Differences In Rejection Rates Research Articles

Is laparoscopic donation safe for paediatric recipients? A study of 85 paediatric recipients comparing open and laparoscopic donor nephrectomy

The safety of adult laparoscopic donor nephrectomy remains controversial with respect to paediatric recipients with few data existing about its efficacy. Small studies have shown no difference in graft survival when compared with open techniques, but previous data from United Network for Organ Sharing suggests a higher incidence of rejection in laparoscopically procured kidneys. We examined the outcome in a total of 85 consecutive paediatric renal recipients, comparing 46 recipients of laparoscopically procured kidneys (performed over a 3-year period, 2004-07) to a historical control of 39 open donor recipients. Thirty-seven laparoscopic donors were by the hand-assisted technique. Mean recipient age was 9.8 (SD 5.04) years in the laparoscopic group and 10.4 (SD 4.67) years in the open group (P = 0.617). Two patients had delayed graft function in the laparoscopic group (4.3%) and one (2.5%) in the open group (P = 0.562). At 1 year follow-up, there was 100% graft survival in the laparoscopic group compared to 92% (P = 0.093) in the open group. Incidence of biopsy-proven acute rejection within 1 year of transplant was 26% (16 episodes in 12 patients) in the laparoscopic group compared to 41% (29 episodes in 16 patients) in the open group (P = 0.219). There were no deaths in the laparoscopic group but there were three deaths (7.6%) in the open group (P = 0.093). Our experience of laparoscopic kidney donation for paediatric recipients suggests excellent outcome with no difference in rejection rate or graft survival compared to open donation. Laparoscopic donation is the optimal method of kidney procurement for paediatric recipients.

Consolidation of Enteric Drainage for Exocrine Secretions in Simultaneous Pancreas-Kidney Transplant

Introduction Management of the exocrine drainage of the pancreatic graft in simultaneous pancreas kidney (SPK) transplantation has been a matter of debate for years. There is currently a trend toward a more physiological enteric drainage (ED). This study compared short- and long-term complications and graft survival in patients with enteric versus bladder exocrine secretion drainage. Patients and methods Between January 1995 and November 2005, we performed 75 SPK transplants: 55 with ED and 20 with bladder drainage (BD). The rates of complications and graft survival were monitored over at least 36 months after transplantation. Results Mean posttransplant follow-up was 119.5 ± 6.6 months. Urinary infection, hematuria, reflux pancreatitis, and repeat surgery rates were all significantly higher among the BD area. There was no intergroup difference in rejection rates or in the incidence of graft thrombosis, transplantectomy, anastomotic dehiscence, or intra-abdominal abscesses. Pancreas and kidney graft survival rates were similar in the two groups. Conclusions In our experience, ED was more physiological than BD, and was associated with fewer complications.

The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report—2009

The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report—2009

Increased host tolerance of multiple cuckoo eggs leads to higher fledging success of the brood parasite

In birds, multiple parasitism is the laying of two or more eggs by one or more parasitic females in a single host nest. Several cognitive mechanisms may explain how multiple parasitism could affect parasite egg discrimination by hosts. Rejection based on discordance predicts that multiple parasitism provides a perceptually more error-prone way for hosts to reject parasitism because more foreign eggs decrease the chance that any one egg is perceived as most dissimilar and recognized as foreign, unless parasite eggs are all similarly highly nonmimetic. In contrast, rejection based on clutch uniformity predicts that in multiple parasitism egg rejection is more error-proof if mimicry by parasite eggs is variable, because increased variation in egg appearance makes for easier egg rejection for hosts. Finally, true egg recognition, that is, rejection based on memory of the host's own eggs, predicts no differences in rejection rates from nests with single or multiple parasitism. We studied common cuckoos, Cuculus canorus , parasitizing a population of great reed warblers, Acrocephalus arundinaceus , in Hungary where multiple parasitism was frequent. Hosts rejected parasite eggs less often in nests with multiple parasitism than in nests with single parasitism. These observations were confirmed by experimental parasitism and support the rejection based on discordance hypothesis. As hosts were more likely to tolerate cuckoo eggs in nests with multiple parasitism, we found that multiple parasitism more than doubled cuckoos' reproductive output per host nest compared to single parasitism.

Outcome for Pediatric Cardiac Transplantation With and Without Bridge Methods

Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. Due to the shortage of pediatric donor hearts, various bridge techniques have been used for pediatric recipients to prolong patient survival until a heart is available. This study evaluates long-term outcome of bridge and nonbridge support for pediatric heart transplantation. Between March 1995 and June 2004, 18 pediatric patients underwent heart transplantation. Six patients (33.3%) underwent biological or mechanical bridge techniques before transplantation. Eight patients (44.4%) required perioperatively extracorporeal membrane oxygenation (ECMO) support. Patient data and records were retrospectively reviewed. Causes of death and long-term outcome were analyzed. Five of eight patients in the ECMO group (62.5%) were successfully decannulated and discharged home with excellent functional classes. No differences in rejection rate, survival rate, and functional class existed between the bridged and nonbridged groups. Overall 1-year and 5-year survival rates were both 83.3% and all have a good functional class. Pediatric heart transplantation can be accomplished with excellent early survival despite multiple prior cardiac operations and relatively severe illness. For the variety in small, low-body-weight pediatric patients, mechanical circulatory support using ECMO is suitable for managing sudden collapse while waiting for heart transplantation, and graft dysfunction after cardiac transplantation. The mortality rate is acceptable in this very high-risk group of patients and long-term outcome is good.

Treatment of HCV recurrence: Do the pretransplantation rules apply?

Treatment of HCV recurrence: Do the pretransplantation rules apply?

Effect of host egg color dimorphism on interactions between the vinous‐throated parrotbill (Paradoxornis webbianus) and common cuckoo (Cuculus canorus)

To investigate the effect of host egg color dimorphism on the vinous‐throated parrotbill (Paradoxornis webbianus) – common cuckoo (Cuculus canorus) interactions, we monitored breeding nests of vinous‐throated parrotbills, and conducted model egg experiments, using two colors: white and blue. Of the 190 nests examined in this study, cuckoo parasitism occurred at 10 nests (8 blue and 2 white egg clutches, respectively), and only blue cuckoo eggs were found. This frequency was similar to the egg‐color ratio of all host nests found (151 blue and 39 white egg clutches). Vinous‐throated parrotbills showed high rejection rate towards both cuckoo eggs and model ones. There was a significant difference in rejection rates towards mimetic (blue) and non‐mimetic (white) eggs in blue egg clutches. Mimetic eggs put in nests took significantly longer to be rejected than non‐mimetic ones. The most common rejection method used by the hosts was egg ejection (puncture‐ejection). The costs of ejecting non‐mimetic eggs tended...

Effects of an educational seminar on rejection demographics in patients presenting for laser in situ keratomileusis.

To evaluate the effectiveness of an educational seminar as an initial screening tool for patients interested in laser in situ keratomileusis (LASIK) and to determine the incidence of and reasons for patients not being candidates for the procedure. A retrospective review of the medical charts of 438 consecutive patients, half of whom attended an educational seminar, and half of whom did not. All patients underwent ophthalmic evaluations as candidates for LASIK. The reasons for patients not proving to be good candidates were determined. Thirteen percent of all patients examined were found not to be suitable candidates for LASIK. There was no difference in rejection rates between patients who had attended a seminar and those who had been screened and educated over the telephone by a skilled technician. The principal reasons for rejection were, in decreasing order of frequency: cataract, presbyopia, abnormal corneal curvature, insufficient corneal thickness, unstable refraction, large pupil, irregular astigmatism, anterior basement membrane dystrophy, previous corneal surgery, uncontrollable dry eye, and previously undiagnosed ocular malignancy. Patients educated through group seminars or individually by trained technicians over the telephone still present for consideration for LASIK with unidentified ocular problems that make them poor surgical candidates. This occurs at a rate of 13%. The majority of the patients required a careful evaluation to uncover the abnormalities.

What Really Happened in Florida’s 2000 Presidential Election

Abstract New evidence from thousands of voting precincts confirms the finding of my report to the U.S. Commission on Civil Rights that in Florida�'s 2000 presidential election, ballots cast by blacks were far more likely than ballots cast by whites to be rejected as invalid. If rejection rates had been equal for blacks and whites, blacks would have cast more than 50,000 additional votes. Racial differences in rejection rates cannot be explained by such factors as education or income, first‐time voting, ballot design, voting technology, or the race and party of election supervisors. John Lott�'s attempt to refute these findings contradicts his earlier study and the report of two dissenting civil rights commissioners that relied on his work. His latest findings result from a flawed research design and are incredible on their face. Additional on‐the‐ground investigation in Florida is needed to test hypotheses about the reasons for the wide racial disparities in ballot rejection rates.

GENETIC AND GEOGRAPHIC VARIATION IN REJECTION BEHAVIOR OF CUCKOO EGGS BY EUROPEAN MAGPIE POPULATIONS: AN EXPERIMENTAL TEST OF REJECTER-GENE FLOW.

Host responses toward brood parasitism have been shown to differ among populations depending on the duration of sympatry between host and parasite, although populations not currently parasitized show rejection behavior against parasitic eggs. The persistence of rejection behavior in unparasitized host populations and rapid increases of rejection rate in parasitized ones have sometimes been explained as the result of gene flow of rejecter genes from sympatry to allopatry (rejecter-gene flow hypothesis). We present data on the rejection behavior of magpies (Pica pica) the main European host of the great spotted cuckoo (Clamator glandarius), in 15 populations (nine sympatric six allopatric) across their distribution range in Europe. Rejection rates of mimetic and nonmimetic model eggs were significantly higher in sympatric than in allopatric magpie populations, although differences in rejection rate of both mimetic and nonmimetic model eggs between magpie populations were significantly correlated even after controlling tor phylogenetic effects, with differences between sympatric and allopatric magpie populations being larger for mimetic than for nonmimetic model eggs. Differences in rejection of mimetic model eggs were related to both genetic and geographic distances between populations, but differences in rejection rate of nonmimetic model eggs were unrelated to these distances. However, when comparing only sympatric populations, differences in rejection rate of both mimetic and nonmimetic model eggs were related to geographic distances. A multiple autocorrelation analysis revealed that differences among populations in rejection rates of mimetic model eggs had a strong geographic component whereas the main component of rejection rate of nonmimetic model eggs was genetic rather than geographic. These results support the rejecter-gene flow hypothesis. We discuss differences in rejection rates of mimetic and nonmimetic model eggs that suggest the egg-recognition ability of the host is genetically based, but is affected by a learning process for fine tuning of recognition.

INFLUENCE OF AGE AND RACE ON THE TIME TO FIRST ACUTE REJECTION IN CADAVERIC RENAL TRANSPLANT (CRT) RECIPIENTS IN THE MYCOPHENOLATE MOFETIL (MMF) ERA

561 An increased incidence of acute rejection in young CRT recipients, especially those that are black, has been described in previous studies. This clinical finding, however, has not been cited for patients who have received MMF as part of their primary immunosuppression. This was a retrospective review of 247 consecutive CRT recipients transplanted at a single center between 6/29/95 and 10/15/98. The influence of age and race on the time to first acute rejection was compared using Kaplan-Meier curves and the log rank test. Cox proportional hazard models were used to adjust for potential confounders. Patients were divided into those aged <50 or ≥50. There were 58 younger whites, 70 older whites, 71 younger blacks, and 49 older blacks. In the overall analysis, there was a significantly higher incidence of first biopsy proven rejection in the recipients aged <50 compared to recipients aged ≥50 (38.6% vs. 19.7%, P=0.002). These findings were also significant when looking at the first 3, 6 and 12 months post-transplant. When analyzing age as a continuous variable, the incidence of first acute rejection was inversely related to recipient age, with younger patients rejecting earlier post-transplant (P=0.03). There was no difference in acute rejections when comparing whites to blacks, however, the difference in rejection rates noted for age was more pronounced in blacks. Younger black recipients had the highest incidence of first acute rejection (P=0.002, RR=4.05) relative to older black recipients who had the lowest incidence of acute rejection. There was no significant difference between older blacks and all whites regardless of age as a variable. After adjusting for sex, race, degree of HLA mismatch, discharge serum creatinine (≤2.2 or >2.2 mg/dl), the use of induction with either OKT3 or antilymphocyte globulin and the type of calcineurin inhibitor in the regression model, age <50 or ≥50 remained a significant predictor of time to first acute rejection (P=0.008, RR=0.49). In the MMF era, younger black recipients (<50) have the highest incidence of first acute rejection.

Racial Differences in Short-Run Earnings Stability and Implications for Credit Markets

This paper examines the claim that observed racial differences in rejection rates for mortgage applications, which persist after controlling for many relevant factors, are due to racial differences in short-run earnings stability, which has not typically been included in empirical tests. The evidence does not support the proposition that blacks suffer from greater earnings instability than comparable whites, as few consistent significant differences between black and white earnings volatility are found. Only in the case of drastic earnings shocks with persistent effects does the possibility of significant racial differences reasonably remain. In general, racial differences in earnings stability appear to be minor and are unlikely to result in substantial differences in creditworthiness

Racial Differences in Short-Run Earnings Stability and Implications for Credit Markets

This paper examines the claim that observed racial differences in rejection rates for mortgage applications, which persist after controlling for many relevant factors, are due to racial differences in short-run earnings stability, which has not typically been included in empirical tests. The evidence does not support the proposition that blacks suffer from greater earnings instability than comparable whites, as few consistent significant differences between black and white earnings volatility are found. Only in the case of drastic earnings shocks with persistent effects does the possibility of significant racial differences reasonably remain. In general, racial differences in earnings stability appear to be minor and are unlikely to result in substantial differences in creditworthiness.

Effect of donor cornea preservation in tissue culture and in McCarey-Kaufmann medium on corneal graft rejection and visual acuity

In a retrospective study the rate of rejection and clouding of the donor cornea for other reasons was investigated in 230 penetrating keratoplasties performed between 1984-1986. Donor corneas were stored in McCarey-Kaufmann Medium (MK) at 4 degrees C or in a modified Minimal Essential Medium (MEM) at 31 degrees C. No statistical differences in rejection rate, cloudiness due to other causes or visual acuity was found between MEM- and MK-stored donor corneas.