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The outcome of lung transplantation (LT) is correlated to donor selection. A donor age65 years is classically considered a contra-indication to lung procurement, and the results of LT from elderly donors remain to be established.

We set a retrospective study of a prospectively maintained database including all LT performed in our institution from January 2014 to March 2019. Donors65 years were included in the elderly group while donors<65 years were included in the control group.

The study group included 241 LT, including 44 (18%) in the elderly group and 197 (82%) in the control group. As compared with the control group, the elderly group was characterized by donor with smaller size (166cm vs. 172cm, p=0.04), less smoking history (14% vs. 40%, p=0.001), less bronchoscopic abnormality (20% vs. 36%, p=0.042), and less chest opacity (16% vs. GLPG0634 research buy 30%, p=0.048); by recipients with smaller size (166cm vs. 170cm, p=0.04) but similar diagnoses and gravity. There was no significant difference between groups in any of the outcomes studied, including Primary Graft dysfunction, 30-day mortality, one-year survival, clad-free survival, and overall survival. In univariate analysis, Oto lung donor score was the only factor associated with one-year survival (6 in alive patients vs. 7 in dead patients, p=0.04), donor age 65 years was not.

Carefully selected lung grafts from donors65 years are associated with similar outcomes than grafts from younger donors, thus being an interesting option to expand the donor pool in a shortage period.

Carefully selected lung grafts from donors65 years are associated with similar outcomes than grafts from younger donors, thus being an interesting option to expand the donor pool in a shortage period.

The objective was to compare the impact of skeletonized vs. pedicled left internal mammary artery (LIMA) harvesting on bleeding after coronary artery by-pass grafting (CABG).

In a randomized single-blinded trial with parallel group design and equal allocation, we randomly assigned 62 patients undergoing primary elective CABG in a tertiary cardiac center to skeletonized or pedicled LIMA dissection. Preoperatively, all aspects of coagulation were assessed. Patients were blinded to LIMA dissection technique and monitored for cumulative drainage at 12h (primary outcome) and myocardial necrosis markers.

With recruitment complete, there were 31 patients in each group and all patients were analyzed. Median postoperative drainage was 395 ml at 12h in all patients, and was lower by 28% at 12h (p=0.02) in patients with skeletonized LIMA (Cohen’s d [95% CI], 0.6 [0.09-1.11]). Patients with LIMA pedicle received more fresh frozen plasma transfusions than skeletonized LIMA group (3 [3-5] vs. 3 [3-3], p=0.03). Study arms did not differ in blood coagulation. LIMA skeletonization (OR [95% CI], 0.04 [0.003-0.44], p=0.009) and higher body mass index (OR [95% CI], 0.63 [0.45-0.89], p=0.008) decreased the odds of being in the top drainage quartile at 12h (≥550 ml). Creatine kinase was lower in skeletonized LIMA directly after surgery (218 [175-310] vs. 424 [256-510] U/l, p=0.0001), at 6h (324 [239-424] vs. 529 [374-707] U/l, p=0.0003) and 12h postoperatively (351 [277-552] vs. 695 [509-1067] U/l, p=0.0001).

LIMA skeletonization results in a lower mediastinal drainage after CABG than pedicled LIMA harvesting. Jagiellonian University grant No. K/ZDS/007961. NCT03622671.

LIMA skeletonization results in a lower mediastinal drainage after CABG than pedicled LIMA harvesting. Jagiellonian University grant No. K/ZDS/007961. NCT03622671.Screening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and post-operative cardiac events. It is uncertain if this is achieved. Here, we investigated whether pre-transplant screening with a stress test or coronary angiogram associated with any difference in major adverse cardiac events (MACE) up to five years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and United Kingdom Renal Registry. Propensity score matched groups were analyzed using Kaplan-Meier and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centers; 51% underwent screening and the proportion undergoing screening by center ranged from 5-100%. The incidence of MACE at 90 days, one and five years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 each in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio 0.80, 95% Confidence Interval 0.31-2.05), one year (1.12, 0.51-2.47) or five years (1.31, 0.86-1.99). Age, male sex and history of ischemic heart disease were associated with MACE. Thus, there is no association between screening for asymptomatic coronary artery disease and MACE up to five years post-transplant. Practices involving unselected screening of transplant recipients should be reviewed.Chronic dermatitis is a hallmark of Dedicator of cytokinesis 8 (DOCK8) deficiency. The migration of DOCK8-deficient T cells to the skin and their survival there have been reported to be defective. Surprisingly, we found that Dock8-/- mice demonstrated an exaggerated contact hypersensitivity (CHS) response to oxazolone with increased ear swelling, T-cell infiltration, and expression of Ifng. To understand the mechanisms of persistent skin inflammation in DOCK8 deficiency, we examined mice with selective deficiency of DOCK8 in T cells or T regulatory cells (Tregs) and found that both have exaggerated CHS. Moreover, oral tolerance to oxazolone, mediated by Tregs, was impaired in Dock8-/- mice. Transfer of Tregs from oxazolone-sensitized wild-type mice, but not Dock8-/- mice, reduced the CHS response of Dock8-/- recipients. Lack of DOCK8 in Tregs resulted in their acquisition of a pathogenic FOXP3+T-bet+IFNγ+ phenotype at CHS sites and promoted their conversion into ex-Tregs. The transfer of Tregs from Dock8-/- mice increased the CHS response of wild-type recipients to oxazolone.