Age and sex predict PaO2/FiO2 ratio in brain-dead donor lungs.

OBJECTIVES: To define the prevalence of various ranges of the ratio of partial arterial oxygen tension to fraction of inspired oxygen (Pao(2)/Fio(2)) and to determine correlative and predictive variables of donor lung Pao(2)/Fio(2). MATERIAL AND METHODS: From the brain death database of Masih Daneshvari Hospital Organ Procurement Center, we extracted demographic data, cause of injury, patient clinical condition, and laboratory findings as independent data. Donor lung suitability was determined with an oxygen challenge test, with results of 400 mm Hg considered ideal; 300 to 399 mm Hg, good; 200 to 299 mm Hg, borderline; and less than 200 mm Hg, not acceptable. RESULTS: Using the Pao(2)/Fio(2) cutoff points, 6.7% of donor lungs were considered ideal; 26.7%, good; 40%, borderline; and 26.7%, unacceptable. Mean (SD; range) Pao(2)/Fio(2) was 266.6 (85.6; 110-460). The Pao(2)/Fio(2) was significantly correlated with age (r = -0.35; P = .02). After entering the study variables into a linear regression model, age (-2.3; P = .008) and sex (51.5; P = .04) were significant predictors of donor lung suitability (R(2) = 0.95; P < .001). CONCLUSION: Results of oxygen challenge tests demonstrated better suitability of lungs from male and younger brain-dead donors. This finding is independent of other variables including cause of brain death and clinical and paraclinical data.

Renal transplantation in Iran over the past two decades: a trend analysis.

BACKGROUND: In this study, we have reported updated statistics of the Iranian Transplantation Registry, the status of the recipients and grafts, and a detailed time trend with respect to patient characteristics. METHODS: We retrospectively reviewed the Iranian Renal Transplantation Registry and information from the Dialysis and Transplant Patients Public Association, to obtain data on all kidney transplantations performed in Iran between 1986 and 2005. Data were gathered regarding the total number of transplantations, graft loss, recipient death, and donor and recipient characteristics, including demographic data, cause of end-stage renal disease (ESRD), and source of kidney. We assessed changes in variables on a biannual basis. RESULTS: A total of 19521 transplantations were registered over the study period, of which, 761 recipients (3.9%) had died and 2333 allografts (11.9%) had been lost. The source of the kidney in 2556 (13%) subjects was a living related donor (LRD), in 16234 (83%) a living unrelated donor (LURD), and in 831 (4%) cadaveric. During the study decades we noted an increase in the number of kidney transplantations (from 22 to 3690), age of recipients (from 30 to 40), male-to-female ratio of recipients (from 0.58 to 0.67), male-to-female ratio of donors (from 0.48 to 0.52), diabetes mellitus (from 0% to 27%), and hypertension (from 4% to 15%), as causes of ESRD, as well as the use of cadaveric kidneys (0% to 11%). CONCLUSION: Analyzing renal transplantation data not only helps to evaluate the effectiveness of transplantation activities in a country, but also provides information to estimate future costs in the health care system.

Outcome of living kidney transplant: pediatric in comparison to adults.

BACKGROUND: Renal transplantation is the most optimal way to manage children with end-stage renal disease. Despite its benefits, pediatric renal transplantation is a challenge for several transplantation centers in terms of achieving a satisfactory outcome. We sought to compare the long-term outcome of pediatric versus adult recipients who underwent renal transplantation. METHOD: We examined, 2631 recipients of a first kidney from a living donor between 1982 and 2002. The two groups were matched for immunosuppressive therapy and number of HLA mismatches. The patients were divided into a pediatric (n=301; age 18 years) to compare 5-year patient and graft survivals. RESULTS: The mean ages of the pediatric and adult groups were 40 +/- 13 and 14 +/- 13 years, respectively. The 5-year graft survival was lower among the pediatric versus the adult group (56% vs 68%; P=.015) with no difference in patient survival (88% vs 86%; P>.05). CONCLUSION: The poorer graft survival in pediatric transplantation may be due to the nature of pediatric transplantation, in terms of inconsistent adherence to medication regimens, worse side effects of medications, higher rate of graft rejection due to recurrent disease, and more intense immunoreactivity of children.

The lithium ratio and the incidence of side effects.

1. During a prospective and outpatient study the correlation between the lithium ratio and the incidence of lithium side effects and type of comedications was studied in 51 Iranian bipolar patients by using new direct method of measuring erythrocyte lithium concentration. 2. Results revealed that patients who received lithium alone the incidence of lithium side effects was extremely lower than those with lithium and neuroleptics in combination. Both neurological and renal side effects of lithium were higher in patients who received lithium in combination with neuroleptics. 3. In patients on lithium alone the lithium ratio among patients with side effects were significantly lower than those without side effects, and the plasma lithium concentrations were significantly higher in those with side effects. In patients who received neuroleptics in combination with lithium, the lithium ratios were also significantly lower in those with serious side effects than those with slight side effects, but there were no significant correlation in plasma lithium concentrations between them. 4. Previous studies about the correlation of the lithium ratio and incidence of side effects have yielded inconsistent results, and methodological problems may be a reason for these discrepancies. By using the new direct method of measuring erythrocyte lithium concentration, repetition of previous studies on lithium ratio may elucidate its value as a tool in daily practice.

The effect of concomitant use of neuroleptic drugs and lithium on the erythrocyte/plasma lithium ratio in Iranian patients with bipolar disorder.

Patients treated with lithium (Li+) and neuroleptic drugs concomitantly are reported to show more pronounced adverse effects than patients on Li+ alone. There are conflicting results about the effect of neuroleptic drugs on the erythrocyte/plasma Li+ ratio and intraerythrocyte Li+ concentration, and methodological problems may be a reason for this. The effect of the concurrent use of neuroleptic drugs with Li+ on the Li+ ratio was studied in 66 patients with bipolar affective disorders during prophylactic Li+ therapy using the new direct method of measuring erythrocyte Li+ concentration. This new direct method has been shown to give much more precise and accurate results than the values obtained by other methods. No relationship was found between the Li+ ratio and sex, age, Li+ dosage, duration of treatment or plasma Li+ concentration. Results revealed that patients taking a combination of Li+ and neuroleptic drugs showed significantly lower Li+ ratios and intraerythrocyte Li+ concentrations as compared with those on Li+ alone. It is notable that this reducing effect of neuroleptic drugs was increased by the concurrent use of two types of neuroleptic drugs. The effect on neuroleptic drugs on the Li+ ratio may be mediated through a stabilizing effect of these drugs on the cell membrane and consequently Li+ transport in erythrocytes.

Inhibition of the morphine withdrawal syndrome and the development of physical dependence by lithium in mice.

Due to the claim that lithium (Li+) reduces morphine self-administration in dependent rats, the effects of acute and chronic Li+ treatments on naloxone-precipitated withdrawal syndrome and physical dependence development to morphine in mice chronically treated with morphine, were evaluated. Morphine dependency was induced by the ingestion of morphine through drinking water in increasing doses for 10 days. Physical dependence to morphine was observed by precipitating an abstinence syndrome with naloxone (2 mg/kg, i.p.). In the acute experiments, Li+ (1 and 10 mg/kg, i.p.) was administered 1 hr prior to challenge with naloxone to morphine-dependent mice whereas for chronic studies, mice received morphine concomitant with Li+ (1200 mg/l) as drinking fluid for 10 days. Results obtained indicate that acute Li+ administration significantly reduced the withdrawal signs, and we were unable to induce some degree of morphine dependency in co-administration of Li+ to mice receiving chronic morphine treatment as compared to chronic morphine administration alone. The present study revealed that even in mice with very much lower serum Li+ levels than the commonly accepted therapeutic range there was a significant reduction in the withdrawal signs. It has been shown that Li+ and morphine have diverse effects on the transmembrane signal control systems. The interaction of Li+ and morphine might be through these systems.

The effect of lithium on morphine-induced analgesia in mice.

1. The effects of acute and chronic lithium (Li+) treatments on the antinociception caused by morphine were studied in mice using the tail-flick test. 2. Subcutaneous injection of morphine (10 mg/kg) caused significant antinociception. 3. Acute Li+ administration (0.05, 0.1, 0.3, 1, 5 and 10 mg/kg, i.p.) alone had no significant antinociceptive effect but changed morphine analgesia; low doses of Li+ (0.1, 0.3 and 1 mg/kg) were found to decrease the antinociception induced by morphine whereas higher doses of the drug (10 mg/kg) potentiated this effect. 4. The 6 day administration of Li+ with a serum level of 0.528 mM decreased the antinociceptive effect of morphine. 5. The effect of Li+ on morphine-induced analgesia persisted for 96 hr in spite of the fact that Li+ drinking was discontinued (the serum Li+ level decreased from 0.528 to 0.022 mM). 6. It has been reported that Li+ might change both the binding of opioids to their receptors and biosynthesis or release of endogenous opioids. There is also a considerable body of evidence which indicates that both Li+ and morphine affect phosphoinositide turnover, intracellular calcium content and cyclic AMP level. The interaction of two drugs may conceivably take place through these systems. 7. These data suggest that the biological effects of Li+ may exist at very much lower serum Li+ levels than the commonly accepted therapeutic range.