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M P Kaye

Publications and source records attributed to M P Kaye.

135 records · Page 8Linked to original sources
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High energy phosphates and catecholamine stores after prolonged ex vivo heart preservation.

Previously, we have demonstrated that hearts preserved ex vivo for 12 hours maintain normal hemodynamic performance after orthotopic transplantation. To complete our studies of these preserved hearts, we evaluated myocardial metabolism by determining high energy phosphate levels and catecholamine concentrations in 22 canine hearts. Group I was the control group in which six hearts were given cold cardioplegic solution; full thickness biopsies were taken from the myocardium in two areas of the right and left ventricles and septum; and adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, creatine phosphate, and catecholamines were determined. Group II, in which the hearts were preserved 12 hours, had eight hearts that were stopped with cold cardioplegic solution, excised, and then preserved in an ex vivo state with a 32 degrees C modified blood perfusate. After a 12-hour perfusion period, the hearts were stopped and biopsies taken. Group III involved cold ischemia and had six hearts that were stopped with cardioplegic solution, excised, opened, flushed, and stored for 2.5 hours at 2 degrees to 4 degrees C. Biopsies were obtained as in groups I and II. Adenosine triphosphate levels were slightly reduced in the 12 hour preserved heart when compared with the control group and the heart in the cold ischemia group preserved for 2.5 hours (p less than 0.01). Creatine phosphate levels were significantly elevated after 12 hour preservation when compared with groups I and III (p less than 0.01). Hearts preserved by cold ischemia also had a reduction (p = 0.03) of creatine phosphate when compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine Nucleotides↗
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Early and late comparison of umbilical vein and PTFE grafts in control and piroxicam-treated dogs.

For comparative analysis of small vessel prostheses, 78 dogs underwent femoral artery replacement with autogenous vein, polytetrafluoroethylene (PTFE) or human umbilical vein (HUV) grafts. Thirty-six animals received antiplatelet therapy with piroxicam orally once a day. Three-hour deposition of 111In-labeled platelets was less on HUV than on PTFE grafts but still greater than on autogenous vein grafts. Accordingly, 3-hour patency rates were lowest with PTFE and highest with autogenous vein, although the difference between HUV and PTFE grafts was not statistically significant. One month following implantation, PTFE grafts had a higher patency rate than HUV grafts (p less than 0.05). Treatment with piroxicam decreased 3-hour platelet deposition, improved 1-month patency of both PTFE (p less than 0.05) and HUV (p less than 0.01) grafts, and decreased pseudointimal thickening on PTFE grafts (p less than 0.01). This experimental study did not demonstrate any clearcut difference in the performance of PTFE and HUV grafts. Piroxicam treatment improved the results with both grafts, which would justify future clinical trials with this simple antiplatelet regimen.

Animals↗
PubMedDate not supplied

Pediatric retransplantation.

Previous studies have attempted to outline the efficacy of heart retransplantation in adults. A limited number of these retransplantation procedures have been performed in children; however, no study to date has evaluated the risk of heart retransplantation in this specific patient population. We conducted a retrospective review of 17 pediatric (non-neonatal) heart transplant recipients who subsequently underwent heart retransplantation. Thirteen male and four female patients underwent retransplantation at four different institutions between 1974 and 1992. Patient age at the time of primary transplantation ranged from 2 to 19 years (mean, 12.5 years) and from 3 to 30 years (mean, 16 years) at retransplantation. The time interval between transplantation procedures ranged from 2 days to 15.6 years and was not predictive of patient outcome. Follow-up after retransplantation ranged from 1 day to 11 years (mean, 2.8 years). All patients were New York Heart Association class 3 or class 4 at the time of retransplantation. After retransplantation all survivors were New York Heart Association class 1. No patient had mechanical device implantation or extracorporeal membrane oxygenation bridge-to-transplantation at primary transplantation or retransplantation. The indication for retransplantation was transplant coronary artery disease (TxCAD) in seven patients (41.2%), acute rejection in four (23.5%), chronic rejection in one (5.8%), chronic rejection associated with TxCAD in four (23.5%), and intraoperative donor organ failure in one (5.8%). No significant difference occurred in linearized rates of rejection or infection or in actuarial freedom from rejection or infection when secondary grafts were compared with primary grafts in patients undergoing retransplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Pediatric thoracic transplantation: the world experience.

Data have been received by the Registry of the International Society for Heart and Lung Transplantation on more than 25,000 patients. Since 1984, patients ranging in age from newborn to 17 years have undergone 1668 heart transplantations, 186 heart-lung transplantations, and 109 lung transplantations. This report summarizes the data received regarding these pediatric thoracic transplant recipients.

Actuarial Analysis↗
PubMedDate not supplied

Redo lung transplantation: a North American-European experience.

An international survey of redo lung transplantation was performed to identify the morbidity and mortality rates and factors correlating with increased or decreased survival after this procedure. Twenty institutions in North America and Europe participated, and the study cohort included 61 patients who underwent 63 redo lung transplantation operations. Patients undergoing a redo heart-lung transplantation were excluded. The indications for reoperation included obliterative bronchiolitis (32 patients), graft failure (14 patients), intractable airway problems (8 patients), severe acute lung rejection (5 patients), and miscellaneous complications (4 patients). Five types of retransplantation procedures were performed, including redo ipsilateral single lung transplantation (24 patients), redo contralateral single lung transplantation (11 patients), single lung transplantation after double lung or heart-lung transplantation (13 patients), redo double lung transplantation (8 patients), and double lung transplantation after a previous single lung transplantation (7 patients). Actuarial survival was 65%, 49%, 42%, 35%, and 32% at 1, 3, 6, 12, and 24 months, respectively; survival was significantly (p < 0.05) worse than that of first-time lung transplant recipients recorded in the International Society for Heart and Lung Transplantation Registry. Actuarial survival did not differ according to the original diagnosis of the recipients, the indication for reoperation, or the type of retransplantation procedure performed. Similarly, recipient cytomegalovirus status and ventilator status before reoperation did not affect postoperative survival. Trends toward an improved outcome were noted in patients who were ambulatory before reoperation and in those receiving an ABO identical, as opposed to ABO compatible, graft at reoperation. Life table and step-wise logistic regression analysis identified donor cytomegalovirus status at reoperation to be an important determinant of outcome, with significantly (p < 0.05) improved survival in the donor cytomegalovirus-negative group. Polymicrobial infection was the most common cause of death at all time intervals after reoperation. The presence of disseminated infection and established multiorgan failure was almost uniformly associated with a fatal outcome. We conclude that redo lung transplantation may be indicated only in well-selected patients with obliterative bronchiolitis, severe airway complications, or graft failure. Donor cytomegalovirus status at reoperation is an important predictor of survival. The presence of disseminated infection and established multiorgan failure should be contraindications to lung retransplantation.

Adolescent↗