Pretransplant Stage Research Articles

Quality of life after adult living donor liver transplantation: A longitudinal prospective follow‐up study

Patient survival after living donor liver transplantation (LDLT) has improved, but improvement of the health-related quality of life (HRQOL) of LDLT recipients is also an important issue. The aim of this study was to assess the HRQOL of LDLT recipients from the preoperative period to 18 months following transplantation by prospectively evaluating Short Form-36 Version 2 (SF-36v2) scores. Complete longitudinal SF-36v2 scores were collected from 35 consecutive LDLT recipients prior to surgery and at 3, 6, 12 and 18 months after transplantation. HRQOL scores were severely impaired in all dimensions preoperatively. Although the scores improved significantly up to 18 months after transplantation, they remained lower than those of healthy controls in the majority of domains. Impaired scores preoperatively were significantly associated with severity of liver disease represented by a higher Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh class C, and scores in such patients improved significantly after LDLT in every dimension at 12 months, indicating that the greater the impairment at the pretransplant stage, the greater the improvement in both physical and mental conditions. Preoperative lower HRQOL scores and higher MELD scores were independently associated with significant physical and mental score gains during the first year after LDLT. The findings of the present study may facilitate the development of measures aimed at improving recipient's post-transplant life and establishing realistic expectations for LDLT recipients.

Psychological impact of working with patients with cystic fibrosis at end-of-life, pre-transplant stage

Multidisciplinary staff who work with end-of-life, pre-transplant patients with cystic fibrosis (CF) have to juggle two seemingly opposing care approaches; active care to maintain their patients' health and condition in anticipation of a transplant, and sensitive palliative care that takes their end-of-life wishes into consideration should they not receive a transplant. Little is known about the psychological impact on staff working within this care dichotomy. The aim of this study is to explore staff's experiences and understand more about the psychological impact of this work on them professionally and personally, and how this affects their ability to provide appropriate care for their patients. A qualitative explorative research design was used. Ten semistructured interviews with multidisciplinary staff working in cystic fibrosis centers and units across the United Kingdom were analyzed using interpretative phenomenological analysis (IPA). Two superordinate themes emerged from the analysis: factors contributing to the "juggle" of active and palliative care, and extent of emotional impact on staff. The study indicates that there is an emotional impact on staff working with patients with CF at end-of-life, pre-transplant stages. Specifically, it reveals the extent of the unpredictability that staff work with, and the range of emotions that staff experience, including uncertainty about professional identity and anxiety about working practices. The depth and intimacy of professional-patient relationships is highlighted, particularly for staff in close contact with and similar in age to their patients. Additionally, the strength of staff's commitment and desire to care for patients within broader humanistic terms that mesh with their own personal values is brought to light. Despite the difficulties with their work, the majority of staff adopted numerous coping strategies to manage their emotions, many of which emphasized the link between their professional and personal values in undertaking their roles.

Heart-Transplantation: Psychiatric Comorbidity, Adherence, Coping and Qol in Patients and their Spouses - Results of a Prospective Longitudinal Study

Introduction: Lack of adherence to medication is the second most common reason for organ failure in patients after heart-transplantation (HTx). Aim of the current study is to identify possible predictors of post TX non-adherence at a pre-transplant stage that refer to psychological variables in patients and their spouses. Methods: Patients listed for HTx were evaluated pre HTx every three months, immediately after HTx and six months thereafter. Adherence pre HTx was measured by TERS (Transplant Evaluation Rating Scale) and a structured interview. Coping with illness was assessed using the “Trierer Skalen zur Krankheitsbewältigung”. Depression, anxiety, and QoL in patients and spouses were assessed by PHQ-D, HADS-D and SF-36. Furthermore, we assessed “dyadic coping”, repressive coping (SDS), protective buffering (BSSS), alexithymia (TAS-20) and social support. Adherence post HTx was assessed using the Medication Experience Scale for Immunosuppressants (MESI). Results: To date, n=33 patients have been evaluated. There is a high correlation between the TERS and the MESI (.85; p= .034). Especially patients listed as “highly urgent” can be categorized as “risk patients” or “patients with concern” regarding non-adherence measured by TERS. Further results, including results on the spouses, will be presented at the symposium. Conclusion: These results indicate that TERS pre HTx is a powerful predictor of post HTx adherence measured by MESI. Further longitudinal data will allow to identify additional predictive variables for non-adherence post HTx, and to determine adequate screening-instruments to identify risk patients. Furthermore, this will allow to design tailored early-stage perioperative psychosomatic interventions for patients and their spouses.

Endocrine-Metabolic Pathophysiologic Conditions and Treatment Approaches after Kidney Transplantation

To review pathophysiologic conditions and diagnostic and therapeutic approaches in the management of endocrine-metabolic disorders after kidney transplantation (KT). We discuss the assessment of diabetes mellitus (DM), hyperlipidemia, hypertension, and disturbances of bone and mineral metabolism after KT. KT offers patients with end-stage kidney disease substantial improvement in life expectancy and quality of life. Despite amelioration of renal dysfunction, however, these patients are at risk for the deterioration of existing and the development of new endocrine pathologic conditions. Pretransplant DM and new-onset diabetes after transplantation are associated with worse patient and graft survival. Little is known about preventing new-onset diabetes after transplantation and managing DM shortly after KT. In addition to glycemic control in patients with diabetes, management of cardiovascular risk factors includes appropriate recognition and treatment of hypertension and dyslipidemia. After KT, patients are at considerable risk for derangements in calcium and vitamin D metabolism. Immunosuppressive medications may cause compromised glucose and lipid metabolism, which may, in turn, contribute to the progression of preexisting and the development of new posttransplant endocrinopathies. Clinical care of kidney transplant patients should include a comprehensive endocrine assessment before and after KT in close collaboration with transplant nephrology providers. A referral to an endocrinologist should be initiated early during the pretransplant stage, and collaborative management should be maintained in kidney transplant patients to improve clinical outcomes.

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide and the third most common cause of cancer-related deaths; the number of new cases per year is approaching 750,000. The magnitude of the incidence of HCC has discouraged any attempts to apply liver transplantation (LT) as the prevailing curative therapy for HCC worldwide because of the limited sources of donated organs (deceased and living donors) and the poor access to sophisticated health care systems in some geographical areas. If these limitations continue to prevail throughout the world, any attempt to significantly reduce HCC-related mortality rates through the application of LT will be delusional. International experiences have confirmed, however, the potential of LT to definitively cure HCC because it presents a unique opportunity to remove both the tumor (HCC is associated with 695,000 deaths per year) and the underlying cirrhosis. Despite its limited access, LT has become the standard of care for patients with small HCCs and the main driving force for alternative strategies offered to patients with intermediate HCCs. In 1996, a prospective cohort study defined restrictive selection criteria that led to superior survival for transplant patients in comparison with any other previous experience with transplantation or other options for HCC. Since then, these selection criteria have become universally known as the Milan criteria (MC) in recognition of their origin. Ever since their adoption in clinical practice, the MC have helped doctors to single out early-stage HCC as a prognostic category of cancer presentation that is amenable to curative treatments. After their implementation, the favorable posttransplant outcomes that were observed in cohort series were so convincing that the MC immediately became the standard of care for early HCC, and further validation by randomized controlled trials (RCTs) was prevented. After the passage of approximately a decade, researchers began to challenge the MC with other proposals designed to capture those patients not meeting the MC who could achieve similar posttransplant survival rates through the expansion of the accepted tumor limits for transplant eligibility. None of these expanded criteria have become the new reference standard for selecting LT candidates with HCC; any broadening of the selection criteria for transplantation is inevitably hampered by severe

Antioxidant phytochemicals in lettuce grown in high tunnels and open field

Genotype along with growing and management conditions can affect the content and the composition of phytochemicals in plants. Two lettuce (Lactuca sativa L.) cultivars, ‘Baronet’ and ‘Red Sails,’ were grown in an open field and high tunnels to examine the effect of growing conditions on their phytochemical content. The total phenolic concentration and antioxidant capacity of lettuce increased in response to transplanting from greenhouse to both open field and high tunnels. However, the increase was much greater when seedlings were transplanted to the open field and was more than 4 fold over the pre-transplant stage. The concentrations of two major phenolic compounds, chicoric acid and chlorogenic acid, were about 2.5–5.5 times higher in both cultivars when grown in open field than in high tunnels. Also, growing lettuce in open field resulted in a greater activation of key genes (phenylalanine ammonia-lyase, L-galactose dehydrogenase and γ-tocopherol methyl transferase) involved in the biosynthesis of phenolic compounds, ascorbic acid and α-tocopherol. ‘Red Sails’ accumulated caffeic acid 4 times as much in open field as it did in high tunnels and overall contained higher amount of phenolic compounds, especially in open field, than did Baronet. Although lettuce plants grown in open field were richer in phytochemicals, a significant reduction in biomass accumulation occurred when the lettuce plants were grown in open field compared to high tunnels regardless of cultivar. These results show that growing conditions, in addition to genotype, can significantly affect the content of many phenolic compounds in lettuce and that growing lettuce under open field can have a positive impact on its health-promoting qualities.

Strategies of Immunosuppression for Liver Transplant Recipients With Hepatocellular Carcinoma

Liver transplantation is considered to be the most efficient therapeutic option for patients with liver cirrhosis and early stage hepatocellular carcinoma (HCC) in terms of overall survival and recurrence rate. The application of restrictive selection criteria based on tumor size and number of nodules is advised to obtain optimal results. Nevertheless, tumor recurrence occurs in 3.5% to 21% of recipients, despite careful pretransplant staging and patient selection. Post transplant recurrence of hepatocarcinoma clearly has a major negative impact on prognosis. Intuitively, an immunosupressed state is undesirable in cancer patients. Inversely, modulation or minimization of immunosuppressive therapy could influence tumor progression and reduce the negative impact of recurrence on posttransplant survival. Experimental evidence shows that mammalian target of rapamycin (mTOR) inhibitors have antiangiogenic and antiproliferative effects. Thus, their application has been proposed as antineoplastic agents for immunosuppressive protocols in liver transplant recipients with HCC and may reduce the rate or the impact of tumor recurrence. Clinical data about efficacy and safety of mTOR-based immunosuppressant protocols in liver transplant recipients with HCC show promising results, namely low recurrence and higher survival rates compared with standard calcineurin inhibitor–based immunosuppressive protocols, even among patients with extended morphological criteria. The safety profile is regarded generally as adequate.

Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage

The standard treatment of chronic hepatitis C, pegylated interferon and ribavirin (pegI/R), has many limitations in both effectiveness and secondary effects, which makes it unsuitable or even contraindicated for some patients. In hepatitis C virus-infected cystic fibrosis patients this treatment could increase respiratory infections with subsequent pulmonary function deterioration. On the contrary, hepatitis C virus (HCV) infection may make lung transplant (LT) unfeasible. We present the case of a cystic fibrosis-young man diagnosed with HCV infection during LT assessment who was treated with pegI/R. In spite of the lung function worsening and respiratory infections, he managed to complete treatment and even sustained virological response (SVR). At present he is on LT waiting list.

Childhood Cerebral X-Linked Adrenoleukodystrophy More Than 5 Years After Hematopoietic Cell Transplantation: The First Case From Serbia and Southeastern Europe

We report the clinical course, brain magnetic resonance imaging (MRI), and proton magnetic resonance spectroscopy findings in a boy with childhood cerebral X-linked adrenoleukodystrophy whose neurological disease keeps progressing more than 5 years after conventional hematopoietic cell transplantation with full donor-derived engraftment accomplishment. The described clinical and radiological findings follow all phases of this childhood cerebral X-linked adrenoleukodystrophy: from the clinically asymptomatic pretransplant stage to the present day. This is the first patient not only from Serbia but from the entire area of Southeastern Europe who underwent hematopoietic cell transplantation for childhood cerebral X-linked adrenoleukodystrophy. The presented disease course and the posttransplant outcome in the only case of transplanted adrenoleukodystrophy from Serbia enhances the overwhelming appeal for better X-linked adrenoleukodystrophy screening, earlier disease detection, and contributes to the well-known anticipation of the refined hematopoietic cell transplantation eligibility criteria in future adrenoleukodystrophy treatment.

Psychological and psychosocial aspects of the solid organ transplant experience–A practice review.

There is an increasing need for empirically based psychotherapy interventions for individuals and their caregiving systems undergoing the solid organ transplant process. Research suggests that the organ transplant recipient experiences an improvement in physical and social functioning and return to daily activities, but not consistently positive change in psychological health. The transplantation process leaves the recipient with a mixture of distressing and challenging experiences. Three temporal stages have been identified in the process: the pretransplant stage, preoperative/candidacy waiting period, and the posttransplant stage, each holding psychological and social issues. The construct of quality-of-life, identified by critical factors and benchmarks in the therapeutic process for transplant recipients, is defined differently in the medical and psychological literature. Differences are discussed in terms of therapeutic interventions. Caregivers are found to experience their own challenges when an intimate has a solid organ transplant. Therapeutic interventions for the caregiving system include stress management, psychoeducation, and repair of relational ruptures.

The Presence of Minimal Residual Disease Pre- and Post-Transplant Is Predictive of Outcome in Recipients of Allogeneic Transplantation for Acute Myeloid Leukaemia.

Abstract 2601Poster Board II-577Minimal residual Disease (MRD) monitoring is known to be of importance in guiding management in patients with acute myeloid leukaemia (AML) treated with chemotherapy. Many subtypes of AML do not, however, have a molecular marker available for MRD monitoring and in this setting the use of multiparametric flow cytometry (MFC) has been evaluated.Few studies have investigated the impact of MRD in the setting of allogeneic transplantation for AML. We speculate that, as with chemotherapy, the outcome in MRD positive patients will be inferior to MRD negative patients due to an increase in disease relapse. In order to investigate this hypothesis we studied 74 patients who underwent allogeneic transplantation for AML in a single centre from 2004–2008. The median age was 47.1 years (range: 20.8–70.1). The overall survival at 2 years was 48% with a median follow-up of 1.96 years. Conditioning was myeloablative in 37 patients and reduced intensity in 37 patients. 46 patients had T cell depletion as part of the conditioning. 48 patients had an unrelated donor and in 26 a sibling donor was used. MRD analysis by MFC (sensitivity 0.04%)in the bone marrow was performed pre-transplant and on day 28 and 100 post-transplant.Using conventional criteria, 47 patients were in CR1, 15 in CR2, 4 in CR > 2 and 8 patients were not in CR at the time of the transplant. Survival at 2 years was 58%, 50%, 25% and 12,5% respectively (p=0.001). We examined the impact of MRD by MFC in patients who were in CR at transplant. Survival at 2 years in patients who were MRD negative (MRD-) pre-transplant was 70% compared to 29% in those who were MRD positive (MRD+) (p=0.003). In multivariate analysis, the most significant factor affecting outcome was being MRD+ pre-transplant (RR of death of 3.04, p=0.011; 95% CI 1.2–7.1). Interestingly, there was no significant difference in survival seen between patients who were MRD+ and those who were not in CR (by conventional tests) pre-transplant (p=0.305).The MRD analysis at day 28 was not predictive of outcome. However, in patients alive and without relapse at day 100, MRD analysis was predictive of outcome (2 year: MRD-70% vs 27% MRD+; p=0.045). In patients who were MRD- at both time-points, survival at 2 years was 81% compared to 42% in those who were MRD+ at one or both time-point (p=0.040).The incidence of disease relapse was 32% at 2 years and non-relapse mortality (NRM) was 8% at day 100 and 22% at 1 year. Interestingly, while the pre-transplant stage was predictive of relapse (2 years: those in CR 28% (no difference for CR1 or >CR1) compared to those not in CR 63%, p=0.004), the presence of MRD positivity was not; neither pre-transplant (p=0.47) nor at day 100 (p=0.29). Conversely, the NRM was significantly higher in those who were MRD+ pre-transplant, but not at day 100. The NRM at day 100 was 4% in MRD- patients and 15% in MRD+ patients (p=0.01). In multivariate analysis this conferred a RR of NRM of 2.12 (p=0.014; 95% CI 1.1–3.8) to MRD+ patients.We conclude that the presence of MRD detected by flow cytometry pre- and day 100 post-transplant is predictive of a worse patient outcome. Interestingly this appears to be predominantly due to an increase in NRM rather than an increase in disease relapse. We speculate that differences in the duration and/or intensity of GVHD prophylaxis may be implicated in this finding and we are currently investigating this hypothesis. A better understanding of these factors will allow us to tailor treatment based on MRD status in an intelligent fashion. Disclosures:No relevant conflicts of interest to declare.

Unrelated Cord Blood Transplantation (UCBT) in Adults with MDS or Secondary Acute Myeloblastic Leukemia (sAML): a Survey On Behalf of Eurocord and CLWP of EBMT.

Abstract 1198Poster Board I-220 Background:Unrelated cord blood transplantation is an alternative option to treat patients with high risk hematologic malignancies in the absence of an HLA identical donor. Results of UCBT in patients with MDS or secondary leukaemia (sAML) have been scarcely published. Method:We performed a survey to identify predictors of outcomes in a large cohort of 108 adults with MDS or sAML reported to Eurocord-Promise data bases (62 centres in 17 countries in Europe) and transplanted with an UCBT from 1998 to 2007. Sixty-seven patients were transplanted for sAML (secondary to MDS in 42 cases) and 41 for MDS. Worst status before UCBT for MDS was RA in 4, RAEB1 in 10, RAEB2 in 14, CMML or RAEBt in 9, unclassified in 4 patients. IPSS classification at transplantation was low, intermediate 1, intermediate 2, high or missing in 8, 12, 7, 6 and 8 patients, respectively. For patients with sAML, 48% were transplanted in CR1 at UCBT. Median age at UCBT was 43 years (from 18 to 72 years). Median time from diagnosis to UCBT was 10 months. Transplant characteristics:77 patients received a single and 31 a double UCBT. UCB grafts had ≥ 2/6 HLA mismatched in 60 % of cases. Myeloablative conditioning regimen (MAC) was given to 57 patients whereas 51 patients received a reduced intensity conditioning regimen (RIC). GVHD prophylaxis consisted in CSA+MMF in 52, CSA+steroids in 43 and other combinations in 13 patients. Median number of collected nucleated cells was 3.4 for single and 4.6 × 107/kg for double UCBT. Median follow-up was 25 months. Results:cumulative incidence (CI) of neutrophil recovery at day 60 was 82±4% with a median time to achieve more than 500 ANC/mm3 of 23 days. Neutrophil recovery was independently associated with number of CD34+ cells/kg (> 1.1 × 105, Hazard Ratio (HR), 1.79; P= .02) and advanced disease status (intermediate 2 or high MDS and sAML not in CR; HR, 1.92; P= .007). CI of grade II-IV acute GVHD at day 100 and chronic GVHD at 2 years were 26±4% (II n=18, III n=6, IV n =6) and 42%±8, respectively. Two-year non-relapse mortality was significantly higher after MAC (62% vs. 34%, p=0.009). In counterpart, 2-year relapse rate was higher after RIC (14% vs 29%, p=0.02). Two-year DFS and OS were 30 and 34%, respectively. In univariate analysis, among patient-, disease- and transplant- factors studied only patients with high risk disease at maximal pre-transplant stage or transplanted > 18 months after diagnosis had significant poorer DFS (disease risk: 49% vs. 22%; time: 35% vs. 15%). However, in multivariate analysis, the only factor associated with decreased DFS was advanced disease (HR: 2.05; p= .01). Conclusion:These data indicate that UCBT is an acceptable alternative option to treat adults with high risk MDS or sAML without a HLA-matched related or unrelated bone marrow donor. Controlled disease at time of transplantation improves outcome. More investigations are needed to compare these results with outcomes after other stem cell sources from unrelated HSCT donor. Disclosures:No relevant conflicts of interest to declare.

A Staging System for Infantile Krabbe Disease to Predict Outcome After Unrelated Umbilical Cord Blood Transplantation

Infantile Krabbe disease, a rare neurodegenerative disorder that leads to rapid demyelination, dysmyelination, and death in the first 2 years of life, is responsive to treatment with umbilical cord blood transplantation provided that the patient is treated in the first weeks of life. At present, family history is the only way to identify patients that are asymptomatic with most patients being diagnosed after onset of symptoms. We hypothesized that a staging system based on clinical indicators and neurophysiological and neuroimaging measures can predict posttreatment variation in patients diagnosed with infantile Krabbe disease. A retrospective review of pretransplant clinical indicators and neurodevelopmental, brain imaging and neurophysiological measures was performed in 42 patients being considered for treatment with umbilical cord blood transplantation. Based on these evaluations, an expert system approach was used to develop a staging system for infantile Krabbe disease. Another set of analyses in the subset of patients who were transplanted (n = 29) evaluated the association between pretransplant stage of disease and posttransplant neurodevelopmental outcomes. A staging algorithm for infants with infantile Krabbe disease was developed and tested for predicting neurodevelopmental outcome after umbilical cord blood transplantation. Standard neurophysiological and neuroimaging tests were not useful in the staging algorithm. Clinical indicators were found to best classify stage of disease. Pretransplant stage was found to be predictive of neurodevelopmental outcome. We conclude that the clinical staging system based solely on signs and symptoms of disease can be used to predict outcomes after umbilical cord blood transplantation. This staging system can be used prospectively to guide physicians unfamiliar with the disorder in evaluating, monitoring, and counseling families about treatment outcomes. The staging will be useful for both patients diagnosed with infantile Krabbe disease because of clinical symptoms and those identified through neonatal screening programs.

Autologous stem cell transplantation (ASCT) in AL amyloidosis: Feasibility outside national amyloidosis referral centers and proposal for simpler pre-transplant staging

17545 Background: Single center data from national amyloidosis referral centers suggest that high dose melphalan based ASCT is an effective upfront treatment strategy for AL amyloidosis. Absence of published randomized control trials, referral bias and center experience make generalizability of this data difficult since data from outside of major referrals centers is limited. Pre-transplant staging is complicated by the profusion of articles describing various adverse risk factors. Methods: Retrospective review of bone marrow transplant database at our institution was conducted. All patients with AL amyloidosis who underwent ASCT were included in the study. We stratified patients based on International Staging System (ISS) for multiple myeloma. Organ and hematological response were assessed using 2005 consensus guidelines. Results: 13 patients (6 males) underwent ASCT for AL amyloidosis with risk adapted high dose melphalan dosing (melphalan mg/m2 100 (n = 1), 150 (n = 8) and 200 (n = 4)). Median age of the patient population was 53 years (range 31–75 years). Organ involvement was as follows - single organ = 6, 2 organs = 4 and 3 organs = 3. 4 patients had cardiac amyloidosis. 100 day transplant related mortality (TRM) was 15.3%. Overall survival was 84 % (95 % CI 51–96%) @ 1 yr and 75% (95% CI 38–91%) @ 2 yrs. Median follow up was 18 months. No deaths were observed >17 months post-transplant. 45 % patients had organ response. Complete hematological response was observed in 45 % patients. Mean duration of peri-transplant hospital stay for ISS stage I, II and III were 20.5 days (n = 2), 23.3 days (n = 9) and 29 days (n = 1) respectively. Number of deaths observed in ISS stage I, II and III were 0 (0/2), 2 (2/9) and 1 (1/1) respectively. Conclusions: Autologous stem cell transplant (ASCT) for AL amyloidosis is a feasible, effective and safe procedure outside of major national referral centers. Pretransplant stratification of amyloidosis patients using ISS for multiple myeloma indicated a trend towards longer peri-transplant hospital stay and mortality with increasing ISS stage. This hypothesis needs to be tested in larger studies. No significant financial relationships to disclose.

Transplantation in Children: A Longitudinal Assessment of Mothers’ Stress, Coping, and Perceptions of Family Functioning

This study examined the parenting stress, coping resources, and family functioning among 27 mothers of children undergoing bone marrow, liver, kidney, and heart transplantation. The mothers completed a comprehensive battery of psychological instruments at the pretransplant stage and at 1- and 6-month posttransplant stages. Increased parenting stress, financial strain, caregiver burden, and family stress were reported following transplantation and persisted for several months. The mothers reported using coping strategies characterized by attempts to maintain family integration and to understand the child's medical situation. Development and evaluation of intervention programs to enhance parents' ability to cope with stress and maintain family stability are warranted.

Host-endophyte specificity of vesicular-arbuscular mycorrhizal colonization of Oryza sativa l. at the pre-transplant stage in low or high phosphorus soil

Three varieties of rice ( Oryza saliva L.) at the pre-transplant stage grown in low or high P soil varied in the levels of colonization by isolates of indigenous vesicular-arbuscular mycorrhizal (VAM) fungi ( Glomus mosseae, G. microcarpum, G. fasciculatum and G. caledonium) and the non-indigenous fungus ( G. etunicatum). Inoculation by VAM fungi resulted in significant differences in proportions of root length colonized, specific root lengths and growth among the various fungus-plant variety combinations and non-inoculated plants. Two varieties of rice plants colonized by the non-indigenous fungus in high and low P soil had reduced growth compared to plants colonized by indigenous fungi, whereas plants of the third variety tested did not show any significant difference in growth when inoculated with either the non-indigenous or the indigenous fungi. Non-inoculated plants always had significantly lower dry weights than plants colonized by the indigenous fungi indicating that rice plants were positively responsive to colonization by the indigenous VAM fungi. This study demonstrated that different isolates of mycorrhizal fungal species colonize a specific variety of rice to varying degrees and individual isolates of mycorrhizal fungi colonize different varieties of rice to varying degrees. The results suggest that differential VAM fungal responses according to the host variety may result in selection pressures which favor certain specific fungus-host variety combinations. The evaluation of plant varieties for endophyte specificity and identification of desirable inoculant strains of endophytes is essential.

Family noncommunication: the search for kidney donors.

Intensive study of the family communication patterns in the search for a kidney transplant donor revealed that, in a significant number of cases, communication is effectively blocked. The authors followed 83 transplant patients and their families throughout the pretransplant stage and for three weeks after the transplant. Although the noncommunication pattern appears to be maladaptive and rather stressful prior to the transplant, it seems to be beneficial for family cohesion in the period after a successful transplant.