allopurinol and Lymphoproliferative-Disorders

Topics: Acute Disease; Allopurinol; Arthritis; Aspirin; Colchicine; Coronary Disease; Diuretics; Gout; Humans; Hypoxanthine Phosphoribosyltransferase; Indomethacin; Kidney; Kidney Calculi; Kidney Diseases; Lead Poisoning; Lymphoproliferative Disorders; Myeloproliferative Disorders; Phenylbutazone; Platelet Aggregation; Probenecid; Purine-Pyrimidine Metabolism, Inborn Errors; Pyrazinamide; Ribose-Phosphate Pyrophosphokinase; Uric Acid; Uricosuric Agents

Gender is currently not a criterion in the allocation of scarce donor organs. The purpose of this study was to determine the effects of gender on patient and graft survival, incidence of rejection, and postoperative complications after orthotopic liver transplantation.. During a 10-year period, 1138 liver transplants were performed on 1010 adult patients at Baylor University Medical Center. In this study, 994 patients with at least 6 months of posttransplant follow-up were reviewed. The four combinations of gender match and mismatch included: group 1, donor female to recipient female (n=229); group 2, donor female to recipient male (n= 126); group 3, donor male to recipient female (n=247); and group 4, donor male to recipient male (n=392). These groups were evaluated for patient survival, graft survival, episodes of rejection, incidence of chronic rejection, and postoperative complications.. All groups were similar with respect to recipient age, underlying medical condition, incidence of bacterial and viral infections, postoperative biliary complications, and the incidence of chronic rejection. Female recipients had the highest incidence of early rejection (0-6 months, 70%) compared with male recipients (60%, P<0.039). Postoperative vascular complication (10%) was highest in group 3 (P<0.01). The two-year graft survival rate for groups 1, 3, and 4 was 76.2%, 75.6%, and 73.5%, respectively. Group 2, donor female to recipient male, had a 2-year graft survival rate of 55.9% (P<0.0001). This finding is not explained by the incidence of early rejection. Chronic rejection does not appear to be contributory. The mean donor age for groups 1, 3, and 4 was 35.7, 25.8, and 30.4 years, respectively. The mean donor age for group 2 was slightly older, at 41.6 years (P<0.0001). This difference, while statistically significant, is of unknown clinical relevance. A multivariate analysis controlling for donor age confirmed the decreased graft and patient survival rates in the donor female to recipient male group.. The decreased graft survival rate in male recipients of female livers warrants further study and may argue for modifying the current management of adult male liver transplant recipients.

Topics: Adenosine; Adult; Allopurinol; Bacterial Infections; Biliary Tract Diseases; Female; Gender Identity; Glutathione; Graft Rejection; Graft Survival; Health Status; Humans; Hypertonic Solutions; Incidence; Insulin; Liver Diseases; Liver Transplantation; Lymphoproliferative Disorders; Male; Organ Preservation; Organ Preservation Solutions; Racial Groups; Raffinose; Sex Characteristics; Survival Rate; Tissue Donors; Treatment Outcome; Virus Diseases

Evolving strategies of pulmonary preservation, bronchial revascularization, immunosuppression, and infectious disease management were used in 15 initial consecutive patients undergoing lung transplantation for emphysema. There were 10 women and 5 men with a mean age of 49 years (range, 36 to 60 years). All patients required supplemental oxygen therapy. One bilateral, 9 left, and 5 right transplantations were performed. Mean preoperative forced expiratory volume in 1 second and total lung capacity were 16% and 146%, respectively, of predicted. Quadruple drug immunosuppression was used. Actuarial 1-year survival in this initial series is 93.3% +/- 6.4% (Kaplan-Meier) with one early cardiac death at day 71. Mean forced expiratory volume in 1 second and diffusing capacity for carbon monoxide at discharge were 43% and 62%, respectively, of predicted. Rehabilitation has been excellent, and all survivors are active and free of supplemental oxygen. During the study, the following treatment strategies have evolved: (1) University of Wisconsin solution has replaced Euro-Collins' solution for pulmonary preservation; (2) direct bronchial revascularization with the internal thoracic artery now is used; (3) an algorithm-based variable dose OKT3 induction regimen has resulted in a major reduction in dosage; and (4) infectious disease management focuses on the prophylaxis of cytomegalovirus and fungal infection using prolonged ganciclovir and early itraconazole therapy as well as the avoidance of Epstein-Barr virus mismatches. Single-lung transplantation for emphysema has excellent early results with continuing evolving management strategies.

Topics: Adenosine; Adolescent; Adult; Allopurinol; Anastomosis, Surgical; Bronchi; Bronchial Arteries; Exercise Tolerance; Female; Forced Expiratory Volume; Glutathione; Graft Rejection; Humans; Hypertonic Solutions; Insulin; Lung Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Organ Preservation Solutions; Oxygen; Oxygen Inhalation Therapy; Pneumothorax; Pulmonary Diffusing Capacity; Pulmonary Emphysema; Raffinose; Surgical Wound Infection; Survival Rate; Tissue Preservation