Progress in Transplantation

Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome's complications. Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome, but the effect of mannitol (a free radical scavenger) on attenuating the syndrome is unclear.

To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome, as indicated by postreperfusion cardiac output and central venous oxygen saturation.

In a randomized clinical trial, 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups. During the anhepatic phase, patients in the mannitol group received 1g/kg mannitol, whereas those in the control group received physiological saline. Mean arterial pressure, cardiac output, and central venous oxygen saturation were measured before and after the portal vein was declamped. Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.

Shiraz Organ Transplant Center, Shiraz, Iran.

In the mannitol group, no significant change was found in mean arterial pressure, cardiac output, and central venous oxygen saturation before and after declamping of the portal vein (P= .78, P= .59, and P= .83, respectively). However, after declamping in the control group, mean arterial pressure, cardiac output, and central venous oxygen saturation were significantly lower than before declamping (P= .003, P= .001, and P <.001, respectively). No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group.

Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia.

Health-related quality of life is a preferred outcome measure for patients with advanced liver disease. The functional health status charts developed by the Dartmouth Primary Care Cooperative Information Project (COOP)/World Organization of National Colleges, Academies and Academic Associations (WONCA) make up a generic instrument for assessing health-related quality of life.

To translate and validate the Persian version of COOP/WONCA in liver transplant candidates and to assess the correlation of Child Pugh classification and Model of End Stage Liver Disease (MELD) score with quality of life.

The Shiraz liver transplant center, the most active liver transplant center in the Middle East.

Consecutive adult outpatients waiting for their first liver transplant who attended follow-up visits in the pretransplant clinic.

Patients completed COOP/WONCA along with the Short Form (SF)-36. Data on the underlying cause of cirrhosis, Child-Pugh classification, and MELD scores were collected from medical records.

A Persian version of the COOP/WONCA was accepted by liver transplant candidates and showed adequate reliability and validity. Similar domains in COOP/WONCA charts and the SF-36 were highly correlated, indicating that construct validity of the COOP/WONCA in relation to the SF-36 was good (77% of correlations were as expected). Moreover, the exploratory factor analysis could not extract 2 different quality-of-life factors. These findings provide sufficient evidence to conclude that the Persian versions of COOP/WONCA charts and the SF-36 measure the same constructs of health-related quality of life and can be used interchangeably. Four of the 6 COOP/WONCA charts did not allow discrimination between groups of patients according to Child Pugh classification, indicating poor known group validity.

Effective lung transplant education helps ensure informed decision making by patients and better transplant outcomes.

To understand the educational needs and experiences of lung transplant patients.

Mixed-method study employing focus groups and patient surveys.

Barnes-Jewish Hospital in St Louis, Missouri.

50 adult lung transplant patients: 23 pretransplant and 27 posttransplant.

Patients' interest in receiving specific transplant information, the stage in the transplant process during which they wanted to receive the education, and the preferred format for presenting the information.

Patients most wanted information about how to sustain their transplant (72%), when to contact their coordinator immediately (56%), transplant benefits (56%), immunosuppressants (54%), and possible out-of-pocket expenses (52%). Patients also wanted comprehensive information early in the transplant process and a review of a subset of topics immediately before transplant (time between getting the call that a potential donor has been found and getting the transplant). Patients reported that they would use Internet resources (74%) and converse with transplant professionals (68%) and recipients (62%) most often.

Lung transplant patients are focused on learning how to get a transplant and ensuring its success afterwards. A comprehensive overview of the evaluation, surgery, and recovery process at evaluation onset with a review of content about medications, pain management, and transplant recovery repeated immediately before surgery is ideal.

Kidney transplant is a most important replacement therapy. It reduces cardiovascular mortality and morbidity but does not fully correct impairments in cardiac function. Fragmented QRS (fQRS) complex includes various RSR′ patterns with different QRS complex morphologies on electrocardiograms.

To analyze fQRS frequency and the relationship between fQRS and left ventricular function in kidney transplant patients.

After demographic data on 39 kidney transplant patients were recorded and biochemical parameters were investigated, electrocardiograms were evaluated for the presence of fQRS. Left ventricular ejection fraction, mitral annular plane systolic excursion, peak early diastolic mitral annular velocities, late diastolic mitral annular velocities, and systolic mitral annular velocity were analyzed.

Fragmented QRS was detected in 16 patients. A history of hypertension was associated with the presence of fQRS. Patients with fQRS had significantly lower systolic and peak early diastolic mitral annular velocities, mitral annular plane systolic excursion, and left ventricular ejection fraction than did patients without fQRS (P = .03, .01, < .001, and .03, respectively).

Detection of fQRS on electrocardiograms may be useful in predicting systolic and diastolic dysfunction of the left ventricle in kidney transplant patients.

Given the shortage of kidneys for transplant, living kidney donation (LKD) is increasingly used to expand the organ donor pool. Although Hispanics/Latinos need disproportionately more kidney transplants, they receive a smaller proportion of living donor kidney transplants than other ethnic/racial groups.

To assess Hispanics' awareness, perceptions, misconceptions, cultural beliefs, and values about and barriers to LKD.

Nine focus groups were conducted with 76 adult Hispanics in Chicago, Illinois, between January and March 2012.

Focus groups included kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public.

Several themes emerged as perceived barriers to LKD. Many participants identified knowledge deficits about LKD, expressing uncertainty about the differences between LKD and deceased donation, and whether kidney disease simultaneously afflicts both kidneys. Many believed that donors experience dramatically shorter life expectancies, are unable to have children, and are more susceptible to kidney disease after donating. Recipients and donors reported that family members were involved in discussions about the donor's decision to donate, with some family members discouraging donation. Financial barriers cited included fear of becoming unable to work, losing one's job, or being unable to pay household bills while recovering. Participants also identified logistic barriers for undocumented immigrants (eg, the inability to obtain government insurance for transplant candidates and uncertainty about their eligibility to donate). Donors desired information about optimizing self-care to promote their remaining kidney's health. Culturally competent interventions are needed to redress Hispanics' knowledge deficits and misconceptions and reduce LKD disparities among Hispanics.

Knowledge is linked consistently with organ donation attitudes, willingness, and consent. Negative information about donation and the recipients of donation can affect public opinion and donation willingness. However, it is unclear which information sources are most important in forming knowledge, particularly in Australia where little prior research exists.

To identify information sources that may inform Australians' organ donation knowledge and attitudes toward transplant recipients.

1487 Australian residents aged 18 years or older who completed an online survey.

Self-reported knowledge, information sources, and attitudes toward transplant recipients.

Participants felt fairly well informed about organ donation, particularly if they registered donation wishes, were female, and were older. More than half reported their driver's license, television news, and discussion with family/friends as donation information sources. However, information sources contributing to knowledge were personal experience, online, hospital, government campaign, discussion with family/friends, Medicare, doctor's surgery, and the newspaper. Differences based on registration status, sex, and age, were found. Discussion with family/friends and movies or television shows, as well as not having seen information in a newspaper or doctor's surgery, contributed to positive attitudes toward recipients, although the variance explained was small.

People felt more informed by personal, medical, and government information sources than by mass media. Family discussion was not only a common information source but also contributed significantly and positively to both donation knowledge and attitudes toward recipients. Further exploration of information sources contributing to donation knowledge and community attitudes toward transplant recipients among young men is needed.

Public acceptance of routine medical procedures is nearly universal, but controversy over dramatic or invasive procedures like transplants is common.

To assess the distributions and organization of public opinion on organ transplant and to discover the magnitude of the direct and indirect impacts of religion, scientific knowledge, and acceptance of evolution on individuals' support for organ transplant.

A representative sample (N = 2069) of the US adult, English-speaking population in 2009.

Participants were administered the International Social Science Survey/USA 2009.

Organ transplants were warmly endorsed by most Americans in 2009, as earlier, but support is not universal. Confirmatory factor analysis shows that Americans' opinions on heart, kidney, and pancreas transplants all reflect the same underlying attitude toward major organ transplants. Structural equation modeling shows that scientific knowledge is the most important influence on these attitudes, with more knowledgeable persons being more supportive. Acceptance of the theory of evolution is the second most important factor, also associated with greater support for transplant. Growing up in a church-going family encourages people to support organ transplant, even after adjusting for other influences. Otherwise denomination and religious belief have only small indirect influences. Demographic differences are small.

These results provide clues about future trends. A religious revival, were it to occur, would not be likely to alter support for transplants. If public knowledge of science continues to increase, or acceptance of the theory of evolution grows, support for transplant will most likely increase.