查看更多>>摘要：Background. This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. Materials and Methods. A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. Results. Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. Conclusion. Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.
查看更多>>摘要：Background and aim. The most important factors affecting organ donation are socioeconomic, educational, and cultural factors. The aim of this study was to evaluate the attitudes, knowledge levels, and behaviors of school teachers toward organ donation Methods. This study surveyed 2400 school teachers working in official public schools. Turkey was divided into 26 regions based on the similarity of social, economic, and geographic factors identified by the Turkish Statistical Institute. Teachers were distributed equally in the city center and towns based on population. The survey procedures were carried out using computer-assisted personal interviewing. Results. Among teachers, 89.6% had a bachelor's degree and 8.5% had a master's degree. In addition, 32.5% worked in primary schools, 33.1% worked in secondary schools, and 34.4% worked in high schools. Furthermore, 0.7% had donated an organ; 66.5% were not considering organ donation in the future, of whom 9.0% indicated religion as the reason for not donating an organ, and 34.8% did not indicate any reason. In addition, 96.6% considered organ donation to be proper behavior for humanity and 68% believed that organ donation is appropriate in religious terms. Conclusions. This study showed that school teachers have inadequate knowledge and attitudes toward organ donation. Encouraging children and adolescents to make a well-informed decision about organ donation and to register this choice will depend largely on preparing school teachers with adequate knowledge and motivation toward creating generations with a positive attitude toward organ donation.
查看更多>>摘要：Background. Unspecified kidney donation (UKD) refers to transplantation from donors unrelated and unknown to the recipient. UKD has contributed to the expansion of the live donor pool in several countries. The United Kingdom Transplant Community has set maximizing UKDs as a priority. The Internet raises awareness and potentially influences the decision-making regarding UKD. This is the first study assessing the quality and readability of online material on UKD. Materials and Methods. Google was searched for the terms "kidney donation" and one of "unspecified," "altruistic," "non-directed," "anonymous," or "good Samaritan," as well as "giving or donating a kidney to a stranger." Two independent assessors reviewed the top 100 websites. Quality was assessed using the Journal of the American Medical Association criteria, the DISCERN instrument and Health On the Net Code certification. Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG), and Simple Measure of Gobble-dygook (SMOG) scores. Results. Only 6% of websites displayed HONcode certification. The mean (+/- SD) JAMA and DISCERN scores of 1.96 (+/- 1.00) and 32.34 (+/- 11.19) indicate poor quality. The mean (+/- SD) FRE, FKG, and SMOG scores of 52.92 (+/- 13.62), 10.60 (+/- 2.72), and 9.64 (+/- 2.22) reveal poor readability. The difference in JAMA and DISCERN scores according to website classification was significant (P < .001, P = .014) with websites from medical, nonprofit, and governmental organizations scoring amongst the lowest, while comprising most search results (61%). Conclusions. Transplant centers and medical organizations should prioritize improving their online resources to lower the risk of individuals pursuing UKD based on unrealistic expectations or being discouraged unjustly.
Kamble, ShanmukhSastre, Maria Teresa MunozKpanake, LonzozouSorum, Paul Clay...
6页
查看更多>>摘要：Background. The large unmet need in India for organs to transplant calls for an increase in living organ donations. This study examined the positions of Indian university students on making a living organ donation. Methods. A convenience sample of 339 students from Karnatak University rated willingness to be a living donor in 48 scenarios consisting of all combinations of 5 factors: recipient's identity (close family member vs stranger), level of surgical risk for the donor, possible long-term health consequences for the donor, probability of transplant success, and likelihood of finding other donors (the subject is one of the rare compatible donors or one donor among others). Results. Cluster analyses showed the existence of 4 qualitatively distinct positions called non-donors (9%); family donors (21%), for whom willingness was very high when recipients were family members and very low when they were strangers; universal donors (30%), for whom willingness was also quite high when a stranger was involved; and conditional donors (23%), who took a risk-benefit perspective. Conclusions. These finding suggest that the fundamental reason for the current shortage of organs in India is neither psychological nor cultural but more likely organizational.
查看更多>>摘要：Background. In Poland, 95% of organs for transplantation come from donation after brain death (DBD). In 2010, Poland officially joined the European countries in which donation after circulatory death is accepted by law. Currently, the Pomeranian Medical University Transplant Center is the only active location for uncontrolled donation after circulatory death (uDCD) in Poland. To estimate the results of uDCD kidney transplantation with a classical approach to organ recovery, we analyzed data from an early phase of uDCD program. Methods. Prospective observation of uDCD kidney allografts (group 1; n = 8) compared with DBD kidney allografts (group 2; n = 30). The organ recovery protocol was set up on rapid abdominal access without regional perfusion before procurement. Results. The organs recovered from uDCD during a 24-month period increased the volume of kidneys transplanted at the center by 9.2%. Delayed graft function was diagnosed in 100% vs 46% of allografts (P = .03), respectively. Nevertheless, early posttransplant follow-up did not reveal any graft loss or recipient death cases in the DCD group. After 12 months of follow-up, the mean glomerular filtration rate was 44.5 vs 57.9 mL/min (P < .02), respectively. Crucial factors for acceptable results of uDCD are strict pretransplant assessment of recovered organs and efficient coordination of the transplant team. Conclusions. Conservative recovery protocol in uDCD under strict prerequisites is feasible to consider in the organ procurement pathway. Preliminary results provide space for an increase in the organ donor pool.
查看更多>>摘要：Background. Liver normothermic machine perfusion (NMP) is being adopted as a method of optimizing livers before transplantation. However, there is further potential to use the NMP model as a platform for drug delivery. Pregnane X receptor (PXR) activation upregulates CYP3A expression and has been shown to be protective against ischemia-reperfusion in rodents. We introduced a PXR activator during NMP and assessed activation of its downstream targets. Methods and Materials. Organs were perfused on a NMP circuit using an oxygenated red cell-based perfusate. A series of livers were allocated to PXR treatment and compared with a control group. Biopsies were taken at the start and end of the perfusion process to quantify CYP3A expression. Perfusion samples were taken throughout the perfusion process and used to measure biochemical variables (lactate and alanine transaminase). Results. Quantification polymerase chain reaction using the delta computed tomography method on 5 livers which received Avasimibe demonstrated successful upregulation of CYP3A43 and CYP3A4 over the course of perfusion by 3.8-fold and 2.2-fold, respectively (P = .026 and P = .098, respectively; Student t test). The 4 control livers had no significant change in expression of CYP3A43 or CYP3A over the course of perfusion. Conclusions. We have demonstrated that NMP can be successfully used as a platform for drug delivery with reliable transcription activation of downstream targets. Although it remains to be seen whether PXR therapy is beneficial in humans, the model suggests that perfusion could be used clinically in the future to further optimize grafts by acting as a drug delivery system.
查看更多>>摘要：Background. Diarrhea among recipients of solid organ transplants is a commonly encountered problem and is often multifactorial in etiology. Owing to the combination of perioperative antibiotic administration and the immunosuppressed status of transplant recipients, a high degree of suspicion for Clostridioides difficile (C. difficile) colitis is prudent. The purpose of this study is to demonstrate the association of an institutional integrated stewardship program with C. difficile testing practices after abdominal solid organ transplantation. Methods. Starting in July 2017, a diagnostic stewardship was enacted in our institution requiring the ordering provider to answer a series of questions within the electronic medical record before ordering a C. difficile toxin test. The charts were reviewed for all solid organ transplant recipients on whom a test was ordered between January 2016 and September 2019. Results. Orders for C. difficile toxin per quarter significantly decreased in the postintervention era (18 vs 8.5, P = .038). Median cost of inpatient treatment and days of therapy per thousand patient days was significantly lower in the postintervention era (median cost, $2,944.55 vs $416.92; P = .01) (days of therapy per thousand patient days, 521.9 vs 300.5; P < .01). Quarterly rates of negative tests were similar between the pre- and postintervention eras (65% vs 73%, P = .38). Conclusions. Although no orders were blocked based on the responses, this multilevel intervention was associated with a 47% decrease in C. difficile testing without effecting the rate of negative testing. These results suggest that we have achieved significant cost savings, in testing and isolation, without sacrificing critical aspects of clinical care.
Wang, RebeccaLongworth, Sarah A.Doyon, Jeffrey B.Lee, Ingi...
5页
查看更多>>摘要：Active tuberculosis (TB) in solid organ transplant (SOT) recipients most commonly occurs due to reactivation of latent infection and is associated with poor clinical outcomes, including allograft loss and death. National transplant societies, including the American Society of Transplantation, recommend screening for latent TB prior to transplant, with treatment in the peritransplant setting to reduce the subsequent risk of TB reactivation. Though screening is traditionally conducted using laboratory-based assays, such as the QuantiFERON-TB Gold, false negatives may occur in SOT candidates due to anergy from end-stage organ dysfunction, highlighting the need for a multimodal diagnostic approach. In this case series, we describe the clinical characteristics and outcomes of 3 SOT recipients at the University of Pennsylvania with negative pretransplant QuantiFERON-TB Gold testing who subsequently developed active TB in the posttransplant setting, contributing to a growing body of knowledge regarding this challenging population. Each patient experienced a complicated clinical course that arose in part from the lack of diagnosis of TB prior to transplant. Because all had epidemiologic risk factors for TB, the findings of our study highlight the need for more individualized approaches to pretransplant TB screening.
查看更多>>摘要：Background. Preemptive kidney transplant (PKT) is recognized as the most beneficial and cost-effective form of renal replacement therapy among patients with end-stage renal disease. Despite optimal outcomes and improved quality of life associated with PKT, its use as a first renal replacement therapy remains low among patients with end-stage renal disease. The goal of this retrospective cohort study was to compare, among adult kidney transplant recipients, characteristics across PKT status. Methods. We compared the characteristics of patients who did and did not have a PKT over 5 years, from 2010 to 2014, using the electronic health records ofKaiser PermanenteMid-Atlantic States. Results. A total of 233 patients received a kidney-alone transplant, and, of these, 44 patients (19%) were PKT and 189 patients (81%) were non-PKT. Of the patients in the PKT group, 43% received a kidney from a deceased donor. PKT recipients were more often White, had polycystic kidney disease or glomerulonephritis, received a living donor organ, and were transplanted at certain transplant centers. Estimated glomerular filtration rate on listing for those who received a deceased donor transplant was higher in PKT than non-PKT patients listed pre-dialysis. Conclusions. PKT was associated with having a living kidney donor and with having a higher estimated glomerular filtration rate at listing for deceased donor recipients.
NSTL
Elsevier