AbstractBackgroundPancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age 50-60 years or BMI 30-34kg/m2).MethodsUtilization of EDC organs required the implementation of a new allocation system within Eurotransplant. The study was a prospective, multicenter, two-armed trial. The primary endpoint was pancreas function after 3 months. Rejection episodes, kidney function and waitlist time were secondary endpoints. Patients receiving an EDC organ were study-group patients; recipients of standard organs were control-group patients. Follow-up was 1 year.Results79 patients were included in 12 German centers; 18 received EDC organs and 61 received standard organs. Recipient demographics were similar. Mean EDC donor age was 51.4 ± 5 years versus 31.7 ± 12 in the control group. Insulin-free graft survival was 83.3% for EDC and 67.2% for standard organs (p=0.245) after 3 months. 1-year pancreas survival was 83.3% and 83.5% in the EDC versus standard group. 1-year kidney allograft survival was approximately 94% in both groups. Rejection episodes and morbidity were similar.ConclusionEXPAND shows in a prospective trial that selected EDC organs of donors aged >50 years can be used with outcomes similar to standard-criteria organs, therefore showing potential to reduce organ shortage and waiting times. This study substantiates the full implementation of EDC organs in a pancreas allocation system. Background Pancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age 50-60 years or BMI 30-34kg/m2). Methods Utilization of EDC organs required the implementation of a new allocation system within Eurotransplant. The study was a prospective, multicenter, two-armed trial. The primary endpoint was pancreas function after 3 months. Rejection episodes, kidney function and waitlist time were secondary endpoints. Patients receiving an EDC organ were study-group patients; recipients of standard organs were control-group patients. Follow-up was 1 year. Results 79 patients were included in 12 German centers; 18 received EDC organs and 61 received standard organs. Recipient demographics were similar. Mean EDC donor age was 51.4 ± 5 years versus 31.7 ± 12 in the control group. Insulin-free graft survival was 83.3% for EDC and 67.2% for standard organs (p=0.245) after 3 months. 1-year pancreas survival was 83.3% and 83.5% in the EDC versus standard group. 1-year kidney allograft survival was approximately 94% in both groups. Rejection episodes and morbidity were similar. Conclusion EXPAND shows in a prospective trial that selected EDC organs of donors aged >50 years can be used with outcomes similar to standard-criteria organs, therefore showing potential to reduce organ shortage and waiting times. This study substantiates the full implementation of EDC organs in a pancreas allocation system. Corresponding author: Dr. Andrea Proneth, University Hospital Freiburg, Department of Surgery, Hugstetter Str. 55, 79106 Freiburg, Germany, e-mail: andrea.proneth@uniklinik-freiburg.de Trial registration: Trial registered at http://ift.tt/PmpYKN NCT01384006 Competing interests: A.P.'s 1, 16 institution (University Hospital Regensburg) received a research grant from Astellas and Novartis to support the conduct of the trial. H.J.S has received lecture honoraria and reimbursement of travel expenses from Novartis, Astellas, Pfizer and Roche, and also receives research support from Pfizer and Novartis. S.A.F. has received lecture honoraria, reimbursement of travel expenses and receives research support from Novartis, Astellas, BMS and Roche. FR received travel grants and speaker's bureau from Novartis, Roche, Biotest and Astellas. All other authors declare that they have no competing interests. The study was sponsored by the University Hospital Regensburg and was supported by research grants from Astellas and Novartis. Authors' contributions: A.P.1, 16 and S.A.F initiated, designed and coordinated the study. A.P.1, 16 collected an interpreted data for analysis, managed medical monitoring and wrote the first manuscript draft. E.K.G. and R.V. were involved in designing the study and critical data interpretation and analysis. A.A.S was involved in launching and designing the study, as well as data collection and inclusion of study patients. R.V., P.S.3, A. W., H.A., S.M., S.N., M.H., M.A.S., B.B., P.S.11,15, T.B., W.O.B., A.P.13, F.R. and H.J.S. were involved in data collection and inclusion of study patients, local ethics approval and critical intellectual discussion of the manuscript. All authors reviewed and approved the manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2nLakyP
Αρχειοθήκη ιστολογίου
-
►
2023
(138)
- ► Φεβρουαρίου (74)
- ► Ιανουαρίου (64)
-
►
2022
(849)
- ► Δεκεμβρίου (61)
- ► Σεπτεμβρίου (74)
- ► Φεβρουαρίου (65)
-
►
2021
(2936)
- ► Δεκεμβρίου (59)
- ► Σεπτεμβρίου (180)
- ► Φεβρουαρίου (325)
-
►
2020
(1624)
- ► Δεκεμβρίου (293)
- ► Σεπτεμβρίου (234)
- ► Φεβρουαρίου (28)
-
►
2019
(13362)
- ► Δεκεμβρίου (19)
- ► Σεπτεμβρίου (54)
- ► Φεβρουαρίου (5586)
- ► Ιανουαρίου (5696)
-
▼
2018
(66471)
- ► Δεκεμβρίου (5242)
- ► Σεπτεμβρίου (5478)
-
▼
Φεβρουαρίου
(4835)
-
▼
Φεβ 06
(183)
- Issue Information
- Recent Progress of Nano-drug Delivery System for L...
- Tetrazole Derivatives as Promising Anticancer Agents
- Meet Our Editorial Board Member
- 1,3,4-Oxadiazoles as Telomerase Inhibitor: Potenti...
- Synthesis of New Antibacterial Cubane-based Nanoco...
- Excitons and Trions in One-Photon- and Two-Photon-...
- Stable and Efficient Organo-Metal Halide Hybrid Pe...
- Laser Irradiation of Metal Oxide Films and Nanostr...
- Progress toward Catalytic Micro- and Nanomotors fo...
- Near-Infrared Excitation/Emission and Multiphoton-...
- Anchoring and Upgrading Ultrafine NiPd on Room-Tem...
- Discontinuities and disruptions in drug dosage gui...
- Emergency department utilisation for inflammatory ...
- Review article: the evidence that vancomycin is a ...
- Letter to the editor concerning “Risk factors for ...
- Factors Influencing Survival following Hip Fractur...
- International survey among orthopaedic trauma surg...
- Risk of pharmacokinetic interactions between antie...
- Fibrosis in ulcerative colitis is directly linked ...
- Erratum
- Memory decline from hippocampal electrodes? Let's ...
- Epilepsia – February 2018 – Announcements
- Response: Memory decline from hippocampal electrod...
- Issue Information–ISSN page
- Effect of ultrahigh temperature treatment on quali...
- Moisture sorption isotherm and changes in physico-...
- Editorial Board
- Table of Contents
- Potential kidney toxicity from the antiviral drug ...
- The regulation of aldosterone secretion by leptin:...
- Editorial introductions
- Renal effects of cytokines in hypertension
- Maximum allowable contrast dose and prevention of ...
- Enzymatic sources and physio-pathological function...
- Retarding progression of chronic kidney disease: u...
- The pivotal role of renal vasodysfunction in salt ...
- Chronic kidney disease and acquired mitochondrial ...
- Exploring old concepts and new paradigms
- Quality measures in acute kidney injury
- Postactivation Potentiation Following Acute Bouts ...
- A comparative study of the antioxidant and intesti...
- Pediatric Oncology Provider Perceptions of a Pedia...
- Family meetings in in-patient specialist palliativ...
- Validation of the Diagnostic Tool for Complexity i...
- Rapid Response Team-Driven Palliative Care Consult...
- Impact of Goals of Care upon End-Of-Life Care Plan...
- First Responders: Educating Interdisciplinary Cham...
- Improving the Validity of MOLST (MA Medical Orders...
- What Is The Goal of Care for This Patient? Documen...
- Effectiveness of Subacute Rehab as a Bridge to Can...
- Hospital-Wide Impact of Early Palliative Care Inte...
- Palliative Care: Bringing It Home (FR432)
- Advance Care Planning: With Whom and When? (QI828)
- Quality Improvement and The Veterans Health Admini...
- Is Nonhospice Palliative Care ‘Colorblind’? Evalua...
- Attributes of Primary Care Physicians Associated w...
- Family Participation in Withholding and Withdrawin...
- Substance Use Disorders 101 for the Palliative Car...
- Advance Care Planning Documentation Practices and ...
- Scoping the scope: endoscopic evaluation of endosc...
- ERCP performed through previously placed duodenal ...
- Restoring the Honor of Our Specialty By Minimizing...
- Timing of Radiation Therapy in Pediatric Wilms Tum...
- Deep Learning Algorithm for Auto-Delineation of Hi...
- Carbohydrate Maldigestion and Malabsorption
- Risk of Pancreatic Cancer in Patients with Pancrea...
- Single Fluid-Filled Intragastric Balloon Safe and ...
- Variceal hemorrhage with white nipple sign associa...
- Microbial contaminants isolated from items and wor...
- Laboratory parameters in lean NAFLD: comparison of...
- Comparative genomics reveals a widespread distribu...
- Bacterial and parasitic contaminants of salad vege...
- Variation in Adolescent Idiopathic Scoliosis Surge...
- Infantile Tremor Syndrome: Response to B12 Therapy
- In Vivo Imaging of Muscle-tendon Morphogenesis in ...
- Variations on Negative Stain Electron Microscopy M...
- Two-photon Intravital Imaging of Leukocytes During...
- Amputee Locomotion: Joint Moment Adaptations to Ru...
- Quantifying Effect of Onabotulinum Toxin A on Pass...
- Impaired cognitive performance in endothelial nitr...
- Sonographic Evaluation of the Posterior Interosseo...
- Relationship of Spinal Cord Injury Level and Durat...
- Generation of Discriminative Human Monoclonal Anti...
- Extraction of Ramie Fiber in Alkali Hydrogen Perox...
- Reporting of Sepsis Cases for Performance Measurem...
- Outcomes and Costs of Patients Admitted to the ICU...
- Equilibration Time Required for Respiratory System...
- Activator Protein-1 Decoy Oligodeoxynucleotide Tra...
- Is Heparin-Binding Protein Inhibition a Mechanism ...
- Amazon and Health Care: Next Moves
- A Seminiferous Tubule Squash Technique for the Cyt...
- In Vivo Electrophysiological Measurement of the Ra...
- Association of Blood Glucose and Clinical Outcome ...
- 447 Consecutive Cases of Pipeline Flex Flow Divers...
- Treatment and survival vary by race/ethnicity in p...
- Current developments in immunotherapy in the treat...
- Psychometric evaluation and adaptation of the Spin...
- Erratum
- Reassessing the value of high-volume cancer care i...
-
▼
Φεβ 06
(183)
- ► Ιανουαρίου (5592)
-
►
2017
(44259)
- ► Δεκεμβρίου (5110)
- ► Σεπτεμβρίου (5105)
-
►
2016
(7467)
- ► Δεκεμβρίου (514)
- ► Σεπτεμβρίου (1038)
- ► Φεβρουαρίου (793)
Αναζήτηση αυτού του ιστολογίου
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
-
Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
-
heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
-
https://ift.tt/2MQ8Ai8
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου
Σημείωση: Μόνο ένα μέλος αυτού του ιστολογίου μπορεί να αναρτήσει σχόλιο.