - David A Baran
- Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, Florida, USA
| | | | - Jack G Copeland
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Hannah Copeland
- Lutheran Hospital - Fort Wayne, Cleveland, Indiana, USA.,Indiana University School of Medicine - Fort Wayne (IUSM-FW), Fort Wayne, Indiana, USA
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2
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Donor substance abuse and heart transplantation outcomes. Heart Fail Rev 2023; 28:207-215. [PMID: 35435527 DOI: 10.1007/s10741-022-10241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
Heart failure continues to account for millions of cases and deaths worldwide. Heart transplant is the gold standard for treatment of advanced heart failure. Unfortunately, the supply of donor hearts continues to be limited with the increase in demand for heart transplantation. In this review, we aim to explore the safety and efficacy of using hearts from donors with history of substance use. Despite the theoretical effect of cocaine and alcohol on the cardiovascular system, several studies demonstrate no difference in outcomes (overall survival, graft rejection, graft vasculopathy) when using hearts from patients with history of cocaine and alcohol use. The opioid epidemic has expanded the potential donor pool where the current studies have not shown any adverse outcomes when considering donors with history of opioid use. The currently available evidence would support the use of donor hearts from patients with history of alcohol, cocaine, opioids, and marijuana use. Further studies are needed to evaluate the safety of using donor hearts from patients with history of nicotine use.
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3
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Ilonze OJ, Vidot DC, Breathett K, Camacho-Rivera M, Raman SV, Kobashigawa JA, Allen LA. Cannabis Use and Heart Transplantation: Disparities and Opportunities to Improve Outcomes. Circ Heart Fail 2022; 15:e009488. [PMID: 36252094 PMCID: PMC9772032 DOI: 10.1161/circheartfailure.122.009488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.
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Affiliation(s)
- Onyedika J. Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | - Denise C. Vidot
- University of Miami School of Nursing and Health Studies, Coral Gables, FL
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
| | | | - Subha V. Raman
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN
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4
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Winder GS, Andrews SR, Banerjee AG, Hussain F, Ivkovic A, Kuntz K, Omary L, Shenoy A, Thant T, VandenBerg A, Zimbrean P. Cannabinoids and solid organ transplantation: Psychiatric perspectives and recommendations. Transplant Rev (Orlando) 2022; 36:100715. [PMID: 35853383 DOI: 10.1016/j.trre.2022.100715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 01/01/2023]
Abstract
Cannabinoid use in patients seeking solid organ transplantation (SOT) is an important and unsettled matter which all transplantation clinicians regularly encounter. It is also a multifaceted, interprofessional issue, difficult for any specialty alone to adequately address in a research article or during clinical care. Such uncertainty lends itself to bias for or against cannabinoid use accompanied by inconsistent policies and procedures. Scientific literature in SOT regarding cannabinoids often narrowly examines the issue and exists mostly in liver and kidney transplantation. Published recommendations from professional societies are mosaics of vagueness and specificity mirroring the ongoing dilemma. The cannabinoid information SOT clinicians need for clinical care may require data and perspectives from diverse medical literature which are rarely synthesized. SOT teams may not be adequately staffed or trained to address various neuropsychiatric cannabinoid effects and risks in patients. In this article, authors from US transplantation centers conduct a systematized review of the few existing studies regarding clinician perceptions, use rates, and clinical impact of cannabinoid use in SOT patients; collate representative professional society guidance on the topic; draw from diverse medical literature bases to detail facets of cannabinoid use in psychiatry and addiction pertinent to all transplantation clinicians; provide basic clinical and policy recommendations; and indicate areas of future study.
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Affiliation(s)
| | - Sarah R Andrews
- Johns Hopkins Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, USA
| | | | - Filza Hussain
- Stanford University Department of Psychiatry and Behavioral Sciences, Palo Alto, California, USA
| | - Ana Ivkovic
- Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA
| | - Kristin Kuntz
- Ohio State University Department of Psychiatry and Behavioral Health, Columbus, Ohio, USA
| | - Lesley Omary
- Vanderbilt University Department of Psychiatry and Behavioral Sciences, Nashville, Tennessee, USA
| | - Akhil Shenoy
- Columbia University Department of Psychiatry, New York City, New York, USA
| | - Thida Thant
- University of Colorado Department of Psychiatry, Aurora, Colorado, USA
| | - Amy VandenBerg
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Paula Zimbrean
- Yale University Department of Psychiatry, New Haven, Connecticut, USA
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5
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Shah H, Fraser M, Agdamag AC, Maharaj V, Nzemenoh B, Martin CM, Alexy T, Garry DJ. Cardiac Transplantation and the Use of Cannabis. Life (Basel) 2021; 11:life11101063. [PMID: 34685434 PMCID: PMC8539629 DOI: 10.3390/life11101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiac transplantation requires the careful allocation of a limited number of precious organs. Therefore, it is critical to select candidates that will receive the greatest anticipated medical benefit but will also serve as the best stewards of the organ. Individual transplant teams have established prerequisites pertaining to recreational drug, tobacco, alcohol, and controlled substance use in potential organ recipients and post-transplantation. Legalization of cannabis and implementation of its prescription-based use for the management of patients with chronic conditions have been increasing over the past years. Center requirements regarding abstinence from recreational and medical cannabis use vary due to rapidly changing state regulations, as well as the lack of clinical safety data in this population. This is evident by the results of the multicenter survey presented in this paper. Developing uniform guidelines around cannabis use will be imperative not only for providers but also for patients.
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Affiliation(s)
- Hirak Shah
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Meg Fraser
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Arianne C. Agdamag
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Valmiki Maharaj
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Bellony Nzemenoh
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Cindy M. Martin
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Tamas Alexy
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
- Correspondence: (T.A.); (D.J.G.)
| | - Daniel J. Garry
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (H.S.); (A.C.A.); (V.M.); (C.M.M.)
- Advanced Heart Failure Program, Mechanical Circulatory Support Service and Cardiac Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA;
- Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (T.A.); (D.J.G.)
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6
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Okoh AK, Chan O, Schultheis M, Gupta M, Shah A, Gold J, Russo MJ, Lee LY, Camacho M. Association between increased-risk donor social behaviors and recipient outcomes after heart transplantation. Clin Transplant 2020; 34:e13787. [PMID: 31961010 DOI: 10.1111/ctr.13787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aims to investigate the association between social behaviors of increased-risk donors (IRD) and recipient outcomes after heart transplantation. METHODS The United Network for Organ Sharing (UNOS) database was queried to identify patients who received a heart transplant between 2004 and 2015. Patients were grouped based on donor's risk status (IRD vs standard risk donor [SRD]). Recipients of IRD were categorized based on donor social behaviors (SB), and recipient survival was assessed. Cox regression analysis was used to identify associations between SB of donors and recipient survival. RESULTS Out of 22 333 heart transplantations performed during the study period, 2769 (12%) received an IRD graft with the following SB: Unprofessional tattoos or piercings (n = 1722) (63%), cocaine use (n = 916) (33%), heavy smoking (n = 437) (16%), and heavy alcohol abuse (n = 610) (22%). Viral screens detected 72(3%) hepatitis B virus (HBV) positive and 12 (0.4%) hepatitis C virus (HCV) positive at donation. There was no difference in recipient survival based on both donor risk and their social behaviors. Cox regression analysis found only donor HCV infection and non-identical ABO mismatch to be associated with poor recipient survival among recipients of IR grafts. CONCLUSION Cardiac allografts from IRD, serologically negative for viruses, can safely be used. There is no association between social behaviors of IRD and recipient survival.
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Affiliation(s)
- Alexis K Okoh
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Olivia Chan
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Molly Schultheis
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Mitalie Gupta
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Aakash Shah
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Justin Gold
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
| | - Mark J Russo
- Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Leonard Y Lee
- Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Margarita Camacho
- Cardiovascular Outcomes Research Institute, RWJ Barnabas Health Heart Centers, NBIMC, Newark, New Jersey
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7
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MacGowan GA, Dark JH, Corris PA, Nair AR. Effects of drug abuse, smoking and alcohol on donor hearts and lungs. Transpl Int 2019; 32:1019-1027. [PMID: 31172575 DOI: 10.1111/tri.13468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
Potential heart and lung donors with a history of illicit drugs and/or smoking and alcohol are frequently offered, though there is no clear guidance on when it is safe to use these organs. A review of the literature on effects of drugs, alcohol and smoking on donor outcomes, and the effects of these on the intact heart and lung was undertaken. There has been a marked increase in deaths from opioid abuse in many developed countries, though recent evidence suggests that outcomes after cardiothoracic transplantation are equivalent to nonopioid donor causes of death. For donor smoking, there is an increased risk with lung transplantation; however, that risk is less when compared to further waiting on the transplant list for a nonsmoking alternative. Heavy alcohol consumption does not adversely affect heart transplantation, and there is no clear evidence of adverse outcomes after lung transplantation. There are no overall effects of cannabis or cocaine on survival after heart or lung transplantation. In all these cases, careful donor assessment can establish if a particular organ can be used. In most cases, use of drugs requires careful assessment, but is not in of itself a contraindication to cardiothoracic transplantation.
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Affiliation(s)
- Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arun R Nair
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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8
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Humar SS, Liu J, Pinzon N, Kumar D, Bhat M, Lilly L, Selzner N. Attitudes of Liver Transplant Candidates Toward Organs From Increased-Risk Donors. Liver Transpl 2019; 25:881-888. [PMID: 30947392 DOI: 10.1002/lt.25467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
Abstract
Increased-risk donor (IRD) organs make up a significant proportion of the deceased organ donor pool but may be declined by patients on the waiting list for various reasons. We conducted a survey of patients awaiting a liver transplant to determine the factors leading to the acceptance of an IRD organ as well as what strategies could increase the rate of acceptance. Adult liver transplant candidates who were outpatients completed a survey of 51 questions on a 5-point Likert scale with categories related to demographics, knowledge of IRDs, and likelihood of acceptance. A total of 150 transplant candidates completed the survey (age 19-80 years). Male patients constituted 67.3%. Many patients (58.7%) had postsecondary education. Only 23.3% of patients had a potential living donor, and 58/144 (40.3%) were not optimistic about receiving an organ in the next 3 months. The overall IRD organ acceptance rate was 41.1%, whereas 26.2% said they would decline an IRD organ. Women were more likely to accept an IRD organ (54.3% versus 34.7%; P = 0.02). Those who had a college education or higher tended to have lower IRD organ acceptability (28.3% versus 47.4%; P = 0.07). Acceptability also increased as the specified transmission risk of human immunodeficiency virus or hepatitis C virus decreased (P < 0.001). Patients were also more likely to accept an IRD organ if they were educated on the benefits of IRD organs (eg, knowledge that an IRD organ was of better quality increased overall acceptance from 41.1% to 63.3%; P < 0.001). Our survey provides insight into liver transplant candidates who would benefit from greater education on IRD organs. Strategies targeting specific educational points are likely to increase acceptability.
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Affiliation(s)
- Sapna S Humar
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jingqian Liu
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Pinzon
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deepali Kumar
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
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9
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Ruckle D, Keheila M, West B, Baron P, Villicana R, Mattison B, Thomas A, Thomas J, De Vera M, Kore A, Wai P, Baldwin DD. Should donors who have used marijuana be considered candidates for living kidney donation? Clin Kidney J 2019; 12:437-442. [PMID: 31198546 PMCID: PMC6543962 DOI: 10.1093/ckj/sfy107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of marijuana in the USA has been steadily increasing over the last 10 years. This study is the first to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. METHODS Living kidney donor transplants performed between January 2000 and May 2016 in a single academic institution were retrospectively reviewed. Donor and recipient groups were each divided into two groups by donor marijuana usage. Outcomes in donor and recipient groups were compared using t-test, Chi-square and mixed linear analysis (P < 0.05 considered significant). RESULTS This was 294 living renal donor medical records were reviewed including 31 marijuana-using donors (MUD) and 263 non-MUDs (NMUD). It was 230 living kidney recipient records were reviewed including 27 marijuana kidney recipients (MKRs) and 203 non-MKRs (NMKR). There was no difference in donor or recipient perioperative characteristics or postoperative outcomes based upon donor marijuana use (P > 0.05 for all comparisons). There was no difference in renal function between NMUD and MUD groups and no long-term difference in kidney allograft function between NMKR and MKR groups. CONCLUSIONS Considering individuals with a history of marijuana use for living kidney donation could increase the donor pool and yield acceptable outcomes.
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Affiliation(s)
- David Ruckle
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohamed Keheila
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Benjamin West
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Pedro Baron
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Rafael Villicana
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Braden Mattison
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Alex Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Jerry Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael De Vera
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Arputharaj Kore
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Philip Wai
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
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10
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Levi ME, Montague BT, Thurstone C, Kumar D, Huprikar SS, Kotton CN. Marijuana use in transplantation: A call for clarity. Clin Transplant 2019; 33:e13456. [PMID: 30506888 DOI: 10.1111/ctr.13456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
Transplant centers have varying policies for marijuana (MJ) use in donors, transplant candidates, and recipients. Rationales for these differences range from concerns for fungal complications, impaired adherence, and drug interactions. This paper reviews the current status of MJ policies and practices in transplant centers and results of a survey sent to the American Society of Transplantation (AST) membership by the Executive Committee of the AST Infectious Diseases Community of Practice.The purpose of the survey was to compare policies and concerns of MJ use to actual observed complications. Of the 3321 surveys sent, 225 members (8%) responded. Transplant centers varied in their approval processes, differing even in organ types within the same institutions. Furthermore, there was discordance among transplant centers in their perceived risks of marijuana use as opposed to complications actually observed. An increasing number of states continue to legalize medical and recreational MJ resulting in widespread availability. Further research is needed to assess the validity of concerns for complications of MJ use in potential donors and recipients. Ultimately, standardized guidelines should be established based on studies and evidence-based criteria to assist transplant programs in their policies around the use of cannabis in their donors and recipients.
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Affiliation(s)
- Marilyn E Levi
- Department of Internal Medicine/Division of Infectious Diseases, University of Colorado, Aurora, Colorado
| | - Brian T Montague
- Department of Internal Medicine/Division of Infectious Diseases, University of Colorado, Aurora, Colorado
| | - Christian Thurstone
- Department of Psychiatry, Denver Health and Hospital Authority and University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Shirish S Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Ising MS, Gallo M, Whited WM, Slaughter MS, Trivedi JR. Changing demographics of heart donors: The impact of donor drug intoxication on posttransplant survival. Am J Transplant 2018; 18:1790-1798. [PMID: 29513379 DOI: 10.1111/ajt.14726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 03/02/2018] [Indexed: 01/25/2023]
Abstract
Recent reports have shown an increase in the number of organ donors from drug intoxication. The impact of donor drug use on survival after cardiac transplant remains unclear. The aim of our study was to illustrate changes in donor death mechanisms and assess the impact on posttransplant survival. We queried United Network of Organ Sharing thoracic transplant and deceased donor databases to identify patients undergoing heart transplantation between 2005 and 2015. We evaluated annual trends in donor death mechanisms. Recipients were propensity matched (drug-intoxicated-non-drug-intoxicated = 1:2) and posttransplant survival was compared using Kaplan-Meier curves. In total, 19 384 donor hearts were used for transplant during the period (donor age 31.6 ± 11.8 years, 72% male). Use of drug-intoxicated donors increased from 2% (2005) to 13% (2015) and decreased from blunt injury (40%-30%) and intracranial hemorrhage (29%-25%). After propensity matching, posttransplant survival of drug-intoxicated donor hearts was 90%, 82%, and 76% at 1, 3, and 5 years, which was similar to non-drug-intoxicated. Heart transplants using drug-intoxicated donors have significantly increased; however, they have not adversely affected posttransplant survival. Hearts from drug-intoxicated donors should be carefully evaluated and considered for transplant.
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Affiliation(s)
- Mickey S Ising
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Michele Gallo
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - William M Whited
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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12
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Trends and outcomes of cardiac transplantation from donors dying of drug intoxication. Am Heart J 2018; 199:92-96. [PMID: 29754672 DOI: 10.1016/j.ahj.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Deaths from drug intoxication have increased in the United States but outcomes of recipients of orthotopic heart transplantation (OHT) from these donors are not well characterized. METHODS We performed a retrospective analysis of the United Network for Organ Sharing's STAR database between January 2000 and March 2014 and assessed mortality and retransplantation using adjusted Cox models by mechanism of donor death. RESULTS Of the 31,660 OHTs from 2000 to 2014, 1233 (3.9%) were from drug intoxication. These donors were more likely to be female, white, with greater tobacco use and higher BMI compared to donors who died of other mechanisms. Drug intoxication accounted for 1.1% of OHT donors in 2000 and 6.2% in March 2014. No significant difference was observed in 10-year mortality (adjusted hazard ratio [HR], 95% confidence interval [CI]: 0.99, 0.87-1.13), 10-year retransplantation (adjusted HR 0.84, 0.49-1.41) or 1-year and 3-year rehospitalization with other mechanisms of death compared to drug intoxication. CONCLUSION There has been a large increase in OHT donors who die of drug intoxication in the United States. OHT outcomes from these donors are similar to those dying from other mechanisms. These data have important implications for donor selection in context of the ongoing opioid epidemic.
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13
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Dorent R, Gandjbakhch E, Goéminne C, Ivanes F, Sebbag L, Bauer F, Epailly E, Boissonnat P, Nubret K, Amour J, Vermes E, Ou P, Guendouz S, Chevalier P, Lebreton G, Flecher E, Obadia JF, Logeart D, de Groote P. Assessment of potential heart donors: A statement from the French heart transplant community. Arch Cardiovasc Dis 2017; 111:126-139. [PMID: 29277435 DOI: 10.1016/j.acvd.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
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Affiliation(s)
- Richard Dorent
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
| | - Estelle Gandjbakhch
- Département de cardiologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Céline Goéminne
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
| | - Fabrice Ivanes
- Service de cardiologie, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Laurent Sebbag
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Fabrice Bauer
- Département de cardiologie, hôpital Charles-Nicolle, centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Eric Epailly
- Service de chirurgie cardiaque, nouvel hôpital civil, centre hospitalier universitaire de Strasbourg, 67091 Strasbourg, France
| | - Pascale Boissonnat
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Karine Nubret
- Département d'anesthésie-réanimation II, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France
| | - Julien Amour
- Département d'anesthésie-réanimation, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Emmanuelle Vermes
- Service de chirurgie cardiaque, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Phalla Ou
- Département de radiologie, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75877 Paris, France
| | - Soulef Guendouz
- Département de cardiologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Philippe Chevalier
- Service de rythmologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Guillaume Lebreton
- Service de chirurgie cardiovasculaire, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Erwan Flecher
- Service de chirurgie cardiovasculaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - Jean-François Obadia
- Service de chirurgie cardiovasculaire, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Damien Logeart
- Département de cardiologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75475 Paris, France
| | - Pascal de Groote
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
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14
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Abstract
PURPOSE OF REVIEW Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population. RECENT FINDINGS There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.
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Affiliation(s)
- Harinder Singh Rai
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA
| | - Gerald Scott Winder
- University of Michigan Department of Psychiatry, 9D 9816 University Hospital, 1500 E. Medical Center Dr. SPC 5118, Ann Arbor, MI, 48109-5118, USA.
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15
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Sorabella RA, Guglielmetti L, Kantor A, Castillero E, Takayama H, Schulze PC, Mancini D, Naka Y, George I. Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database. Transplant Proc 2016; 47:2944-51. [PMID: 26707319 DOI: 10.1016/j.transproceed.2015.10.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/07/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To address the shortage of donor hearts for transplantation, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study was to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on posttransplantation recipient outcomes. METHODS Adult (≥18 years) patients undergoing heart transplantation from July 1, 2004, to December 31, 2012, in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year posttransplantation status; survivors (group S, n = 13,643) and patients who died or underwent cardiac retransplantation at 1-year follow-up (group NS/R = 1785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or retransplantation at 1 year were determined using multivariable logistic regression analysis. RESULTS Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years, and 72% were male. On multivariable logistic regression analysis, donor age >40 years (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.27 to 1.64), graft ischemic time >3 hours (OR 1.32, 1.16 to 1.51), and the use of cardioplegia (OR 1.17, 1.01 to 1.35) or Celsior (OR 1.21, 1.06 to 1.38) preservative solution were significant predictors of recipient death or retransplantation at 1 year posttransplantation. Male donor sex (OR 0.83, 0.74 to 0.93) and the use of antihypertensive agents (OR 0.88, 0.77 to 1.00) or insulin (OR 0.84, 0.76 to 0.94) were protective from adverse outcomes at 1 year. CONCLUSIONS These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.
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Affiliation(s)
- R A Sorabella
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - L Guglielmetti
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - A Kantor
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - E Castillero
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - H Takayama
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - P C Schulze
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - D Mancini
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Y Naka
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - I George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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16
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Abstract
Heart transplantation is the most effective therapy for patients with Stage D heart failure with a median life expectancy of ≈10 to 15 years. Unfortunately, many patients die on the waiting list hoping for a chance of survival. The life boat cannot rescue everyone. Over a decade, the donor pool has remained relatively stable, whereas the number of heart transplant candidates has risen. Potential recipients often have many comorbidities and are older because the criteria for heart transplantation has few absolute contraindications. Women, Hispanics, and patients with restrictive heart disease and congenital heart disease are more likely to die while awaiting heart transplantation than men, white patients, and those with either ischemic or dilated cardiomyopathy. To better match the market, we need to (1) increase the donor pool, (2) reduce the waitlist, and (3) improve the allocation system. This review article addresses all 3 options and compares strategies in the United States to those in other countries.
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Affiliation(s)
- Eileen M Hsich
- From the Heart and Vascular Institute at the Cleveland Clinic, OH; and Case Western Reserve University School of Medicine, Cleveland, OH.
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17
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A Survey of Increased Infectious Risk Donor Utilization in Canadian Transplant Programs. Transplantation 2016; 100:461-4. [PMID: 26285016 DOI: 10.1097/tp.0000000000000843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Donors at increased risk of transmitting viral infections are a potential source of transplantable organs. Studies demonstrate that organs from increased risk donors (IRDs) are associated with excellent outcomes. However, considerable variation in practice likely exists. METHODS We performed a cross-country survey of Canadian Organ Transplant centers to determine organ utilization practices from IRDs. RESULTS Of 40 surveys sent to transplant programs across Canada, 24 (60%) were returned. Of those, 60.9% (15/24) had a formal policy for their use, and 21.7% (5/24) had never accepted an IRD. Only 41.7% (10/24) had access to timely nucleic acid testing (NAT), and respondents were more likely to accept IRD if NAT was available. For example the likelihood of using organs from an intravenous drug user increased from 12.5% (4/24) with serology negative donors to 70.8% (17/24) if NAT was available and the donor had no increased activity within the window period (P < 0.001). Only 37.5% (9/24) discussed the use of IRDs with candidates at listing, with 54.2% (13/24) stating that having a standardized consent would increase utilization of IRDs. CONCLUSIONS The results suggest that availability of NAT would increase IRD utilization. In addition written policies and procedures on IRD use and the consent process would be recommended in many Canadian centers.
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18
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Gonzalez-Stawinski GV. Donor Hearts: Time to Look at Them in a Different Light? J Card Fail 2016; 22:383-4. [PMID: 27058407 DOI: 10.1016/j.cardfail.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
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19
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Wood DM, Chan WL, Dargan PI. Using drug-intoxicated deaths as potential organ donors: impression of attendees at the American college of medical toxicology 2014 annual scientific meeting. J Med Toxicol 2015; 10:360-3. [PMID: 25023224 DOI: 10.1007/s13181-014-0413-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Over the last decade, there has been a reduction of organ donation from intracranial haemorrhage-, stroke- and blunt trauma-related deaths in the USA. There has been a corresponding increase in the use of drug-intoxicated patients as organ donors from 2.1 % in 2003 to 6.8 % in 2013. METHODS Questionnaire survey of attendees at the American College of Medical Toxicology 2014 Annual Scientific Meeting breakout session on transplantation from deaths related to poisoning was performed. Participants were asked whether they would recommend the use of solid organs from cocaine- or carbon monoxide-related death before and after the breakout session. RESULTS Forty-eight US participants (attending 23, fellow 15, resident 3 and other (including non-medical) 7) completed the survey, and 97.8 and 89.1 % of participants would consider cocaine- and carbon monoxide-related deaths for potential organ donation pre-breakout session, respectively; this increased to 100 % for both post-breakout sessions. There was variability in the consideration of different solid organs (the heart, lungs, liver, pancreas and kidneys)-76.2-95.2 and 76.2-85.7 % for individual solid organs for cocaine- and carbon monoxide-related deaths, respectively. For both scenarios, participants were least likely to consider potential heart donation (76.2 % of participants for both), which increased to 100 % following the breakout session. CONCLUSIONS Medical toxicologists have some reservation in recommending solid organs for transplantation from deaths from cocaine and carbon monoxide. Given the decrease in potential organ donors from typical methods of death, further work is needed to promote organ donation in deaths related to acute poisoning.
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Affiliation(s)
- David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK,
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20
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Donor evaluation in heart transplantation: The end of the beginning. J Heart Lung Transplant 2014; 33:1105-13. [DOI: 10.1016/j.healun.2014.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/16/2014] [Accepted: 05/28/2014] [Indexed: 12/20/2022] Open
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21
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Kilic A, Emani S, Sai-Sudhakar CB, Higgins RSD, Whitson BA. Donor selection in heart transplantation. J Thorac Dis 2014; 6:1097-104. [PMID: 25132976 DOI: 10.3978/j.issn.2072-1439.2014.03.23] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/17/2014] [Indexed: 01/17/2023]
Abstract
There is increased scrutiny on the quality in health care with particular emphasis on institutional heart transplant survival outcomes. An important aspect of successful transplantation is appropriate donor selection. We review the current guidelines as well as areas of controversy in the selection of appropriate hearts as donor organs to ensure optimal outcomes. This decision is paramount to the success of a transplant program as well as recipient survival and graft function post-transplant.
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Affiliation(s)
- Ahmet Kilic
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sitaramesh Emani
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Chittoor B Sai-Sudhakar
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Robert S D Higgins
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bryan A Whitson
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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22
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Abstract
Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing. As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.
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Affiliation(s)
- Jaimee Holbrook
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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23
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Fiorelli AI, Stolf NAG, Pego-Fernandes PM, Oliveira Junior JL, Santos RHB, Contreras CAM, Filho DDL, Dinkhuysen JJ, Moreira MCV, Mejia JAC, Castro MCR. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. Transplant Proc 2011; 43:211-5. [PMID: 21335190 DOI: 10.1016/j.transproceed.2010.12.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient < 0.8 (RR = 1.3) (B), ischemia > 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor.
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Affiliation(s)
- A I Fiorelli
- Brazilian Association for Organ Transplantation, Brazil.
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