Heart transplantation in selected patients 70 years of age and older can be performed as successfully as in younger patients (<70 years of age) with similar morbidity, mortality, and intermediate-term survival. Advanced age as defined (> or =70 years) should not be an exclusion criterion for heart transplantation. The risks and benefits of transplant surgery should be applied individually in a selective fashion.

There was only a 20% increase in the weight of the rem-A reproducible experimental animal model of fulminant liver lobes due to swelling. No hepatocytes stained nant hepatic failure (FHF) resembling the clinical condipositively for BrdU and PCNA, and none showed mitotic tion is needed. We have developed such a model in the figures. In contrast, all PH controls showed vigorous rat by combining resection of the two anterior liver lobes liver regeneration. function tests, prothrombin time) and to assessDespite improvement in our understanding of hepatic failliver regenerative response in the residual omental liver ure and determination of the inciting etiology in the majority lobes (weight, protein content, incorporation of bromoof cases, it is unclear which specific biochemical abnormalideoxyuridine [BrdU], expression of proliferation cell nuties are pathognomonic for FHF and which elements are esclear antigen [PCNA], mitotic activity), plasma levels of sential for patient survival. A reproducible experimental hepatocyte growth factor (HGF) and transforming model of FHF relevant to the clinical setting is therefore growth factor b (TGF-b 1 ), and tissue expression of the highly desirable because it would allow studies to improve HGF and it's receptor c-met. Rats undergoing partial our insight into the full gamut of metabolic and physiological hepatectomy of 68% (PH; n Å 42) and a sham operation derangements in FHF and would facilitate the design of new (SO; n Å 42) served as controls. All SO and PH controls therapeutic modalities. survived. PH rats showed only transient decreases inWe have developed a novel experimental model of FHF in body temperature, signs of modest early hepatic dysthe rat. In this simple and highly reproducible preparation, function (hyperlactemia, hyperammonemia, prolonged resection of the two anterior liver lobes (68% liver mass) is PT time), and normal restitution of liver mass. All FHF combined with ligation of the common right liver lobes pedicle rats became comatose by 24 hours postoperatively. Most (24% liver mass). As a result, the functional liver mass is animals (90%) died within 24-48 hours postoperatively greatly reduced, there is a significant amount of liver tissue (mean, 39 { 11 hours). Changes in blood chemistry reundergoing necrosis leading to toxemia, and animal survival flected rapid development of liver failure. Plasma HGF is dependent on the ability of the residual omental liver lobes levels were markedly elevated and at all time points (8% liver mass) to regenerate. Here, we present data on aniwere higher than in PH controls (P õ .05). At the same mal survival, sequential changes in blood chemistry, and retime, expression of HGF and c-met messenger RNA in generative response in the residual viable liver tissue. the remnant liver was delayed. Plasma TGF-b 1 levels increased early (18 hours) and remained twofold to three-MATERIALS AND METHODS fold higher than that of PH and SO controls (P õ .05).Animal studies were performed in compliance with institutional and National R...

Carefully selected donor hearts 50 years of age and older can be used for heart transplantation with long-term survival and related outcomes similar to those of younger donor organs. This use of selective cardiac allografts maximizes donor organ usage and expands the donor pool effectively without an adverse impact on long-term results.

Combined heart-kidney transplantation yields satisfactory long-term results similar to those for heart-only transplantation, with a low incidence of cardiac allograft rejection and renal allograft survival when both allografts are from the same donor. This approach effectively expands the selection criteria for heart-only and kidney-only transplantation in potential candidates with coexisting end-stage cardiac and renal disease.

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