The cold chain delivery of organs for transplantation: from research laboratories and individual enthusiasts to pan- global networks in 50 years

It is some 50 years since the first published reports appeared of ex vivo preservation of organs for transplantation. Over the intervening decades, organ preservation strategies have become one essential component of world-wide clinical transplant services. In the formative years, translational research in organ hypothermic preservation was grappling with the questions about whether static or dynamic storage was preferable, and the practical implications of those choices. Those studies were also informing the newly expanding clinical transplant services. During the middle years, both preservation modalities were practiced by individual group choices. By the 2000s, the shift in donor demographics demanded a re-evaluation of organ preservation strategies, and now a new era of research and development is promoting adoption of new technologies. In this review we outline many important academic studies which have contributed to this successful history, and give profile to the increasing innovative approaches which are being evaluated for the future. Doi.org/10.54680/fr24310110112.

Risk Factors for Revision Surgery Following Revision Total Knee Arthroplasty Using a Hinged Knee Prosthesis for Septic and Aseptic Indications

INTRODUCTION

The use of hinged knee replacements (HKRs) for limb salvage is a popular option for revision total knee arthroplasty (RTKA). Although recent literature focuses on the outcomes of HKR for septic and aseptic RTKAs, little is reported on the risk factors of returning to the operating room. The purpose of this study was to evaluate risk factors of revision surgery and revision after receiving HKR for septic versus aseptic etiology.

METHODS

A multicenter, retrospective review was conducted on consecutive patients who received HKR from January 2010 to February 2020 with a minimum follow-up of 2 years. Patients were separated into two groups: septic and aseptic RTKAs. Demographic, comorbidity, perioperative, postoperative, and survivorship data were collected and compared between groups. Cox hazard regression was used to identify risk factors associated with revision surgery and revision.

RESULTS

One-hundred fifty patients were included. Eighty-five patients received HKR because of prior infection, and 65 received HKR for aseptic revision. A larger proportion of septic RTKA returned to the OR versus aseptic RTKA (46% vs 25%, P = 0.01). Survival curves revealed superior revision surgery-free survival favoring the aseptic group ( P = 0.002). Regression analysis revealed that HKR with concomitant flap reconstruction was associated with a three-fold increased risk of revision surgery ( P < 0.0001).

DISCUSSION

HKR implantation for aseptic revision is more reliable with a lower revision surgery rate. Concomitant flap reconstruction increased the risk of revision surgery, regardless of indication for RTKA using HKR. Although surgeons must educate patients about these risk factors, HKR remains a successful treatment option for RTKA when indicated.

LEVEL OF EVIDENCE

prognostic, level III evidence.

Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee

BACKGROUND

Nutritionally compromized patients, with preoperative serum albumin (SAB) < 3.5g/dL, are at higher risk for periprosthetic joint infection (PJI) in total joint arthroplasty. The relationship between nutritional and PJI treatment success is unknown. The purpose of this study was to examine the relationship between preresection nutrition and success after first-stage resection in planned two-stage exchange for PJI.

METHODS

A retrospective review was performed on 418 patients who had first-stage resection of a planned two-stage exchange for chronic hip or knee PJI between 2014 and 2018. A total of 157 patients (58 hips and 99 knees) were included who completed first stage, had available preop SAB and had a 2-year follow-up. Failure was defined as persistent infection or repeat surgery for infection after resection. Demographic and surgical data were abstracted and analyzed.

RESULTS

Among knee patients with preop SAB >3.5 g/dL, the failure rate was 32% (15 of 47) versus a 48% (25 of 40) failure rate when SAB <3.5 g/dL (P = .10). Similarly, the failure rate among hip patients with preop SAB >3.5 g/dL versus 12.5% (3 of 24) versus 44% (15 of 34) for hip patients with SAB <3.5 g/dL (P = .01). Multivariable regression results indicated that patients with SAB< 3.5 g/dL (P = .0143) and Musculoskeletal Infection Society host type C (P = .0316) were at an increased risk of failure.

CONCLUSION

Low preoperative SAB and Musculoskeletal Infection Societyhost type-C are independent risk factors for failure following first-stage resection in planned two-stage exchange for PJI. Efforts to nutritionally optimize PJI patients, when possible, may improve the outcome of two-stage exchange.

Varus Collapse in Total Knee Arthroplasty: Does Fixation or Bone Fail First?

INTRODUCTION

Aseptic tibial loosening is now considered the most common reason that total knee arthroplasties (TKA) fail long term. There are unique subsets of patients that fail into varus alignment of the tibial tray with collapse of the medial proximal tibia. It is currently unknown if the implant fixation fails first or if the proximal medial tibia collapses first.

MATERIALS

We performed a retrospective analysis of 88 patients that were revised at our institution secondary to aseptic varus collapse of the proximal tibia. Two fellowship-trained arthroplasty surgeons performed a retrospective analysis on sequential precollapse radiographs in each patient to determine which failed first: the implant fixation (implant-cement or cement-bone interface) or the medial proximal tibia.

DISCUSSION

36/88 (40.9%) patients had a series of precollapse radiographs that could be reviewed. Failure at the implant-cement interface before varus collapse in 23 vs 22 patients, failure at the implant-cement and cement-bone interface before varus collapse in two patients, and contemporaneous failure at the implant-cement interface and varus collapse in 11 vs 12 patients were identified by reviewers one and two, respectively.

CONCLUSION

The most frequent mechanism of failure identified was failure of the implant-cement interface followed by subsequent medial tibial varus collapse. Improving implant fixation may decrease the incidence of this unique failure mechanism. We advocate the use of supplemental stem fixation in high-risk patients and optimal cement techniques for all patients as methods of potentially avoiding tibial varus collapse, one of the most frequent modes of long-term failure.

Metabolic and embryonic responses to terrestrial incubation of Fundulus grandis embryos across a temperature gradient

This study simulated terrestrial incubation and measured rates of embryogenesis, nitrogen elimination, heart rate, lactate production, maximum length of time a hatch could be delayed and developmental responses of terrestrially incubated Gulf killifish Fundulus grandis embryos at temperatures ranging from 20 to 30° C. Temperature had a positive relationship with rate of embryogenesis, but a negative relationship with extent of extended incubation. The 30° C treatment reached embryonic maturity 6 days before the 20° C treatment. Embryos hatched between intervals of 240 and 336, 144 and 288, 96 and 240 and 96 and 192 h after reaching developmental maturity for the 20, 23, 26 and 30° C treatments. Significantly higher concentrations of total nitrogen, in the form of ammonia and urea, were recorded in the 20 and 30° C treatments. While temperature significantly influenced lactate and ATP concentrations, no significant influence of time of incubation was detected. Terrestrial embryos displayed an ability to develop quickly during embryogenesis and prolong incubation for an extended period of time after reaching embryonic maturity. This adaptation may be a life-history trait used to minimize asynchronous hatching, cannibalism and cohort size heterogeneity.

Effects of the estrogen mimic genistein as a dietary component on sex differentiation and ethoxyresorufin-O-deethylase (EROD) activity in channel catfish (Ictalurus punctatus)

A number of aquaculture species, including channel catfish Ictalurus punctatus, are fed high proportions of soybean meal in their diet. We have investigated the potential for the most common phytoestrogen in soybean meal to alter phenotypic sex during sexual differentiation in channel catfish. Channel catfish were fed four dietary concentrations of the phytoestrogen genistein (0, 2, 4, and 8 mg g(-1)) to determine its effect on gonadal sex differentiation. The four treatment diets were fed to sexually undifferentiated channel catfish between 5 and 140 days post hatch (dph) and between 60 and 150 dph. Phenotypic sex was determined by histological examination of the gonads. Ethoxyresorufin-O-deethylase activity was not significantly different among the treatment and control groups. Phenotypic sex was significantly dependant on dietary phytoestrogen concentration (P = 0.01). Additionally, logistic regression showed a significant relation between genistein concentration in the diet and gonadal sex (P = 0.02). Intersex individuals were present at all treatment concentrations, with increasing proportions of intersex fish as the genistein concentration increased for individuals fed treated diets between 5 and 140 dph. Increased proportions of phenotypically male individuals resulted from chronic dietary exposure to the estrogen mimic genistein. There were no significant differences in the proportions of males and females between feed treatment durations. These findings establish that dietary concentrations of genistein can alter sex ratios in cultured channel catfish populations and demonstrates the need to further understand the actions of this and other prominent phytoestrogens in aquaculture species.

Diallel and generation means analyses for the components of resistance to Cercospora arachidicola in peanut

The inheritance of the components of partial resistance to Cercospora arachidicola Hori in peanut (Arachis hypogaea L.) was examined in two five-parent diallels and in the six generations of two single crosses in greenhouse tests. The Griffing (1956) analysis indicated general combining ability (GCA) to be of most importance, yet large ratios of SCA/GCA sum of squares suggested nonadditive genetic variance as well. Reciprocal effects were found for lesion area and lesion number/10 cm(2) leaf area. The importance of nonadditive genetic variance was substantiated by the lack of fit for the additive-dominance model in the Hayman's analysis (1954 a, b). Further evidence from the Hayman's analysis indicated that epistasis may be important in determining the inheritance of some of the components of resistance. Additive gene effects alone accounted for the genetic variability observed among the generation means from two single crosses for all components of resistance except latent period. There was evidence that epistasis was an important mode of gene action for the inheritance of latent period.

Preparation of a homogeneous and stable form of bovine milk lipoprotein lipase

Lipoprotein lipase was purified to homogeneity from bovine skim milk by a two-step procedure using chromatography on heparin-Sepharose. As determined by gradient-polyacrylamide gel electrophoresis in sodium dodecyl sulfate, purified lipoprotein lipase showed a single band with an apparent molecular weight of 55,000. The use of Triton N-101 in the washing buffers was the major improvement from previously reported purification procedures that resulted in a stable homogeneous preparation of the enzyme.

The incident at Tuol Chrey: pathologic and toxicologic examinations of a casualty after chemical attack

The results of the pathologic and toxicologic examinations of specimens from a casualty who died several weeks after a chemical attack in Kampuchea are discussed. While the effects of tricothecene mycotoxins have been described in domestic and experimental animals, there is a paucity of information about the pathologic effects of these toxins in humans. The possible effects of endemic diseases such as falciparum malaria, viral hepatitis, and nutritional deficiencies, as well as of the sudden, unexpected death syndrome among refugees from Southeast Asia, have been reviewed. If the results of the histologic examinations in this case are considered alone, it is not possible to establish a cause-effect relationship. However, the circumstances of injury, the relationship of pathologic findings to the studies of experimental animals, and the results of the toxicologic examinations of environmental and biologic specimens indicate that the combinations of tricothecene mycotoxins detected are not consistent with natural occurrence and provide evidence that the pathologic effects are related to a toxic agent.