William Frist - Academia.edu (original) (raw)
Papers by William Frist
Journal of Nuclear Medicine, Jun 1, 1995
andis the majorcauseof later deathin hearttrans plant recipients. Allograft CAD is characterizedb... more andis the majorcauseof later deathin hearttrans plant recipients. Allograft CAD is characterizedby diffuse vascular intirnal hyperplasia involving the entire length of the epicardial and intrarnyocardialcoronaiy arteries (3). Because of the nature of this disease, its recognition by coronaly angiography is limited (4,5). Recent studies re ported thatvirtually all cardiac allograftsdeveloped vascu lar lesions 1 yr after transplantation(6). In contrast, less than 40% of patients who survived more than 4 yr had angiographicevidence of CAD (3,4). Several studies have demonstrated that a considerable number of allografts which had significant CAD (lumen narrowing >80%) de termined at autopsy or retransplantation showed no sign of the disease by conventional angiography(6). More reliable modalities to detect the development of allograft CAD are clearly desirable. Computerized quantitative coronary an giography (7) and intracoronaiy ultrasound (8â€"9) have been proposed to detect allograftCAD. PET is a noninva sive modality which has been used to assess prhnaiy CAD (10â€"11) and cardiac allograft rejection (12â€"13). Flow and metabolic studies of the heart have been accurately quan titatedwith positron-emittingradiotracerssuch as ‘3N-arn monia (11) and [18F]fluorodeoxyglucose (14â€"15). The pur pose of this study was to evaluate the ability of PET using 13N-amrnonia to accurately assess the progression of al lograft CAD.
Pediatrics, Mar 1, 1992
The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Cent... more The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Center during a 31-month period were reviewed to define the size of the donor pool in the pediatric population and to assess the role of physicians in the procurement of these much-needed organs. Computerized discharge abstracts showed that 57 pediatric patients died without contraindications to organ donation. Manual review of these 57 medical records yielded 46 records suitable for review by Tennessee Donor Services. From this group, 19 eligible donors were identified. All eligible donors died from trauma, intracerebral hemorrhage, anoxic events, or hydrocephalus. Physicians failed to ask one family for permission to donate. All 18 of the families who were asked agreed to donate and organs were successfully procured from all 18 patients. These data suggest that families of pediatric patients are much more willing to agree to donation than the families of adult patients. As a result of this study, a simplified audit process has been developed for hospitals to use in evaluating compliance with required-request legislation.
Journal of Thoracic and Cardiovascular Surgery, Apr 1, 1987
Journal of Cardiopulmonary Rehabilitation, 1993
Transplantation, 1995
PDGF is a potent mitogen for vascular smooth muscle cells (SMC) and may play an important role in... more PDGF is a potent mitogen for vascular smooth muscle cells (SMC) and may play an important role in the pathogenesis of cardiac allograft vasculopathy (CAV). Two isoforms of PDGF-A chain exist as a result of alternative mRNA splicing that either includes (long-form) or excludes (short-form) exon 6. Short-form PDGF-A is expressed in both resting and activated cells, while the long-form is present predominantly in activated cells. Using RT/PCR, we have found previously that long-form PDGF-A chain was expressed in human cardiac allografts but not in normal human hearts. In the experiments reported here, we studied the cellular distribution of PDGF-A chain isoforms and expression of PDGF receptor-alpha in cardiac allografts. In situ hybridization and immunohistochemistry confirmed the PCR data and demonstrated that expression of long-form PDGF-A chain was diffusely increased in cardiac allografts, predominantly in myocytes and vascular structures. Expression of PDGF receptor alpha also was induced in cardiac allografts and was not detected in any of the normal hearts. Induction of PDGF receptor alpha in cardiac allografts was associated with the presence of long-form PDGF-A chain. In vitro experiments with human endothelial cells demonstrated that aFGF, IL-6, and TGF-beta, which are produced in cardiac allografts in vivo, induced expression of long-form PDGF-A chain. Expression of long-form PDGF-A chain and its receptor was markedly increased in cardiac allografts, predominantly in vascular structures and myocytes. Alterative splicing of PDGF-A chain variants may be mediated by growth factors and cytokines produced in vivo.
Impact of Cardiac Surgery on the Quality of Life, 1990
Transplantation, 1993
Although surgical proficiency is essential to the immediate outcome of transplantation, long-term... more Although surgical proficiency is essential to the immediate outcome of transplantation, long-term success depends upon how adequately the transplantation recipient is managed. Immunosuppression, the most critical aspect of after care, is subject to wide variation. In January 1990, a survey was sent to the directors of all transplant programs in the United States performing one or more kidney, heart, liver, heart-lung, or pancreas transplant in 1988. Detailed data were obtained on both the drugs and methods used for induction and maintenance immunosuppression, as well as the treatment of rejection. Each program director was asked to rank each immunosuppressive approach according to its perceived impact on patient outcomes. Over 85% of all eligible program directors completed the survey. There is no evidence of survey respondent bias. The use of polyclonal and monoclonal agents for induction immunosuppression was favored most by pancreas program directors (72-76%). These agents were least preferred by liver transplant programs (35-37%). About half of kidney, heart, and heart-lung program directors preferred these agents. Triple-drug therapy consisting of CsA, PRED, and AZA was considered the most preferable maintenance protocol for all transplants (i.e., kidney, 89%; heart, 94%; liver, 88%; heart-lung, 86%; pancreas, 96%). Either i.v. steroids or OKT3 were regarded as the preferred approaches for the treatment of acute or resistant rejection. Finally, the acceptability of outpatient treatment of rejection varied by transplant type (i.e., kidney, 9%; heart, 58%; liver, 5%; heart-lung, 29%; pancreas, 8%). Although there are similarities in the ratings of various aspects of immunosuppressive therapy, there are important differences. This information is critical to anticipate the implications of new immunosuppressive agents and to evaluate changes in the use of existing drugs and therapeutic approaches.
Southern Medical Journal, 1987
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... An abstract is unavailable. This article is ...
New England Journal of Medicine, 2005
... and use of reliable information, which has generated increased provider-level competition, th... more ... and use of reliable information, which has generated increased provider-level competition, the cost of ... a system primarily around the needs of consumers and patients does not mean ... be primary care providers, along with academic health centers and large hospital systems that ...
Journal of the American College of Cardiology, 1990
Journal of Clinical Investigation, 1994
Accelerated coronary atherosclerosis in cardiac transplants (cardiac allograft vasculopathy, CAV)... more Accelerated coronary atherosclerosis in cardiac transplants (cardiac allograft vasculopathy, CAV) is characterized by coronary intimal hyperplasia. Acidic fibroblast growth factor (aFGF) is a potent mitogen for vascular smooth muscle cells and endothelial cells, and its expression is increased in cardiac allografts, suggesting it may play a role in the pathogenesis of CAV. The activity of aFGF is dependent on binding to transmembrane receptors. To investigate whether receptors for aFGF are also induced after transplantation, polymerase chain reaction, in situ hybridization, and immunohistochemistry were used to analyze expression of four receptors for aFGF (FGFR1-FGFR4). Expression of mRNA encoding extracellular immunoglobulin-like domains of FGFR1 was increased 35-fold in cardiac allografts compared with normal hearts and was predominantly present in cardiac myocytes and vascular structures. Alternatively spliced mRNA that encodes transmembrane forms of FGFR1, which contain the signal-transducing tyrosine kinase domains, was induced in allografts during rejection, in infiltrating cells, vascular structures, and myocytes. In vitro experiments showed that differential expression of FGF receptor isoforms was induced by aFGF, and also by IL-6 and TGF-beta, which are expressed in cardiac allografts during rejection. The results show that expression of both aFGF and its receptors is altered in cardiac allografts and suggest that these events are important in the pathogenesis of CAV.
Health Psychology, 1995
We explored the relations between positive expectations and adjustment, adherence, and health in ... more We explored the relations between positive expectations and adjustment, adherence, and health in cardiac transplant patients. Thirty-one patients and their nurse completed questionnaires before transplantation and at 3 times after surgery. As predicted, patients' self-reported positive expectations were generally associated with good mood, adjustment to the illness, and quality of life, even in patients who experienced health setbacks. High preoperative expectations predicted later adherence to a complex medical regimen. Positive expectations measured before the transplant predicted a substantial amount of the variance in the nurse's ratings of physical health 6 months after surgery, covarying for adherence behavior and preoperative health.
Clinical & Experimental Immunology, 1993
CHEST Journal, 1993
To analyze a single-center experience with infectious complications of single lung transplantatio... more To analyze a single-center experience with infectious complications of single lung transplantation (SLT) with special emphasis on risk factors for infection in the transplanted and native lung. Consecutive case series. University teaching hospital. Fifteen consecutive SLT recipients (mean age, 43 years; 9 men and 6 women). Mean follow-up was 337 days. Fifteen patients had 24 infectious episodes (1.6 per patient) of which 83 percent were life-threatening, 79 percent involved the lung, airway, or pleural space, and 79 percent occurred in the first 4 months after transplantation. Despite this high infectious morbidity, there were no infectious deaths. The most important infections were bacterial pneumonia (n = 10), cytomegalovirus (CMV) pneumonia (n = 5), and bronchial anastomotic infections (n = 3). Significant risk factors for bacterial pneumonia were a diagnosis of primary or secondary pulmonary hypertension (p < 0.05) and the presence of airway complications of stenosis or dehiscence (p < 0.05). No risk factors for overall lung infections were identified. The native lung was involved in 6 of 16 lung infections and was the exclusive site of infection in 4 cases. Underlying disease in the native lung may have predisposed to infection at that site by a mechanism of inadequate blood flow or impaired ventilation. Three bronchial anastomotic infections (Pseudomonas, Candida, Aspergillus) occurred, all with dehiscence of the anastomosis. These were highly morbid but resolved with antibiotics, stent placement, and surgical retention in two of the three cases. The five episodes of CMV pneumonia caused mild (four patients) or moderate (one patient) dysfunction and responded to antiviral agents without relapse. The frequency, complexity, and morbidity of infections after SLT were great, but most infections were manageable and good outcomes were achieved. A pretransplant diagnosis of pulmonary hypertension or posttransplant occurrence of bronchial stenosis or dehiscence were associated with a higher rate of bacterial pneumonia. The underlying disease in the native lung may predispose to infection at that site.
The Annals of Thoracic Surgery, 1993
Minimal data are available regarding the results of patients who have undergone myocardial revasc... more Minimal data are available regarding the results of patients who have undergone myocardial revascularization more than twice. The records of 13 consecutive patients who underwent a coronary artery bypass procedure for the third time were reviewed. The indication for operation was unstable angina in all patients. All patients were placed on cardiopulmonary bypass through a median sternotomy. The mean number of bypass grafts placed at the third operation was 1.9 (range, 1 to 3 grafts). A new internal mammary artery graft was placed in 6 patients (2 had prior internal mammary artery grafts). Hospital mortality was 7.7% (1/13). The single death was due to incomplete revascularization in a patient with poor distal vessels. Three patients required intraaortic balloon pump support postoperatively, and 2 patients had prolonged ventilatory insufficiency. There have been no late deaths. The 12 survivors have been followed up a mean of 44 months (range, 6 to 90 months). Four remain asymptomatic; 5 have mild angina easily controlled with medication. All except 1 are in improved condition compared with their preoperative status. We conclude that a third myocardial revascularization can be performed with low mortality and morbidity and with the expectation of long-lasting symptomatic improvement.
The Annals of Thoracic Surgery, 1993
Substantial progress has been made in clinical heart-lung transplantation. Although outcomes vary... more Substantial progress has been made in clinical heart-lung transplantation. Although outcomes vary across centers, 1-year patient survival is now 59%. This study was an attempt to assess consensus among transplant program directors regarding the major determinants of patient outcome. In the National Cooperative Transplantation Study we evaluated consensus through a survey of all heart-lung transplant programs active in 1988. Of the eligible programs, 23 (85%) returned completed surveys. Data on the medical and surgical determinants of outcome were analyzed. There was considerable consensus among program directors as to the importance of several factors. The three most critical predictors of favorable outcomes were periodic pulmonary function tests to detect rejection (85.7%), avoidance of use of prednisone during the first 14 days after transplantation (76.2%), and annual left and right heart catheterization with coronary arteriography (76.2%). Several approaches were considered undesirable or unnecessary. These included electrocardiogram as standard rejection monitoring technique (71.4%), cytoimmunological monitoring as standard rejection monitoring technique (66.7%), and routine steroid discontinuation after transplantation (66.7%). On various other treatment approaches there was little evidence of consensus. These included prophylaxis with acyclovir and severe bronchiolitis as a criterion for retransplantation. Although controversial, consensus conferences are one means by which to evaluate technological innovations. Based on their results, practice guidelines can be developed to better inform third-party payers on issues related to transplantation.
The Annals of Thoracic Surgery, 1994
The Annals of Thoracic Surgery, 1988
Journal of Nuclear Medicine, Jun 1, 1995
andis the majorcauseof later deathin hearttrans plant recipients. Allograft CAD is characterizedb... more andis the majorcauseof later deathin hearttrans plant recipients. Allograft CAD is characterizedby diffuse vascular intirnal hyperplasia involving the entire length of the epicardial and intrarnyocardialcoronaiy arteries (3). Because of the nature of this disease, its recognition by coronaly angiography is limited (4,5). Recent studies re ported thatvirtually all cardiac allograftsdeveloped vascu lar lesions 1 yr after transplantation(6). In contrast, less than 40% of patients who survived more than 4 yr had angiographicevidence of CAD (3,4). Several studies have demonstrated that a considerable number of allografts which had significant CAD (lumen narrowing >80%) de termined at autopsy or retransplantation showed no sign of the disease by conventional angiography(6). More reliable modalities to detect the development of allograft CAD are clearly desirable. Computerized quantitative coronary an giography (7) and intracoronaiy ultrasound (8â€"9) have been proposed to detect allograftCAD. PET is a noninva sive modality which has been used to assess prhnaiy CAD (10â€"11) and cardiac allograft rejection (12â€"13). Flow and metabolic studies of the heart have been accurately quan titatedwith positron-emittingradiotracerssuch as ‘3N-arn monia (11) and [18F]fluorodeoxyglucose (14â€"15). The pur pose of this study was to evaluate the ability of PET using 13N-amrnonia to accurately assess the progression of al lograft CAD.
Pediatrics, Mar 1, 1992
The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Cent... more The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Center during a 31-month period were reviewed to define the size of the donor pool in the pediatric population and to assess the role of physicians in the procurement of these much-needed organs. Computerized discharge abstracts showed that 57 pediatric patients died without contraindications to organ donation. Manual review of these 57 medical records yielded 46 records suitable for review by Tennessee Donor Services. From this group, 19 eligible donors were identified. All eligible donors died from trauma, intracerebral hemorrhage, anoxic events, or hydrocephalus. Physicians failed to ask one family for permission to donate. All 18 of the families who were asked agreed to donate and organs were successfully procured from all 18 patients. These data suggest that families of pediatric patients are much more willing to agree to donation than the families of adult patients. As a result of this study, a simplified audit process has been developed for hospitals to use in evaluating compliance with required-request legislation.
Journal of Thoracic and Cardiovascular Surgery, Apr 1, 1987
Journal of Cardiopulmonary Rehabilitation, 1993
Transplantation, 1995
PDGF is a potent mitogen for vascular smooth muscle cells (SMC) and may play an important role in... more PDGF is a potent mitogen for vascular smooth muscle cells (SMC) and may play an important role in the pathogenesis of cardiac allograft vasculopathy (CAV). Two isoforms of PDGF-A chain exist as a result of alternative mRNA splicing that either includes (long-form) or excludes (short-form) exon 6. Short-form PDGF-A is expressed in both resting and activated cells, while the long-form is present predominantly in activated cells. Using RT/PCR, we have found previously that long-form PDGF-A chain was expressed in human cardiac allografts but not in normal human hearts. In the experiments reported here, we studied the cellular distribution of PDGF-A chain isoforms and expression of PDGF receptor-alpha in cardiac allografts. In situ hybridization and immunohistochemistry confirmed the PCR data and demonstrated that expression of long-form PDGF-A chain was diffusely increased in cardiac allografts, predominantly in myocytes and vascular structures. Expression of PDGF receptor alpha also was induced in cardiac allografts and was not detected in any of the normal hearts. Induction of PDGF receptor alpha in cardiac allografts was associated with the presence of long-form PDGF-A chain. In vitro experiments with human endothelial cells demonstrated that aFGF, IL-6, and TGF-beta, which are produced in cardiac allografts in vivo, induced expression of long-form PDGF-A chain. Expression of long-form PDGF-A chain and its receptor was markedly increased in cardiac allografts, predominantly in vascular structures and myocytes. Alterative splicing of PDGF-A chain variants may be mediated by growth factors and cytokines produced in vivo.
Impact of Cardiac Surgery on the Quality of Life, 1990
Transplantation, 1993
Although surgical proficiency is essential to the immediate outcome of transplantation, long-term... more Although surgical proficiency is essential to the immediate outcome of transplantation, long-term success depends upon how adequately the transplantation recipient is managed. Immunosuppression, the most critical aspect of after care, is subject to wide variation. In January 1990, a survey was sent to the directors of all transplant programs in the United States performing one or more kidney, heart, liver, heart-lung, or pancreas transplant in 1988. Detailed data were obtained on both the drugs and methods used for induction and maintenance immunosuppression, as well as the treatment of rejection. Each program director was asked to rank each immunosuppressive approach according to its perceived impact on patient outcomes. Over 85% of all eligible program directors completed the survey. There is no evidence of survey respondent bias. The use of polyclonal and monoclonal agents for induction immunosuppression was favored most by pancreas program directors (72-76%). These agents were least preferred by liver transplant programs (35-37%). About half of kidney, heart, and heart-lung program directors preferred these agents. Triple-drug therapy consisting of CsA, PRED, and AZA was considered the most preferable maintenance protocol for all transplants (i.e., kidney, 89%; heart, 94%; liver, 88%; heart-lung, 86%; pancreas, 96%). Either i.v. steroids or OKT3 were regarded as the preferred approaches for the treatment of acute or resistant rejection. Finally, the acceptability of outpatient treatment of rejection varied by transplant type (i.e., kidney, 9%; heart, 58%; liver, 5%; heart-lung, 29%; pancreas, 8%). Although there are similarities in the ratings of various aspects of immunosuppressive therapy, there are important differences. This information is critical to anticipate the implications of new immunosuppressive agents and to evaluate changes in the use of existing drugs and therapeutic approaches.
Southern Medical Journal, 1987
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... An abstract is unavailable. This article is ...
New England Journal of Medicine, 2005
... and use of reliable information, which has generated increased provider-level competition, th... more ... and use of reliable information, which has generated increased provider-level competition, the cost of ... a system primarily around the needs of consumers and patients does not mean ... be primary care providers, along with academic health centers and large hospital systems that ...
Journal of the American College of Cardiology, 1990
Journal of Clinical Investigation, 1994
Accelerated coronary atherosclerosis in cardiac transplants (cardiac allograft vasculopathy, CAV)... more Accelerated coronary atherosclerosis in cardiac transplants (cardiac allograft vasculopathy, CAV) is characterized by coronary intimal hyperplasia. Acidic fibroblast growth factor (aFGF) is a potent mitogen for vascular smooth muscle cells and endothelial cells, and its expression is increased in cardiac allografts, suggesting it may play a role in the pathogenesis of CAV. The activity of aFGF is dependent on binding to transmembrane receptors. To investigate whether receptors for aFGF are also induced after transplantation, polymerase chain reaction, in situ hybridization, and immunohistochemistry were used to analyze expression of four receptors for aFGF (FGFR1-FGFR4). Expression of mRNA encoding extracellular immunoglobulin-like domains of FGFR1 was increased 35-fold in cardiac allografts compared with normal hearts and was predominantly present in cardiac myocytes and vascular structures. Alternatively spliced mRNA that encodes transmembrane forms of FGFR1, which contain the signal-transducing tyrosine kinase domains, was induced in allografts during rejection, in infiltrating cells, vascular structures, and myocytes. In vitro experiments showed that differential expression of FGF receptor isoforms was induced by aFGF, and also by IL-6 and TGF-beta, which are expressed in cardiac allografts during rejection. The results show that expression of both aFGF and its receptors is altered in cardiac allografts and suggest that these events are important in the pathogenesis of CAV.
Health Psychology, 1995
We explored the relations between positive expectations and adjustment, adherence, and health in ... more We explored the relations between positive expectations and adjustment, adherence, and health in cardiac transplant patients. Thirty-one patients and their nurse completed questionnaires before transplantation and at 3 times after surgery. As predicted, patients' self-reported positive expectations were generally associated with good mood, adjustment to the illness, and quality of life, even in patients who experienced health setbacks. High preoperative expectations predicted later adherence to a complex medical regimen. Positive expectations measured before the transplant predicted a substantial amount of the variance in the nurse's ratings of physical health 6 months after surgery, covarying for adherence behavior and preoperative health.
Clinical & Experimental Immunology, 1993
CHEST Journal, 1993
To analyze a single-center experience with infectious complications of single lung transplantatio... more To analyze a single-center experience with infectious complications of single lung transplantation (SLT) with special emphasis on risk factors for infection in the transplanted and native lung. Consecutive case series. University teaching hospital. Fifteen consecutive SLT recipients (mean age, 43 years; 9 men and 6 women). Mean follow-up was 337 days. Fifteen patients had 24 infectious episodes (1.6 per patient) of which 83 percent were life-threatening, 79 percent involved the lung, airway, or pleural space, and 79 percent occurred in the first 4 months after transplantation. Despite this high infectious morbidity, there were no infectious deaths. The most important infections were bacterial pneumonia (n = 10), cytomegalovirus (CMV) pneumonia (n = 5), and bronchial anastomotic infections (n = 3). Significant risk factors for bacterial pneumonia were a diagnosis of primary or secondary pulmonary hypertension (p < 0.05) and the presence of airway complications of stenosis or dehiscence (p < 0.05). No risk factors for overall lung infections were identified. The native lung was involved in 6 of 16 lung infections and was the exclusive site of infection in 4 cases. Underlying disease in the native lung may have predisposed to infection at that site by a mechanism of inadequate blood flow or impaired ventilation. Three bronchial anastomotic infections (Pseudomonas, Candida, Aspergillus) occurred, all with dehiscence of the anastomosis. These were highly morbid but resolved with antibiotics, stent placement, and surgical retention in two of the three cases. The five episodes of CMV pneumonia caused mild (four patients) or moderate (one patient) dysfunction and responded to antiviral agents without relapse. The frequency, complexity, and morbidity of infections after SLT were great, but most infections were manageable and good outcomes were achieved. A pretransplant diagnosis of pulmonary hypertension or posttransplant occurrence of bronchial stenosis or dehiscence were associated with a higher rate of bacterial pneumonia. The underlying disease in the native lung may predispose to infection at that site.
The Annals of Thoracic Surgery, 1993
Minimal data are available regarding the results of patients who have undergone myocardial revasc... more Minimal data are available regarding the results of patients who have undergone myocardial revascularization more than twice. The records of 13 consecutive patients who underwent a coronary artery bypass procedure for the third time were reviewed. The indication for operation was unstable angina in all patients. All patients were placed on cardiopulmonary bypass through a median sternotomy. The mean number of bypass grafts placed at the third operation was 1.9 (range, 1 to 3 grafts). A new internal mammary artery graft was placed in 6 patients (2 had prior internal mammary artery grafts). Hospital mortality was 7.7% (1/13). The single death was due to incomplete revascularization in a patient with poor distal vessels. Three patients required intraaortic balloon pump support postoperatively, and 2 patients had prolonged ventilatory insufficiency. There have been no late deaths. The 12 survivors have been followed up a mean of 44 months (range, 6 to 90 months). Four remain asymptomatic; 5 have mild angina easily controlled with medication. All except 1 are in improved condition compared with their preoperative status. We conclude that a third myocardial revascularization can be performed with low mortality and morbidity and with the expectation of long-lasting symptomatic improvement.
The Annals of Thoracic Surgery, 1993
Substantial progress has been made in clinical heart-lung transplantation. Although outcomes vary... more Substantial progress has been made in clinical heart-lung transplantation. Although outcomes vary across centers, 1-year patient survival is now 59%. This study was an attempt to assess consensus among transplant program directors regarding the major determinants of patient outcome. In the National Cooperative Transplantation Study we evaluated consensus through a survey of all heart-lung transplant programs active in 1988. Of the eligible programs, 23 (85%) returned completed surveys. Data on the medical and surgical determinants of outcome were analyzed. There was considerable consensus among program directors as to the importance of several factors. The three most critical predictors of favorable outcomes were periodic pulmonary function tests to detect rejection (85.7%), avoidance of use of prednisone during the first 14 days after transplantation (76.2%), and annual left and right heart catheterization with coronary arteriography (76.2%). Several approaches were considered undesirable or unnecessary. These included electrocardiogram as standard rejection monitoring technique (71.4%), cytoimmunological monitoring as standard rejection monitoring technique (66.7%), and routine steroid discontinuation after transplantation (66.7%). On various other treatment approaches there was little evidence of consensus. These included prophylaxis with acyclovir and severe bronchiolitis as a criterion for retransplantation. Although controversial, consensus conferences are one means by which to evaluate technological innovations. Based on their results, practice guidelines can be developed to better inform third-party payers on issues related to transplantation.
The Annals of Thoracic Surgery, 1994
The Annals of Thoracic Surgery, 1988