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Organ Type (organ + type)
Selected AbstractsPredictors of length of stay for pediatric liver transplant recipientsLIVER TRANSPLANTATION, Issue 8 2004John C. Bucuvalas The resources that are directed towards the care of liver transplant recipients are substantial. Approximately 100 million dollars are spent on the hospitalization of the 400,500 children in the United States who undergo liver transplantation each year. Using length of stay as a surrogate marker for hospital resource use, we sought to identify factors that impact length of stay and assess the trends of hospitalization after liver transplantation for a representative population of pediatric liver transplant recipients. The study population was comprised of 956 patients who underwent primary liver transplantation between 1995 and 2003 and survived at least 90 days. Data were retrieved from the Studies of Pediatric Liver Transplantation data registry. The primary outcome was the length of initial hospitalization after liver transplantation. Independent variables were age, gender, race, pediatric end-stage liver disease score (PELD), year of transplantation, organ type, primary disease, length of operation, and insurance status. The mean and standard deviation of length of stay after liver transplantation was 24.0 ± 24.5 days. Multivariate analyses showed that increased hospital stay was associated with infants less than 1 year of age, fulminant liver failure, receiving a technical variant organ from a cadaveric donor, government insurance, and transplant era (before 1999 vs. 1999 or later). Decreasing height z-scores and increasing length of operation were also associated with increased hospital stay. In conclusion, these parameters accounted for only 11% of the total variance, suggesting that post-transplant complications and course account for much of the variability of resource use in the immediate post-transplant period. (Liver Transpl 2004;10:1011,1017.) [source] Optimizing the use of donated cadaver livers: Analysis and policy development to increase the application of split-liver transplantationLIVER TRANSPLANTATION, Issue 10 2002Jean C. Emond MD The American Society of Transplant Surgeons and the American Society of Transplantation jointly sponsored a conference in Crystal City, Virginia, on March 28th and 29th, 2001, to explore mechanisms for maximizing the cadaver-organ donor pool. Participants from transplantation medicine, surgery, organ procurement organizations, the general public, and government convened to address expanding utilization of each organ type. The committee assigned to review liver organ utilization identified multiple practices that could expand the potential donor pool including non,heart beating donors, marginal grafts, efficient allocation of cadaver organs, and wider application of split-liver transplantation. This article details the data reviewed by the liver committee and their recommendations on policy development for the expanded application of split-liver transplantation. [source] Respiratory syncytial virus prophylaxis: A survey of pediatric solid organ transplant centersPEDIATRIC TRANSPLANTATION, Issue 4 2009Marian G. Michaels Abstract:, RSV can cause respiratory illness after SOT, yet preventive recommendations are lacking for this population. To ascertain current preventive practices against RSV disease in pediatric SOT candidates and recipients, a survey was developed. The survey was mailed to 108 SOT programs in the United States (liver, 42; heart, 28; lung, 11; intestinal, 25; and heart-lung, 2). Results were tabulated and analyzed using standard methods. Sixty-two percent (67/108) of surveys were completed. Forty-nine percent (33/67) of programs reported using RSV prophylaxis; palivizumab was used at 97% (32/33) of centers with 26 giving palivizumab to candidates and 27 to recipients. Prophylaxis was provided to infants aged 0,12 months by 27/29 (93%) of responding centers; 23/29 of centers extended its use to infants aged 0,24 months. Three centers gave prophylaxis to children between ages two and four yr and two centers for those over four yr. RSV prophylactic strategies, and in particular the use of palivizumab, are employed by almost 50% of responding pediatric SOT centers. Strategies varied at centers based on age and organ type. Data on RSV hospitalization and outcome are needed to refine approaches to RSV immunoprophylaxis in these high-risk patients. [source] Functional analysis and expression characteristics of chloroplastic Prx IIEPHYSIOLOGIA PLANTARUM, Issue 3 2008Filipe Gama Peroxiredoxins (Prxs) are ubiquitous thiol-dependent peroxidases capable of eliminating a variety of peroxides through reactive catalytic cysteines, which are regenerated by reducing systems. Based on amino acid sequences and their mode of catalysis, five groups of thiol peroxidases have been distinguished in plants, and type II Prx is one of them with representatives in many sub-cellular compartments. The mature form of poplar chloroplastic Prx IIE was expressed as a recombinant protein in Escherichia coli. The protein is able to reduce H2O2 and tert-butyl hydroperoxide and is regenerated by both glutaredoxin (Grx) and thioredoxin (Trx) systems. Nevertheless, compared with Trxs, Grxs, and more especially chloroplastic Grx S12, are far more efficient reductants towards Prx IIE. The expression of Prx IIE at both the mRNA and protein levels as a function of organ type and abiotic stress conditions was investigated. Western blot analysis revealed that Prx IIE gene is constitutively expressed in Arabidopsis thaliana, mostly in young and mature leaves and in flowers. Under photo-oxidative treatment and water deficit, almost no change was observed in the abundance of Prx IIE in A. thaliana, while the level of Prx Q (one of the two other chloroplastic Prxs with 2-Cys Prx) increased in response to both stresses, indicating that plastidic members of the Prx family exhibit specific patterns of expression under stress. [source] Access and Outcomes Among Minority Transplant Patients, 1999,2008, with a Focus on Determinants of Kidney Graft SurvivalAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010P.-Y. Fan Coincident with an increasing national interest in equitable health care, a number of studies have described disparities in access to solid organ transplantation for minority patients. In contrast, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations. In this paper, we review trends in access to solid organ transplantation and posttransplant outcomes by organ type, race and ethnicity. In addition, we present an analysis of categories of factors that contribute to the racial/ethnic variation seen in kidney transplant outcomes. Disparities in minority access to transplantation among wait-listed candidates are improving, but persist for those awaiting kidney, simultaneous kidney and pancreas and intestine transplantation. In general, graft and patient survival among recipients of solid organ transplants is highest for Asians and Hispanic/Latinos, intermediate for whites and lowest for African Americans. Although much of the difference in outcomes between racial/ethnic groups can be accounted for by adjusting for patient characteristics, important observed differences remain. Age and duration of pretransplant dialysis exposure emerge as the most important determinants of survival in an investigation of the relative impact of center-related versus patient-related variables on kidney graft outcomes. [source] Provider Utilization of High-Risk Donor Organs and Nucleic Acid Testing: Results of Two National SurveysAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009L. M. Kucirka Fears of infectious transmission from CDC high-risk donors (HRDs) remain a significant disincentive, and the potential for human immunodeficiency virus/hepatitis C virus (HIV/HCV) nucleic acid testing (NAT) to allay these fears remains unstudied. We hypothesized that NAT, which narrows the window period between infection and detectability compared to the standard ELISA, might lead to increased provider willingness to use HRDs. Between January and April 2008, we performed two national surveys: one of current NAT practice among organ procurement organizations (OPOs); a second of HRD use among transplant surgeons. Surgeons who reported accepting 10% or more offers for a given HRD behavior and organ type were classified as ,high utilizers' of that subgroup. We built hierarchical models to examine associations between OPO NAT performance and provider utilization. Providers who ranked medical risks of HIV or HCV as important disincentives to HRD use had significantly lower odds of being high utilizers (HIV odds ratio 0.22, HCV odds ratio 0.41, p < 0.005). Furthermore, both HIV and HCV NAT performance were associated with significantly higher odds of being high utilizers (HIV odds ratio 1.58, HCV 2.69, p < 0.005). The demonstrated associations between OPO NAT performance and high provider utilization of HRDs should be considered in the ongoing debate about NAT in transplantation. [source] | ||||||||||