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1.
BMC Health Serv Res ; 19(1): 755, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655578

RESUMO

BACKGROUND: No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. METHODS: Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors' sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients' clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors' perceptions of the donation results and transplant procedure were assessed using measures that we developed. RESULTS: The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079-0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045-1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250-1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. CONCLUSIONS: Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.


Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Satisfação Pessoal , Idoso , Feminino , Humanos , Japão , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
Transplant Proc ; 51(8): 2527-2532, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473010

RESUMO

OBJECTIVES: To study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period. PATIENTS AND METHODS: Living kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal. RESULTS: Ninety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism. CONCLUSIONS: HbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.


Assuntos
Diabetes Mellitus/sangue , Seleção do Doador/métodos , Hemoglobina A Glicada/análise , Doadores Vivos/estatística & dados numéricos , Estado Pré-Diabético/sangue , Jejum/sangue , Feminino , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Fatores de Risco
3.
Transplant Proc ; 51(7): 2425-2429, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277908

RESUMO

BACKGROUND AND AIM: Acute kidney injury (AKI) is common in patients undergoing liver transplantation and is associated with reduced patient and graft survival. The aim is to assess the occurrence of AKI following living donor liver transplantation and to evaluate the associated risk factors and outcomes. SUBJECTS AND METHODS: Forty-nine Egyptian patients with hepatitis C virus who underwent living donor liver transplantation were divided into Group A (17 patients with AKI defined as increased creatinine > 50% of the initial pretransplant level) and Group B (non-AKI patients). Fluid balance, kidney function, preoperative and intraoperative risk factors, outcomes, and 1-year mortality were assessed. RESULTS: The mean age was 48 ± 7.51 and the majority of patients assessed were men (89.8%). The 17 patients with AKI had higher preoperative creatinine and higher Model for End-Stage Liver Disease scores (1.3 ± 0.16, 15.7 ± 5.07, respectively) than the non-AKI patients (1.1 ± .15, 13.7 ± 4.61, respectively), with P values of .04 and < .01, respectively. They also had significantly lower levels of albumin (2.98 ± .50). AKI patients had longer intensive care unit (ICU) stays (10 ± 3 d) compared to non-AKI patients (5 ± 2), with a P value of .03. A logistic multivariable regression test revealed that only a long ICU stay is a predictor of developing acute kidney injury among patients who have undergone living donor liver transplantation (odds ratio 1.23, 95% confidence interval 1.1-2.1, with a P value of .012). CONCLUSION: Many pre- and intra-operative factors are associated with AKI development; however, a long ICU stay is an independent potential factor for kidney infection.


Assuntos
Lesão Renal Aguda/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/etiologia , Adulto , Egito/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Doadores Vivos/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
4.
Transplant Proc ; 51(7): 2205-2209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31345596

RESUMO

PURPOSE: We evaluated potential kidney living donors and recipients for donation in our transplant center. MATERIALS AND METHODS: Candidates to be kidney living donors and kidney transplant recipients (KTxR) were retrospectively evaluated. All candidates were informed and assessed by transplant coordinator and nephrologists. All data were obtained from archive records. RESULTS: The mean ages of 194 kidney living donors and 182 KTxR were 45.7 ± 13.1 and 37.7 ± 14.6 years, respectively. Percentages of female candidates were 55.2% and 34.1% among kidney living donors and KTxR respectively. The kidney living donor candidates were the patients' mothers (27.3%), spouses (24.2%), siblings (21.6%), fathers (12.4%), and sons or daughters (6.2%) of KTxRs and others (8.2%). The numbers of donors with body mass index (BMI) > 30 kg/m2 and > 35kg/m2 were 56 (28.9%) and 17 (8.8%) respectively. Due to withdrawal from donation (21.2%) and renal problems (15.3%), 85/194 (43.8%) kidney living donors were excluded. Of the remaining 51/182 (28%) KTxR candidates, 26/182 (14.2%) were unsuitable because their panel-reactive antibody (PRA) > 20%. Sixty-six KTxR were performed in our center. Nine donor candidates were rejected due to obesity (BMI > 35 kg/m2). CONCLUSION: Most of our kidney living donors were mothers, housewives, and uneducated persons. Due to high percentages of suitability among candidates of KTxRs and kidney living donors as 72% and 56% may be an advantage for living kidney donation. However, PRA positivity in the recipients drew attention as a major barrier. The high incidence of obesity among the donor candidates suggests that societies must be more sensitive about this issue.


Assuntos
Transplante de Rim/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Família , Feminino , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Enferm. nefrol ; 22(2): 124-128, abr.-jun. 2019. mapas
Artigo em Espanhol | IBECS | ID: ibc-186310

RESUMO

En España se ha conseguido gestionar la donación de órganos a lo largo de los últimos 30 años, de manera más efectiva que en el resto de los países. Aun así, no hemos alcanzado la autosuficiencia. La prevalencia de enfermedad renal en nuestro país para el año 2017 fue de 685 p.m.p. teóricamente el 22% de estos pacientes serán candidatos a trasplante renal, lo que supone una necesidad de 150 trasplantes renales p.m.p. En 2017, la lista de espera para trasplante renal albergaba a 7.211 pacientes, 3.269 consiguieron trasplantarse (332 de donante vivo), lo que suponen 70 trasplantes p.m.p. El porcentaje aumenta cuando hablamos de receptores jóvenes, ya que, el número de donantes mayores de 60 años supera el 50% del total. Así mismo, se observan notables diferencias en la distribución de actividad de trasplante renal de donante vivo por CCAA. Con la donación renal de vivo, se pretende atender mejor las necesidades de la lista de espera para trasplante, reducir los tiempos de espera en general y aumentar la oferta de una excelente opción terapéutica, con mejores resultados en supervivencia y rehabilitación para el paciente, siendo actualmente una opción muy segura también para los donantes. El abordaje de los pacientes con enfermedad renal crónica debe plantearse desde el punto de vista multidisciplinar (enfermeras, nefrólogos, psicólogos y cirujanos), destacando el papel clave de la enfermera como gestora de cuidados, por la influencia que ejerce en su educación sanitaria y en la orientación terapéutica que se proporciona desde las consultas de enfermedad renal avanzada


In Spain, organ donation has been managed over the last 30 years, more effectively than in the rest of the countries. Even so, we have not reached self-sufficiency, specifically in the case of kidney transplantation, there is still a negative balance between patients who annually enter the waiting list and organs available for transplantation. The prevalence of kidney disease in our country in 2017 was 685 donors per million population (p.m.p) theoretically 22% of these patients will be candidates for kidney transplantation, which means a need for 150 kidney transplants p.m.p. In 2017, the waiting list for kidney transplantation had 7,211 patients, 3,269 were transplanted (332 from living donor), which means 70 transplants p.m.p. The percentage increases in young recipients, since, the number of donors older than 60 years exceeds 50% of the total. There are also notable differences in the distribution of renal transplant activity from living donors by Autonomous Community. Kidney donation from living donors, aims to better meet the needs of the waiting list for transplant, reduce waiting times in general and increase the supply of an excellent therapeutic option, with better results in survival and rehabilitation for the patient, being currently a very safe option also for donors. The approach to patients with chronic kidney disease must be multidisciplinary (nurses, nephrologists, psychologists and surgeons), highlighting the key role of the nurse as manager of care, by the influence on their health education and therapeutic guidance, which it is provided from the consultations in advanced chronic kidney disease


Assuntos
Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Doadores Vivos/estatística & dados numéricos , Falência Renal Crônica/enfermagem , Obtenção de Tecidos e Órgãos/tendências , Programas Nacionais de Saúde/tendências
6.
Surgery ; 166(2): 205-208, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31072668

RESUMO

BACKGROUND: Body mass index of living kidney donors has increased substantially. Determining candidacy for live kidney donation among obese individuals is challenging because many donation-related risks among this subgroup remain unquantified, including even basic postdonation mortality. METHODS: We used data from the Scientific Registry of Transplant Recipients linked to data from the Centers for Medicare and Medicaid Services to study long-term mortality risk associated with being obese at the time of kidney donation among 119,769 live kidney donors (1987-2013). Donors were followed for a maximum of 20 years (interquartile range 6.0-16.0). Cox proportional hazards estimated the risk of postdonation mortality by obesity status at donation. Multiple imputation accounted for missing obesity data. RESULTS: Obese (body mass index ≥ 30) living kidney donors were more likely male, African American, and had higher blood pressure. The estimated risk of mortality 20 years after donation was 304.3/10,000 for obese and 208.9/10,000 for nonobese living kidney donors. Adjusting for age, sex, race/ethnicity, blood pressure, baseline estimated glomerular filtration rate, relationship to recipient, smoking, and year of donation, obese living kidney donors had a 30% increased risk of long-term mortality compared with their nonobese counterparts (adjusted hazard ratio: 1.32, 95% CI: 1.09-1.60, P = .006). The impact of obesity on mortality risk did not differ significantly by sex, race or ethnicity, biologic relationship, baseline estimated glomerular filtration rate, or among donors who did and did not develop postdonation kidney failure. CONCLUSION: These findings may help to inform selection criteria and discussions with obese persons considering living kidney donation.


Assuntos
Transplante de Rim/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Nefrectomia/mortalidade , Obesidade/complicações , Sistema de Registros , Transplantados/estatística & dados numéricos , Fatores Etários , Índice de Massa Corporal , Estudos de Coortes , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Masculino , Nefrectomia/métodos , Obesidade/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Fatores de Tempo
7.
Transplant Proc ; 51(4): 1054-1057, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101170

RESUMO

OBJECTIVE: The aim of this study was to determine the sociodemographic characteristics of people who applied to be kidney donors at an organ transplantation center. MATERIAL AND METHODS: A total of 728 participants in the kidney donor program were included in the study between 2015 and 2018 at Istanbul Yeniyüzyil University Gaziosmanpasa Hospital. The sociodemographic data of the participants were retrospectively analyzed through computer records, and data were analyzed. RESULTS: Two hundred thirty-nine men and 489 women were included into the study. Six hundred ten were live donors, and 118 were cadaveric donors. Of the donors included in the study, 24.9% were illiterate, 52.1% were primary school graduates, 17.3% were high school graduates, and 5.7% were university graduates. Of the living donors, 156 (25.5%) were spouses, 91 (14.9%) were mothers, 72 (11.9%) were siblings, 65 (10.5%) were fathers, 64 (10.7%) were children, 46 were (7.5%) were other relatives, and 116 (19.0%) were nonrelatives. CONCLUSIONS: In recent years, the number of live kidney transplantations has increased. Therefore, it is necessary to protect their well-being by using evidence-based donor evaluation and treatment strategies to prevent and treat negative consequences of donations.


Assuntos
Transplante de Rim , Doadores Vivos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adulto , Criança , Feminino , Humanos , Masculino , Transplante de Órgãos/estatística & dados numéricos , Estudos Retrospectivos
8.
JAMA Netw Open ; 2(4): e191851, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30977847

RESUMO

Importance: There are limited resources providing postdonation conditions that can occur in living donors (LDs) of solid-organ transplant. Consequently, it is difficult to visualize and understand possible postdonation outcomes in LDs. Objective: To assemble an open access resource that is representative of the demographic characteristics in the US national registry, maintained by the Organ Procurement and Transplantation Network and administered by the United Network for Organ Sharing, but contains more follow-up information to help to examine postdonation outcomes in LDs. Design, Setting, and Participants: Cohort study in which the data for the resource and analyses stemmed from the transplant data set derived from 27 clinical studies from the ImmPort database, which is an open access repository for clinical studies. The studies included data collected from 1963 to 2016. Data from the United Network for Organ Sharing Organ Procurement and Transplantation Network national registry collected from October 1987 to March 2016 were used to determine representativeness. Data analysis took place from June 2016 to May 2018. Data from 20 ImmPort clinical studies (including clinical trials and observational studies) were curated, and a cohort of 11 263 LDs was studied, excluding deceased donors, LDs with 95% or more missing data, and studies without a complete data dictionary. The harmonization process involved the extraction of common features from each clinical study based on categories that included demographic characteristics as well as predonation and postdonation data. Main Outcomes and Measures: Thirty-six postdonation events were identified, represented, and analyzed via a trajectory network analysis. Results: The curated data contained 10 869 living kidney donors (median [interquartile range] age, 39 [31-48] years; 6175 [56.8%] women; and 9133 [86.6%] of European descent). A total of 9558 living kidney donors with postdonation data were analyzed. Overall, 1406 LDs (14.7%) had postdonation events. The 4 most common events were hypertension (806 [8.4%]), diabetes (190 [2.0%]), proteinuria (171 [1.8%]), and postoperative ileus (147 [1.5%]). Relatively few events (n = 269) occurred before the 2-year postdonation mark. Of the 1746 events that took place 2 years or more after donation, 1575 (90.2%) were nonsurgical; nonsurgical conditions tended to occur in the wide range of 2 to 40 years after donation (odds ratio, 38.3; 95% CI, 4.12-1956.9). Conclusions and Relevance: Most events that occurred more than 2 years after donation were nonsurgical and could occur up to 40 years after donation. Findings support the construction of a national registry for long-term monitoring of LDs and confirm the value of secondary reanalysis of clinical studies.


Assuntos
Doação Dirigida de Tecido/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Obtenção de Tecidos e Órgãos/métodos , Adulto , Ensaios Clínicos como Assunto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Íleus/epidemiologia , Íleus/etiologia , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Proteinúria , Sistema de Registros , Estudos Retrospectivos
9.
Lancet ; 393(10185): 2059-2072, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31006573

RESUMO

BACKGROUND: ABO-incompatible renal transplantation (ABOi-rTx) is increasingly used to overcome organ shortage. Evidence about its non-inferiority in comparison with ABO-compatible renal transplantation (ABOc-rTx) needs to be analysed at early and late timepoints. We aimed to investigate differences in outcome after ABOi-rTX and ABOc-rTX. METHODS: We did a systematic review and meta-analysis of observational studies published up until Dec 31, 2017, that reported outcome data (≥1 year of follow-up) after ABOi-rTx and included an ABO-compatible control group, by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Embase Ovid, MEDLINE Ovid, and PubMed. Trials on recipients of ABOi-rTx were assessed, if an ABO-compatible control group was included and if outcome data on at least graft or recipient survival with 1 year or more of follow-up were available. Exclusion criteria included case reports, editorials, reviews and letters, animal studies, meeting papers, studies unable to extract data, non-renal solid organ and bone-marrow transplant studies, and deceased donor ABOc-rTx. Data were extracted from published reports. Primary endpoints were all-cause mortality and graft survival at 1, 3, 5, and more than 8 years after transplantation. In the meta-analysis, we used a fixed-effects model if the I2 value was 0, and both a fixed-effects and random-effects model if I2 was more than 0. This study is registered with PROSPERO, number CRD42018094550. FINDINGS: 1264 studies were screened and 40 studies including 49 patient groups were identified. 65 063 patients were eligible for analysis, 7098 of whom had undergone ABOi-rTx. Compared with ABOc-rTx, ABOi-rTx was associated with significantly higher 1-year mortality (odds ratio [OR] 2·17 [95% CI 1·63-2·90], p<0·0001; I2=37%), 3 years (OR 1·89 [1·46-2·45], p<0·0001; I2=29%), and 5 years (OR 1·47 [1·08-2·00], p=0·010; I2=68%) following transplantation. Death-censored graft survival was lower with ABOi-rTx than with ABOc-rTx at 1 year (OR 2·52 [1·80-3·54], p<0·0001; I2=61%) and 3 years (OR 1·59 [1·15-2·18], p=0·0040; I2=58%) only. Graft losses were equivalent to that of ABOc-rTx after 5 years and patient survival after 8 years. No publication bias was detected and the results were robust to trial sequential analysis until 5 years after transplantation; thereafter, data became futile or inconclusive. INTERPRETATION: Despite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programmes. FUNDING: None.


Assuntos
Incompatibilidade de Grupos Sanguíneos/imunologia , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Transplante de Rim/mortalidade , /estatística & dados numéricos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Masculino , Estudos Observacionais como Assunto , Razão de Chances
10.
Transplant Proc ; 51(2): 504-508, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879577

RESUMO

BACKGROUND: Living donor kidney transplantation is the best type of renal replacement therapy. However, large numbers of potential living kidney donors (LKDs) are declined because of various reasons. The aim of this study is to define and quantify the reasons for declining potential LKDs. METHODS: All potential LKDs evaluated at our center between September 2008 and December 2016 were reviewed. Data were collected from the electronic database. RESULTS: A total of 2090 potential LKDs were evaluated, with an average age of 32 years (range, 18-67 years) and men constituting 72.6%. A total of 675 (32.3%) were accepted for donor nephrectomy. Living kidney donation did not proceed in 830 (39.7%): 661 (79.6%) because of donor-related reasons and 169 (20.4%) because of recipient-related reasons. Donor-related reasons included medical contraindications (61.7%), immunological barriers (23.1%), surgical contraindications (7.9%), and psychosocial reasons (7.3%). A total of 585 (28.0%) potential LKDs voluntarily withdrew themselves at variable time points during the evaluation process, even after being accepted for donation. Male and young (18-35 years) potential LKDs were more likely to withdraw compared with female and older (>35 years) potential LKDs (34.3% vs 11.4%, P < .005 and 29.6% vs 24.5%, P = .02, respectively). CONCLUSIONS: Despite the large number of potential LKDs, medically complex donors are increasing, and a significant proportion decided to withdraw at some point during the evaluation process. The latter highlights the need to increase public awareness about living donation, to perform more careful initial screening and targeted educational programs, and to provide continuous support for potential LKDs.


Assuntos
Transplante de Rim , Doadores Vivos/provisão & distribução , Adolescente , Adulto , Idoso , Tomada de Decisões , Feminino , Humanos , Doadores Vivos/psicologia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Ann Surg Oncol ; 26(5): 1454-1462, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30737669

RESUMO

BACKGROUND: Previous studies comparing outcomes of hepatocellular carcinoma (HCC) patients after living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) showed conflicting results, and most studies measured survival outcomes from the time of liver transplantation (LT). METHOD: This retrospective study was aimed to evaluate the long-term outcomes of HCC patients listed for LT using intention-to-treat (ITT) and propensity score matching (PSM) analyses. Clinicopathological data were retrieved from a prospectively collected database. RESULTS: From 1995 to 2014, 375 HCC patients were listed for LT. ITT-LDLT group had 188 patients, whereas ITT-DDLT group had 187 patients. Twenty-seven patients (14.4%) and 122 patients (65.2%) were delisted from LDLT and DDLT waitlist, respectively. The 1-, 3- and 5-year overall survival rates were significantly better in ITT-LDLT group than ITT-DDLT group (94.1 vs. 77.5%, 81.4 vs. 48.7% and 75.9 vs. 40.8%). High alphafetoprotein (AFP) and ITT-DDLT treatment arm were independent poor prognostic factors affecting overall survival. LDLT group (n = 161) had more young patients, poorer liver function, higher AFP, more tumors outside Milan/UCSF criteria, when compared with DDLT group (n = 85). After PSM, the 1-, 3- and 5-year overall (95.4 vs. 98.5%, 80.0 vs. 92.3% and 73.4 vs. 84.4%) and recurrence-free (87.7% vs. 90.8%, 76.9% vs. 83.1% and 72.2% vs. 81.5%) survival rates were comparable between the matched LDLT and the matched DDLT group, respectively. CONCLUSION: Survival benefit of LDLT was observed for HCC patients with ITT analysis. Despite a more advanced tumor stage, overall and recurrence-free survival rates were comparable between LDLT and DDLT using PSM analysis.


Assuntos
Carcinoma Hepatocelular/mortalidade , Análise de Intenção de Tratamento , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/mortalidade , Doadores Vivos/estatística & dados numéricos , Pontuação de Propensão , Adulto , Idoso , Cadáver , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
13.
Curr Opin Organ Transplant ; 24(2): 182-187, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30762665

RESUMO

PURPOSE OF REVIEW: With an increasing demand for donor organs, strategies to increase the number of available donor organs have become more focused. Compensating donors for donation is one strategy proposed to increase the availability of organs for transplant. This has been implemented in several systems internationally, but debate continues in the United States with respect to appropriate strategies. The National Organ Transplant Act (NOTA) currently prohibits the transfer of any human organ 'for valuable consideration' for transplantation, but allows for the removal of financial disincentives. RECENT FINDINGS: Several proposals currently exist for compensating patients for living donation. Recent data have focused on studying and creating mechanisms for reimbursement of costs incurred as part of the donation process, which is related to the removal of disincentives to living donation. Others have advocated for the provision of actual incentives to patients for the act of donating, in an attempt to further expand living donation. The current debate focuses on what measures can reasonably be taken to increase donation, and whether additional incentives will encourage more donation or reduce the motivation for altruistic donation. SUMMARY: Currently, the transplant community broadly supports the removal of disincentives for living donors, including reimbursement of expenses for travel, housing and lost wages incurred during evaluation, surgery and after care. Others have advocated for financial incentives to further increase the number of donor organs available for transplant. Although the removal of disincentives is currently allowed under the existing legal structure of NOTA, providing financial incentives for living donation would require further evaluation of the economics, law, ethics and public readiness for a significant policy shift.


Assuntos
Apoio Financeiro , Custos de Cuidados de Saúde , Doadores Vivos/psicologia , Transplante de Órgãos/economia , Obtenção de Tecidos e Órgãos/economia , Humanos , Doadores Vivos/estatística & dados numéricos , Doadores Vivos/provisão & distribução , Motivação , Obtenção de Tecidos e Órgãos/organização & administração , Estados Unidos
14.
Medicine (Baltimore) ; 98(7): e14494, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762774

RESUMO

Few studies have investigated the risk of physiological sequelae in living kidney donors (KDs). We conducted a population-based cohort study using the National Health Insurance Research Database of Taiwan, which covers more than 99% of citizens.We comprehensively investigated the risk of medical disorders after kidney donation in living KDs using a maximum follow-up of 13 years. From January 1997 to December 2010, 1081 living KDs and 1082 age- and sex-matched non-KDs were eligible. Primary outcomes comprised end-stage renal disease, chronic kidney disease, stroke, cancer, acute myocardial infarction, acute renal failure (ARF), and diabetes.The adjusted hazard ratios (HRs) for developing ARF, diabetes, hyperlipidemia, hypertension, cancer, end-stage renal disease, acute myocardial infarction, and stroke were similar between the KD and non-KD cohorts (P > .05). Although differences in the adjusted HRs of ARF were nonsignificant, the cumulative incidence rate of ARF 13 years after donation was 7.48 per 1000 person-years in the KD cohort compared with 3.46 in the matched non-KD cohort. The incidence rate ratio for ARF between donors and nondonors significantly increased to 2.16 (95% confidence interval, 1.61-2.71).Living KDs experienced no significant health disorders following kidney donation but should be alert to the higher incidence rate of ARF.


Assuntos
Nível de Saúde , Rim , Doadores Vivos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Neoplasias/epidemiologia , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Acidente Vascular Cerebral/epidemiologia , Taiwan
15.
Medicine (Baltimore) ; 98(5): e13979, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702556

RESUMO

Among living donor liver transplantation recipients, the impact of educational levels on survival has rarely explored. Thus, the purpose of study is to analyze the survival rate differences across educational levels among recipients who underwent living donor liver transplantation.We retrospectively analyzed 2007 adult recipients who underwent living donor liver transplantation in a single large center. The educational level was divided into three categories: middle school or lower, high school, and college or higher. The primary outcome was all-cause mortality after living donor liver transplantation. Stratified log-rank test and Cox proportional hazard model were employed for statistical analysis.The incidence rates of all-cause mortality were 23.85, 20.19, and 18.75 per 1000 person-year in recipients with middle school or lower, high school, and college or higher education groups, respectively. However, the gender-stratified log-rank test has not shown a statistically significant difference (P = .3107). In the unadjusted model, hazard ratio (HR) was 1.02 [95% confidence interval (CI) = 0.79-1.33] in high school and 1.23 (95% CI = 0.93-1.64) and in middle school or lower educational level, respectively; In the full adjusted model, the HR of high school was 0.98 (95% CI = 0.75-1.28) and the HR of middle school or lower was 1.01 (95% CI = 0.74-1.37).Although study population of this study is large, we could not find significant survival rate differences by the levels of education. Social selection and high compliance rate might contribute to this result.


Assuntos
Sucesso Acadêmico , Transplante de Fígado/mortalidade , Doadores Vivos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Fatores Etários , Índice de Massa Corporal , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
16.
Prog Urol ; 29(3): 166-172, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30704916

RESUMO

INTRODUCTION: The aim of this study was to determine the prevalence of anatomic variations (renal, vascular and urological) and acquired renal pathologies in living kidney donor candidates (LKDC). METHODS: This is a retrospective study of all LKDC referred to our center between April 2003 and September 2014. Of the 491 LKDC, 189 were initially excluded for medical reasons (n=140) or others reasons (n=49), without undergoing a radiological assessment. In total, 302 had a radiological assessment (angio-CT or MRI) in anticipation of the donation and 226/302 (73.5%) could donate a kidney. RESULTS: One or more anatomical variations and/or acquired abnormalities were observed in 178/302 (58.9%) of the LKDC. The most frequent were arterial variations or abnormalities (multiple arteries, fibrodysplasia, aneurysms, stenosis≥70%) which where observed in 39.3% of the LKDC, followed by the venous abnormalities (27.8%). Kidney stones were observed in 5.6% of the LKDC and the urinary abnormalities (duplication/ureteral bifidity) were found in 3% of the LKDC. No malignant tumour was diagnosed, while 4 benign tumours (1.3%) were identified, and one of them required additional investigations. CONCLUSION: We found a high prevalence of anatomical variations and acquired abnormalities in a population of LKDC. However, these findings resulted in the exclusion of only 4% of the candidates, because they did not contraindicate the donation or, in most of cases, the contralateral kidney could be used. LEVEL OF EVIDENCE: 3.


Assuntos
Seleção do Doador/métodos , Transplante de Rim/métodos , Rim/patologia , Doadores Vivos/estatística & dados numéricos , Humanos , Rim/anormalidades , Cálculos Renais/epidemiologia , Estudos Retrospectivos
17.
J Int Med Res ; 47(5): 1856-1867, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30614340

RESUMO

OBJECTIVE: To investigate the effect of ascorbic acid (AA) on hemostatic function during living donor liver transplantation (LDLT). METHODS: Blood samples from 21 LDLT recipients were taken within 30 minutes after induction and at 120 minutes after reperfusion. Rotational thromboelastography (TEG) and western blot analysis were used to analyze for fibrinolysis and functional changes in c-Cbl and Cbl-b, respectively. TEG test samples were prepared as one of three groups: C group (0.36 mL of blood), N group (0.324 mL of blood + 0.036 mL of 0.9% normal saline), and A group (0.324 mL of blood + 0.036 mL of 200 µmol/L-AA dissolved in 0.9% normal saline). RESULTS: AA decreased fibrinolysis and increased clot rigidity at baseline and 120 minutes after reperfusion. Cbl-b expression was significantly increased at baseline and 120 minutes after reperfusion in the A group compared with the C and N groups. However, c-Cbl phosphorylation was most significantly decreased in the A group at baseline and 120 minutes after reperfusion. CONCLUSION: AA can significantly decrease fibrinolysis and improve clot rigidity in LT recipients during LDLT, and functional changes in Cbl-b and c-Cbl might represent the underlying mechanism. AA may be considered for use during LDLT to decrease hyperfibrinolysis.


Assuntos
Ácido Ascórbico/uso terapêutico , Plaquetas/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Transplante de Fígado/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Proteína Oncogênica v-cbl/metabolismo , Proteínas Proto-Oncogênicas c-cbl/metabolismo , Trombose/tratamento farmacológico , Antioxidantes/uso terapêutico , Plaquetas/metabolismo , Plaquetas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína Oncogênica v-cbl/genética , Fosforilação , Estudos Prospectivos , Proteínas Proto-Oncogênicas c-cbl/genética , Trombose/etiologia , Trombose/metabolismo
19.
J Natl Med Assoc ; 111(2): 202-209, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30409716

RESUMO

OBJECTIVE: The aim of this study was to provide a contemporary analysis of longitudinal kidney transplant outcomes and to evaluate potential causes of ethnic disparities among African American (AA) and Caucasian American (CA) patients undergoing kidney transplantation at our institution. PATIENTS AND METHODS: 1400 patients were identified who underwent kidney transplantation from 2003 to 2013 from a large, academic institution in Cleveland, OH. Relevant recipient and donor demographic and clinical covariates were obtained from an institutional transplant database. Simple descriptive statistics and comparative survival analyses were performed to assess overall survival and graft survival. RESULTS: The final cohort was comprised of 341 AA and 1059 CA patients. AAs were less likely to receive a living donor transplant (27.6% vs. 57.2%, p < 0.001) compared to CAs. Overall patient survival did not significantly differ between the two groups even when stratified by ethnicity. However, AAs had a significantly lower rate of graft survival (p < 0.001). On stratified analysis, there was no difference in the rate of graft survival among AAs and CAs who received living donor grafts. On univariate analysis, AAs demonstrated higher rates of immunosuppression non-compliance and chronic rejection (both p < 0.05). On multivariate analysis, AA recipient ethnicity (HR 1.56, p = 0.047), recipient history of diabetes (HR 1.67, p < 0.001), and AA donor ethnicity (HR 1.56, p = 0.047) were significantly associated with graft failure. CONCLUSION: AAs undergoing deceased donor renal transplantation demonstrated lower graft survival compared to CAs. Conversely, this disparity did not exist among AAs undergoing living donor transplantation. AAs had higher rates of deceased donor transplantation, immunosuppression non-compliance, chronic rejection, and diabetes. Opportunities exist to use patient education, alternative immunosuppression regimens, and living transplantation to close the ethnic disparity in renal allograft survival.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Rejeição de Enxerto/etnologia , Disparidades nos Níveis de Saúde , Transplante de Rim/estatística & dados numéricos , Diabetes Mellitus/enzimologia , Feminino , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Doadores Vivos/estatística & dados numéricos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
20.
Eur Radiol ; 29(10): 5272-5279, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30560360

RESUMO

PURPOSE: Cortical biopsy is the cornerstone to reveal a cause of unexplained dysfunction of the kidney transplant. Nevertheless, only a few studies have reported the biopsy technique with its performance. We described a novel technique of ultrasound (US)-guided kidney transplant biopsy using cortex-only view and analyzed its diagnostic efficacy and safety. MATERIALS AND METHODS: Between January 2014 and December 2016, a consecutive series of 188 patients who underwent US-guided kidney transplant biopsy using cortex-only view by an experienced radiologist were evaluated (mean age, 46.1 ± 12.5 years; range, 21-79 years). Biopsy time, biopsy distance, biopsy core number, and glomerular number per patient were recorded. Successful biopsy (e.g., adequate, 10 or more glomeruli; marginal, 7-9 glomeruli) and complication rates were investigated, using Banff criteria and Clavien-Dindo classification, respectively. RESULTS: Mean biopsy time, distance, and core number were 20.6 ± 6.7 min (range, 10-44 min), 3.2 ± 0.7 cm (range, 2.1-5.4 cm), and 1.9 ± 0.3 (range, 1.0-3.0), respectively. Mean glomerular number per patient was 20.4 ± 10.0 (range, 0-54). Adequate and marginal biopsy rates were 87.2% (164/188) and 95.2% (179/188), respectively. There was no major complication requiring treatment (no patient with Clavien-Dindo grade 2 or greater complication), while there were self-limiting minor complications in 5 patients (overall complication rate, 2.7%). CONCLUSION: US-guided biopsy using cortex-only view is feasible and safe in sampling cortical tissues of kidney transplant. KEY POINTS: • Ultrasound (US)-guided kidney transplant biopsy using cortex-only view is feasible and safe. • Adequate and marginal biopsy rates were 87.2% and 95.2%, respectively. • No major complication requiring treatment occurred after biopsy.


Assuntos
Transplante de Rim/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre , Estudos de Viabilidade , Feminino , Rejeição de Enxerto/patologia , Humanos , Biópsia Guiada por Imagem/métodos , Nefropatias/patologia , Nefropatias/cirurgia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Doadores de Tecidos/estatística & dados numéricos , Ultrassonografia , Ultrassonografia de Intervenção/métodos , Adulto Jovem
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