Logistical Factors Influencing Cold Ischemia Times in Deceased Donor Kidney Transplants.

BACKGROUND: Prolonged cold ischemia time (CIT) is associated with a significant risk of short- and long-term graft failure in deceased donor kidney transplants across the world. The aim of this prospective longitudinal study was to determine the importance of logistical factors on CIT. METHOD: Data on 1763 transplants were collected prospectively over 14 months from personnel in 16 transplant centers, 19 histocompatibility and immunogenetics laboratories, transport providers, and National Health Service Blood and Transplant. RESULTS: The overall mean CIT was 13.8 hours, with significant center variation (P < 0.0001). Factors that significantly reduced CIT were donation after circulatory death (P = 0.03), shorter transport time (P = 0.0002), use of virtual crossmatch (XM) (P < 0.0001), and use of donor blood for pretransplant XM (P < 0.0001). The CIT for transplants that went ahead with a virtual XM was 3 hours shorter than those requiring a pretransplant XM (P < 0.0001). There was a mean delay of 3 hours in starting transplants despite organ, recipient, and pretransplant XM result being ready, suggesting that theater access contributes significantly to increased CIT. DISCUSSION: This study identifies logistical factors relating to donor, transport, crossmatching, recipient, and theater that impact significantly on CIT in deceased donor renal transplantation, some of which are modifiable; attention should be focussed on addressing all of these.

Probiotics in the management of gastrointestinal disease: analysis of the attitudes and prescribing practices of gastroenterologists and surgeons.

OBJECTIVE: Probiotics are increasingly advocated in the management of various gastrointestinal disorders. The aim of this study was to investigate the current attitudes and prescribing practices of surgeons and gastroenterologists for probiotics in the treatment of gastrointestinal disorders. METHODS: A questionnaire was designed to look at the frequency of probiotic prescribing, types of probiotics used, indications for and duration of treatment and clinicians' experiences with probiotic use. A total of 220 questionnaires were mailed to consultant gastroenterologists and surgeons practicing in the UK. RESULTS: The overall response rate was 80.5%, of which 69.5% of respondents said they recommended or prescribed probiotic food supplements to their patients, including 53.4% of surgeons and 80.8% of gastroenterologists (P = 0.00013). The most popular probiotic supplements among surgeons were probiotic-containing yoghurt and drinks (79.5% and 71.8%, respectively), whereas VSL#3 was more popular with gastroenterologists (83.3%). The most popular indications were irritable bowel syndrome (70.7% of prescribers) and pouchitis (67.5% of prescribers). Many respondents prescribed long-term probiotics. Most consultants had been prescribing probiotics for a period of 1 to 5 years. CONCLUSION: Probiotics are popular among gastroenterologists and surgeons in the UK for the treatment of gastrointestinal disorders. Further evidence to support their routine use, by way of large, well-designed randomized controlled trials, is necessary.