Heart transplantation in the new era of extended donor criteria

The heart transplantation (HT) is undoubtedly the best treatment for end-stage heart failure patients (2). However, the organ shortage remains a major challenge in cardiac surgery. Facing this problem, the medical community starts to extend the donor criteria to select more suitable organs for HT. The use of ECDs is still controversial, since it is associated with a high incidence of primary graft failure (3), and although it guarantees longer survival than without transplantation, there is still some hesitation in accepting this practice.

Donor selection for lung transplant in Turkey: Is it necessary to wait for an ideal donor?

Background: The aim of this study was to evaluate the donor criteria used in lung transplantation in our clinic. Methods: A total of 55 cadaveric donors who were accepted for lung transplantation in our clinic between December 2016 and January 2019 were retrospectively analyzed according to ideal donor criteria. The donors were divided into two groups as ideal and non-ideal ones according to their age, partial pressure of oxygen in arterial blood, history of smoking, and ventilation day. Donor data, recipient characteristics and survival outcomes were evaluated. Results: Of 55 donors accepted for lung transplantation, 24 (43.7%) were ideal and 31 (56.3%) were non-ideal donors. The 90-day mortality and one-year survival rates were not significantly different between the two groups. The 90-day mortality was 25% in the ideal group and 22.6% in the non-ideal group (p=0.834). The one-year survival rates after lung transplantation were 64.5% versus 70.6% in the ideal and non-ideal groups, respectively (p=0.444). Conclusion: The whole clinical picture should be evaluated before accepting or rejecting donors for lung transplantation. The use of lung donors that do not meet the ideal criteria does not impair short- and mid-term results, compared to ideal lung donors. Strict implementation of donor criteria may prevent using suitable donors for lung transplantation. Use of non-ideal donors can reduce waiting list mortality.

Characteristics of convalescent plasma donors and their antibody titers in Bangladesh

Background: Convalescent plasma is considered a promising therapy for severe COVID-19 disease. It is collected from the voluntary donors. Measurement of the antibody titer is necessary before transfusion to predict the outcome in the recipients. Characteristics of the convalescent plasma donors in Bangladesh and their antibody titers are not known.Methods: Convalescent plasma was collected from the voluntary donors who survived the COVID-19 disease to transfuse to the severe COVID-19 patients under a randomized control trial. Total IgG antibody titer was measured in the donor plasma by indirect enzyme-linked immunosorbent assay. Data was collected in a preformed questionnaire before donor plasma collection.Results: The median age is 32 (18-55) years. Fever, cough, sore throat, diarrhea was most common among 68.3% of the symptomatic participants and the remaining 31.7% were asymptomatic at the time when they were RT-PCR positive. Overall, 57.1% of participants had mild symptoms, 11.1% had moderate symptoms and none had severe symptoms. Participants’ antibody titers were measured 41.68±14.072SD days after the RT-PCR positive date. Rapid qualitative test could not detect antibody in 11 (17.5%) potential donors. Of the remaining 52 (82.5%) antibody positive participants titer was measured in 43 participants and found 1:320 in 17 (27.0%) (n=63), 1:160 in another 17 (27.0%) (n=63) and 1:80 in rest of the 9 (14.28%) (n=63) Participants. The mean titer of the donors who were hospitalized during their illness (1:274.29) was statistically significantly higher (p=0.043, CI>95%). The mean titer was also higher in female than in male, symptomatic than asymptomatic participants and in donors of A positive blood group. However, these finding are not statistically significant. Antibody titer does not correlate with time of RT-PCR negativity from initial RT-PCR positivity, time from RT-PCR positivity to titer date, age and body mass index.Conclusions: All RT-PCR positive COVID-19 patients subsequently may not develop antibody. Although antibody titer among hospitalized symptomatic patients was significantly higher, further study is needed to recommend optimal convalescent plasma donor criteria.