PubMed · 8356635
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F Sanfilippo. 1993. Organ allocation: current problems and future issues.. https://pubmed.ncbi.nlm.nih.gov/8356635/
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BACKGROUND: Delayed graft function (DGF) remains an important complication in renal transplantation. In this multicenter study, we investigated the influence of donor and recipient factors on the occurrence of DGF and DGF's effect on long-term graft survival. METHODS: A total of 547 transplanted kidney allografts, retrieved from multi-organ donors, were analyzed, and results were compared with literature on kidney-only donors. RESULTS: Median follow-up of patients without graft failure was 3.4 years. Twenty-four percent of the recipients developed DGF. In univariate analysis, the following factors significantly increased the incidence of DGF: (a) among the donor factors, mean creatinine level >120 micromol/L and prolonged cold ischemia time (CIT); and (b) among the recipient factors, previous transplant(s), no intraoperative use of mannitol, poor quality of reperfusion, absence of intraoperative diuresis, and pretransplant anuria or oliguria. After stepwise logistic regression, donor age, CIT, recipient's number of previous transplants, and intraoperative diuresis proved to be of independent prognostic value for the occurrence of DGF. Overall graft survival was 91%, 87%, and 72% at 3 months, 1 year, and 4 years after transplantation, respectively. In case of DGF, graft survival was approximately 10% lower when compared with cases with immediate graft function (P<0.001). No difference in incidence of DGF was found between grafts of multi-organ donors and kidney-only donors. CONCLUSIONS: DGF results in an approximately 10% higher rate of graft failure. DGF incidence can be reduced by the administration of mannitol during transplantation, which minimizes CIT and optimizes donor management. Grafts from multi-organ donors and kidney-only donors appear to be of equal quality.
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STUDY DESIGN: This is a cadaver study in which video fluoroscopy is used to measure motion of the unstable spine at C1-C2 during intubation maneuvers. OBJECTIVES: To quantify the amount of motion that occurs at an unstable C1-C2 spinal segment during the use of various intubation techniques using a cadaver model. SUMMARY OF BACKGROUND DATA: In previous work by the authors, a methodology and measurements for the unstable C5-C6 segment in a cadaver model were developed. These studies showed that the most motion was created by a chin lift and jaw thrust and that oral techniques created more motion than nasal intubation. The potential motion that occurs during intubation with instability at C1-C2 is yet unstudied. Therefore, a study to determine the effects of intubation on the spine with an unstable C1-C2 segment was designed. METHODS: Six human cadavers were used for the study. Measurements before and after transoral osteotomy of the odontoid were performed using video fluoroscopy. Pre-intubation maneuvers and oral and nasal intubation were studied. RESULTS: Oral intubation and nasal intubation caused similar diminution of space available for the cord. Chin lift and jaw thrust caused a larger diminution of space available for the cord than either nasal or oral intubation techniques. CONCLUSIONS: Although nasal intubation is the accepted procedure for intubation of the unstable spine, nasal and oral intubation seemed to have the same ability to narrow the space available for the cord in the model in this study. Great care should be taken while performing the chin lift/jaw thrust maneuvers in preparation for intubation, because these pre-intubation techniques caused the most motion and hence narrowed the space available for the cord in the unstable cervical spine.