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Garcia VD, Pestana JOMDA, Pêgo-Fernandes PM. Is donation after circulatory death necessary in Brazil? If so, when? J Bras Pneumol 2022; 48:e20220050. [PMID: 35475870 PMCID: PMC9064620 DOI: 10.36416/1806-3756/e20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Valter Duro Garcia
- . Serviço de Nefrologia e Transplante Renal, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS), Brasil
| | | | - Paulo Manuel Pêgo-Fernandes
- . Disciplina de Cirurgia Torácica, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, (SP) Brasil
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de Jong RW, Jager KJ, Vanholder RC, Couchoud C, Murphy M, Rahmel A, Massy ZA, Stel VS. Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease. Nephrol Dial Transplant 2021; 37:126-138. [PMID: 33486525 PMCID: PMC8719583 DOI: 10.1093/ndt/gfaa342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Access to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD. METHODS We surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low-, middle- and high-gross domestic product purchasing power parity (GDP PPP). RESULTS In total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P < 0.05). Professionals' attitudes towards several treatments became more positive with increasing GDP (P < 0.05). Uptake of in-centre haemodialysis was sufficient to 73% of respondents, but many wanted increased uptake of home dialysis, Tx and CCM. Respondents experienced different barriers according to availability of specific treatments in their centre. The occurrence of barriers (financial, staff shortage, lack of space/supplies and patient related) decreased with increasing GDP (P < 0.05). CONCLUSIONS Differences in factors influencing modality choice when providing RRT or CCM to adults with ESKD were found among low-, middle- and high-GDP countries in Europe. Therefore a unique pan-European policy to improve access to treatments may be inefficient. Different policies for clusters of countries could be more useful.
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Affiliation(s)
- Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Raymond C Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent
University Hospital, Ghent, Belgium
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis La
Plaine, France
| | - Mark Murphy
- The Irish Kidney Association CLG, Dublin, Ireland
| | - Axel Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main,
Germany
| | - Ziad A Massy
- INSERM U1018, Équipe 5, Centre de Recherche en Epidémiologie et Santé des
Populations (CESP), Université Paris Saclay et Université Versailles Saint Quentin en
Yvelines (UVSQ), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris
(APHP), Hôpital Universitaire Ambroise Paré, Boulogne-Billancourt,
France
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
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Holzhauser L, Imamura T, Bassi N, Fujino T, Nitta D, Kanelidis AJ, Narang N, Kim G, Raikhelkar J, Murks C, Onsager D, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Increasing heart transplant donor pool by liberalization of size matching. J Heart Lung Transplant 2019; 38:1197-1205. [PMID: 31672219 DOI: 10.1016/j.healun.2019.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/27/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The heart transplant (HT) guidelines recommendation to match recipient and donors within 30% of body weight lacks a strong evidence base and is not well established in patients bridged to transplant with left ventricular assist devices (LVAD). In light of the scarcity of donor hearts, we investigated the effect of size mismatch on hemodynamics, one-year survival and length of stay (LOS) following HT. METHODS Single-center retrospective analysis of consecutive HT patients from April 2007 to September 2017. Recipients were divided into 3 cohorts based on donor-to-recipient weight ratio (DRWR): (1) undersized (<0.7), (2) size-matched, (0.7-1.3); (3) oversized (>1.3). RESULTS 288 consecutive patients were identified (mean age 53 ± 11 years; 76% male), 46 were undersized (0.61 ± 0.05), 210 size-matched (0.94 ± 0.16), and 32 oversized (1.65 ± 0.38). There was no significant difference in donor left ventricular end diastolic diameter (LVEDD) between the 3 groups (p = 0.11). The donor/recipient (D/R) predicted heart mass (PHM) was lowest in the undersized group (0.92 ± 0.13). There were no significant differences in 1-year survival in the overall and LVAD cohort (p = 0.65 and 0.59, respectively). Neither donor LVEDD nor D/R PHM differed among survivors or non-survivors. LOS was longer in the undersized group than the size-matched cohort (p = 0.004). The undersized group had hearts with the highest filling pressures and lowest cardiac index at 1 week among the remaining groups (p = 0.009, 0.017, and p = 0.05, respectively). There were no clinically significant differences in hemodynamics at 1 or 6 months. CONCLUSIONS HT undersizing affects hemodynamics early but not later in the course and does not impact 1-year survival. The liberalization of size matching may increase the HT donor pool significantly.
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Affiliation(s)
- Luise Holzhauser
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Teruhiko Imamura
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Nikhil Bassi
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, California
| | - Takeo Fujino
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Daisuke Nitta
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Anthony J Kanelidis
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Nikhil Narang
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Catherine Murks
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - David Onsager
- Department of Surgery, Division of Cardio-thoracic surgery, University of Chicago, Chicago, Illinois
| | - Tae Song
- Department of Surgery, Division of Cardio-thoracic surgery, University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, Division of Cardio-thoracic surgery, University of Chicago, Chicago, Illinois
| | - Valluvan Jeevanandam
- Department of Surgery, Division of Cardio-thoracic surgery, University of Chicago, Chicago, Illinois
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois.
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