Is it permissible for a child with neurodevelopmental disabilities to be a living donor transplant candidate, but not a deceased donor candidate? Should donor source influence transplant center deliberations?

2016 ◽  
Vol 21 (2) ◽  
pp. e12850 ◽  
Author(s):  
Aaron Wightman
Keyword(s):  
Living Donor ◽  
Deceased Donor ◽  
Neurodevelopmental Disabilities ◽  
Transplant Center ◽  
Transplant Candidate ◽  
Donor Transplant ◽  
Donor Source

scholarly journals COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Gaia Peluso ◽  
Silvia Campanile ◽  
Alessandro Scotti ◽  
Vincenzo Tammaro ◽  
Akbar Jamshidi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Viral Infections ◽  
Elective Surgery ◽  
Deceased Donor ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Transplant Center ◽  
Living Donor Transplantation ◽  
Donor Kidney Transplantation

Introduction. SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract. Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections. We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era. Patients and Methods. The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic. We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years. Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic. Results. From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors. The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic. All the transplanted patients remained COVID negative during the follow-up. The number of transplants performed has been constant compared to the same months of 2018 and 2019. In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy. Conclusion. Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities. Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients.

Association between Longer Travel Distance for Transplant Care and Access to Kidney Transplantation and Graft Survival in the United States

2021 ◽  
pp. ASN.2020081242
Author(s):  
Adrian M. Whelan ◽  
Kirsten L. Johansen ◽  
Sandeep Brar ◽  
Charles E. McCulloch ◽  
Deborah B. Adey ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Graft Failure ◽  
Living Donor ◽  
Deceased Donor ◽  
The United States ◽  
Travel Distance ◽  
Transplant Center ◽  
Living Donor Transplantation ◽  
Transplant Candidates

BackgroundTransplant candidates may gain an advantage by traveling to receive care at a transplant center that may have more favorable characteristics than their local center. Factors associated with longer travel distance for transplant care and whether the excess travel distance (ETD) is associated with access to transplantation or with graft failure are unknown.MethodsThis study of adults in the United States wait-listed for kidney transplantation in 1995–2015 used ETD, defined as distance a patient traveled beyond the nearest transplant center for initial waiting list registration. We used linear regression to examine patient and center characteristics associated with ETD and Fine–Gray models to examine the association between ETD (modeled as a spline) and time to deceased or living donor transplantation or graft failure.ResultsOf 373,365 patients, 11% had an ETD≥50 miles. Traveling excess distance was more likely among patients who were of non-Black race or those whose nearest transplant center had lower annual living donor transplant volume. At an ETD of 50 miles, we observed a lower likelihood of deceased donor transplantation (subhazard ratio [SHR], 0.85; 95% confidence interval [95% CI], 0.84 to 0.87) but higher likelihood of living donor transplantation (SHR, 1.14; 95% CI, 1.12 to 1.16) compared with those who received care at their nearest center. ETD was weakly associated with higher risk of graft failure.ConclusionsPatients who travel excess distances for transplant care have better access to living donor but not deceased donor transplantation and slightly higher risk of graft failure. Traveling excess distances is not clearly associated with better outcomes, especially if living donors are unavailable.

scholarly journals Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation

2018 ◽  
Vol 13 (10) ◽  
pp. 1550-1555 ◽  
Author(s):  
Catherine M. Sullivan ◽  
Kitty V. Barnswell ◽  
Kate Greenway ◽  
Cindy M. Kamps ◽  
Derrick Wilson ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Kidney Transplant ◽  
Living Donor ◽  
Waiting List ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Center ◽  
And Control ◽  
Trial Intervention ◽  
Donor Transplant

Background and objectivesMany patients with ESKD face barriers in completing the steps required to obtain a transplant. These eight sequential steps are medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on helping patients complete these steps.Design, setting, participants, & measurementsOur study was a cluster randomized, controlled trial involving 40 hemodialysis facilities and four transplant centers in Ohio, Kentucky, and Indiana from January 1, 2014 to December 31, 2016. Four trained kidney transplant recipients met regularly with patients on hemodialysis at 20 intervention facilities, determined their step in the transplant process, and provided tailored information and assistance in completing that step and subsequent steps. Patients at 20 control facilities continued to receive usual care. Primary study outcomes were waiting list placement and receipt of a deceased or living donor transplant. An exploratory outcome was first visit to a transplant center.ResultsBefore the trial, intervention (1041 patients) and control (836 patients) groups were similar in the proportions of patients who made a first visit to a transplant center, were placed on a waiting list, and received a deceased or living donor transplant. At the end of the trial, intervention and control groups were also similar in first visit (16.1% versus 13.8%; difference, 2.3%; 95% confidence interval, −0.8% to 5.5%), waitlisting (16.3% versus 13.8%; difference, 2.5%; 95% confidence interval, −1.2% to 6.1%), deceased donor transplantation (2.8% versus 2.2%; difference, 0.6%; 95% confidence interval, −0.8% to 2.1%), and living donor transplantation (1.2% versus 1.0%; difference, 0.1%; 95% confidence interval, −0.9% to 1.1%).ConclusionsUse of trained kidney transplant recipients as navigators did not increase first visits to a transplant center, waiting list placement, and receipt of deceased or living donor transplants.

Laparoscopic Donor Nephrectomy at a Low Volume Living Donor Transplant Center: Successful Outcomes can be Expected

2003 ◽  
Vol 170 (3) ◽  
pp. 731-733 ◽  
Author(s):  
DAVID A. DUCHENE ◽  
D. BROOKE JOHNSON ◽  
SHUJUN LI ◽  
JAY S. RODEN ◽  
ARTHUR I. SAGALOWSKY ◽  
...  
Keyword(s):  
Living Donor ◽  
Donor Nephrectomy ◽  
Laparoscopic Donor Nephrectomy ◽  
Transplant Center ◽  
Low Volume ◽  
Successful Outcomes ◽  
Donor Transplant

scholarly journals Social Determinants of Health and Race Disparities in Kidney Transplant

2021 ◽  
Vol 16 (2) ◽  
pp. 262-274 ◽  
Author(s):  
Hannah Wesselman ◽  
Christopher Graham Ford ◽  
Yuridia Leyva ◽  
Xingyuan Li ◽  
Chung-Chou H. Chang ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Social Determinants Of Health ◽  
Kidney Transplant ◽  
Social Determinants ◽  
Living Donor ◽  
Deceased Donor ◽  
Determinants Of Health ◽  
Lower Probability ◽  
Subdistribution Hazard ◽  
Donor Transplant

Background and objectivesBlack patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation.Design, setting, participants, & measurementsVia medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010–2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome.ResultsEven after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant.ConclusionsRace and social determinants of health are associated with the likelihood of undergoing kidney transplant.

scholarly journals Prediction model for early graft failure after liver transplantation using aspartate aminotransferase, total bilirubin and coagulation factor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinsoo Rhu ◽  
Jong Man Kim ◽  
Kyunga Kim ◽  
Heejin Yoo ◽  
Gyu-Seong Choi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Prediction Model ◽  
Aspartate Aminotransferase ◽  
Graft Failure ◽  
Living Donor ◽  
Total Bilirubin ◽  
Deceased Donor ◽  
Time Dependent ◽  
Early Graft ◽  
Early Graft Failure

AbstractThis study was designed to build models predicting early graft failure after liver transplantation. Cox regression model for predicting early graft failure after liver transplantation using post-transplantation aspartate aminotransferase, total bilirubin, and international normalized ratio of prothrombin time was constructed based on data from both living donor (n = 1153) and deceased donor (n = 359) liver transplantation performed during 2004 to 2018. The model was compared with Model for Early Allograft Function Scoring (MEAF) and early allograft dysfunction (EAD) with their C-index and time-dependent area-under-curve (AUC). The C-index of the model for living donor (0.73, CI = 0.67–0.79) was significantly higher compared to those of both MEAF (0.69, P = 0.03) and EAD (0.66, P = 0.001) while C-index for deceased donor (0.74, CI = 0.65–0.83) was only significantly higher compared to C-index of EAD. (0.66, P = 0.002) Time-dependent AUC at 2 weeks of living donor (0.96, CI = 0.91–1.00) and deceased donor (0.98, CI = 0.96–1.00) were significantly higher compared to those of EAD. (both 0.83, P < 0.001 for living donor and deceased donor) Time-dependent AUC at 4 weeks of living donor (0.93, CI = 0.86–0.99) was significantly higher compared to those of both MEAF (0.87, P = 0.02) and EAD. (0.84, P = 0.02) Time-dependent AUC at 4 weeks of deceased donor (0.94, CI = 0.89–1.00) was significantly higher compared to both MEAF (0.82, P = 0.02) and EAD. (0.81, P < 0.001). The prediction model for early graft failure after liver transplantation showed high predictability and validity with higher predictability compared to traditional models for both living donor and deceased donor liver transplantation.

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