RESUMO
The development of de novo donor-specific HLA antibody (dnDSA) is a critical feature contributing to late allograft failure. The complexity of the issue is further complicated by organ-specific differences, detection techniques, reliance of tissue histopathology and changing diagnostic criteria, ineffective therapies, and lack of consensus. To tackle these issues, the Sensitization in Transplantation Assessment of Risk (STAR) 2017 was initiated as a collaboration of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics consisting of 8 working groups with the goal to provide guidelines on how to assess risk and risk stratify patients based on their potential alloimmune and DSA status. Herein is a summary of discussions by the Naïve Abdominal Working Group, highlighting currently available data and identifying gaps in our knowledge on the development and impact of dnDSA following kidney transplantation.
Assuntos
Rejeição de Enxerto/diagnóstico , Sobrevivência de Enxerto/imunologia , Antígenos HLA/imunologia , Histocompatibilidade/imunologia , Isoanticorpos/sangue , Transplante de Rim/efeitos adversos , Doadores de Tecidos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Humanos , Isoanticorpos/imunologia , Relatório de Pesquisa , Medição de Risco , Sociedades MédicasRESUMO
The presence of preexisting (memory) or de novo donor-specific HLA antibodies (DSAs) is a known barrier to successful long-term organ transplantation. Yet, despite the fact that laboratory tools and our understanding of histocompatibility have advanced significantly in recent years, the criteria to define presence of a DSA and assign a level of risk for a given DSA vary markedly between centers. A collaborative effort between the American Society for Histocompatibility and Immunogenetics and the American Society of Transplantation provided the logistical support for generating a dedicated multidisciplinary working group, which included experts in histocompatibility as well as kidney, liver, heart, and lung transplantation. The goals were to perform a critical review of biologically driven, state-of-the-art, clinical diagnostics literature and to provide clinical practice recommendations based on expert assessment of quality and strength of evidence. The results of the Sensitization in Transplantation: Assessment of Risk (STAR) meeting are summarized here, providing recommendations on the definition and utilization of HLA diagnostic testing, and a framework for clinical assessment of risk for a memory or a primary alloimmune response. The definitions, recommendations, risk framework, and highlighted gaps in knowledge are intended to spur research that will inform the next STAR Working Group meeting in 2019.
Assuntos
Sobrevivência de Enxerto/imunologia , Antígenos HLA/imunologia , Histocompatibilidade/imunologia , Isoanticorpos/imunologia , Transplante de Órgãos , Guias de Prática Clínica como Assunto/normas , Medição de Risco/métodos , Doadores de Tecidos , Humanos , Relatório de PesquisaRESUMO
The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98-8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97-1/00). Mean donor weights were similar (179.6 +/- 40.8 vs. 167.4 +/- 30.3 lb; p = NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 +/- 9.5 vs. 31.2 +/- 7.8 year; p < 0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p < 0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 +/- 0.7 vs. 2.9 +/- 0.5 h; p < 0.01) was longer; however, return to diet (6.9 +/- 2.8 vs. 25.6 +/- 6.1 h; p < 0.01), narcotics requirement (17.9 +/- 6.3 vs. 56.3 +/- 6.4h; p < 0.01) and length of stay (51.7 +/- 22.2 vs. 129.6 +/- 65.7 h; p < 0.01) were less than open donor nephrectomy. Costs were similar ($11072 vs. 10840). Graft function and 1-week Cr of 1.4 +/- 0.9 vs. 1.6 +/- 1.1 g/dL (p = NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs.
Assuntos
Laparoscopia/métodos , Doadores Vivos , Nefrectomia/métodos , Atividades Cotidianas , Custos e Análise de Custo , Humanos , Transplante de Rim/métodos , Transplante de Rim/fisiologia , Laparoscopia/economia , Tempo de Internação , Nefrectomia/economia , Ohio , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Postura , Fatores de TempoRESUMO
Three comprehensive premarital assessment questionnaires (PAQs) are described, evaluated on their psychometric characteristics, and compared. They include the PREmarital Preparation and Relationship Enhancement (PREPARE) questionnaire, the Facilitating Open Couple Communication, Understanding and Study (FOCCUS) questionnaire, and the RELATionship Evaluation (RELATE). Recommendations for using each PAQ are discussed.