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Ali F, Chant K, Scales A, Sellwood M, Gallagher K. Neonatal organ donation: Retrospective audit into potential donation in a single neonatal unit. Nurs Crit Care 2024; 29:532-535. [PMID: 37353898 DOI: 10.1111/nicc.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Research has shown that many babies who die in neonatal units could have been potential tissue and/or organ donors. Despite the existence of guidelines supporting its implementation, the incidence of neonatal donation remains rare in the United Kingdom. AIM The aim of this audit was to retrospectively determine potential eligibility for neonatal tissue and/or organ donation referral in infants who died in a single UK tertiary-level neonatal unit between 2012 and 2021. Cause of death and documentation of any discussions held regarding referral for donation were also explored. STUDY DESIGN An audit was undertaken to identify all neonatal deaths at a single tertiary-level NICU in London from 2012-2021. Infants who retrospectively could have been referred as potential tissue and/or organ donors were identified using current NHS Blood and Transplant inclusion and exclusion criteria. RESULTS AND CONCLUSION A significant missed potential for neonatal tissue and/or organ donation referrals was identified, which is likely not just limited to the unit audited. Causes of death were as expected for a tertiary level neonatal unit and centre for therapeutic cooling of babies born with hypoxic perinatal brain injuries. Only one documented conversation was found regarding neonatal donation. RELEVANCE TO CLINICAL PRACTICE To enable conversations regarding neonatal donation to become a routine part of end-of-life care discussions with families as appropriate, good links between neonatal healthcare professionals and Specialist Nurses in Organ Donation need to be established. This will facilitate the referral of all suitable neonates as potential donors and ensure that neonatal staff feel supported to care for babies identified as potential donors.
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Affiliation(s)
- Faizah Ali
- Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Kathy Chant
- University College London Hospital NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
| | | | - Mark Sellwood
- University College London Hospital NHS Foundation Trust, London, UK
| | - Katie Gallagher
- University College London Hospital NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
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Assfalg V, Miller G, Stocker F, Hüser N, Hartmann D, Heemann U, Tieken I, Zanen W, Vogelaar S, Rosenkranz AR, Schneeberger S, Függer R, Berlakovich G, Ysebaert DR, Jacobs-Tulleneers-Thevissen D, Mikhalski D, van Laecke S, Kuypers D, Mühlfeld AS, Viebahn R, Pratschke J, Melchior S, Hauser IA, Jänigen B, Weimer R, Richter N, Foller S, Schulte K, Kurschat C, Harth A, Moench C, Rademacher S, Nitschke M, Krämer BK, Renders L, Koliogiannis D, Pascher A, Hoyer J, Weinmann-Menke J, Schiffer M, Banas B, Hakenberg O, Schwenger V, Nadalin S, Lopau K, Piros L, Nemes B, Szakaly P, Bouts A, Bemelman FJ, Sanders JS, de Vries APJ, Christiaans MHL, Hilbrands L, van Zuilen AD, Arnol M, Stippel D, Wahba R. Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation 2024; 108:1200-1211. [PMID: 38073036 DOI: 10.1097/tp.0000000000004878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Wouter Zanen
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Függer
- Department of Surgery, Krankenhaus der Elisabethinen and Johannes Kepler University, Linz, Austria
| | | | - Dirk R Ysebaert
- Department of HPB and Transplantation Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | | | - Dimitri Mikhalski
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, ULB, Brussels, Belgium
| | | | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anja S Mühlfeld
- Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Richard Viebahn
- Chirurgische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Bochum, Germany
| | - Johann Pratschke
- Chirurgische Klinik CCM/CVK, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ingeborg A Hauser
- Department of Nephrology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Bernd Jänigen
- Department of General and Digestive Surgery, Transplant Unit, Freiburg, Germany
| | - Rolf Weimer
- Department of Internal Medicine, Nephrology/Renal Transplantation, University of Giessen, Giessen, Germany
| | - Nicolas Richter
- Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
| | - Susan Foller
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ana Harth
- Medizinische Klinik I Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Christian Moench
- General-, Visceral- and Transplantation Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Nitschke
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, LMU University of Munich, Munich, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplant Surgery, UKM Muenster, Münster, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, University Medical Center, Philipps University Marburg, Marburg, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, Division of Nephrology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Schiffer
- Nephrology and Hypertension, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Bernhard Banas
- Abteilung für Nephrologie, Universitäres Transplantationszentrum, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, Rostock University Medical Centre, Rostock, Germany
| | - Vedat Schwenger
- Department of Nephrology and Transplant Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg-Kidney Transplant Program, Wuerzburg, Germany
| | - Laszlo Piros
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Balazs Nemes
- Department of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Szakaly
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Antonia Bouts
- Pediatric Nephrology Department, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan S Sanders
- Departement of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center and Transplant Center, Leiden, the Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dirk Stippel
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Ambagtsheer F, Bunnik E, Pengel LHM, Reinders MEJ, Elias JJ, Lacetera N, Macis M. Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda. Transpl Int 2024; 37:12483. [PMID: 38644936 PMCID: PMC11027084 DOI: 10.3389/ti.2024.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 04/23/2024]
Abstract
The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eline Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Liset H. M. Pengel
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marlies EJ Reinders
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Julio J. Elias
- Department of Economics, School of Business, University of CEMA, Buenos Aires, Argentina
| | | | - Mario Macis
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
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Machin H, Sutton G, Baird PN. Examining Corneal Tissue Exportation Fee and Its Impact on Equitable Allocation. Cornea 2022; 41:390-395. [PMID: 34483277 DOI: 10.1097/ico.0000000000002856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
METHODS We conducted grounded theory semistructured interviews, purposively inviting participants until themed saturation was met. Sentiment analysis was used to determine opinion. RESULTS We interviewed n = 92 global eye tissue and eye bank professionals. We determined that corneal tissue, which is exported, costs between US $100 and US $6000 or is provided as gratis. Collectively, interviewees indicated that, globally, there were no fixed fee structures in place, and the fee was influenced by multiple factors on both export and import sides. They indicated that ultimately corneas were allocated based on the importers' ability to pay the price determined by the exporting eye bank. DISCUSSION Allocation of corneal tissue, which is exported, is influenced by the fees charged by the exporters to meet their bottom line and the funds available to importers. Therefore, export allocation is not equitable, with those who can pay a higher fee, prioritized. Steps to guide and support exporters with the development of fee structures that promote equitable allocation are essential. This will assist both export and import eye bank development, corneal tissue access development, and those awaiting a corneal transplant.
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Affiliation(s)
- Heather Machin
- Lions Eye Donation Service, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
| | - Gerard Sutton
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; and
- The University of Technology Sydney, Graduate School of Health, New South Wales, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
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5
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Sachdev M, Chakraborty S, Bansal M, Bhargava R, Dua V. Encouraging Outcomes of Alternate Donor Hematopoietic Stem Cell Transplant in Pediatric High-risk/Relapsed Leukemias: A Single Center Experience. J Pediatr Hematol Oncol 2021; 43:e1148-e1152. [PMID: 34133381 DOI: 10.1097/mph.0000000000002227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
Outcomes of high-risk and relapsed pediatric acute leukemias continue to be suboptimal. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative modality. However, <30% of patients have matched sibling donors available. Hence, alternate donors (matched unrelated and haploidentical) are being used to improve outcomes. We retrospectively analyzed our data of all children with high-risk/relapsed acute leukemias who underwent alternate donor HSCT at our center from April 2015 to July 2020. A total of 15 patients were included-3 underwent matched unrelated and 12 underwent haploidentical HSCT. Before HSCT, all patients were in complete remission (CR): CR1-1, CR2-11, and CR3-3. All patients engrafted except one. Median time to neutrophil and platelet engraftment was 15 and 16 days, respectively. There were 3 transplant related mortalities. One patient was lost to follow-up. Remaining 11 patients remain in remission and are alive. The cumulative incidence of acute graft versus host disease was 57.1% and of chronic graft versus host disease was 21.4%. Overall survival was 80% and the event-free survival was 73.3%. The median follow-up of alive patients was 775 days (range: 333 to 2077 d). Our experience shows encouraging outcomes using alternate donor HSCT for these patients from developing world.
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Affiliation(s)
- Mansi Sachdev
- Department of Hematology, Pediatric Hemato-Oncology, and Bone Marrow Transplant, Fortis Memorial Research Institute (FMRI), Gurugram, Haryana, India
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6
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Abstract
PURPOSE OF REVIEW Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted every facet of hematopoietic cell transplantation. This article reviews the adjustments to recipient and donor care that occurred in response to this unprecedented event. RECENT FINDINGS Transplant centers modified algorithms, patient flow, education, and how we provided care. Our donor center partners reworked how donors were evaluated and products delivered to the transplant center. Our professional societies provided guidelines for patient and donor care and rapidly modified these based upon the never-ending stream of new data learned about SARS-CoV-2. Our research organizations provided rapid analyses to ensure the care modifications necessitated did not have a profound negative impact on our patients or donors. SUMMARY The efforts of transplant providers and donor centers worldwide allowed patients to receive the transplant needed with assurances that they were receiving the best care available despite the worldwide challenge.
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Affiliation(s)
- Marcie Riches
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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7
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Machin H, Buckland L, Georges P, Ghabcha M, Golding-Holbrook T, Leighton C, Mackey A, Weinel L, Whiting V, Sutton G, Baird PN. Supply and Demand of Domestic Corneal Tissue and Its Implications on Export Potential-Using Australia as an Example. Cornea 2021; 40:1229-1235. [PMID: 33290321 DOI: 10.1097/ico.0000000000002599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Corneal tissue importation is only possible if another country is able to export corneas without impacting its own domestic demand. Currently, there is little evidence to indicate whether export nations have such surplus capacity and in a position to export. To explore this concept, we examined our nation, Australia, which is reported to routinely decline donations because of its ability to meet domestic corneal transplant demand. Our research offers insights and opportunities for Australia and other nations to evaluate their domestic and international supply and allocation of corneal tissue in this space. METHOD We collated 12 months of data on collected and noncollected donations, through participating Australian Eye Banks. The explanation of why some known donors were declined or not pursued indicated if demand was met and potential surplus-for-export levels. RESULTS There were 7.5% (n = 11,889) of deaths in Australia that were notified to Australian Eye Banks during our reporting period. Of those, 9.3% (n = 1106/11,889) were recovered and allocated, 15.7% (n = 1863/11,889) were known but declined, and 75% (n = 8920/11,889) were not pursued. Of those that were declined, 64.3% (n = 1197/1863) were declined because of limitations with service/manpower at the eye bank, whereas 35.7% (n = 666/1863) were declined because demand was met. CONCLUSIONS Australia did not meet demand all the time, during our data period. There were adequate quantities of potential donors to support increasing recovery for domestic allocation and provide for exportation without hindrance to Australian demand. Further examination of domestic supply and demand cycles and the export process is required before routine exportation.
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Affiliation(s)
- Heather Machin
- Lions Eye Donation Service, Center for Eye Research Australia, University of Melbourne, East Melbourne, Australia
| | - Lisa Buckland
- Lions Eye Bank of Western Australia, Lions Eye Institute, Perth, Australia
| | - Pierre Georges
- New South Wales Tissue Banks, New South Wales Organ and Tissue Donation Service, Sydney, Australia
| | - Mona Ghabcha
- New South Wales Tissue Banks, New South Wales Organ and Tissue Donation Service, Sydney, Australia
| | - Tamme Golding-Holbrook
- Eye Bank of South Australia, Department of Ophthalmology, Surgical and Perioperative Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Candice Leighton
- Queensland Eye Bank, Queensland Tissue Bank, Organ and Tissue Donation Service, Metro South Health, Brisbane, Australia
| | - Adrienne Mackey
- Lions Eye Donation Service, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Surgery|Ophthalmology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Luke Weinel
- Eye Bank of South Australia, Department of Ophthalmology, Surgical and Perioperative Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Victoria Whiting
- Queensland Eye Bank, Queensland Tissue Bank, Organ and Tissue Donation Service, Metro South Health, Brisbane, Australia
| | - Gerard Sutton
- New South Wales Tissue Banks, New South Wales Organ and Tissue Donation Service, Sydney, Australia
- Discipline of Ophthalmology, Sydney Medical School, Save Sight Institute, The University of Sydney, Sydney, Australia; and
- Graduate School of Health, The University of Technology Sydney, Sydney, Australia
| | - Paul N Baird
- Department of Surgery|Ophthalmology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Abstract
Heart transplantation is the only long-lasting lifesaving option for patients with terminal cardiac failure. The number of available human organs is however far below the actual need, resulting in substantial mortality of patients while waiting for a human heart. Mechanical assist devices are used to support cardiac function but are associated with a high risk of severe complications and poor quality of life for the patients. Consistent success in orthotopic transplantation of genetically modified pig hearts into baboons indicates that cardiac xenotransplantation may become a clinically applicable option for heart failure patients who cannot get a human heart transplant. In this overview, we project potential paths to clinical cardiac xenotransplantation, including the choice of genetically modified source pigs; associated requirements of microbiological, including virological, safety; optimized matching of source pig and recipient; and specific treatments of the donor heart after explantation and of the recipients. Moreover, selection of patients and the regulatory framework will be discussed.
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Affiliation(s)
- Bruno Reichart
- Walter Brendel Center for Experimental Medicine, LMU Munich, Munich, Germany
| | - Matthias Längin
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Joachim Denner
- Institute of Virology, Free University Berlin, Berlin, Germany
| | - Reinhard Schwinzer
- Department of General-, Visceral-, and Transplantation Surgery, Transplant Laboratory, Hannover Medical School, Hannover, Germany
| | - Peter J Cowan
- Immunology Research Centre, St. Vincent's Hospital Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, VIC, Australia
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, LMU Munich, Munich, Germany
- Department of Veterinary Sciences, and Center for Innovative Medical Models (CiMM), LMU Munich, Munich, Germany
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9
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Schlegel A, Foley DP, Savier E, Flores Carvalho M, De Carlis L, Heaton N, Taner CB. Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation. Transplantation 2021; 105:1892-1903. [PMID: 34416750 DOI: 10.1097/tp.0000000000003825] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although the utilization of donation after circulatory death donors (DCDs) for liver transplantation (LT) has increased steadily, much controversy remains, and no common acceptance criteria exist with regard to donor and recipient risk factors and prediction models. A consensus conference was organized by International Liver Transplantation Society on January 31, 2020, in Venice, Italy, to review the current clinical practice worldwide regarding DCD-LT and to develop internationally accepted guidelines. The format of the conference was based on the grade system. International experts in this field were allocated to 6 working groups and prepared evidence-based recommendations to answer-specific questions considering the currently available literature. Working group members and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and recommendations provided by working group 2, covering the entire spectrum of donor and recipient risk factors and prediction models in DCD-LT.
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Affiliation(s)
- Andrea Schlegel
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
- Hepatobiliary Unit, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - David P Foley
- University of Wisconsin School of Medicine and Public Health, William S. Middleton VA Medical Center, Madison, WI
| | - Eric Savier
- Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université Pitié-Salpêtrière Hospital, Paris, France
| | - Mauricio Flores Carvalho
- Hepatobiliary Unit, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - C Burcin Taner
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
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10
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Abstract
BACKGROUND Despite the kidney supply shortage, 18%-20% of deceased donor kidneys are discarded annually in the United States. In 2018, 3569 kidneys were discarded. METHODS We compared machine learning (ML) techniques to identify kidneys at risk of discard at the time of match run and after biopsy and machine perfusion results become available. The cohort consisted of adult deceased donor kidneys donated between December 4, 2014, and July 1, 2019. The studied ML models included Random Forests (RF), Adaptive Boosting (AdaBoost), Neural Networks (NNet), Support Vector Machines (SVM), and K-nearest Neighbors (KNN). In addition, a Logistic Regression (LR) model was fitted and used for comparison with the ML models' performance. RESULTS RF outperformed other ML models. Of 8036 discarded kidneys in the test dataset, LR correctly classified 3422 kidneys, whereas RF correctly classified 4762 kidneys (area under the receiver operative curve [AUC]: 0.85 versus 0.888, and balanced accuracy: 0.681 versus 0.759). For the kidneys with kidney donor profile index of >85% (6079 total), RF significantly outperformed LR in classifying discard and transplant prediction (AUC: 0.814 versus 0.717, and balanced accuracy: 0.732 versus 0.657). More than 388 kidneys were correctly classified using RF. Including biopsy and machine perfusion variables improved the performance of LR and RF (LR's AUC: 0.888 and balanced accuracy: 0.74 versus RF's AUC: 0.904 and balanced accuracy: 0.775). CONCLUSIONS Kidneys that are at risk of discard can be more accurately identified using ML techniques such as RF.
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Affiliation(s)
- Masoud Barah
- Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL
| | - Sanjay Mehrotra
- Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Jagdale A, Kumar V, Anderson DJ, Locke JE, Hanaway MJ, Eckhoff DE, Iwase H, Cooper DK. Suggested Patient Selection Criteria for Initial Clinical Trials of Pig Kidney Xenotransplantation in the United States. Transplantation 2021; 105:1904-1908. [PMID: 33481554 PMCID: PMC10124769 DOI: 10.1097/tp.0000000000003632] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a critical shortage of kidneys for transplantation into patients with kidney failure. Genetically-engineered pigs could provide an additional source. Increasing success is being reported of the transplantation of pig kidneys in nonhuman primates. Consideration is now being given to the selection of patients for the first clinical trial of pig kidney transplantation. In some US states, patients aged 55–65, particularly if of blood group O, may wait >5 years for a donor organ, by which time >50% are likely to have died or removed from the wait-list because they are no longer acceptable for transplantation. We suggest these patients, if otherwise healthy, might accept the opportunity of early pig kidney transplantation.
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Affiliation(s)
- Abhijit Jagdale
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas J. Anderson
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jayme E. Locke
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J. Hanaway
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Devin E. Eckhoff
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hayato Iwase
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K.C. Cooper
- Xenotransplantation Program, Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Ballouz D, Sawant OB, Hurlbert S, Titus MS, Majmudar PA, Kumar A, Zhou Y, Musch DC, Mian SI. Impact of the COVID-19 Pandemic on Keratoplasty and Corneal Eye Banking. Cornea 2021; 40:1018-1023. [PMID: 34029240 PMCID: PMC8244805 DOI: 10.1097/ico.0000000000002748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to assess the impact of COVID-19 guidelines for corneal donor tissue screening and the utility of routine postmortem COVID-19 testing of donors intended for surgical use at a single eye bank. METHODS A retrospective analysis of referrals to and eligible donors from an eye bank between March 1, 2020, and June 30, 2020, was performed, with the same time period in 2019 as a control. Referrals who were not procured because of Eye Bank Association of America COVID-19 guidelines and eye bank-specific restrictions were noted. The results of 1 month of routine postmortem testing performed by the eye bank were examined. Analysis of variance tests were performed to assess the change between donors from 2019 to 2020. RESULTS There was a significant reduction in both the number of total referrals to the eye bank (P = 0.044) and donors eligible for surgical transplantation (P = 0.031). Eye Bank Association of America COVID-19 guidelines reduced the number of referrals over this period by 4% to 14%. Of the 266 surgically eligible donors who received postmortem COVID-19 testing in June by the eye bank, 13 resulted positive (4.9%). CONCLUSIONS Despite a reduction in referrals and eligible corneal transplant donors at a single eye bank, there was a surplus of surgically suitable corneal tissue during the first wave of the COVID-19 pandemic. Eye banks should consider routine postmortem COVID-19 testing to identify asymptomatic infected donors although the risk of transmission of COVID-19 from infected donors is unknown.
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Affiliation(s)
- Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Onkar B. Sawant
- Center for Vision and Eye Banking Research, Eversight, Cleveland, OH;
| | - Susan Hurlbert
- Department of Clinical Operations, Eversight, Ann Arbor, MI
| | | | | | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Shahzad I. Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
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13
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Deshpande S, Sparks JD, Alsoufi B. Pediatric heart transplantation: Year in review 2020. J Thorac Cardiovasc Surg 2021; 162:418-421. [PMID: 34045058 DOI: 10.1016/j.jtcvs.2021.04.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Shriprassad Deshpande
- Department of Cardiology and Cardiac Critical Care, Children's National Hospital, Washington, DC
| | - Joshua D Sparks
- Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky.
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14
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Arora R, Sharda S, Sahu J, Manchanda V, Jain P, Gupta I, Gotmare N, Bharti N. Role of Reverse Transcriptase Polymerase Chain Reaction in Cornea Donors During the COVID-19 Pandemic. Cornea 2021; 40:1044-1047. [PMID: 33935238 PMCID: PMC8244808 DOI: 10.1097/ico.0000000000002742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to report the analysis of reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal (NP) samples of cornea donors dying because of causes unrelated to severe acute respiratory coronavirus (SARS-CoV-2). METHODS A retrospective analysis of all cornea donors dying from causes other than SARS-CoV-2 between August 2020 and December 2020 was performed. Informed consent was obtained from the next of kin of the deceased for RT-PCR testing from NP swabs. Rapid antigen testing from all the deceased was performed before in situ cornea excision. In addition, NP samples in viral transport media for RT-PCR were also collected for SARS-CoV-2 analysis. Corneas were released from the eye bank only after a negative RT-PCR report. RESULT One hundred eighteen corneas from 59 donors were obtained by the eye bank. Eleven donors (18.64%) were positive for SARS-CoV-2 on RT-PCR testing. Six of these 11 donors had a Ct value of E gene less than 25. CONCLUSIONS NP samples of cornea donors dying due to causes other than coronavirus disease-19 were positive for SARS-CoV-2 on RT-PCR. This implicates that donors could be having asymptomatic/undetected coronavirus disease infection. We recommend adding the routine testing of NP samples of all cornea donors in the eye banking protocol in this ongoing SARS-CoV-2 pandemic.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Shipra Sharda
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Jigyasa Sahu
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India.
| | - Parul Jain
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Isha Gupta
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Nikhil Gotmare
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
| | - Nisha Bharti
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India; and
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15
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Mrzljak A, Mikulic D, Busic M, Vukovic J, Jadrijevic S, Kocman B. Liver Transplantation in Croatia: "David Among Goliaths". Transplantation 2021; 105:1389-1391. [PMID: 34157714 DOI: 10.1097/tp.0000000000003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb, Croatia
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Danko Mikulic
- Department of Surgery, Merkur University Hospital, Zagreb, Croatia
| | | | - Jurica Vukovic
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Branislav Kocman
- Department of Surgery, Merkur University Hospital, Zagreb, Croatia
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16
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Yoshioka T, Tabuchi T, Maeda Y, Tsugawa Y. Trends in Bone Marrow Donor Registration in Japan Following a Celebrity's Disclosure of Leukemia. JAMA Netw Open 2021; 4:e2118698. [PMID: 34323989 PMCID: PMC8322997 DOI: 10.1001/jamanetworkopen.2021.18698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cohort study examines the association of a celebrity’s public disclosure of an acute lymphocytic leukemia diagnosis and trends in bone marrow donor registration in Japan.
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Affiliation(s)
- Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE), Fukushima Medical University, Fukushima, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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17
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Anguela-Calvet L, Moreno-Gonzalez G, Sbraga F, Gonzalez-Costello J, Tsui S, Oliver-Juan E. Heart Donation From Donors After Controlled Circulatory Death. Transplantation 2021; 105:1482-1491. [PMID: 33208694 DOI: 10.1097/tp.0000000000003545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The gold-standard therapy for advanced-stage heart failure is cardiac transplantation. Since the first heart transplant in 1967, the majority of hearts transplanted came from brain death donors. Nevertheless, in recent years, the option of donation after circulatory death (DCD) is gaining importance to increase donor pool. Currently, heart-transplant programs using controlled donation after circulatory death (cDCD) have been implemented in the United Kingdom, Belgium, Australia, United States of America, and, recently, in Spain. In this article, we performed a concise review of the literature in heart cDCD; we summarize the pathophysiology involved in ischemia and reperfusion injury during this process, the different techniques of heart retrieval in cDCD donors, and the strategies that can be used to minimize the damage during retrieval and until transplantation. Heart transplant using DCD hearts is in continuous improvement and must be implemented in experienced cardiac transplant centers.
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Affiliation(s)
- Laura Anguela-Calvet
- Intensive Care Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Transplant Procurement Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Gabriel Moreno-Gonzalez
- Intensive Care Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Transplant Procurement Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Fabrizio Sbraga
- Cardiac Surgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jose Gonzalez-Costello
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Advance Heart Failure and Cardiac Transplantation Unit, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Steven Tsui
- Cardiothoracic Surgery Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Eva Oliver-Juan
- Intensive Care Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Transplant Procurement Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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18
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Armenti ST, Ballouz D, Mian SI. Updated safety precautions and guidance on eye banking procedures during the coronavirus disease 2019 pandemic. Curr Opin Ophthalmol 2021; 32:338-342. [PMID: 34010230 DOI: 10.1097/icu.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious coronavirus causing the COVID-19 pandemic. Although airborne spread through infectious respiratory droplets is the primary source of transmission, recent literature has suggested the ocular surface may be able to harbor viral particles. Here, we aim to discuss how SARS-CoV-2 affects the ocular surface and updated guidance on how SARS-CoV-2 transmission should be considered in the setting of eye banking and corneal transplantation procedures. RECENT FINDINGS SARS-CoV-2 RNA can be found on the ocular surface, which may suggest the eye as a site of viral replication. However, there is poor correlation between PCR positivity on the ocular surface and ocular symptoms. To date, although viral particles can be found on the ocular surface, use of standard antiseptic procedures during corneal tissue procurement appears to sufficiently reduce viral load. In addition, preprocedure testing may further decrease the chances of transplanting an infected cornea without significantly impacting the overall accessibility to corneal tissue by decreasing the donor pool. SUMMARY Corneal transplantation remains a well tolerated and highly successful procedure with no evidence of viral transmission with transplantation. Although the ocular surface has the required receptors to allow for viral replication, there is no clear evidence that the eye is a site for primary viral infection.
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Affiliation(s)
- Stephen T Armenti
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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19
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Peyser A, Brownridge S, Rausch M, Noyes N. The evolving landscape of donor egg treatment: success, women's choice, and anonymity. J Assist Reprod Genet 2021; 38:2327-2332. [PMID: 34148151 DOI: 10.1007/s10815-021-02262-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze donor oocyte (DE) data across 6 years for oocyte usage efficiency, trends, and whether changes impacted outcomes. METHODS From 2014 to 2019, 323 DE embryo transfers were completed in 200 recipients using oocytes derived of 163 donors. We assessed data for oocytes being freshly retrieved (FRESH-EGG) vs. purchased frozen (FROZEN-EGG); embryos transferred fresh (FRESH-ET) vs. frozen (FROZEN-ET); cycles SHARED (two recipients) vs. SOLE (one recipient); single (SET) vs. double (DET) embryo transfers and usage of PGT-A. Primary outcome was ongoing pregnancy plus live birth (OP/LB) rate. RESULTS A total of 229 FRESH-EGG (70%) and 94 FROZEN-EGG (30%) cycles were completed. Overall, the use of FRESH-EGG yielded a higher OP/LB compared to FROZEN-EGG (49% vs. 30%, p = 0.001); within the FRESH-EGG group, OP/LB was similar when comparing FRESH-ET vs. FROZEN-ET (58% vs. 45%, p = 0.07). Within the FRESH-ET group, those using FRESH-EGG had a higher OP/LB than those using FROZEN-EGG (58% vs. 27%, p < 0.001). SHARED vs. SOLE cycles (p = 0.6), donor age (21-32 years; p = 0.4), and age of intended parents (maternal p = 0.3, paternal p = 0.2) did not significantly impact OP/LB. Notably, the use of PGT-A did not improve odds for an OP/LB (p = 0.7). CONCLUSION The use of FRESH-EGG with FRESH-ET without PGT-A remains superior to newer DE treatment combinations. Specifically, the use of FROZEN-EGG and PGT-A did not improve outcomes. Although changing DE practices may enhance experience and affordability, patients and providers must appreciate that choices do not always favorably impact success. Additionally, newly available genetic-ancestry testing may pose longer-term ramifications mandating change in treatment and/or counseling.
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Affiliation(s)
- Alexandra Peyser
- Zucker School of Medicine at Hofstra/Northwell, Northwell Fertility, New York, NY, 10065, USA.
| | - Stephanie Brownridge
- Zucker School of Medicine at Hofstra/Northwell, Northwell Fertility, New York, NY, 10065, USA
| | - Mary Rausch
- Zucker School of Medicine at Hofstra/Northwell, Northwell Fertility, New York, NY, 10065, USA
| | - Nicole Noyes
- Zucker School of Medicine at Hofstra/Northwell, Northwell Fertility, New York, NY, 10065, USA
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20
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Babiker A, Ingersoll JM, Adelman MW, Webster AS, Broder KJ, Stittleburg V, Waggoner JJ, Kraft CS, Woodworth MH. Validation of High-Sensitivity Severe Acute Respiratory Syndrome Coronavirus 2 Testing for Stool-Toward the New Normal for Fecal Microbiota Transplantation. Clin Transl Gastroenterol 2021; 12:e00363. [PMID: 34106090 PMCID: PMC8189625 DOI: 10.14309/ctg.0000000000000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/08/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Mounting evidence demonstrates potential for fecal-oral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The US Food and Drug Administration now requires SARS-CoV-2 testing of potential feces donors before the use of stool manufactured for fecal microbiota transplantation. We sought to develop and validate a high-sensitivity SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) procedure for testing stool specimens. METHODS A modified extraction method was used with an RT-PCR assay adapted from the Centers for Disease Control and Prevention PCR protocol for respiratory specimens. Contrived specimens were created using pre-COVID-19 banked stool specimens and spiking in known concentrations of SARS-CoV-2-specific nucleic acid. The highest transcript concentration at which 2/2 or 1/2 SARS-CoV-2 targets were detected in 9/10 replicates was defined as the dual-target limit and single-target limit of detection, respectively. The clinical performance of the assay was evaluated with stool samples collected from 17 nasopharyngeal swab RT-PCR-positive patients and 14 nasopharyngeal RT-PCR-negative patients. RESULTS The dual-target and single-target limit of detection were 56 copies/μL and 3 copies/μL, respectively. SARS-CoV-2 was detected at concentrations as low as 0.6 copies/μL. Clinical stool samples from known COVID-19-positive patients demonstrated the detection of SARS-CoV-2 in stool up to 29 days from symptom onset with a high agreement with nasopharyngeal swab tests (kappa statistic of 0.95, P value < 0.001). DISCUSSION The described RT-PCR test is a sensitive and flexible approach for the detection of SARS-CoV-2 in stool specimens. We propose an integrated screening approach that incorporates this stool test to support continuation of fecal microbiota transplantation programs.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica M. Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Max W. Adelman
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew S. Webster
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kari J. Broder
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Victoria Stittleburg
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jesse J. Waggoner
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen S. Kraft
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael H. Woodworth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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21
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Sypek MP, Kausman JY, Watson N, Wyburn K, Holt SG, Hughes P, Clayton PA. The Introduction of cPRA and Its Impact on Access to Deceased Donor Kidney Transplantation for Highly Sensitized Patients in Australia. Transplantation 2021; 105:1317-1325. [PMID: 34019363 DOI: 10.1097/tp.0000000000003410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In March 2016, Australia's deceased donor kidney allocation program introduced calculated panel reactive antibody (cPRA) based on antibody exclusions using multiplex assays to define sensitization for waitlisted candidates. We aimed to assess the impact of this change and review access to transplantation for highly sensitized patients under the current allocation rules. METHODS Registry data were used to reconstruct changes in panel reactive antibody (PRA)/cPRA for all patients active on the waiting list between 2013 and 2018. A multilevel, mixed-effects negative binomial regression model was used to determine the association between sensitization and transplantation rate in the cPRA era. RESULTS Following the introduction of cPRA, there was an increase in the percentage of the waiting list classified as highly sensitized (PRA/cPRA ≥80%) from 7.2% to 27.8% and very highly sensitized (PRA/cPRA ≥99%) from 2.7% to 15.3%. Any degree of sensitization was associated with a decreased rate of transplantation with a marked reduction for those with cPRA 95%-98% (adjusted incidence rate ratio, 0.36 [95% confidence interval, 0.28-0.47], P < 0.001) and cPRA ≥99% (adjusted incidence rate ratio, 0.09 [95% confidence interval, 0.07-0.12], P < 0.001). CONCLUSIONS The proportion of the waiting list classified as highly sensitized increased substantially following the introduction of cPRA, and despite current prioritization, very highly sensitized patients have markedly reduced access to deceased donor transplantation.
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Affiliation(s)
- Matthew P Sypek
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Joshua Y Kausman
- Department of Nephrology, Royal Children's Hospital, Melbourne, Australia
- Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Narelle Watson
- Transplantation and Immunogenetics Services, Australian RedCross Lifeblood, Brisbane, Australia
| | - Kate Wyburn
- Royal Prince Alfred Hospital and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen G Holt
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Hughes
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
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22
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Cotter TG, Aronsohn A, Reddy KG, Charlton M. Liver Transplantation of HCV-viremic Donors Into HCV-negative Recipients in the United States: Increasing Frequency With Profound Geographic Variation. Transplantation 2021; 105:1285-1290. [PMID: 32639400 PMCID: PMC9206877 DOI: 10.1097/tp.0000000000003382] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Direct-acting antiviral therapy made possible the novel practice of utilizing hepatitis C virus (HCV)-viremic (HCV RNA-positive) donors into HCV-negative recipients in the United States. Although initial reports of outcomes have been satisfactory, higher-quality longer-term outcomes remain to be elucidated. METHODS National data were examined from the Organ Procurement and Transplantation Network on adult patients in the United States who underwent a primary, single organ, deceased donor liver transplant from January 1, 2016 to March 31, 2020. Outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA-positive (D HCV+) donors were compared with HCV RNA-negative (D HCV-) donors. RESULTS There has been a 35-fold increase in D HCV+/R- liver transplants over the past 4 y in the United States, from 8 in 2016 to 280 in 2019. There was an almost 6-fold difference in this practice among UNOS geographic regions. Graft survival following D HCV+/R- liver transplantation was excellent, with 1-y rates being 91% and 90% and 2-y rates being 88.5% and 87% for D HCV+/R- and D HCV-/R-, respectively (P = 0.672). In multivariate analysis, adjusting for other donor and recipient attributes, D HCV+/R- was not associated with patient or graft survival. CONCLUSIONS The practice of D HCV+/R- continues to increase without discernible impact on medium-term outcomes. Notable geographic variation exists, suggesting inconsistent perceptions about the impact of D HCV+/R- transplantation on outcomes. These results strengthen the perceived safety in utilizing HCV-viremic donor organs as a donor pool expansion strategy, not only in the United States, but also worldwide.
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Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, Section of Gastroenterology & Hepatology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
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Affiliation(s)
- Ala Ali
- Department of Nephrology, Nephrology and Renal Transplantation Center, The Medical City, Baghdad, Iraq
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Abstract
There is a severe shortage in the availability of donor organs for lung transplantation. Novel strategies are needed to optimize usage of available organs to address the growing global needs. Ex vivo lung perfusion has emerged as a powerful tool for the assessment, rehabilitation, and optimization of donor lungs before transplantation. In this review, we discuss the history of ex vivo lung perfusion, current evidence on its use for standard and extended criteria donors, and consider the exciting future opportunities that this technology provides for lung transplantation.
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Affiliation(s)
- Nikhil K. Prasad
- Department of Surgery, University of Maryland School of Medicine
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine
| | - Tara Talaie
- Department of Surgery, University of Maryland School of Medicine
| | | | - Yunge Zhao
- Department of Surgery, University of Maryland School of Medicine
| | - Christine L. Lau
- Department of Surgery, University of Maryland School of Medicine
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Bursztyn N, Arad T, Fink T, Cohen J, Stein M. Donor Factors Associated with Familial Consent for Organ Donation among Trauma Casualties: a 10-Year Retrospective Study. Isr Med Assoc J 2021; 23:286-290. [PMID: 34024044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Consent rates for organ donation remain one of the most important factors determining the number of organs available for transplantation. Trauma casualties constitute a substantial part of the deceased organ donor pool and have unique characteristics that distinguish them from the general donor population. However, this group has not been extensively studied. OBJECTIVES To identify donor factors associated with positive familial consent for solid organ donation among trauma casualties. METHODS This retrospective study included all trauma casualties who were admitted to the Rabin Medical Center, Beilinson hospital, during the period from January 2008 to December 2017, who were potential organ donors. Data collected included demographic features, the nature of the injury, surgical interventions, and which organs were donated. Data was collected from the Rabin Medical Center Trauma Registry. RESULTS During the study period 24,504 trauma patients were admitted and 556 died over their hospital course. Of these 76 were potential donors, of whom 32 became actual donors and donated their organs. Two factors showed a statistically significant correlation to donation, namely female gender (P = 0.018) and Jewish religion of the deceased (P = 0.032). CONCLUSIONS Only a small group of in hospital trauma deaths were potential solid organ donors (13.7%) and less than half of these became actual donors. Consent rates were higher when the deceased was female or Jewish.
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Affiliation(s)
- Naama Bursztyn
- Department of General Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Arad
- Department of Internal Medicine B, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Department of General Intensive Care, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Tamar Fink
- Department of General Intensive Care, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Jonathan Cohen
- National Center of Transplantation, Ministry of Health, Tel Aviv, Israel
| | - Michael Stein
- Department of General Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dolla C, Mella A, Vigilante G, Fop F, Allesina A, Presta R, Verri A, Gontero P, Gobbi F, Balagna R, Giraudi R, Biancone L. Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors. PLoS One 2021; 16:e0249552. [PMID: 33819285 PMCID: PMC8021200 DOI: 10.1371/journal.pone.0249552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. Methods A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003–2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Results Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. Conclusions Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.
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Affiliation(s)
- Caterina Dolla
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Alberto Mella
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Giacinta Vigilante
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Fabrizio Fop
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Anna Allesina
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Roberto Presta
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Aldo Verri
- Department of Vascular Surgery, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, "AOU Città della Salute e della Scienza” Hospital, University of Turin, Turin, Italy
| | - Fabio Gobbi
- Department of Anesthesia, Intensive Care and Emergency, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Roberto Balagna
- Department of Anesthesia, Intensive Care and Emergency, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Roberta Giraudi
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
- * E-mail:
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Benvenuto L, Snyder ME, Aversa M, Patel S, Costa J, Shah L, Robbins H, D’Ovidio F, Sonett J, Stanifer BP, Lemaitre P, Arcasoy S, Anderson MR. Geographic Differences in Lung Transplant Volume and Donor Availability During the COVID-19 Pandemic. Transplantation 2021; 105:861-866. [PMID: 33760792 PMCID: PMC7993650 DOI: 10.1097/tp.0000000000003600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Regional variation in lung transplantation practices due to local coronavirus disease 2019 (COVID-19) prevalence may cause geographic disparities in access to lung transplantation. METHODS Using the United Network for Organ Sharing registry, we conducted a descriptive analysis of lung transplant volume, donor lung volume, new waitlist activations, and waiting list deaths at high-volume lung transplant centers during the first 3 months of the pandemic (March 1. 2020, to May 30, 2020) and we compared it to the same period in the preceding 5 years. RESULTS Lung transplant volume decreased by 10% nationally and by a median of 50% in high COVID-19 prevalence centers (range -87% to 80%) compared with a median increase of 10% (range -87% to 80%) in low prevalence centers (P-for-trend 0.006). Donation services areas with high COVID-19 prevalence experienced a greater decrease in organ availability (-28% range, -72% to -11%) compared with low prevalence areas (+7%, range -20% to + 55%, P-for-trend 0.001). Waiting list activations decreased at 18 of 22 centers. Waiting list deaths were similar to the preceding 5 years and independent of local COVID-19 prevalence (P-for-trend 0.36). CONCLUSIONS Regional variation in transplantation and donor availability in the early months of the pandemic varied by local COVID-19 activity.
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Affiliation(s)
- Luke Benvenuto
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Mark E. Snyder
- Division of Pulmonary, Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Meghan Aversa
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Shreena Patel
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Joseph Costa
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lori Shah
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Hilary Robbins
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Frank D’Ovidio
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Joshua Sonett
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Bryan P. Stanifer
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Philippe Lemaitre
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Michaela R. Anderson
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
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Abstract
BACKGROUND Deceased donor kidneys with acute kidney injury (AKI) and donation after circulatory death (DCD) kidneys are viable sources of organs. The outcomes of renal transplantation from DCD donors with AKI are not known. METHODS A retrospective review of deceased donor renal transplants performed from 2006 to 2016 was conducted using the United Network for Organ Sharing dataset. Donors were stratified by DCD or brain dead status and by AKI stage. Recipients were followed until graft failure or the end of study. Cox regression was used to adjust for donor, recipient, and transplant covariates known to affect the incidence of delayed graft function and graft survival. RESULTS A total of 135 644 patients were included in the study. The odds of delayed graft function among DCD recipients were significantly higher across all donor AKI stages. The unadjusted risk of overall and death-censored graft failure were similar between the 2 groups. After adjusting for covariates, there was a significant increase in the risk of overall graft failure in recipients of DCD allografts from donors with stage 2 AKI. There was also a higher risk of death-censored graft failure among stage 1 and 2 AKI DCD recipients. CONCLUSIONS DCD renal allografts from donors experiencing stage 1 and 2 AKI have a higher adjusted risk of death-censored graft failure than AKI stage-matched donation after brain death renal allografts. Their use, however, is still associated with improved outcomes compared with waitlist mortality.
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Affiliation(s)
- Daniel Lia
- Division of Transplant Surgery, Department of Surgery, Northwell Health, Manhasset, NY
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Abstract
Despite improvements in postliver transplant outcomes through refinements in perioperative management and surgical techniques, several changing trends in liver transplantation have presented challenges. Mortality on the waitlist remains high. In the United States, Europe, and the United Kingdom, there is an increasing need for liver transplantation, primarily as a result of increased incidence of nonalcoholic steatohepatitis-related cirrhosis and cancer indications. Meanwhile, donor suitability has decreased, as donors are often older and have more comorbidities. Despite a mismatch between organ need and availability, many organs are discarded. Notwithstanding this, many solutions have been developed to overcome these challenges. Innovative techniques in allograft preservation, viability assessment, and reconditioning have allowed the use of suboptimal organs with adequate results. Refinements in surgical procedures, including live donor liver transplantations, have increased the organ pool and are decreasing the time and mortality on the waitlist. Despite many challenges, a similar number of solutions and prospects are on the horizon. This review seeks to explore the changing trends and challenges in liver transplantation and highlight possible solutions and future directions.
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Affiliation(s)
- Tommy Ivanics
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Phillipe Abreu
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Eleonora De Martin
- APHP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM 1193, Université Paris-Sud, DHU Hepatinov, Villejuif, France
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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Knechtle SJ, Niedfeldt D, Sudan D, Jackson A, Jamieson I, Hartwig M, Milano C. Another Step Toward Becoming a Transplant Community. Ann Surg 2021; 273:e149-e150. [PMID: 33086314 DOI: 10.1097/sla.0000000000004472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stuart J Knechtle
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Debra Sudan
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Annette Jackson
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Ian Jamieson
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Hartwig
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
| | - Carmelo Milano
- Duke Transplant Center, Duke University School of Medicine, Durham, North Carolina
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Okafor IA, Chia T. Covid-19: Emerging Considerations for Body Sourcing and Handling. A Perspective View from Nigeria. Anat Sci Educ 2021; 14:154-162. [PMID: 33370511 DOI: 10.1002/ase.2047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
The current Coronavirus disease (Covid-19) pandemic has spread to about 220 countries of the world and has resulted in a significant number of deaths globally. Infections are still on the rise, and the impact on the global death rate could be devastating. There are fears over the likely impact of a large number of deaths on body sourcing and handling of cadavers for teaching and research. Historically, epidemics come with several challenges and have often led to some level of negligence of ethical practices and health and safety regulations associated with body sourcing and handling. The authors highlighted some emerging problems in this article, focusing on Africa and Nigeria in particular. These problems include a higher risk of coronavirus exposure for body handlers, shortage of cadavers for teaching and learning, a lack of standard regulations leading to unethical body sourcing and handling, and a lack of monitoring and collaboration needed for a well-coordinated Covid-19 pandemic response strategy. If these issues are ignored, the previous gains made in anatomical ethical practices may be destroyed. Some useful recommendations for policymaking geared toward prevention or curtailing these emerging issues have been instilled in this article.
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Affiliation(s)
- Izuchukwu Azuka Okafor
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Pan African University of Life and Earth Science Institute, University of Ibadan, Ibadan, Nigeria
| | - Terkuma Chia
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
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Affiliation(s)
- Mohammed AlMutlak
- Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Eye Bank Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Jennifer Y Li
- Ophthalmology Department, University of California, Davis, Davis, CA
- Medical Advisory Board, Eye Bank Association of America, Washington, DC
| | - Halah Bin Helayel
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; and
| | - Rafah Fairaq
- Ophthalmology Department, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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Abstract
Kidney transplantation is the best available treatment choice for patients suffering from end-stage renal disease; however, not all patients with end-stage renal disease have equal access to it. The aim of the study was to measure the factors that may influence access to the kidney transplant waiting list in eastern Hungary. A total of 254 patients with renal failure between 18 and 75 years old from 8 dialysis centers participated in the study. The factors associated with access to the waiting list were identified by univariate descriptive analysis and multivariate logistic regression analysis where the outcome variable was placement on the kidney transplant waiting list. Our findings demonstrates that patients registered on the waiting list were younger (odds ratio [OR] = 0.96; 95% confidence interval [CI], 0.94-0.98), were male (OR = 0.54; 95% CI, 0.30-0.98), were economically active (OR = 0.53; 95% CI, 0.29-0.98), and had greater knowledge in the field (OR = 1.17; 95% CI, 1.03-1.33). Disparity in access to the kidney transplant waiting list in Hungary does exist.
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Affiliation(s)
- Anita Barth
- Department of Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Nursing Science, Faculty of Health, University of Debrecen, Nyiregyhaza, Hungary; Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
| | | | - Balázs Nemes
- Department of Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Affiliation(s)
- James A Richards
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, United Kingdom
- The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Rohit Gaurav
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, United Kingdom
- The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Sara S Upponi
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, United Kingdom
- The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Andrew J Butler
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, United Kingdom
- The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
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Affiliation(s)
- Feras Bader
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Yosef Manla
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | | | - And Nizar Attallah
- Medical Subspecialty Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Li EW, Lee A, Vaseghi-Shanjani M, Anagnostopoulos A, Jagelaviciute G, Kum E, Petraszko T, Elmoazzen H, Allan D, Fingrut W. Multimedia resources to support the recruitment of committed hematopoietic stem cell donors: Perspectives of the most-needed donors. Transfusion 2021; 61:274-285. [PMID: 33269472 PMCID: PMC8516029 DOI: 10.1111/trf.16186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recruitment of committed unrelated hematopoietic stem cell donors from the most-needed demographics remains a challenge for donor recruitment organizations worldwide. Multimedia resources are gaining attention as a modality to support recruitment efforts; however, there is a lack of guidance for the development of such tools. This qualitative study explores the perspectives of eligible stem cell donors on an educational whiteboard video about stem cell donation, generating insights into how whiteboard videos and related multimedia may be optimized for donor recruitment. STUDY DESIGN AND METHODS Eight semistructured focus groups were conducted with 38 potential donors from the most-needed demographics (young, male, and non-Caucasian) after they had watched a 3.5-minute whiteboard video explaining key concepts in stem cell donation (https://youtu.be/V4fVBtxnWfM). Constructivist grounded theory was used to identify themes and to develop a framework for understanding participants' preferred features of recruitment multimedia. RESULTS Participants identified a range of features contributing to the effectiveness of recruitment multimedia, adding that the whiteboard video is an effective, integrated, and readily accessible format for supporting donor recruitment. Topics that participants felt are important to address include knowledge gaps regarding donation procedures, concerns about donor safety, and the particular need for specific donor demographics. Suggested avenues for improvement include the addition of donor/recipient/patient personal experiences, attention-grabbing hooks, and a call to action including opportunities for further learning. CONCLUSIONS Several considerations were generated to inform the development of future multimedia for donor education/recruitment and are relevant to donor recruitment organizations worldwide.
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Affiliation(s)
- Edward W. Li
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Lee
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Vaseghi-Shanjani
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Anagnostopoulos
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabriele Jagelaviciute
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Elena Kum
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tanya Petraszko
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - David Allan
- Canadian Blood Services, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Warren Fingrut
- Stem Cell Club, Toronto, Ontario, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Van Loon E, Lerut E, de Loor H, Kuypers D, Emonds MP, Anglicheau D, Gwinner W, Essig M, Marquet P, Naesens M. Antibody-mediated rejection with and without donor-specific anti-human leucocyte antigen antibodies: performance of the peripheral blood 8-gene expression assay. Nephrol Dial Transplant 2020; 35:1328-1337. [PMID: 32594133 DOI: 10.1093/ndt/gfaa096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recently a peripheral blood 8-gene expression assay was developed for non-invasive detection of antibody-mediated rejection (ABMR) after kidney transplantation. Its value has not yet been evaluated in detail in clinical scenarios with different baseline disease probability [human leucocyte antigen donor-specific antibodies (HLA-DSA)-positive versus HLA-DSA-negative cases at the time of stable graft function versus graft dysfunction]. METHODS Here we investigated the diagnostic accuracy of the 8-gene expression assay for histology of ABMR (ABMRh) with or without HLA-DSA in a cross-sectional cohort study of 387 blood samples with a concomitant graft biopsy. RESULTS In patients with HLA-DSA (n = 64), the 8-gene expression assay discriminated DSA-positive ABMRh (DSAposABMRh) cases (n = 16) with good diagnostic performance {area under the receiver operating characteristic curve [AUROC] 83.1% [95% confidence interval (CI) 70.8-95.3]}. Also, in HLA-DSA-negative samples (n = 323), a clinically relevant diagnostic performance for DSAnegABMRh cases was found (n = 30) with an AUROC of 75.8% (95% CI 67.4-84.4). The 8-gene assay did not discriminate DSAposABMRh cases from DSAnegABMRh cases. There was a net benefit for clinical decision-making when adding the 8-gene expression assay to a clinical model consisting of estimated glomerular filtration rate, proteinuria, HLA-DSA and age. CONCLUSION The 8-gene expression assay shows great potential for implementation in the clinical follow-up of high-risk HLA-DSA-positive patients and clinical relevance in HLA-DSA-negative cases.
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Affiliation(s)
- Elisabet Van Loon
- KU Leuven Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Evelyne Lerut
- Department of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Henriette de Loor
- KU Leuven Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
| | - Dirk Kuypers
- KU Leuven Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Paule Emonds
- KU Leuven Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
- Histocompatibility and Immunogenetic Laboratory, Red Cross-Flanders, Mechelen, Belgium
| | - Dany Anglicheau
- Paris Descartes, Sorbonne Paris Cité University, INSERM U1151, Paris, France
- Department of Nephrology and Kidney Transplantation, RTRS Centaure, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Marie Essig
- CHU Limoges, Department of Nephrology, Dialysis and Transplantation, University of Limoges, U850 INSERM, Limoges, France
| | - Pierre Marquet
- CHU Limoges, University of Limoges, U850 INSERM, Limoges, France
| | - Maarten Naesens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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Da BL, Ezaz G, Kushner T, Crismale J, Kakked G, Gurakar A, Dieterich D, Schiano TD, Saberi B. Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation. JAMA Netw Open 2020; 3:e2027551. [PMID: 33275155 PMCID: PMC7718602 DOI: 10.1001/jamanetworkopen.2020.27551] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Increased utilization of hepatitis C virus (HCV)-positive liver allografts for liver transplant (LT) has been endorsed as one of several ways to combat national organ shortages. However, HCV-positive donors remain poorly characterized, and Organ Procurement and Transplantation Network regional differences in the utilization of HCV-positive liver allografts are unclear. OBJECTIVE To characterize HCV-positive donors and the allografts that come from them. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, the Scientific Registry of Transplant Recipients database was queried for all donors who underwent HCV testing from June 2015 to December 2018. Clinical and allograft characteristics were evaluated, and utilization across the United States was studied. Patients with positive or negative results for HCV antibody (Ab) and HCV nucleic acid amplification testing (NAT) were included in this study. Donors utilized for living donor transplant and pediatric (age <18 years) recipients were excluded. MAIN OUTCOMES AND MEASURES The primary comparison was between donors who were HCV Ab positive and those who were HCV Ab negative. Regional variations in the utilization of HCV-positive and HCV-negative donors were analyzed. RESULTS Of 24 500 donors utilized for LT, 1887 (7.7%) were HCV Ab positive; 64.4% of HCV Ab-positive donors were HCV NAT positive. HCV Ab-positive donors were younger (median [interquartile range] age, 35 [29-46] years vs 40 [27-54] years) and had fewer comorbidities, such as diabetes (8.3% vs 12.0%) and hypertension (25.9% vs 35.2%), compared with HCV Ab-negative donors. These findings were even more pronounced in HCV Ab-positive /NAT-positive compared with HCV Ab-positive/NAT-negative donors. Organ Procurement and Transplantation Network regions 2, 3, 10, and 11 had the highest absolute utilization of HCV Ab-positive donors, accounting for 64.4% of all HCV Ab-positive donors used in the United States. Region 1 had the highest relative utilization of HCV Ab-positive donors (18.7%). The use of HCV Ab-positive donors in some regions was associated with the rate of drug overdose, but this was not always the case. Similar utilization results were found with HCV NAT-positive donors. CONCLUSIONS AND RELEVANCE In this cross-sectional study, HCV-positive donors were younger and healthier than utilized HCV-negative donors. Significant differences exist in the utilization of HCV-positive donors across the 11 Organ Procurement and Transplantation Network regions, which is not entirely explained by organ demand or by higher availability of HCV-positive livers as per the distribution of the opioid epidemic. Initiatives to increase the use of HCV-positive donors, particularly in regions of high organ demand, should be implemented.
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Affiliation(s)
- Ben L. Da
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Division of Hepatology, Department of Internal Medicine, Donald and Barbara Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York
| | - Ghideon Ezaz
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gaurav Kakked
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas D. Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Behnam Saberi
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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ASIMAKOPOULOU E, STYLIANOU V, DIMITRAKOPOULOS I, ARGYRIADIS A, BELLOU–MYLONA P. Knowledge and Attitudes Regarding Organ Transplantation Among Cyprus Residents. J Nurs Res 2020; 29:e132. [PMID: 33156139 PMCID: PMC7808348 DOI: 10.1097/jnr.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Organ transplantation was one of the greatest achievements of medical science during the 20th century. Knowledge, education, and culture all play prominent roles in transplantation because of the complexity of the process from donation to transplantation. PURPOSE The aim of this research was to determine and analyze the knowledge and attitudes about organ donation and transplantation among the general population in Limassol, Cyprus. METHODS A quantitative research approach was followed, and a questionnaire consisting of closed-ended questions was completed by adults from the general population in Limassol. RESULTS One thousand two hundred adults out of the 1,346 adults who were contacted responded to the survey (response rate: 89%) and were included as participants. Of the participants, 93.4% (p < .05) considered organ donation to be lifesaving, 57% expressed interest (and 39.8% expressed disinterest) in becoming organ donors, 80.6% (p < .05) expressed awareness of there being a waiting list for people in need of organ transplantation, 50.4% agreed that brain death must be confirmed before organ removal for transplantation, and 47% recalled having been informed about organ donation through the media, with 31.5% stating that they had never been informed about organ donation. CONCLUSIONS The participants demonstrated limited awareness regarding the organ donation system in Cyprus. Furthermore, a significant percentage stated that they lacked a source for obtaining related information. The Cypriot society should be informed and encouraged to participate in organ donation to increase the rate of organ transplantation.
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Affiliation(s)
| | - Vaso STYLIANOU
- PhD(c), RN, Staff Nurse, School of Health Sciences, Frederick University, Nicosia, Cyprus
| | - Ioannis DIMITRAKOPOULOS
- MSc, RN, Special Teaching Staff, School of Health Sciences, Frederick University, Nicosia, Cyprus
| | - Alexandros ARGYRIADIS
- PhD, RN, Assistant Professor, School of Health Sciences and School of Education and Social Sciences, Frederick University, Nicosia, Cyprus
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Ngai J, Masuno K, Moazami N. Anesthetic Considerations During Heart Transplantation Using Donation After Circulatory Death. J Cardiothorac Vasc Anesth 2020; 34:3073-3077. [PMID: 32660929 PMCID: PMC7313525 DOI: 10.1053/j.jvca.2020.06.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/11/2022]
Abstract
Worldwide, the majority of heart transplant organs are from donation after brain death. However, the shortage of suitable donors places severe limitations on this route. One option to increase the donor pool is to use organs from donation after circulatory death (DCD). Transplant centers for solid organs have been using DCD organs for years. At this time, 40% of solid organ transplantation in the United Kingdom uses organs from DCD. Use of DCD for solid organ transplants in Canada is also rising. Recently, there has been interest in using DCD organs for heart transplantation. The authors will discuss their experience of 4 heart transplants with organs from DCD donors after normothermic regional perfusion (NRP). The authors' first heart transplant using a DCD organ was in January 2020, and the fourth was in March 2020, just before the coronavirus disease 2019 (COVID-19) pandemic. The authors' protocol using NRP allows adequate evaluation of the donor heart to confidently determine organ acceptance. The co-location of the donor and the recipient in neighboring operating rooms limits ischemic times. Avoidance of an expensive ex vivo organ perfusion machine is an additional benefit for programs that may not have the resources required to purchase and maintain the machine. Some hospitals may not have the resources and space to be able to co-locate both the donor and recipient. Use of cold storage may be an option to transport the procured organ, similar to donation after brain death organs. The authors hope that this technique of NRP in DCD donors can help further increase the donor pool for heart transplantation in the United States.
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Affiliation(s)
- Jennie Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY.
| | - Kiriko Masuno
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
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Pahari H, Shellagi N, Nath B. Deceased Donor Liver Transplantation in India in the COVID-19 Era: Current Scenario and Future Perspectives. Transplant Proc 2020; 52:2684-2687. [PMID: 32620390 PMCID: PMC7287470 DOI: 10.1016/j.transproceed.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been recently declared a global pandemic. As of June 5, 2020, over 75,000 cases have been reported with nearly 2500 deaths in India alone. COVID-19 has severely impacted deceased donor liver transplant (DDLT) programs throughout the world. Acceptance of deceased liver donors has decreased worldwide because of the unknown risks associated with COVID-19 transmission or postoperative infection in the immediate post-transplant period, along with the risks to the health care workers in a multidisciplinary setting. In India, DDLT has come to a standstill in the setting of a national lockdown. Many national guidelines have emerged on how to safely perform transplant as well on immunosuppressive regimens and care of patients posttransplant. Here, we take a look at the current situation and summarize the different guidelines and future perspectives of DDLT in India in the COVID-19 era.
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Affiliation(s)
- Hirak Pahari
- Division of Liver Transplantation, Medica Superspeciality Hospital, Kolkata, India.
| | - Nikhil Shellagi
- Division of Liver Transplantation, Medica Superspeciality Hospital, Kolkata, India
| | - Barun Nath
- Division of Liver Transplantation, Medica Superspeciality Hospital, Kolkata, India
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Massie AB, Boyarsky BJ, Werbel WA, Bae S, Chow EK, Avery RK, Durand CM, Desai N, Brennan D, Garonzik-Wang JM, Segev DL. Identifying scenarios of benefit or harm from kidney transplantation during the COVID-19 pandemic: A stochastic simulation and machine learning study. Am J Transplant 2020; 20:2997-3007. [PMID: 32515544 PMCID: PMC7300693 DOI: 10.1111/ajt.16117] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 01/25/2023]
Abstract
Clinical decision-making in kidney transplant (KT) during the coronavirus disease 2019 (COVID-19) pandemic is understandably a conundrum: both candidates and recipients may face increased acquisition risks and case fatality rates (CFRs). Given our poor understanding of these risks, many centers have paused or reduced KT activity, yet data to inform such decisions are lacking. To quantify the benefit/harm of KT in this context, we conducted a simulation study of immediate-KT vs delay-until-after-pandemic for different patient phenotypes under a variety of potential COVID-19 scenarios. A calculator was implemented (http://www.transplantmodels.com/covid_sim), and machine learning approaches were used to evaluate the important aspects of our modeling. Characteristics of the pandemic (acquisition risk, CFR) and length of delay (length of pandemic, waitlist priority when modeling deceased donor KT) had greatest influence on benefit/harm. In most scenarios of COVID-19 dynamics and patient characteristics, immediate KT provided survival benefit; KT only began showing evidence of harm in scenarios where CFRs were substantially higher for KT recipients (eg, ≥50% fatality) than for waitlist registrants. Our simulations suggest that KT could be beneficial in many centers if local resources allow, and our calculator can help identify patients who would benefit most. Furthermore, as the pandemic evolves, our calculator can update these predictions.
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Affiliation(s)
- Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Eric K.H. Chow
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois, USA
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
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The Lancet Haematology. Filling a gap in UK health services: the role of charities. Lancet Haematol 2020; 7:e697. [PMID: 32976741 DOI: 10.1016/S2352-3026(20)30295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fuchs M, Schibilsky D, Zeh W, Berchtold-Herz M, Beyersdorf F, Siepe M. Does the heart transplant have a future? Eur J Cardiothorac Surg 2020; 55:i38-i48. [PMID: 31106338 PMCID: PMC6537946 DOI: 10.1093/ejcts/ezz107] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022] Open
Abstract
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Heart failure has remained the leading cause of death globally for the last 15 years—and its prevalence will continue to rise. Fifty years ago, heart failure management was enriched by the possibility of a heart transplant. Despite impressive improvements in medical treatment for heart failure, a heart transplant remains the most effective long-lasting treatment for advanced heart failure in terms of mortality and quality of life. However, donor and recipient characteristics have changed dramatically in recent years, leading to more complex decision-making regarding organ acceptance and to more demanding operations and postoperative management. With improving pathophysiological understanding in the last decades, today’s scientific interest still focuses on basic knowledge. How to retrieve and conserve organs to minimize ischaemic injury; how best to allocate them, considering the likelihood of success (developing a heart-allocation scoring system similar to that for lung allocation); how to match donor/recipient characteristics (ABO blood-group antigen compatibility versus incompatibility); and how to avoid graft failure, rejection and secondary morbidities such as malignomas and cardiac allograft vasculopathy after the heart transplant—all these factors remain fundamental challenges in today’s transplant medicine. The use of ex vivo perfusion (e.g. via the Organ Care System®, TransMedics, Andover, MA, USA) may play an important role in this change. Remarkably, there are huge regional divergences in current transplant practices: Whereas the number of transplants continues to rise in most Eurotransplant countries and other major transplant networks, there are some countries in which transplant numbers are static or even dropping (as in Germany). This difference results in wide variations across different countries as to how advanced heart failure is treated using mechanical circulatory-assist devices.
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Affiliation(s)
- Matthias Fuchs
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Corresponding author. Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany. Tel: +49-7633-4020; fax: +49-7633-4029909; e-mail: (M. Fuchs)
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Zeh
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Clerkin KJ, Griffin JM, Sayer G, Farr MA, Topkara VK. Local competition influences donor heart acceptance practice. J Heart Lung Transplant 2020; 39:835-838. [PMID: 32418866 PMCID: PMC7721478 DOI: 10.1016/j.healun.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kevin J Clerkin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Jan M Griffin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Sade RM, Entwistle JWC. Limiting Multiorgan Transplantation: Your Patient Should Not Receive Two Organs While Mine Receives None. Ann Thorac Surg 2020; 111:771-777. [PMID: 32712097 DOI: 10.1016/j.athoracsur.2020.05.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Institute of Human Values in Health Care, Charleston, Medical University of South Carolina, Charleston, South Carolina.
| | - John W C Entwistle
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Ardura M, Hartley D, Dandoy C, Lehmann L, Jaglowski S, Auletta JJ. Addressing the Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hematopoietic Cell Transplantation: Learning Networks as a Means for Sharing Best Practices. Biol Blood Marrow Transplant 2020; 26:e147-e160. [PMID: 32339662 PMCID: PMC7194714 DOI: 10.1016/j.bbmt.2020.04.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
The full impact of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on the field of hematopoietic cell transplantation (HCT) is unknown. This perspective paper reviews the following: current COVID-19 epidemiology, diagnosis, and potential therapies; care considerations unique to HCT recipients; and the concept of a learning network to assimilate emerging guidelines and best practices and to optimize patient outcomes through facilitating shared learning and experience across transplantation centers.
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Affiliation(s)
- Monica Ardura
- Host Defense Program, Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio University College of Medicine, Columbus, Ohio
| | - David Hartley
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher Dandoy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Leslie Lehmann
- Pediatric Stem Cell Transplant Center, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Samantha Jaglowski
- Division of Hematology, The Ohio State University, Columbus, Ohio; The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jeffery J Auletta
- Host Defense Program, Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio University College of Medicine, Columbus, Ohio; The Ohio State University Comprehensive Cancer Center, Columbus, Ohio; Blood and Marrow Transplant Program, Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.
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Saeed B. Deceased Organ Donation in Syria: Challenges and Solutions. EXP CLIN TRANSPLANT 2020; 18:27-30. [PMID: 32758117 DOI: 10.6002/ect.rlgnsymp2020.l5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The first living-donor kidney transplant in Syria was performed 41 years ago; by 2019, 5407 renal transplants had been performed there. Three heart transplants from deceased donors were performed in the late 1980s; cardiac transplant activities have since discontinued. In 2003, a new, national Syrian legislation was enacted authorizing the use of organs from living unrelated donors and from deceased donors. This important law was preceded by another big stride in this regard: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the enactment of this law, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to < 2% in 2007. Kidney transplants continued at comparable rates until 2010, before the beginning of the political crisis in 2011. Four decades after the first successful kidney transplant in Syria, however, patients needing an organ transplant must rely on living donors only. Moreover, 17 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria, and additional improvement of the legal framework is needed. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be major factors inhibiting initiation of a deceased-donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased-donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.
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Affiliation(s)
- Bassam Saeed
- From the Farah Association for Child with Kidney Disease, Damascus, Syria
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Kubal C, Roll GR, Ekser B, Muiesan P. Donation after circulatory death liver transplantation: What are the limits for an acceptable DCD graft? Int J Surg 2020; 82S:36-43. [PMID: 32389812 DOI: 10.1016/j.ijsu.2020.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 01/06/2023]
Abstract
The utilization of donation after circulatory death (DCD) livers has been growing over the last decade. In large-volume centers, survival outcomes have improved and are comparable to outcomes with brain death donor (DBD) liver transplantation (LT). The relatively concentrated success with DCD LT demonstrated by high-volume transplant centers has rekindled international enthusiasm. The combination of increasing expertise in DCD LT and ongoing shortage in transplantable organs has promoted expansion of the DCD donor pool with regards to donor age, body mass index and donor warm ischemia time. In this review, we focused on the practice patterns in DCD liver graft utilization in the last decade, along with the possibilities for further expansion of DCD liver graft utilization and new technologies, such as machine perfusion.
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Affiliation(s)
- ChandrashekharA Kubal
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Garrett R Roll
- Department of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, CA, USA.
| | - Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
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