Impact of patient characteristics and comorbidity profile on activation of patients on the kidney transplantation waiting list.

BACKGROUND: The aim of this study was to examine which demographic and comorbidity factors affected the activation of patients with end-stage renal disease on the national kidney transplantation waiting list. METHODS: This was a prospective cohort study across 13 transplantation centers in the United Kingdom from October 1, 2006 to September 30, 2007. Data were collected for all new adult patients (n = 1530) referred to the renal transplantation assessment clinic. The proportion of patients who were activated to the waiting list after a minimum one year follow-up was estimated. Factors influencing activation of patients on the waiting list were examined. RESULTS: A total of 872 (58.9%) patients were activated to the transplantation waiting list. The likelihood of activation to the transplantation waiting list was lower in patients older than 65 years (P = .021), nonwhite ethnicity (P < .0001), smokers (P < .0001), and those in whom diabetes was the cause of renal failure (P = .004). Multivariate analysis showed that there was an adverse impact of comorbidity such as ischemic heart disease (P = .003), diabetes (P = .006), and peripheral vascular disease (P = .007) on the likelihood of activation to the waiting list. CONCLUSION: Patient characteristics and comorbidity are associated with the probability of activation of patients to the waiting list.

Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs.

BACKGROUND: In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. METHODS: Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. RESULTS: Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. CONCLUSION: In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.