Transplantation research最新文献

{"title":"Attitudes of young adults from the UK towards organ donation and transplantation.","authors":"Laura Coad, Noel Carter, Jonathan Ling","doi":"10.1186/2047-1440-2-9","DOIUrl":"10.1186/2047-1440-2-9","url":null,"abstract":"<p><strong>Background: </strong>This study examines the attitudes of young British adults towards donating their own organs and those of their family members.</p><p><strong>Methods: </strong>An opportunity sample of 119 participants (65 female) completed an attitude questionnaire.</p><p><strong>Results: </strong>Most participants were in favour of donation though substantially fewer had signed up to the organ donation register. A minority of participants was aware of the proposed opt-out system for donation.</p><p><strong>Conclusions: </strong>The results from this study corroborate and extend previous work in that more participants were prepared to receive an organ than donate one. Knowing someone who had donated an organ was associated with a more positive attitude towards donation. Implications for policy are discussed.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2013-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31438655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of vascular anastomosis time on early kidney transplant outcomes.","authors":"Karim Marzouk,&nbsp;Joseph Lawen,&nbsp;Ian Alwayn,&nbsp;Bryce A Kiberd","doi":"10.1186/2047-1440-2-8","DOIUrl":"https://doi.org/10.1186/2047-1440-2-8","url":null,"abstract":"<p><strong>Background: </strong>Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Relatively less is known about the warm time associated with vascular anastomosis and early outcomes.</p><p><strong>Methods: </strong>A retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from January 2006 to August 2012 was analyzed to examine the association between anastomosis time and delayed graft function (need for dialysis) and length of hospital stay.</p><p><strong>Results: </strong>Delayed graft function (DGF) was observed in 56 patients (18.8%). The median anastomosis time was 30 minutes (interquartile range 24, 45 minutes). Anastomosis time was independently associated with DGF in a multivariable, binary logistic regression analysis (odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001). An anastomosis time >29 minutes was also associated with a 3.5 fold higher (OR 3.5, 95% CI 1.6, 7.3, P = 0.001) risk of DGF. Median days in hospital was 9 (interquartile range 7, 14 days). Every 5 minutes of longer anastomosis time (0.20 days per minute, 95% CI 0.13, 0.27, P <0.001) was associated with 1 extra day in hospital in a multivariable linear regression model. An anastomosis time >29 minutes was associated with 3.8 (95% CI 1.6, 6.0, P <0.001) more days in hospital.</p><p><strong>Conclusion: </strong>Anastomosis time may be an underappreciated but modifiable variable in dictating use of hospital resources. The impact of anastomosis time on longer term outcomes deserves further study.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2013-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31433060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Campath, calcineurin inhibitor reduction and chronic allograft nephropathy (3C) study: background, rationale, and study protocol.","authors":"Richard Haynes, Colin Baigent, Paul Harden, Martin Landray, Murat Akyol, Argiris Asderakis, Alex Baxter, Sunil Bhandari, Paramit Chowdhury, Marc Clancy, Jonathan Emberson, Paul Gibbs, Abdul Hammad, Will Herrington, Kathy Jayne, Gareth Jones, Nithya Krishnan, Michael Lay, David Lewis, Iain Macdougall, Chidambaram Nathan, James Neuberger, Chas Newstead, Ravi Pararajasingam, Carmelo Puliatti, Keith Rigg, Peter Rowe, Adnan Sharif, Neil Sheerin, Sanjay Sinha, Chris Watson, Peter Friend","doi":"10.1186/2047-1440-2-7","DOIUrl":"10.1186/2047-1440-2-7","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the best treatment for patients with end-stage renal failure, but uncertainty remains about the best immunosuppression strategy. Long-term graft survival has not improved substantially, and one possible explanation is calcineurin inhibitor (CNI) nephrotoxicity. CNI exposure could be minimized by using more potent induction therapy or alternative maintenance therapy to remove CNIs completely. However, the safety and efficacy of such strategies are unknown.</p><p><strong>Methods/design: </strong>The Campath, Calcineurin inhibitor reduction and Chronic allograft nephropathy (3C) Study is a multicentre, open-label, randomized controlled trial with 852 participants which is addressing two important questions in kidney transplantation. The first question is whether a Campath (alemtuzumab)-based induction therapy strategy is superior to basiliximab-based therapy, and the second is whether, from 6 months after transplantation, a sirolimus-based maintenance therapy strategy is superior to tacrolimus-based therapy. Recruitment is complete, and follow-up will continue for around 5 years post-transplant. The primary endpoint for the induction therapy comparison is biopsy-proven acute rejection by 6 months, and the primary endpoint for the maintenance therapy comparison is change in estimated glomerular filtration rate from baseline to 2 years after transplantation. The study is sponsored by the University of Oxford and endorsed by the British Transplantation Society, and 18 centers for adult kidney transplant are participating.</p><p><strong>Discussion: </strong>Late graft failure is a major issue for kidney-transplant recipients. If our hypothesis that minimizing CNI exposure with Campath-based induction therapy and/or an elective conversion to sirolimus-based maintenance therapy can improve long-term graft function and survival is correct, then patients should experience better graft function for longer. A positive outcome could change clinical practice in kidney transplantation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT01120028 and ISRCTN88894088.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2013-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31404456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological interactions of CYP2C19 genotypes with CYP3A4*18, CYP3A5*3, and MDR1-3435 in living donor liver transplantation recipients.","authors":"King-Wah Chiu,&nbsp;Tsung-Hui Hu,&nbsp;Toshiaki Nakano,&nbsp;Kuang-Den Chen,&nbsp;Chia-Yun Lai,&nbsp;Li-Wen Hsu,&nbsp;Hui-Peng Tseng,&nbsp;Ho-Ching Chiu,&nbsp;Yu-Fan Cheng,&nbsp;Shigeru Goto,&nbsp;Chao-Long Chen","doi":"10.1186/2047-1440-2-6","DOIUrl":"https://doi.org/10.1186/2047-1440-2-6","url":null,"abstract":"<p><strong>Background: </strong>Polymorphisms in CYP2C19 are related to the metabolic oxidation of drugs to varying degrees. The CYP3A4*18, CYP3A5*3, and MDR1-3435 variant alleles are very important, particularly in tacrolimus metabolism in organ transplant rejection.</p><p><strong>Aim: </strong>The aim of this study is o explore possible interactions among different CYP2C19 genotypes, namely, between homozygous extensive metabolizers (HomEM), heterozygous extensive metabolizers (HetEM), and poor metabolizers (PM), and the CYP3A4*18, CYP3A5*3, and MDR1-3435 variants in living donors and patients who received a living donor liver transplant (LDLT).</p><p><strong>Methods: </strong>This prospective study enrolled 133 living donors and 133 corresponding recipients. On the basis of the HomEM, HetEM, and PM CYP2C19 genotypes, the distributions of CYP3A4*18 (exon 10; T878C), CYP3A5*3 (intron 3; A6986G), and MDR1-3435 (exon 26; C3435T) genotypes were analyzed for single nucleotide polymorphisms among donors and recipients.</p><p><strong>Results: </strong>Among 102 HomEM genotypes, including 56 donors and 46 recipients, 91.2% of individuals harbored the T/T genotype of CYP3A4*18; 53.9% possessed G/G, and 34.3% had A/G genotypes of CYP3A5*3; and 38.2% had C/C and 50.0% had C/T genotypes at MDR1-3435. Among 130 HetEM genotypes, including 58 donors and 72 recipients, 97.7% of individuals possessed T/T genotype at CYP3A4*18; 50.0% harbored G/G and 41.5% had A/G genotypes at CYP3A5*3; and 40.0% had C/C and 49.2% had C/T genotypes at MDR1-3435. In 34 PMs, including 19 donors and 15 recipients, 88.2% had T/T genotypes at CYP3A4*18; 41.2% had G/G and 58.8% had A/G genotypes at CYP3A5*3; and 47.1% possessed C/C and 47.1% had C/T genotypes at MDR1-3435. On the basis of the CYP2C19 genotypes, no statistically significant distribution of genotypes were observed between donors and recipients for all genotypes of CYP3A4*18, CYP3A5*3, and MDR1-3435 (P >0.05).</p><p><strong>Conclusions: </strong>In conclusion, the CYP2C19 genotypes do not affect the expression of CYP3A4*18, CYP3A5*3, or MDR1-3435 variants, which are independently distributed among donors and recipients during LDLT.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2013-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31384889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endomyocardial, intralymphocyte, and whole blood concentrations of ciclosporin A in heart transplant recipients.","authors":"Ida Robertsen,&nbsp;Pål Falck,&nbsp;Arne K Andreassen,&nbsp;Nina K Næss,&nbsp;Niclas Lunder,&nbsp;Hege Christensen,&nbsp;Lars Gullestad,&nbsp;Anders Asberg","doi":"10.1186/2047-1440-2-5","DOIUrl":"https://doi.org/10.1186/2047-1440-2-5","url":null,"abstract":"<p><strong>Background: </strong>In the early phases following heart transplantation a main challenge is to reduce the impact of acute rejections. Previous studies indicate that intracellular ciclosporin A (CsA) concentration may be a sensitive acute rejection marker in renal transplant recipients. The aims of this study were to evaluate the relationships between CsA concentrations at different target sites as potential therapeutic drug monitoring (TDM) tools in heart transplant recipients.</p><p><strong>Methods: </strong>Ten heart transplant recipients (8 men, 2 women) on CsA-based immunosuppression were enrolled in this prospective single-center pilot study. Blood samples were obtained once to twice weekly up to 12 weeks post-transplant. One of the routine biopsies was allocated to this study at each sampling time. Whole blood, intralymphocyte, and endomyocardial CsA concentrations were determined with validated HPLC-MS/MS-methods. Mann-Whitney U test was used when evaluating parameters between the two groups of patients. To correlate whole blood, intralymphocyte, and endomyocardial CsA concentrations linear regression analysis was used.</p><p><strong>Results: </strong>Three patients experienced mild rejections. In the study period, the mean (range) intralymphocyte CsA trough concentrations were 10.1 (1.5 to 39) and 8.1 (1.3 to 25) ng/106 cells in the rejection and no-rejection group, respectively (P=0.21). Corresponding whole blood CsA concentrations were 316 (153 to 564) and 301 (152 to 513) ng/mL (P=0.33). There were no correlations between whole blood, intralymphocyte, or endomyocardial concentrations of CsA (P >0.11).</p><p><strong>Conclusions: </strong>The study did not support an association between decreasing intralymphocyte CsA concentrations and acute rejections. Further, there were no association between blood concentrations and concentrations at sites of action, potentially challenging TDM in these patients.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2013-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31340838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood transfusion in deceased donor kidney transplantation.","authors":"Karim Marzouk,&nbsp;Joseph Lawen,&nbsp;Bryce A Kiberd","doi":"10.1186/2047-1440-2-4","DOIUrl":"https://doi.org/10.1186/2047-1440-2-4","url":null,"abstract":"<p><strong>Background: </strong>Given the unpredictable timing of deceased donor organs and the need for blood transfusion, this study was carried out to determine the rate and risk factors for transfusion in order to identifying a low-risk cohort in the face of a critical blood shortage.</p><p><strong>Methods: </strong>This retrospective chart review examined 306 consecutive deceased solitary kidney transplant recipients from January 2006 to August 2012.</p><p><strong>Results: </strong>Records show that 80 (26.1%) patients were transfused with a total of 300 units (0.98 units/transplant) during their first hospital stay. Transfusions were higher in patients on warfarin (8/14, 57%, 5.1 units/transplant) and antiplatelet agents (46/136, 33.8%, 1.1 unit/transplant) compared to no anticoagulants (74/156, 16.7%, 0.47 units/transplant). In a multivariable logistic regression analysis warfarin (odd ratio (OR) 8.2, 95% confidence interval (CI) 2.5-27, P=0.001), antiplatelet agents (OR 2.9, 95% CI 1.6-5.3, P=0.001), recipient age ≥55 years (OR 2.2, 95% CI 1.2-3.9, P=0.008), recipient male (OR 0.36, 95% CI 0.2-0.64, P=0.001) and preop hemoglobin ≥115 g/L (OR 0.32, 95% CI 0.18-0.57, P<0.001) were independent predictors of blood transfusion. Lower bleeding cohorts with transfusion rates <5% could not be identified.</p><p><strong>Conclusion: </strong>The need for blood is significantly higher in subjects on either warfarin or antiplatelet agents. These patients might be avoided if kidney transplantation is to occur during a critical blood shortage. Unfortunately even patients not on anticoagulation are at some risk.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":" ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2013-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40250589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol TOP-Study (tacrolimus organ perfusion): a prospective randomized multicenter trial to reduce ischemia reperfusion injury in transplantation of marginal liver grafts with an ex vivo tacrolimus perfusion.","authors":"Sebastian Pratschke,&nbsp;Michael Eder,&nbsp;Michael Heise,&nbsp;Silvio Nadalin,&nbsp;Andreas Pascher,&nbsp;Peter Schemmer,&nbsp;Marcus N Scherer,&nbsp;Frank Ulrich,&nbsp;Heiner Wolters,&nbsp;Karl-Walter Jauch,&nbsp;Dirk Wöhling,&nbsp;Martin K Angele","doi":"10.1186/2047-1440-2-3","DOIUrl":"https://doi.org/10.1186/2047-1440-2-3","url":null,"abstract":"<p><strong>Background: </strong>Critical organ shortage results in the utilization of extended donor criteria (EDC) liver grafts. These marginal liver grafts are prone to increased ischemia reperfusion injury (IRI) which may contribute to deteriorated graft function and survival. Experimental data have shown that the calcineurin inhibitor tacrolimus exerts protective effects on hepatic IRI when applied intravenously or directly as a hepatic rinse. Therefore, the aim of the present study is to examine the effects of an ex vivo tacrolimus perfusion on IRI in transplantation of EDC liver grafts.</p><p><strong>Methods/design: </strong>The TOP-Study (tacrolimus organ perfusion) is a randomized multicenter trial comparing the ex vivo tacrolimus perfusion of marginal liver grafts with placebo. We hypothesize that a tacrolimus rinse reduces IRI, potentially improving organ survival following transplantation of EDC livers. The study includes livers with two or more EDC, according to Eurotransplant International Foundation's definition of EDC livers. Prior to implantation, livers randomized to the treatment group are rinsed with tacrolimus at a concentration of 20 ng/ml in 1000 ml Custodiol solution and in the placebo group with Custodiol alone. The primary endpoint is the maximum serum alanine transamninase (ALT) level within the first 48 hours after surgery; however, the study design also includes a 1-year observation period following transplantation. The TOP-Study is an investigator-initiated trial sponsored by the University of Munich Hospital. Seven other German transplant centers are participating (Berlin, Frankfurt, Heidelberg, Mainz, Münster, Regensburg, Tübingen) and aim to include a total of 86 patients.</p><p><strong>Discussion: </strong>Tacrolimus organ perfusion represents a promising strategy to reduce hepatic IRI following the transplantation of marginal liver grafts. This treatment may help to improve the function of EDC grafts and therefore safely expand the donor pool in light of critical organ shortage.</p><p><strong>Trial register: </strong>EudraCT number: 2010-021333-31, ClinicalTrials.gov identifier: NCT01564095.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2013-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31310181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the long term impact of kidney donation on life expectancy and end stage renal disease.","authors":"Bryce A Kiberd","doi":"10.1186/2047-1440-2-2","DOIUrl":"https://doi.org/10.1186/2047-1440-2-2","url":null,"abstract":"<p><strong>Unlabelled: </strong></p><p><strong>Background: </strong>Long term studies of live kidney donation do not show evidence of appreciable risks to the donor. However nephrectomy reduces total glomerular filtration rates (GFR) and is associated with increased rates of proteinuria and possibly hypertension. It is not clear to what extent these changes are associated with reduced life expectancy (LE) or increased risk of end stage renal disease (ESRD) since follow up is incomplete in most reports.</p><p><strong>Methods: </strong>In a computer simulation model based on a US population chronic kidney disease model, increased hazard rates for higher blood pressure, proteinuria and low GFR were applied to healthy individuals undergoing donor nephrectomy. Subsequent LE and cumulative risk of ESRD were calculated.</p><p><strong>Results: </strong>Kidney donation is projected to reduce LE by 0.83 years and increase the absolute cumulative risk of ESRD by 0.89% for a 40-year-old white male. White females were predicted to have slightly greater loss of life and less added ESRD risk. Conversely, Blacks have greater risks of ESRD after donation. Older donors with hypertension were predicted to lose less life years and lower cumulative ESRD risks than young donors. Despite these increased risks most donors will have better life expectancy and lower ESRD rates than the general population since they are a highly selected cohort.</p><p><strong>Conclusions: </strong>This study attempts to quantify increases in death and ESRD from donor nephrectomy assuming the risk factors of hypertension, low GFR and proteinuria have the same significance in this population as in the general population. Further study is required to better estimate the risks of donation and test whether these assumptions are valid.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2013-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31241960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of reduced dose cyclosporine and corticosteroids to reduce new onset diabetes mellitus and acute rejection in kidney transplant recipients.","authors":"Edward H Cole,&nbsp;G V Ramesh Prasad,&nbsp;Carl J Cardella,&nbsp;Joseph S Kim,&nbsp;Kathryn J Tinckam,&nbsp;Daniel C Cattran,&nbsp;Jeffrey R Schiff,&nbsp;David N Landsberg,&nbsp;Jeffrey S Zaltzman,&nbsp;John S Gill","doi":"10.1186/2047-1440-2-1","DOIUrl":"https://doi.org/10.1186/2047-1440-2-1","url":null,"abstract":"<p><strong>Background: </strong>New onset diabetes mellitus (NODM) and acute rejection (AR) are important causes of morbidity and risk factors for allograft failure after kidney transplantation.</p><p><strong>Methods: </strong>In this multi-center, open label, single-arm pilot study, 49 adult (≥18 years of age), low immunologic risk, non-diabetic recipients of a first deceased or living donor kidney transplant received early steroid reduction to 5 mg/day combined with Thymoglobulin® (Genzyme Transplant, Cambridge, MA, USA) induction, low dose cyclosporine (2-hour post-dose (C2) target of 600 to 800 ng/ml) and mycophenolic acid (MPA) therapy.</p><p><strong>Results: </strong>Six months after transplantation, two patients (4%) developed NODM and one patient (2%) developed AR. Four patients had impaired fasting glucose tolerance based on 75-g oral glucose tolerance testing (OGTT). There was one patient death. There were no episodes of cytomegalovirus (CMV) infection or BK virus nephritis. In contrast, in a historical cohort of n = 27 patients treated with Thymoglobulin induction, and conventional doses of cyclosporine and corticosteroids, the incidence of NODM and AR was 18% and 15%.</p><p><strong>Conclusions: </strong>The pilot study results suggest that Thymoglobulin induction combined with early steroid reduction, reduced cyclosporine exposure and MPA, may reduce the incidence of both NODM and AR in low immunological risk patients. A future controlled study enriched for patients at high risk for NODM is under consideration.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: http://NCT00706680.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"2 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2013-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31204012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to kidney transplantation: outcomes of the non-referred.","authors":"Meteb M Albugami,&nbsp;Romuald Panek,&nbsp;Steven Soroka,&nbsp;Karthik Tennankore,&nbsp;Bryce A Kiberd","doi":"10.1186/2047-1440-1-22","DOIUrl":"https://doi.org/10.1186/2047-1440-1-22","url":null,"abstract":"<p><strong>Unlabelled: </strong></p><p><strong>Background: </strong>There is a concern that some, especially older people, are not referred and could benefit from transplantation.</p><p><strong>Methods: </strong>We retrospectively examined consecutive incident end stage renal disease (ESRD) patients at our center from January 2006 to December 2009. At ESRD start, patients were classified into those with or without contraindications using Canadian eligibility criteria. Based on referral for transplantation, patients were grouped as CANDIDATE (no contraindication and referred), NEITHER (no contraindication and not referred) and CONTRAINDICATION. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden.</p><p><strong>Results: </strong>Of the 437 patients, 133 (30.4%) were CANDIDATE (mean age 50 and CCI 3.0), 59 (13.5%) were NEITHER (age 76 and CCI 4.4), and 245 (56.1%) were CONTRAINDICATION (age 65 and CCI 5.5). Age was the best discriminator between NEITHER and CANDIDATES (c-statistic 0.96, P <0.0001) with CCI being less discriminative (0.692, P <0.001). CANDIDATES had excellent survival whereas those patients designated NEITHER and CONTRAINDICATION had high mortality rates. NEITHER patients died or developed a contraindication at very high rates. By 1.5 years 50% of the NEITHER patients were no longer eligible for a transplant.</p><p><strong>Conclusions: </strong>There exists a relatively small population of incident patients not referred who have no contraindications. These are older patients with significant comorbidity who have a small window of opportunity for kidney transplantation.</p>","PeriodicalId":89864,"journal":{"name":"Transplantation research","volume":"1 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/2047-1440-1-22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31296439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}