Background: Thoracic organ transplantation remains limited by the reciprocal problems of rejection and the toxicities of nonspecific immunosuppression. Mixed bone marrow chimerism reliably produces donor-specific transplantation tolerance without immunosuppressive drugs. We have previously described a nonmyeloablative conditioning regimen based on recipient treatment with antilymphocyte serum, tacrolimus, and low-dose total-body irradiation that yields long-term multilineage allogeneic bone marrow chimerism in the rat.
View Article and Find Full Text PDFBackground: Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. To address controversial aspects of this disease, we reviewed our experience.
Methods: The study was performed by retrospective chart review.
J Heart Lung Transplant
August 1998
Background: Mixed bone marrow chimerism reliably produces donor-specific transplantation tolerance for a variety of solid organ and cellular grafts. We used a rat heterotopic tracheal transplant model for chronic rejection to investigate whether mixed chimerism could successfully prevent obstructive airway disease.
Methods: Mixed allogeneic chimeras were prepared by reconstituting lethally irradiated Wistar-Furth (WF) recipients with a mixture of 5 x 10(6) T-cell-depleted syngeneic (WF) and 100 x 10(6) T-cell-depleted allogeneic (ACI) bone marrow cells (ACI + WF --> WF).
Development of partial conditioning strategies to achieve reliable engraftment of allogeneic bone marrow with minimum recipient morbidity could extend the therapeutic application of bone marrow transplantation (BMT) to enzyme deficiency states, hemoglobinopathies, autoimmune diseases, and the induction of tolerance for solid organ and cellular allografts. In this study we describe a nonmyeloablative rat BMT model and examine the effect of clinically available immunosuppressants on the minimum amount of total body irradiation (TBI) required for allogeneic engraftment. Donor ACI marrow was depleted of T cells using immunomagnetic beads and transplanted to major histocompatibility complex- and minor antigen-mismatched Wistar Furth (WF) rats (ACI --> WF) conditioned with varying doses of TBI.
View Article and Find Full Text PDFObjectives: To assess the effect of cardiopulmonary bypass on allograft function and recipient survival in double-lung transplantation.
Methods: Retrospective review of 94 double-lung transplantations.
Results: Cardiopulmonary bypass was used in 37 patients (CPB); 57 transplantations were accomplished without bypass (no-CPB).
Ann Thorac Surg
February 1998
Background: Abciximab (ReoPro; Eli Lilly and Co, Indianapolis, IN) is a monoclonal antibody that binds to the platelet glycoprotein IIb/IIIa receptor and produces powerful inhibition of platelet function. Clinical trials of abciximab in patients undergoing coronary angioplasty have demonstrated a reduction in thrombotic complications and have encouraged the widespread use of this agent. We have observed a substantial incidence of excessive bleeding among patients who receive abciximab and subsequently require emergency cardiac operations.
View Article and Find Full Text PDFJ Thorac Cardiovasc Surg
February 1998
Objectives: Uncertainty persists as to the best lung transplant operation for patients with pulmonary hypertension. To quantify short- and long-term outcomes after single- and double-lung transplantation for pulmonary hypertension, we reviewed our clinical experience.
Methods: A retrospective review of 58 lung transplants at a single institution between 1989 and 1996 was performed.
J Heart Lung Transplant
April 1997
Background: Panel-reactive antibody (PRA) is commonly used before thoracic organ transplantation to estimate a potential recipient's degree of humoral sensitization.
Methods: To assess the influence of an elevated PRA on survival and the incidence of rejection in pulmonary transplantation, the records of 247 patients that underwent single or double lung transplantation were reviewed.
Results: Twenty-one of 247 patients (8.
Background: Allogeneic organ donation will never provide the quantities of organs required for patients with end-stage disease. It is estimated that over 3,000 candidates for a potentially lifesaving sold-organ transplant will die this year while on the waiting list as a result of the donor shortage. A further understanding of the mechanisms of xenoreactivity might make xenotransplantation a viable therapeutic option.
View Article and Find Full Text PDFCurrent nonspecific immunosuppression for thoracic organ transplantation is limited by infection, end-organ toxicity, malignancy, and failure to completely control rejection. Donor-specific transplantation tolerance after bone marrow transplantation and the creation of mixed chimerism is a promising means for achieving drug-free allograft acceptance. This review explores bone marrow transplantation as a method for tolerance induction, the superior clinical characteristics of mixed chimerism, and recent developments that enhance marrow engraftment, minimize graft-versus host disease, and avoid lethal conditioning of the recipient.
View Article and Find Full Text PDFMedial dissection of the aorta after blunt trauma is a rare occurrence. We report the case of a 79-year-old woman injured in a motor vehicle crash who suffered an acute DeBakey type I aortic dissection.
View Article and Find Full Text PDFBackground: The malignant potential of indeterminate solitary pulmonary nodules (SPN) mandates accurate diagnostic management.
Methods: 613 patients undergoing either computed tomographic lung biopsy (CT-Bx) (n = 312) or thoracoscopic excisional biopsy (Thor-Bx) (n = 301) for the diagnosis of SPN were evaluated for relative accuracy, complications, and effect on clinical treatment.
Results: CT-Bx identified a malignant diagnosis (Dx) in 201 (64%) of 312 patients; 85 (42%) underwent operations.
A three year old Rhodesian Ridgeback dog with a history of a small draining tract in the dorsal cervical area, was found to have a dermoid sinus on surgical exploration. The affected tissue was removed and histopathology done. The sinus is an inherited condition in this breed of dog, with surgical correction and neutering of affected individuals the treatments of choice to reduce the incidence of the dermoid sinus condition in the next generation.
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