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J Forty

Publications and source records attributed to J Forty.

41 records · Page 3Linked to original sources
PubMedDate not supplied

Does the mode of donor death influence the early outcome of lung transplantation? A review of lung transplantation from donors involved in major trauma.

BACKGROUND: Pulmonary dysfunction, often delayed in presentation, is among the sequelae of major trauma. Transplantation of lungs from donors involved in major trauma therefore carries a risk of early graft dysfunction. This study was conducted to assess this risk. METHODS: A retrospective comparison of the outcome from 123 donors (57 donors resulting from major trauma, group T, and 66 donors with nontraumatic origin, group NT) in 125 consecutive technically successful lung or heart-lung transplantations. Variables analyzed included the following: clinical and bacteriologic details of donors and indexes of early graft dysfunction in the recipients. RESULTS: Group T donors were more likely to be younger and male (p < 0.05) and more likely to have had lung ventilation for over 48 hours (p < 0.05) than group NT donors. Microbial contamination of routine donor bronchial lavage (72 of 122, 61%) was no higher in group T (34 of 57, 60%), but, in this group, enteric gram-negative bacilli were more common (30% versus 7%; p < 0.05). Male patients were more likely to receive lungs from group T donors (35 male, 23 female), and female patients were more likely to receive lungs from group NT donors (27 male, 40 female). Mode of donor death did not affect the following indexes of early graft function: length of postoperative ventilation, ratio of arterial oxygen tension to fractional concentration of inspired oxygen at 1 or 24 hours after transplantation, or the incidence of diffuse alveolar damage in lung biopsy specimens at 7 days. Thirty-day mortality (28%) was no higher among recipients of group T lungs, but six recipient deaths were donor-related (donor-transmitted pneumonia in five and donor acquired fat embolism in one case). CONCLUSION: The use of donors involved in major trauma does not increase the risk of early complications after lung transplantation providing their specific characteristics are recognized.

Adult↗
PubMedDate not supplied

Single lung transplantation with simultaneous contralateral pneumonectomy for cystic fibrosis.

A 24-year-old man with cystic fibrosis and marked reduction of volume of the left hemithorax caused by skeletal asymmetry and mediastinal shift underwent successful right single lung transplantation with simultaneous left pneumonectomy. Despite significant preoperative microbiologic contamination, it proved possible to sterilize the pneumonectomy space and no airway complications occurred. Good long-term results have been achieved, and the historic assumption that single lung transplantation is unsuitable for patients with septic lung disease is challenged.

Adult↗
PubMedDate not supplied

Activation of the alternative pathway of complement in hyperacute xenograft rejection of rabbit hearts by human blood.

Isolated rabbit hearts were perfused as autoperfusing working preparations with human blood to simulate discordant hyperacute xenograft rejection. Perfusion with unmodified human blood resulted in immediate thrombotic failure of the hearts. This process was initiated by immunoglobulin M heterophile human anti-rabbit antibody, mediated by the classic pathway of complement and platelet-activating factor, and effected by platelets. Prevention of this process resulted in organ damage by another process occurring at about 20 minutes. Removal of heterophile antibody from the perfusing blood had no effect on this second event, but specific inactivation of the alternative pathway of complement prevented its generation despite normal titers of antibody and normal classic pathway activity. Studies of the deposition of components of the human complement system on the endothelium of the xenoperfused hearts confirm a role for the alternative pathway of complement in xenograft rejection in this discordant species combination.

Acute Disease↗