Preimplantation Histological Score Associates with 6-Month GFR in Recipients of Perfused, Older Kidney Grafts: Results from a Pilot Study

Nephron ◽  
2021 ◽  
pp. 1-13
Author(s):  
Camillo Carrara ◽  
Paolo Cravedi ◽  
Annalisa Perna ◽  
Francesco Peraro ◽  
Alessandro Villa ◽  
...  
Keyword(s):  
Pilot Study ◽  
Renal Perfusion ◽  
Histological Score ◽  
Renal Flow ◽  
Recipient Age ◽  
Deceased Donors ◽  
Pulsatile Perfusion ◽  
Histologic Changes ◽  
Iohexol Plasma Clearance ◽  
Selection Of

<b><i>Background:</i></b> Biopsy-guided selection of older kidneys safely expands the organ pool, and pretransplant perfusion improves the preservation of these fragile organs. Herein, we studied morphofunctional variables associated with graft outcomes in perfused, histologically evaluated older kidneys. <b><i>Methods:</i></b> This single-center prospective cohort pilot study evaluated the relationships between preimplantation histologic scores and renal perfusion parameters during hypothermic, pulsatile, machine perfusion (MP) and assessed whether these morphofunctional parameters associated with GFR (iohexol plasma clearance) at 6 months after transplantation in 20 consecutive consenting recipients of a biopsy-guided single or dual kidney transplant from &#x3e;60-year-old deceased donors. <b><i>Results:</i></b> The donor and recipient age was 70.4 ± 6.5 and 63.6 ± 7.9 years (<i>p</i> = 0.005), respectively. The kidney donor profile index (KDPI) was 93.3 ± 8.4% (&#x3e;80% in 19 cases), histologic score 4.4 ± 1.4, and median (IQR) cold ischemia time 19.8 (17.8–22.8 h; &#x3e;24 h in 5 cases). The 6-month GFR was 41.2 (34.9–55.7) mL/min. Vascular resistances positively correlated with global histologic score (<i>p</i> = 0.018) at MP start and then decreased from 0.88 ± 0.43 to 0.36 ± 0.13 mm Hg/mL/min (<i>p</i> &#x3c; 0.001) in parallel with a three-fold renal flow increase from 24.0 ± 14.7 to 74.7 ± 31.8 mL/min (<i>p</i> &#x3c; 0.001). Consistently, vascular resistance reductions positively correlated with global histologic score (<i>p</i> = 0.009, <i>r</i> = −0.429). Unlike KDPI or vascular resistances, histologic score was independently associated with 6-month GFR (beta standardized coefficient: −0.894, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> MP safely improves graft perfusion, particularly in kidneys with severe histologic changes that would not be considered for transplantation because of high KDPI. The preimplantation histologic score associates with the functional recovery of older kidneys even in the context of a standardized program of pulsatile perfusion.

scholarly journals Potential for Aquifer Storage and Recovery (ASR) in South Bihar, India

2021 ◽  
Vol 13 (6) ◽  
pp. 3502
Author(s):  
Somnath Bandyopadhyay ◽  
Aviram Sharma ◽  
Satiprasad Sahoo ◽  
Kishore Dhavala ◽  
Prabhakar Sharma
Keyword(s):  
Pilot Study ◽  
Environmental Sustainability ◽  
Hard Rock ◽  
Climatic Conditions ◽  
Aquifer Storage And Recovery ◽  
Aquifer Recharge ◽  
Aquifer Storage ◽  
Cropping Season ◽  
Selection Of ◽  
Surface Technique

Among the several options of managed aquifer recharge (MAR) techniques, the aquifer storage and recovery (ASR) is a well-known sub-surface technique to replenish depleted aquifers, which is contingent upon the selection of appropriate sites. This paper explores the potential of ASR for groundwater recharge in the hydrological, hydrogeological, social, and economic context of South Bihar in India. Based on the water samples from more than 137 wells and socio-economic surveys, ASR installations were piloted through seven selected entrepreneurial farmers in two villages of South Bihar. The feasibility of ASR in both hard rock and deep alluvial aquifers was demonstrated for the prominent aquifer types in the marginal alluvial plains of South Bihar and elsewhere. It was postulated through this pilot study that a successful spread of ASR in South Bihar can augment usable water resources for agriculture during the winter cropping season. More importantly, ASR can adapt to local circumstances and challenges under changing climatic conditions. The flexible and participatory approach in this pilot study also allowed the farmers to creatively engage with the design and governance aspects of the recharge pit. The entrepreneurial farmers-led model builds local accountability, creates avenues for private investments, and opens up the space for continued innovation in technology and management, while also committing to resource distributive justice and environmental sustainability.

Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age

2020 ◽  
Vol 35 (4) ◽  
pp. 687-696
Author(s):  
Jimena Cabrera ◽  
Mario Fernández-Ruiz ◽  
Hernando Trujillo ◽  
Esther González ◽  
María Molina ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Cox Regression ◽  
Patient Survival ◽  
Incidence Rates ◽  
Allocation Policy ◽  
Recipient Age ◽  
Deceased Donors ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching. Methods We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression. Results We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040). Conclusions ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.

Gross and Histologic Changes in the Developing Rabbit Subglottis in Response to a Controlled Depth of Injury

2002 ◽  
Vol 127 (5) ◽  
pp. 442-447 ◽  
Author(s):  
Leila A. Mankarious ◽  
Shilpa R. Cherukupally ◽  
Allison B. Adams
Keyword(s):  
Pilot Study ◽  
Soft Tissues ◽  
Cricoid Cartilage ◽  
Fibrous Tissue ◽  
Biochemical Changes ◽  
Morphologic Change ◽  
Age Group ◽  
Prolonged Intubation ◽  
Structural Support ◽  
Histologic Changes

OBJECTIVE: Our goal was to determine the effects of both perichondrial and intracartilaginous injury in the developing rabbit subglottis versus normal development. DESIGN: We conducted a descriptive, pilot study of changes in the shape and histology of the subglottis after a controlled depth of injury in 27 New Zealand White rabbits, ages 4 weeks, 8 weeks, and 1 1/2 years. INTERVENTION: Within each age group, 3 animals underwent no surgery, 3 underwent perichondrial injury, and 3 underwent intracartilaginous injury. RESULTS: Perichondrially injured animals in the 4-week age group developed a marked abnormality in the shape of the cricoid cartilage in the injured region. Cartilage of the perichondriallly injured animals in the 8-week and 1 1/2-year groups became histologically consistent with fibrous tissue. The cartilage of all animals that underwent intracartilaginous injury was replaced with fibrous tissue. CONCLUSION: In this observational study, we identified 3 relevant findings. First, the responses of the cartilage to a perichondrial injury suggest that the luminal soft tissues may exert some morphologic control in developmentally young animals. Second, only the 4-week-old group's cartilage was tolerant of a perichondrial injury with continued growth of the ring. Third, no animal's cartilage could withstand an intracartilaginous injury regardless of age. Acquired or congenital cricoid cartilage abnormalities are a frequent source of airway distress in both pediatric and adult populations. Narrowing of the cricoid cartilage, as seen in subglottic stenosis (SGS), creates a significant increase in morbidity and mortality rates 1 with an array of surgical interventions described extensively in the otolaryngology literature. The acquired form of SGS usually is iatrogenic, resulting from prolonged intubation or surgical intervention. Few published reports exist describing the histologic changes associated with SGS. Of the published studies, the source of SGS appears to be both cartilage ring abnormalities and concomitant mucosal fibrosis. 2–5 Histologic examination of injured cricoid samples suggests that the abnormal cricoid growth and development may be due to a combination of (1) inflammation within the cartilage leading to loss of chondrocytes, (2) replacement of the cartilage with fibrosis leading to decreased cartilage extracellular matrix and loss of structural support, and/or (3) alterations in the shape of the ring. It is generally accepted that intubation is better tolerated in younger patients than in older patients. Premature infants can be intubated for up to 4 to 5 months, but adults can be intubated for a maximum of 2 to 3 weeks before an alternate airway is sought. However, no exact guidelines exist for the duration of intubation as a function of age. Even physicians who care for intubated patients disagree about when to consider tracheotomy. We began our series of experiments attempting to understand the biochemical changes that would explain the difference in tolerance to intubation and the mechanisms behind loss of the structural support of the cricoid ring. In preparing the experimental substrate for these studies, we identified an interesting age-dependent and depth of injury-dependent morphologic change in the rabbit subglottis that was not expected. Biochemical changes in the rabbit subglottis will follow in future reports; however, herein we report on the observed morphologic changes. Due to the limited number of animals in this study, the data presented represent a pilot study.

Prerecorded Instructions for Teaching Food Preparation Skills

1975 ◽  
Vol 69 (10) ◽  
pp. 457-460
Author(s):  
Gloria J. Fuller ◽  
Elizabeth Hillier ◽  
Florence Mckinney ◽  
Ruth Pestle
Keyword(s):  
Pilot Study ◽  
Food Preparation ◽  
Cassette Tape ◽  
Specific Skill ◽  
Selection Of ◽  
Blind Students

This article fully describes the selection of ingredient measurement as the specific skill to be taught, preparation of a script, pretesting, review by experts, recording on a cassette tape, and testing the tape with five blind students in a school for the blind. The result of this pilot study was that it was found that some blind students can indeed learn through the use of prerecorded instructions. Specific tips and recommendations for the preparation of prerecorded instructional tapes are presented.

USABILITY OF DIGITAL MEDIA IN PATIENTS WITH COPD: A PILOT STUDY

2013 ◽  
Vol 29 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Amy Cheung ◽  
Anton Janssen ◽  
Oliver Amft ◽  
Emiel F. M. Wouters ◽  
Martijn A. Spruit
Keyword(s):  
Pilot Study ◽  
Digital Media ◽  
Response Speed ◽  
Fast Response ◽  
Ease Of Use ◽  
Chronic Obstructive ◽  
Digital Medium ◽  
Obstructive Pulmonary Disease ◽  
Tele Monitoring ◽  
Selection Of

Background: Digital media can be integrated in tele-monitoring solutions, serving as the main interface between the patient and the caregiver. Consequently, the selection of the most appropriate digital medium for the specified target group is critical to ensure compliance with the tele-monitoring system.Objectives: This pilot study aims to gather insights from patients with chronic obstructive pulmonary disease (COPD) on the ease-of-use, efficacy, effectiveness, and satisfaction of different types of digital media.Methods: Five off-the-shelf digital media devices were tested on nine patients at CIRO+ in Horn, The Netherlands. Usability was evaluated by asking patients to use each device to answer questions related to their symptoms and health status. Subsequently, patients completed a paper-based device usability questionnaire, which assessed prior experience with digital media, device dimensions, device controllability, response speed, screen readability, ease-of-use, and overall satisfaction. After testing all the devices, patients ranked the devices according to their preference.Results: We identified the netbook as the preferred type of device due to its good controllability, fast response time, and large screen size. The smartphone was the least favorite device as patients found the size of the screen to be too small, which made it difficult to interact with.Conclusion: The pilot study has provided important insights to guide the selection of the most appropriate type of digital medium for implementation in tele-monitoring solutions for patients with COPD. As the digital medium is an important interface to the patient in tele-monitoring solutions, it is essential that patients feel motivated to interact with the digital medium on a regular basis.

Noninvasive assessment of liver steatosis in deceased donors: A pilot study

2018 ◽  
Vol 24 (4) ◽  
pp. 551-556 ◽  
Author(s):  
Manuela Cesaretti ◽  
Nicolas Poté ◽  
Francois Cauchy ◽  
Federica Dondero ◽  
Safi Dokmak ◽  
...  
Keyword(s):  
Pilot Study ◽  
Liver Steatosis ◽  
Deceased Donors ◽  
Noninvasive Assessment

Selection of CPAP Interface: A Pilot Study to Compare Initial Sleep Technologists' Recommendation of Interface With Patients' Preferred Choice After a Trial of the Interfaces

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 1060A
Author(s):  
Rui Ya Soh ◽  
Leong Chai Leow ◽  
Song Tar Toh ◽  
Hong Juan Han ◽  
Gan Liang Tan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Selection Of
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