Postnatal Transitional Weight Loss and Adverse Outcomes in Extremely Premature Neonates.

The early postnatal weight loss (EPWL) is highly variable in the extremely low birth weight infants (birth weight <1000 g, ELBW). It is reported to be unassociated with adverse outcomes within a range of 3-21% of birth weight. Its wide range might have contributed to this lack of association. The aim of our paper is to study the effects of maximum EPWL, graded as low, medium and large on clinical outcomes in ELBW infants. In a retrospective cohort observational study EPWL was measured as maximum weight loss from birth weight (MWL) in ELBW infants and grouped as low (5-12%) moderate (18.1-12%) and high (18-25%). The clinical course and complications of infants were compared between the groups. Gestational age (GA) was highest and surfactant administration, peak inspiratory pressure requirement, fluid intake, urinary output, oxygen dependent days and the number of oxygen dependent infants at age 28 days were lower in the low MWL compared to the high MWL group. However, all these significant P-values declined after controlling for GA. Diabetes mellitus and pregnancy associated hypertension were not noted in mothers in high MWL group, whereas 38% of mothers in low MWL group suffered from the latter (P=0.05). Maximum postnatal transitional weight loss, assessed in the range of low, moderate and high, is not associated with adverse outcomes independent of gestational age in ELBW infants. Maternal hypertension decreases EPWL in them.

Preschool Teachers' Language and Literacy Practices with Dual Language Learners.

The purposes of this study were to (a) examine the degree to which teachers used linguistically responsive practices to support the language and literacy development of Spanish-speaking Dual Language Learners (DLL) and (b) to investigate the associations between these practices and select teacher-level factors. The sample consisted of 72 preschool teachers. Observational data were collected on practices. Teachers self-reported on language and culture beliefs, Spanish speaking ability, and classroom composition. Results indicated that teachers, including those who spoke Spanish, used few linguistically responsive practices to support preschool DLLs. Only Spanish-speaking ability was related to practices. Implications for targeted professional development are discussed.

Right ventricular assist device results in worse post-transplant survival.

BACKGROUND: To our knowledge, how the need for a right ventricular assist device (RVAD) with a left ventricular assist device (LVAD) affects outcomes after orthotopic heart transplantation has not been studied in a multi-institutional database. METHODS: The United Network for Organ Sharing (UNOS) database was queried for all adult orthotopic heart transplantations from the period 2005-2012. Patients requiring a RVAD + LVAD as a bridge to transplant were compared with patients requiring a LVAD only and patients requiring no ventricular assist device (VAD). RESULTS: During the study period, 16,955 orthotopic heart transplantations were performed. Of these, 13,209 (77.9%) patients did not require a VAD, 3,270 (19.3%) required a LVAD only, and 457 (2.7%) required a RVAD + LVAD. The RVAD + LVAD group had the longest length of stay (25.7 days) compared with the no VAD group (20.8 days) and the LVAD-only group (21.1 days) (p < 0.001). On multivariate analysis, requirement of a RVAD + LVAD before transplantation was independently associated with post-transplant mortality (hazard ratio 1.22, 95% confidence interval 1.01-1.49, p = 0.04). Other variables associated with mortality included donor age, pulsatile flow LVAD as a bridge to transplant, prolonged ischemic time, worsening renal function, black race, history of diabetes in recipient, class II panel-reactive antibody >10%, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplant. CONCLUSIONS: The requirement of a RVAD in addition to a LVAD before orthotopic heart transplantation is associated with worse post-transplant outcomes and increased mortality.

An initial evaluation of a weight loss intervention for individuals who engage in emotional eating.

UNLABELLED: Emotional eating may contribute to variability in weight loss and may warrant specialized treatment, although no randomized studies of specialized treatments exist for individuals who engage in emotional eating. This pilot study tested a new weight loss intervention for individuals who emotionally eat and compared it to the standard behavioral weight loss treatment (SBT). 79 predominantly female (95 %), predominantly African American (79.7 %) individuals who emotionally eat (BMI = 36.2 ± 4.1 kg/m(2)) were randomized to (1) a new enhanced behavioral treatment (EBT), incorporating skills for managing emotions and emotional eating or (2) a SBT. Primary outcomes were weight and emotional eating at 20 weeks. Weight decreased significantly in both groups (SBT: -5.77 kg (-7.49, -4.04); EBT: -5.83 kg (-7.57, -4.09)), with no significant between-group differences. Similar results were produced for emotional eating. Results suggest that SBT may be effective for reducing weight and emotional eating in individuals who emotionally eat, and that adding emotional-eating specific strategies may not provide additional benefits beyond those produced by SBT interventions in the short-term.Registration site: www.clinicaltrials.gov . REGISTRATION NUMBER: NCT02055391.

Analysis of Bilingual Children's Performance on the English and Spanish Versions of the Woodcock-Muñoz Language Survey-R (WMLS-R).

The purpose of this study was to investigate the way in which items on the Woodcock-Muñoz Language Survey Revised (WMLS-R) Spanish and English versions function for bilingual children from different ethnic subgroups who speak different dialects of Spanish. Using data from a sample of 324 bilingual Hispanic families and their children living on the United States mainland, differential item functioning (DIF) was conducted to determine if test items in English and Spanish functioned differently for Mexican, Cuban, and Puerto Rican bilingual children. Data on child and parent language characteristics and children's scores on Picture Vocabulary and Story Recall subtests in English and Spanish were collected. DIF was not detected for items on the Spanish subtests. Results revealed that some items on English subtests displayed statistically and practically significant DIF. The findings indicate that there are differences in the difficulty level of WMLS-R English-form test items depending on the examinees' ethnic subgroup membership. This outcome suggests that test developers need to be mindful of potential differences in performance based on ethnic subgroup and dialect when developing standardized language assessments that may be administered to bilingual students.

Use of Heavy Drinking Donors in Heart Transplantation is Not Associated With Worse Mortality.

BACKGROUND: Although orthotopic heart transplantation (OHT) remains the preferred treatment for end-stage heart failure, there continues to be a critical shortage of organ donors. The goal of this study is to examine outcomes after orthotopic OHT using heavy drinking donors (HDDs) in a large, national database. METHODS: The United Network for Organ Sharing database was examined for all primary, adult OHT carried out from 2005 to 2012. RESULTS: There were 14,928 total OHT performed during the study period with 2,274 (15.2%) using HDD. Recipients of HDD were older (53.4 vs. 51.9 years, P < 0.001), more likely men (80.7 vs 74.4%, P < 0.001), less likely sex mismatched (21.5 vs 27.5%, P < 0.001), more likely race mismatched (57.4 vs 52.4%, P < 0.001), and had less total HLA mismatches (4.55 vs 4.65, P < 0.001). The HDD were older (37.0 vs 30.5 years, P < 0.001), more likely men (82.2 vs 69.9%, P < 0.001), and more likely to have heavy cigarette use (38.1 vs 13.2%, P < 0.001). Length of stay was not different (20.3 vs 19.7 days, P = 0.02). On multivariate analysis, use of HDD was not associated with mortality at 30 days (hazards ratio [HR], 1.12; 95% confidence interval [95% CI], 0.90-1.39; P = 0.30), 1 year (HR, 0.96; 95% CI, 0.83-1.11; P = 0.56), and at 5 years (HR, 1.02; 95% CI, 0.91-1.13; P = 0.79). Variables associated with mortality at 5 years included increasing donor age, prolonged ischemic time, worsening recipient creatinine, recipient black race, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplantation. CONCLUSION: Heart transplantation can be performed using carefully selected HDDs with good outcomes.

Long-term outcomes in heart transplantation using donors with a history of past and present cocaine use.

OBJECTIVES: Organ donors with a history of cocaine use are thought to be less favourable for orthotopic heart transplantation (OHT). This study examined long-term survival in OHT using donors with a history of cocaine use. METHODS: The United Network for Organ Sharing (UNOS) database was examined for primary, adult heart transplants from 2000 to 2010. Cox proportional hazards analysis using covariates associated with mortality was used to examine survival. RESULTS: There were 19 636 total OHTs with 2274 (11.6%) using donors with a history of dependent cocaine use (DCU). Of these, 1008 (44.3%) donors were current cocaine users. Recipients of DCU were more likely to be male (79.0 vs 75.7%, P < 0.001), more likely diabetic (16.5 vs 14.8%, P = 0.003) and were less likely to be sex mismatched (23.0 vs 28.6%, P < 0.001). DCU donors were older (32.5 vs 31.4 years, P < 0.001), more likely male (79.7 vs 69.8%, P < 0.001) and had higher ischaemic times (3.27 vs 3.20 h, P = 0.001). On multivariate analysis, DCU was not associated with mortality [hazard ratio (HR): 0.95, 95% CI: 0.87-1.03, P = 0.22]. Variables associated with mortality included recipient body mass index, sex mismatch, race mismatch, black race, ischaemic time, recipient creatinine, donor age, donor smoking history and mechanical ventilation or extracorporeal membrane oxygen as a bridge to transplantation. On subset analysis, CCU was not associated with mortality (HR: 0.97, 95% CI: 0.89-1.05, P = 0.42). On Kaplan-Meier analysis, median survival was not different when comparing current (3890.0 days), past (3,889.0 days) and non-cocaine using donors (4165.0 days); P = 0.54. CONCLUSIONS: Use of carefully selected donors with a history of past and current cocaine use does not result in worse outcomes.

Effects of weight loss on foot structure and function in obese adults: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effects of weight reduction on foot structure, gait, and dynamic plantar loading in obese adults. DESIGN: In a 3-month randomized-controlled trial, participants were randomized to receive either a weight loss intervention based on portion-controlled meals or a delayed-treatment control. PARTICIPANTS: 41 adults (32 F, 9 M) with a mean ± SD age of 56.2 ± 4.7 years and a BMI of 35.9 ± 4.2 kg/m(2). MEASUREMENTS: Arch Height Index (AHI), Malleolar Valgus Index (MVI), spatial and temporal gait parameters, plantar peak pressure (PP) and weight were measured at baseline, 3, and 6 months. RESULTS: The intervention group experienced significantly greater weight loss than did the control group (5.9 ± 4.0 kg versus 1.9 ± 3.2 kg, p = 0.001) after 3 months. There were no differences between the groups in anatomical foot structure or gait. However, the treatment group showed a significantly reduced PP than the control group beneath the lateral arch and the metatarsals 4 (all p values < .05) at 3 months. The change in PP correlated significantly with the change in weight at the metatarsal 2 (r = 0.57, p = 0.0219), metatarsal 3 (r = 0.56, p = 0.0064) and the medial arch (r = 0.26, p < 0.0001) at 6 months. CONCLUSION: This was the first RCT designed to assess the effects of weight loss on foot structure, gait, and plantar loading in obese adults. Even a modest weight loss significantly reduced the dynamic plantar loading in obese adults. However, weight loss appeared to have no effects on foot structure and gait.

A randomized controlled study of a healthy corner store initiative on the purchases of urban, low-income youth.

OBJECTIVE: Although many initiatives exist to improve the availability of healthy foods in corner stores, few randomized trials have assessed their effects. This study evaluated, in a randomized controlled trial, the effects of a first-generation healthy corner store intervention on students' food and beverage purchases over a 2-year period. METHODS: Participants (n = 767) were fourth-, fifth-, and sixth-grade students. Ten schools and their nearby corner stores (n = 24) were randomly assigned to the healthy corner store intervention or an assessment-only control. Intercept surveys directly assessed the nutritional characteristics of students' corner store purchases at baseline, 1 and 2 years. Students' weight and heights were measured at baseline, 1 and 2 years. RESULTS: There were no differences in energy content per intercept purchased from control or intervention schools at year 1 (P = 0.12) or 2 (P = 0.58). There were no differences between control and intervention students in BMI z score (year 1, P = 0.83; year 2, P = 0. 98) or obesity prevalence (year 1, P = 0.96; year 2, P = 0.58). CONCLUSIONS: A healthy corner store initiative did not result in significant changes in the energy content of corner store purchases or in continuous or categorical measures of obesity. These data will help to inform future interventions.

Examining ABO compatible donors in double lung transplants during the era of lung allocation score.

BACKGROUND: The short-term and long-term effect of using ABO compatible donors in the era of lung allocation score is unknown. This study determined if carefully selected ABO compatible donors could be used in double lung transplantation (DLT) with good outcomes. METHODS: The United Network for Organ Sharing database was retrospectively reviewed for adult DLT from May 2005 to December 2011. RESULTS: Of 6,655 double lung transplants, 493 (7.4%) were with ABO compatible donors and 6,162 (92.6%) were with ABO identical donors. In multivariate analysis, use of ABO compatible donors was not associated with mortality at 30 days (HR, 1.16; 95% CI, 0.76 to 1.79, p = 0.49), 1 year (HR, 1.10; 95% CI, 0.86 to 1.42, p = 0.46), and 5 years (HR, 1.06; 95% CI, 0.83 to 1.34, p = 0.65). Variables associated with mortality at 5 years were donor female sex, donor age 60 years or greater, prolonged ischemic time, increasing recipient creatinine, recipient age, race mismatch, and mechanical ventilation or extracorporeal membrane oxygenation as a bridge to transplantation. Length of stay was longer in the ABO compatible group (30.9 vs 25.9 days, p = 0.001). Acute rejection episodes on index hospitalization (8.8 vs. 8.9%, p = 1.00), peak posttransplant forced expiratory volume in 1 second (FEV1) (82.7 vs 79.7%, p = 0.053), and decrement in FEV1 over time were not different (p = 0.13). Freedom from bronchiolitis obliterans syndrome was similar (1,475 vs 1,454 days, p = 0.17). CONCLUSIONS: The use of ABO compatible donors in the era of lung allocation score was not associated with short-term or long-term mortality and resulted in equivalent posttransplant lung function. A DLT with carefully selected ABO compatible donors can result in excellent outcomes.

Single-lung transplantation with ABO-compatible donors results in excellent outcomes.

BACKGROUND: The goal of this study was to determine if carefully selected ABO-compatible donors in single-lung transplantation results in acceptable outcomes. METHODS: The United Network for Organ Sharing database was reviewed for adult single-lung transplant recipients from May 2005 to December 2011. Recipients of lungs from ABO-compatible donors were compared with those of ABO-identical donors. Mortality was examined with risk-adjusted multivariable Cox proportional hazards regression using significant univariate predictors. RESULTS: Of 3,572 single-lung transplants, 342 (9.6%) were from ABO-compatible donors. The two groups were evenly matched in recipient age (60.8 vs 60.2 years, p = 0.28), male gender (61.8% vs 58.2%, p = 0.10), lung allocation score (43.4 vs 42.6, p = 0.32), forced expiratory volume in 1 second (FEV1; 41.2% vs 40.8%, p = 0.32), and ischemic time (4.2 vs 4.0 hours, p = 0.09), and donor age (34.4 vs 32.9, p = 0.07) and male gender (61.5 vs 65.5, p = 0.14). ABO-compatible donors were less likely to be race mismatched (58.3% vs 50.9%, p = 0.01). Median survival was not different (1,284.0 vs 1,540 days, p = 0.39). On multivariate analysis, lungs from ABO-compatible donors were not associated with mortality (hazard ratio, 1.02; 95% confidence interval, 0.85-1.22; p = 0.86). Prolonged ischemic time, increasing recipient creatinine, increasing recipient age, race mismatch, class I plasma reactive antigen panel > 10%, and the use of mechanical ventilation or extracorporeal membrane oxygenation were associated with mortality. Peak post-transplant FEV1 (64.5% vs 64.0%, p = 0.69) and decrement in FEV1 over time were similar (p = 0.82). CONCLUSIONS: This large multi-institutional analysis of ABO-compatible donors in single-lung transplantation demonstrates that careful selection of ABO-compatible donors results in excellent outcomes.

Continuous flow left ventricular assist device technology has influenced wait times and affected donor allocation in cardiac transplantation.

OBJECTIVE: Bridge to transplantation patients with continuous flow left ventricular assist devices (cfLVADs) are assigned United Network for Organ Sharing status 1A or 1B priority while awaiting orthotopic heart transplantation. We investigated the influence of cfLVAD on the waitlist times and organ allocation. METHODS: The United Network for Organ Sharing database was examined from 2005 to 2012 for patients with cfLVAD and pulsatile flow LVAD (pLVAD). These 2 cohorts were compared with patients who did not receive LVAD. RESULTS: Of 16,476 total orthotopic heart transplantations, 3270 (19.8%) were performed on patients with an LVAD as a bridge to transplantation. The cfLVAD group had the longest total waitlist time (259.6 days) compared with the pLVAD (134.6 days) and non-LVAD (121.7 days) groups (P < .001). The cfLVAD group spent more time in status 1A (44.7 days) than did the pLVAD (32.1 days) and non-LVAD (16.4 days) cohorts (P < .001). The median waitlist survival was better for the cfLVAD group (1234.0 days) than in the pLVAD (441.0 days) and non-LVAD (471.0 days) groups (P < .001). The cfLVAD recipients were older, had a greater body mass index, and more often had diabetes than did pLVAD and non-LVAD patients. The cfLVAD cohort received hearts from older, more often male donors, with a greater body mass index. Post-transplant survival was not significantly different among the 3 groups on Kaplan-Meier analysis (P = .12). CONCLUSIONS: Despite being older, less favorable recipients, the cfLVAD patients spent more time in status 1A and had greater waitlist survival. This might allow cfLVAD patients to receive preferred donor hearts, which might allow for better post-transplant survival.

Impact of extracorporeal membrane oxygenation or mechanical ventilation as bridge to combined heart-lung transplantation on short-term and long-term survival.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV) can be used as a bridge to heart-lung transplantation (HLT). The goal of this study was to determine if pretransplantation ECMO or MV affects survival in HLT. METHODS: The United Network for Organ Sharing database was reviewed for all adult patients receiving HLT from 1995 to 2011. The primary outcome measured was risk-adjusted all cause mortality. RESULTS: There were 542 adult patients received HLT during the study period. Of these, 15 (2.8%) required ECMO and 22 (4.1%) required MV as a bridge to transplantation. The groups were evenly matched with regards to recipient age, recipient gender, ischemic time, donor age, and donor gender. The ECMO cohort had worse survival than the control group at 30 days (20.0% vs. 83.5%) and 5 years (20.0% vs. 47.4%; P<0.001). When compared with control, patients requiring MV had worse survival at 1 month (77.3% vs. 83.5%) and 5 years (26.5% vs. 47.4%; P<0.001). The use of ECMO (hazard ratio [HR]=3.820, 95% confidence interval [CI]=1.600-9.116; P=0.003) or MV (HR=2.011, 95% CI=1.069-3.784; P=0.030) as a bridge to transplantation was independently associated with mortality on multivariate analysis. Recipient female gender was associated with survival (HR=0.754, 95% CI=0.570-0.998; P=0.048). CONCLUSIONS: HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality. Further studies are needed to optimize survival in these high-risk patients.

Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history.

BACKGROUND: We attempt to determine if adult, single-lung transplantation could be performed with acceptable results in heavy-smoking donors (HSDs; > 20 pack-years). METHODS: The United Network of Organ Sharing database was examined for adult single-lung transplantation from 2005 to 2011. RESULTS: Of the 3,704 single-lung transplantations, 498 (13.4%) were from HSDs. The 2 groups were similar in recipient age (60.6 vs. 60.7 years, p = 0.20), male gender (61.3% vs. 59.8%, p = 0.54), ischemic time (4.1 vs. 4.2 hours, p = 0.11), and pre-transplant forced expiratory volume in 1 second (FEV1; 41.1% vs. 40.0% predicted). Recipients of HSDs had lower lung allocation score (39.7 vs. 38.0, p = 0.02), less human leukocyte antigen mismatches (4.6 vs. 4.5, p = 0.01), and higher class I panel reactive antibody (2.9% vs. 3.8%, p < 0.001). HSDs were older (33.0 vs. 41.3 years, p < 0.001) and less likely male (62.5 vs. 56.0%, p = 0.01). Recipients with HSDs had longer length of stay (20.5 vs. 23.0 days, p < 0.001) and lower peak FEV1 after single-lung transplantation (80.1% vs. 73.4%, p < 0.001). Freedom from bronchiolitis obliterans syndrome (p = 0.64), post-single-lung transplantation decrement in FEV1 (p = 0.07), and median survival (1,516 vs. 1,488 days, p = 0.10) were similar. Multivariable analysis found receiving lungs from actively smoking HSDs was associated with mortality (hazard ratio [HR], 1.23, 95% confidence interval [CI], 1.05-1.45; p = 0.01). Use of HSDs who were not actively smoking was not associated with mortality (HR, 0.84; 95% CI, 0.59-1.19; p = 0.33). Mortality was associated with recipient age, longer ischemic time, race mismatch, class I panel reactive antibody > 10%, mechanical ventilation, and extracorporeal membrane oxygenation as a bridge to transplantation. CONCLUSIONS: Although single-lung transplantation with actively smoking HSDs results in worse results, outcomes are acceptable and should continue to be considered.

Relationship of selected bacterial vaginosis-associated bacteria to Nugent score bacterial vaginosis among urban women early in pregnancy.

Among urban, primarily African American pregnant women, 74% were identified with Nugent score bacterial vaginosis (BV). All BV-associated bacteria were more prevalent among women with Nugent score BV. Bacterial vaginosis-associated bacteria 3 (BVAB3) had the highest positive predictive value, whereas Gardnerella vaginalis and Atopobium spp. had the highest sensitivity. Atopobium spp. levels had the most significant area under the curve.

Impact of low donor to recipient weight ratios on cardiac transplantation.

BACKGROUND: International Society of Heart and Lung Transplantation guidelines for adult heart transplantation (HT) suggest a donor to recipient body weight ratio (WR) of greater than 0.8. For female to male transplants, a WR of greater than 0.9 is recommended. METHODS: The United Network for Organ Sharing database was examined for adult HT from 1999 to 2011. Controls with a WR of 0.9 or greater (normal donor to recipient weight ratio) were compared with patients with a WR of 0.6 to 0.89 (WRL) and a WR of less than 0.59 (WRVL). The primary measured outcome was survival. RESULTS: Of the 21,928 patients undergoing HT, 14,592 (66.6%) were performed with a normal donor to recipient weight ratio, 7212 (32.9%) were performed with WRL, and 124 (0.6%) were performed with WRVL. In male donor to male recipient, male donor to female recipient, and female donor to female recipient HT, the use of WRL did not influence median survival (P = .3621) and was not associated with increased mortality (P = .7273). In female donor to male recipient HT, WRL was associated with decreased median survival (435 days, P = .0241) and was associated with increased mortality (hazard ratio, 1.201; P = .0383). CONCLUSIONS: HT can be safely performed using WRL donors between sex-matched and male to female transplants. However, in female to male transplants, WRL donors are associated with decreased survival. Although clinical circumstances will guide decision making, consensus criteria may be revisited to liberalize the pool of acceptable donors in an era of unprecedented donor shortage.

Developing measures of community-relevant outcomes for violence prevention programs: a community-based participatory research approach to measurement.

Community-Based Participatory Research is a research paradigm that encourages community participation in designing and implementing evaluation research, though the actual outcome measures usually reflect the "external" academic researchers' view of program effect and the policy-makers' needs for decision-making. This paper describes a replicable process by which existing standardized psychometric scales commonly used in youth-related intervention programs were modified to measure indicators of program success defined by community partners. This study utilizes a secondary analysis of data gathered in the context of a community-based youth violence prevention program. Data were retooled into new measures developed using items from the Alabama Parenting Questionnaire, the Hare Area Specific Self-Esteem Scale, and the Youth Asset Survey. These measures evaluated two community-defined outcome indicators, "More Parental Involvement" and "Showing Kids Love." Results showed that existing scale items can be re-organized to create measures of community-defined outcomes that are psychometrically reliable and valid. Results also show that the community definitions of parent or parenting caregivers exemplified by the two indicators are similar to how these constructs have been defined in previous research, but they are not synonymous. There are nuanced differences that are important and worthy of better understanding, in part through better measurement.

Cardiac transplantation with ABO-compatible donors has equivalent long-term survival.

BACKGROUND: We sought to determine the long-term effects of ABO-compatible donors (ACD) in adult cardiac transplantation (OHT). METHODS: The United Network for Organ Sharing database was examined for adult OHT from 2000 to 2010. RESULTS: Of 20,353 patients undergoing OHT, 3,046 (15%) were with ACD. Recipients of ACD were younger (51.2 vs 52.0 years; P = .002), less likely male (74.1 vs 76.5; P = .004), and had shorter ischemic time (3.1 vs 3.2 hours; P < .001). The 2 groups had similar donor age (31.5 vs 31.5; P = .973), preponderance of male gender (70.9% vs 71.4%; P = .341), and gender mismatching (27.8 vs 27.9; P = .956). Recipients of ACD had similar duration of stay (20.4 vs 20.1 days; P = .544) and median survival times were similar (3,961 vs 4,005 days; P = .078). On multivariate analysis, ACD were associated with increased mortality at 1 year (hazard ratio [HR], 1.139; 95% confidence interval [CI], 1.015-1.278; P = .027). ACD were not associated with mortality at 10 years (HR, 1.032; 95% CI, 0.952-1.119; P = .437). Variables associated with mortality at 10 years included donor age, ischemic time, recipient creatinine, recipient black race, congenital disease, restrictive cardiomyopathy, status 1A, gender mismatch, race mismatch, and mechanical ventilation or extracorporeal membrane oxygenation as a bridge to transplantation. CONCLUSION: OHT with select ACD results in equivalent long-term survival.

Double-lung transplantation can be safely performed using donors with heavy smoking history.

BACKGROUND: Lung transplantation using grafts from donors with a history of heavy smoking (>20 pack-years) is thought to confer worse prognosis. We attempt to determine if adult, double-lung transplantation can be safely performed with lungs from heavy-smoking donors (HSD). METHODS: The United Network for Organ Sharing (UNOS) database was examined for adult, double-lung transplants from 2005 to 2011. RESULTS: Of 5,900 double-lung transplants, 766 (13.0%) were from HSDs. The two groups were similar in recipient age (49.8 vs 50.5 years, p = 0.15), male sex (56.9% vs 56.5%, p = 0.87), and lung allocation score (45.8 vs 44.9, p = 0.18). Recipients of lungs from HSDs had lower forced expiratory volume in 1 second (FEV1; 34.3 vs 36.1% predicted, p = 0.04), longer ischemic time (5.75 vs 5.58 hours, p = 0.01), less human leukocyte antigen mismatch (4.51 vs 4.62, p = 0.01), and lower class I plasma reactive antigens (2.64 vs 3.69%, p = 0.001). HSDs were older (40.9 vs 32.6 years, p < 0.001) and less likely male (51.7 vs 59.7%, p < 0.001). Recipients of lungs from HSDs had longer median length of stay (18.0 vs 17.0 days, p < 0.001). Freedom from bronchiolitis obliterans syndrome (p = 0.09), decrement in FEV1 (p = 0.12), peak FEV1 (79.8% vs 79.0%, p = 0.51), and median survival (2,043 vs 1,928 days, p = 0.69) were not different. On multivariate analysis, HSD lungs were not associated with death (hazard ratio, 1.003; 95% confidence interval, 0.867 to 1.161, p = 0.96). Death was associated with donor age, ischemic time, race mismatch, mechanical ventilation, and extracorporeal membranous oxygenation before transplantation. CONCLUSIONS: Double-lung transplantation can be safely performed with lungs from donors with a heavy smoking history.

Cardiac transplantation can be safely performed using selected diabetic donors.

OBJECTIVE: Cardiac transplantation (OHT) using diabetic donors (DDs) is thought to adversely influence survival. We attempt to determine if adult OHT can be safely performed using selected DDs. METHODS: The United Network for Organ Sharing (UNOS) database was examined for adult OHT from 2000 to 2010. RESULTS: Of the 20,348 patients undergoing OHT, 496 (2.4%) were with DDs. DDs were older (39.6 vs 31.3 years; P < .001), more likely female (41.5% vs 28.3%; P < .001), and had a higher body mass index (BMI) (29.9 vs 26.4; P < .001). Recipients of DD hearts were older (53.4 vs 51.8; P = .004) and more likely to have diabetes (18.9% vs 14.9%; P = .024). The 2 groups were evenly matched with regard to recipient male gender (78.0% vs 76.1%; P = .312), ischemic time (3.3 vs 3.2 hours; P = .191), human leukocyte antigen mismatches (4.7 vs 4.6; P = .483), and requirement of extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (0.8% vs 0.5%; P = .382). Median survival was similar (3799 vs 3798 days; P = .172). On multivariate analysis, DD was not associated with mortality (hazard ratio [HR], 1.155; 95% confidence interval [CI], 0.943-1.415; P = .164). As previously demonstrated, donor age, decreasing donor BMI, ischemic time, recipient creatinine, recipient black race, recipient diabetes, race mismatch, and mechanical ventilation or ECMO as a bridge to transplant were associated with mortality. On multivariate analysis of subgroups, neither insulin-dependent diabetes (1.173; 95% CI, 0.884-1.444; P = .268) nor duration of diabetes for more than 5 years (HR, 1.239; 95% CI, 0.914-1.016; P = .167) was associated with mortality. CONCLUSIONS: OHT can be safely performed using selected DDs. Consensus criteria for acceptable cardiac donors can likely be revised to include selected DDs.