Bartlettvinson8139

Expansion of lost wages reimbursement programs to all donors in the US would be an important step towards achieving financial neutrality for this unique population, and could also help meet the growing demand for transplantable organs by increasing living donation rates.

Expansion of lost wages reimbursement programs to all donors in the US would be an important step towards achieving financial neutrality for this unique population, and could also help meet the growing demand for transplantable organs by increasing living donation rates.

Delayed graft function (DGF) of a kidney transplant results in increased cost and complexity of management. For clinical care or a DGF trial, it would be ideal to accurately predict individual DGF risk and provide preemptive treatment. A calculator developed by Irish et al has been useful for predicting population, but not individual risk.

We analyzed the Irish calculator (IC) in the DeKAF prospective cohort (incidence of DGF= 20.4%) and investigated potential improvements.

We found that the predictive performance of the calculator in those meeting Irish inclusion criteria was comparable to that reported by Irish et. al. For cohorts excluded by Irish a) in pump-perfused kidneys the IC over-estimated DGF risk; b) in simultaneous pancreas kidney (SPK) transplants, the DGF risk was exceptionally low. For all 3 cohorts, there was considerable overlap in IC scores between those with and those without DGF. Using a modified definition of DGF - excluding those with a single dialysis in the first 24 hours posttransplant - we found that the calculator had similar performance as with the traditional DGF definition. Studying whether DGF prediction could be improved, we found that recipient cardiovascular disease was strongly associated with DGF even after accounting for IC predicted risk.

The IC can be a useful population guide for predicting DGF in the population for which it was intended, but has limited scope in expanded populations (SPK, pump) and for individual risk prediction. DGF risk prediction can be improved by inclusion of recipient cardiovascular disease.

The IC can be a useful population guide for predicting DGF in the population for which it was intended, but has limited scope in expanded populations (SPK, pump) and for individual risk prediction. DGF risk prediction can be improved by inclusion of recipient cardiovascular disease.

The evaluation of renal function changes over time is crucial in day-to-day renal transplant care and a major outcome in clinical trials. Little is known about the reliability of estimated glomerular filtration rate (eGFR) in reflecting real GFR changes.

We analyzed the variability of eGFR slope by 63 equations in estimating measured GFR (mGFR) changes in 110 renal transplant patients. The agreement between eGFR and mGFR slopes was evaluated by the concordance correlation coefficient (CCC) and the limits of agreement (LA). Cyclopamine chemical structure Patients were grouped based on mGFR slope in rapid GFR loss faster than -3 ml/min/year; stable renal function -3 to +3 ml/min/year; and improvement in GFR higher than +3 ml/min/year.

CCC averaged 0.36 and LA ±10 ml/min/year, indicating very poor agreement between eGFR and mGFR slopes. eGFR slope classified patients into the same group of mGFR slope only in 25% of the cases. In about two thirds of patients, eGFR slope was either markedly faster or slower than mGFR slope. In half of these cases the discrepancy between mGFR and eGFR slopes was ≥50%.

Formulas are neither accurate nor precise in reflecting real GFR decline in renal transplant patients, making them unreliable for clinical practice and trials.

Formulas are neither accurate nor precise in reflecting real GFR decline in renal transplant patients, making them unreliable for clinical practice and trials.

Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) are noninvasive surrogates for hepatic steatosis and fibrosis, respectively, and could help identify extended criteria donors in liver transplantation (LT). We aimed to determine the accuracy of CAP/LSM in deceased donors along with post-LT changes.

Accuracy of preprocurement CAP/LSM to grade/stage steatosis/fibrosis was determined using liver biopsy as reference. Transplant outcomes, including primary nonfunction (PNF) and early allograft dysfunction (EAD), were recorded. Recipients underwent CAP/LSM as outpatients. Areas under the receiver operating characteristic curve (AUROC) and regression models were constructed to analyze data.

We prospectively evaluated 160 allografts (138 transplanted). Same-probe paired baseline/post-LT CAP was 231 dB/m (181-277) / 225 (187-261) (p=0.61), and LSM 7.6 kPa (6.3-10.8) / 5.9 (4.6-8.7) (p=0.002), respectively. CAP reading was affected by BMI and LSM by ALT, race and bilirubin. Although CAP did not correlate with steatosis from frozen sections (rho=0.08; p=0.47), it correlated with steatosis from permanent sections (rho=0.32; p<0.001) and with oil red O histomorphometry (rho=0.35, p=0.001). CAP identified moderate-to-severe steatosis with an AUROC curve of 0.79 (0.66-0.91), for a negative predictive value of 100% at a cutoff value of 230 dB/m. LSM correlated with fibrosis staging (rho=0.22, p=0.007) and it identified discarded allografts with advanced fibrosis/cirrhosis. Patients with no to minimal fibrosis had an LSM of 7.6 (6-10.1) kPa.

Our results are proof-of-concept of the utility of CAP/LSM during organ procurement. Establishing the precise role of these noninvasive tools in the organ allocation process mandates confirmatory studies.

Our results are proof-of-concept of the utility of CAP/LSM during organ procurement. Establishing the precise role of these noninvasive tools in the organ allocation process mandates confirmatory studies.Transplant candidates should undergo an assessment of their mental health, social support, lifestyle and behaviours. The primary aims of this 'psychosocial evaluation' are to ensure transplantation is of benefit to life expectancy and quality of life, and to allow optimisation of the candidate and transplant outcomes. The content of psychosocial evaluations is informed by evidence regarding pretransplant psychosocial predictors of transplant outcomes. This review summarises the current literature on pretransplant psychosocial predictors of transplant outcomes across differing solid-organ transplants, and discusses the limitations of existing research. Pretransplant depression, substance misuse, and nonadherence are associated with poorer post-transplant outcomes. Depression, smoking and high levels of prescription opioid use are associated with reduced post-transplant survival. Pretransplant nonadherence is associated with post-transplant rejection, and nonadherence may mediate the effects of other psychosocial variables such as substance misuse.