Infections transmitted from donors to recipients following organ transplantation.

There is an ever-increasing gap between the number of donors and those waiting for organ grafts, resulting in increased waiting times and mortality on transplant waiting lists. Consequently, every potential donor must be considered for possible transplantation even if they are outside the conventional donor criteria. To address this imbalance, organs are currently transplanted from living donors, older donors, haemodynamically unstable and non-heart-beating donors, and donors with prior infections. There is a potential to transmit infections and, to a lesser extent, malignancy from the donor organ to the immunosuppressed recipient, and this may also have an effect on subsequent organ function in the recipient. Thus, transmission of infections from organ donors to recipients represents low but serious potential risks that must be weighed against a candidate's risk of dying before a transplant becomes available.

Gastroduodenal tuberculosis management guidelines, based on a large experience and a review of the literature.

BACKGROUND: To review our experience of gastroduodenal tuberculosis before formulating management guidelines, we did a retrospective analysis at a large tertiary-care teaching institution in North India. METHOD: We reviewed 23 consecutive cases of biopsy-proven gastroduodenal tuberculosis over a period of 15 years. RESULTS: The major presenting features were gastric outlet obstruction (61%) and upper gastrointestinal (uGI) bleeding (26%). In 3 patients (13%), clinical, radiological and intraoperative features suggested malignancy/pseudotumour: periampullary mass in 2 and gastric mass in 1 patient. Five patients (23%) also had extragastrointestinal tuberculosis. Despite uGI endoscopy and biopsies, the preoperative diagnosis was correct for only 2 people. All patients except 1 required surgery for either diagnosis or therapy. Two patients with massive uGI hemorrhage requiring emergency surgery died in the postoperative period. The other patients responded well to antitubercular treatment after surgery. CONCLUSIONS: Gastroduodenal tuberculosis has 3 forms of presentation: obstruction, uGI bleeding, and gastric or periampullary mass suggestive of malignancy. Endoscopic biopsy has a poor yield. Surgery is usually required for diagnosis or therapy, after which patients respond well to antituberculous treatment. In areas endemic for tuberculosis, a good biopsy from the site of gastroduodenal bleeding or mass lesion and the surrounding lymph nodes should always be obtained.