Advances in heart surgical treatment have been impressive in the last 15 years. In end-stage heart disease, procedures are now performed routinely which were only experimental one or two decades ago. Heart transplantation has become a well-established procedure. According to the Gen eral Registry of the International Society of Heart and Lung Transplantation. 40,738 heart transplantations had been performed through the end of 1997 with survival rates of 78 % at one year, 65 % at five years, and 42 % at ten years. The progress in this field has been due to intense efforts in understanding and modulating immune responses to the trans planted heart, to elaborate therapeutic strategies to constrain infections, and to improved out-patient care. Accordingly, heart transplantation is integrated into the facilities of the health care systems, the routine of physicians, and the awareness of patients. The resulting increase in potential organ recipients has not been met, however, by an equivalent increase of available donor organs. This increasing discrepancy has forced the technical improvement and clinical evalua tion of mechanical circulatory support systems as an option for treatment of critically ill patients with a failing heart. Initially, these assist devices were only used to maintain sufficient circulation in post-cardiotomy heart failure until myocardial function had recov ered. Since the late 1980s, their primary use has been that of bridging patients with heart failure until a suitable organ is available so that heart transplantation can be performed.
Organ transplantation has almost disappeared from headlines in the daily press, possibly because it failed to fulfill exaggerated expectations. Transplanta tion pathology has become more and more important, not only with relation to therapeutic transplantations but even more in its fundamental theories. There is some analogy here to the development in space science where spectacular achievements were followed by sobering frustrations and where, for the time being, the effect on technology is more fruitful than the outcome of the original far-reaching projects. That transplant rejection was defined, in most of its stages, as an immunologic process, has given many new impulses to immunology in general. Transplantation assays have become a pet experiment in immunobiology and an abundant source of general information and knowledge. The implications of such a development could not be predicted when the present volume was outlined and planned. In accordance with the concept of WILLI MASSHOFF, general transplantion pathology was given a central position as a fundamental science, while the chapters on the transplantation of various tissues are of a more paradigmatic character. It was MASSHOFF who invited competent authors and who managed to balance their articles, despite some overlapping, so as to draw a comprehensive picture of contemporary transplanta tion pathology. WILLI MASSHOFF died while he was editing the first manuscripts. As co-editors we have undertaken to complete the publication that we began together.
This comprehensively covers everything from pathophysiology to the evaluation of patients presenting with heart failure to medical management, device therapy, heart transplantation and mechanical circulatory support, and include relevant cardiac imaging studies such as echocardiograms and magnetic resonance imaging studies which could be seen in their entirety as well as pathology slides, hemodynamic tracings and videos of cardiac surgery such as heart transplants and ventricular assist device implantation. Finally, the book would have videos of patients with heart failure, heart transplants or ventricular assist devices, describing their clinical presentation and experiences. It is structured so that it can be used as a guide by physicians studying for the general Cardiology or Advanced Heart Failure and Cardiac Transplantations Boards.
This essay on "brain death" ("bd", hereinafter) was written with the purpose of: a) reviewing this novel concept based on the already gained scientific experience b) pointing out the serious problems that have been emerged c) answering the question whether "bd" is identical to the biological death of man and d) to be known the views of the Anthropology of the Orthodox Eastern Church on the subject of transplantations from "brain dead" patients. The new information published in authoritative medical journals creates even larger concern and shows more clearly that "bd" is not identical with biological death and that it has crept into medicine for purely utilitarian reasons, namely to relieve the Intensive Care Units from the "burden" of these critically ill patients and to provide precious organs for transplantation. My contribution in relation to the medical and social speculation on the problem of "bd" consists of: a) two novel suggestions concerning the reliability of its diagnosis and b) two novel aspects concerning the pathologic physiology of the "complex spinal responses", the presence of which invalidate the diagnosis of "brain death".
The lungs have a dual blood supply. The pulmonary arteries provide desaturated blood while the bronchial arteries provide oxygenated blood. Lung transplantation has stimulated an interest in the role of the bronchial arteries. In the beginning of the lung transplantation era, it was clear that insufficient bronchial artery perfusion presented a major cause of death in the early postoperative period. The idea of re-connecting the donor bronchial arteries to the recipients systemic blood supply (i.e. performing bronchial artery revascularization (BAR)) is almost as old as the idea of lung transplantation. Experimental studies have been made since 1950, while the first clinical experiences were reported in 1992. When the lung transplantation program was initiated in Denmark in 1992, BAR was applied from the beginning. Until today 66 en-bloc double lung transplantations, 20 single lung transplantations, 9 heart-lung transplantations and one bilateral lung transplantation with BAR have been performed at Rigshospitalet. This represents by far the worlds largest experience with BAR. Martin A. Nørgaard was studying BAR from 1994 to 2002.
Immune system plays a crucial role in defending organism from pathogens. However, immunological functions may be severely impaired by a number of disorders including acquired immunodeficiencies, possibly due to infections, chronic diseases, immunosuppressive drugs or surgeon therapies. Aim of the study was to evaluate immune reconstitution in children with acquired immunodeficiency. Attention was focused on two groups of HIV-1 vertically infected children and on a cohort of leukaemia children who underwent Umbilical Cord Blood Transplantation (UCBT). HIV-infected children showed a significant normalization of immune functions investigated, with a long-term maintaining of good clinical and immunological parameters. Also children who underwent UCBT showed a notable immune restoration. An early application of antiretroviral treatment from the third month of life favours immune reconstitution and the application of a simplified regimen seems to permit the maintenance of good immunological results obtained during the previous successful HAART. In the context of transplanted children our data underline applicability and advantages of UBCT compared to Bone marrow (BM) transplantations
An up-to-date overview of blood and marrow transplantations, the book discusses in detail Indication to transplantation and pre-transplant considerations. An outlook on the latest developments and their future aspects is included, while problems and pre- and post-transplant complications are fully explored.
This comprehensive textbook, covering all aspects of the perioperative management of patients undergoing organ transplantation, serves as the standard reference for clinicians who care for transplant patients on a day-to-day basis as well as those who encounter organ transplantation only occasionally in their clinical practice. Anesthesia and Perioperative Care for Organ Transplantation covers transplantation of the heart, lung, liver, pancreas, and kidney, as well as multivisceral and composite tissue graft transplantations. For each kind of transplantation, the full spectrum of perioperative considerations is addressed: preoperative preparation, intraoperative anesthesia management, surgical techniques, and postoperative care. Each chapter contains evidence-based recommendations, relevant society guidelines, management algorithms, and institutional protocols as tables, flow diagrams, and figures. Photographs demonstrating surgical techniques, anesthesia procedures, and perfusion management are included. Anesthesia and Perioperative Care for Organ Transplantation is for anesthesiologists and critical care physicians, transplantation surgeons, nurse anesthetists, ICU nurses, and trainees.