Multiorgan transplant program in a nonacademic center: organizational structure and outcomes.

Given the complexity of solid organ transplantation, it is reasonable to believe that numerous factors are at play in achieving the enviable outcomes reported. The aim of this study is to examine the role of an organizational structure in maintaining the outcomes of a multiorgan transplant program at a nonacademic center. A retrospective analysis of 2378 solid organ transplants at Nazih Zuhdi Transplant Institute between March 1985 and December 2008 was performed. The 1-year and 3-year patient and graft survival rates, rate of retransplantation, and median length of hospital stay were compared with US national data released by the Scientific Registry of Transplant Recipients in January 2009. The 1-year patient survival rates were 87.5% for heart, 95.1% for kidney, 75.8% for lung, 89.6% for liver, and 100.0% for pancreas. The 3-year patient survival rates were 73.5% for heart, 89.7% for kidney, 57.8% for lung, 87.7% for liver, and 100.0% for pancreas. A well-structured transplant program along with competent medical, administrative, and ancillary support can achieve comparable patient and graft survival rates independent of volume.

Orthotopic liver transplant using allografts from geriatric population in the United States: is there any age limit?

OBJECTIVES: Observations of minimal pathophysiological changes in the liver with healthy aging represent the rationale for expanding the donor pool with older donors. However, a debate exists for their upper age limit. The aim of this study is to examine the outcomes of orthotopic liver transplants from older patients (>or= 60 years). MATERIALS AND METHODS: Using the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) data, we retrospectively analyzed graft and patient survivals of orthotopic liver transplants done with octogenarian grafts (n=197) and compared them with orthotopic liver transplants done with donors aged between 60 and 79 years (n=4003) and < 60 years (n=21 290) during 2003 to 2007. RESULTS: One- and 3-year graft and patient survival rates among recipients of hepatic allografts from donors < 60 years of age were significantly superior to recipients of octogenarian grafts (graft: 84% vs 75.5% at 1 year; 74.2% vs 61.2% at 3 years; P < .001; patient: 87.8% vs 81.0% at 1-year; 79.3% vs 69.1% at 3 years; P < .001). However, there was no survival difference between recipients of allografts from donors aged > 80 years and 60-79 years (graft: 75.5% vs 77.4% at 1 year; 61.2% vs 64.2% at 3 years; P = .564; patient: 81.0% vs 83.8% at 1 year; 69.1% vs 71.8% at 3 years; P = .494). It correlates well with hepatitis C virus-seronegativity and relatively lower model for end-stage liver disease score among recipients of octogenarian grafts (P < .001). CONCLUSIONS: Careful donor evaluation, avoidance of additional donor risk factors, and their pairing with appropriate recipients offer acceptable functional recovery, even with donors > 80 years.

Hemolytic uremic syndrome in association with typhoid fever.

BACKGROUND: Hemolytic uremic syndrome (HUS) has been associated with typhoid fever caused by Salmonella typhi. The pathogenesis of HUS in the context of S typhi infection is not known. The authors report on a patient with typhoid fever in whom HUS and myocarditis developed during the course of his illness and in whom there was no evidence of a Shiga-toxin (Stx)-producing organism. METHODS: Antibodies directed against the Escherichia coli O157:H7 and S typhi lipopolysaccharide (LPS) were sought in the serum sample taken during the acute phase using line-blot immunoassays. Polymerase chain reaction was performed to detect the presence of stx1 and stx2 genes in the patient's S typhi isolate. RESULTS: There was no evidence for immunoglobulin (Ig) M and IgA against the LPS of E coli O157:H7, whereas anti-S typhi LPS IgM and IgA were strongly positive. In the polymerase chain reaction, DNA from the Stx-producing E coli controls yielded stx1 and stx2 fragments of the expected sizes on agarose gel electrophoresis, whereas no stx1 and stx2 fragments were obtained from the S typhi isolate. The S typhi did, however, yield a band when amplified with primers specific for viaB, an S typhi gene. CONCLUSION: S typhi may be responsible for some cases of HUS, and the inciting toxin may not be Stx.