Despite experimental advantages for certain heart preservation solutions (HPS), their clinical popularity and related survival are uncertain. We surveyed all active UNOS heart transplant centers to determine their HPS. HPS survival benefits were tested using the UNOS heart transplant registry. Centers used from 1 to 3 types of 167 solutions. Of these formulations, 55.1% were commonly cited solutions. The other (custom) mixtures differed from those usually reported. All solutions were classified as intracellular (I, [Na++] < 70 mEq/L) or extracellular (E, [Na++] > or = 70 mEq/L). Significant variations in solution usage were observed among major regions of U.S. transplant activity (Northeast [NE], Southeast [SE], and West [W], P < 0.001). For example, 62.5% of University of Wisconsin (UW) and 49.3% of "Other" usage occurred in the NE; 75% of Roe and 100% of Collins usage occurred in the SE; and 100% of Krebs and 46% of Stanford usage occurred in the W. Logistic regression analyses of 9401 patients who underwent transplantation from 10/87 to 12/92 showed a reduction in the adjusted one month mortality odds ratio for grafts preserved with I rather than E solutions (0.85, P < 0.05). Compared with the most commonly used solution, Plegisol (20.1% of cases), the following adjusted odds ratios for one-month mortality were observed: UW, 1.09 (ns); Stanford, 0.80 (P < 0.10); Roe, 0.36 (P < 0.001); Collins, 0.82 (ns); Krebs, 0.14 (P < 0.01). Using the same one month comparison with Plegisol, 16.8% of grafts that received Custom-I solutions also fared better (0.75, P < 0.05) than the 21.4% that had Custom-E mixtures (0.91, ns). HPS usage varies greatly and there are regional preferences. There may be early survival benefits for certain intracellular HPS--however, further study is warranted to explore such relationships.
Between 1973 and 1982 there was a significantly higher incidence of minimal change nephrotic syndrome among Asian compared with non-Asian children in Leicestershire. Most Asians in Leicestershire are Gujarati-speaking Hindus, but Sikhs and Muslims are also represented; no group of Asians (defined by religion, language, or birthplace) was at special risk of developing nephrotic syndrome. Nephrotic syndrome was more preponderant in Asian children living within the city of Leicester, and there was an unusually low incidence in non-Asian children within the city. Both racial and environmental factors may be important in the increased susceptibility to minimal change nephrotic syndrome in Asian children. Minimal change nephrotic syndrome is universally common in childhood. Its incidence is known to vary in different populations, being 2 to 3/105 children aged less than 15 years per year in Europe and North America, 2but 11/105 per year in Arab children in Libya.
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