Clinical transplantation
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Clinical transplantation · Aug 1997
Risk factors for prolonged hospitalization after kidney transplants.
A major variable in the cost of kidney transplants is the length of initial hospitalization. Using multivariate analysis, we studied risk factors for hospital stay > 10 d post-transplant. Between 1 January 1985 and 31 August 1995 a total of 1588 patients underwent first or second kidney transplants at the University of Minnesota. ⋯ For living donor recipients, risk factors were recipient age < 18 yr (p = 0.01), donor age > 50 yr (p = 0.03), female sex (p = 0.05), pretransplant respiratory disease (p = 0.1), pretransplant peripheral vascular disease (p = 0.05), and recipient weight > 90 kg (p = 0.1). From our data, a profile emerged of recipients likely to have a longer hospital stay. Important variables, either simultaneous with or related to DGF, include donor and recipient age, diabetes, pretransplant recipient weight, PRA at transplant, preservation time, and pretransplant respiratory or peripheral vascular disease.
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One of the ways to fight the growing organ shortage in transplantation is by procuring organs from non-heart-beating (NHB) donors. In order to determine the NHB kidney donor pool and evaluate its significance for renal transplantation, the potential is estimated in this study by retrospective death chart review. All 200 in-hospital deaths aged 3-65 yr reported at the University Hospital Maastricht in 1994, including 25 deaths at the Emergency Department (ED), were analyzed. ⋯ This estimate shows that the potential of NHB kidney donors is large, and its impact on organ shortage would be considerable. Since 68% of potential NHB kidney donors, and also 70% of the medically most suitable donors, were found in ED, ICU, and CCU, focusing on these hospital units for implementation of routine procurement of kidneys from NHB donors is probably most effective. We therefore plead for the introduction of NHB kidney procurement protocols in EDs, ICUs, and CCUs.
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Clinical transplantation · Apr 1997
Intensive care unit management in liver transplant recipients: beneficial effect on survival and preservation of quality of life.
Determinants of outcome of intensive care unit (ICU) stay and quality of life in survivors was prospectively assessed in 50 consecutive liver transplant recipients requiring intensive care unit (ICU) management. Variables assessed included demographic, clinical and laboratory characteristics, measures of severity of illness (Child-Pugh, Apache II, and organ system failure scores) and quality of life measures (physical functioning, perceived quality of life, stress, depression, and adaptive coping). Overall ICU survival was 82% (41/50). ⋯ There was no difference in post-discharge quality of life (as assessed by the perceived quality of life, stress, depression, and coping scores) in survivors of ICU stay as compared with patients who never required ICU care. Our study suggests that the ICU management can have a positive impact on outcome for liver transplant recipients. If they survive (and 82% did in this study), their quality of life is unaffected and as good as those whose postoperative course was not complicated by a critical illness requiring ICU care.
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Clinical transplantation · Feb 1997
Rescuing Prometheus: a policy proposal to alleviate excess demand for liver transplantation.
A growing demand for liver transplantation coupled with a static supply of organs results in an excess demand crisis. Excess demand for liver transplantation equals the number of patients left on the UNOS waiting list at the end of the year who have not expired, undergone transplant, or been withdrawn. ⋯ A cohesive rationing policy should manage both the demand for transplantation and the supply of transplantable organs. Demand-side management as applied to liver transplantation could decrease the incidence of critically ill patients waiting for transplants, the number of retransplants performed and the total cost of transplantation to the health care system.
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Clinical transplantation · Dec 1996
Comparative StudyDisproportionate HLA matching may contribute to racial disparity in patient survival following cardiac transplantation.
The purpose of this study is to investigate the impact of recipient race as well as HLA matching upon long-term survival following heart transplantation (HTx). The study also determines whether the degree of HLA matching between Caucasians and African Americans differs. This study was a retrospective analysis of 336 males (77% Caucasians and 23% African Americans) transplanted between 1983 and 1994, all having received cyclosporine-based immunosuppression. ⋯ African Americans showed a similar trend, although statistical significance was not reached. When comparing equivalent degrees of matching, African Americans had inferior survival rate when poorly matched for Class I relative to Caucasians. No statistical difference was observed for moderate matched Class I or for Class II analysis.