Donor Cause Of Death Research Articles

Technical Failure in Pancreas Transplantation: A Composite Model for Predicting Risk in the Current Era

Purpose: Define the incidence of technical failure (TF) in pancreas transplants performed during the current era, examine risk factors, and develop a predictive composite risk model. Methods: Retrospective review of 1,115 pancreas transplants performed between 1998 and 2011 at a single center. TF is defined as graft loss within 90 days of transplant due to thrombosis, anastomotic leak, intra-abdominal infection, bleeding, or graft pancreatitis. The association of donor and recipient factors with TF was assessed by univariate and multivariate analyses. Recipient factors were age, gender, retransplant, pretransplant vascular disease, and pretransplant dialysis. Donor factors were age, gender, race, DCD, mechanism of death, BMI, preservation time, Creatinine, Amylase, and history of pancreatitis, drug, or alcohol abuse. Immune factors were HLA mismatches and PRA. Immunsuppression compared induction and maintenance agents as well as immunosuppressive era. Surgical factors were type of transplant (SPK/PTA/PAK) and bladder v. enteric drainage. Results: TF occurred in 10.2% of patients (5.6% thrombosis, 2.6% pancreatitis, 1.3% infection, 0.5% leak, and 0.2% bleeding). Risk factors in univariate analysis were SPK transplants (HR1.52, p=0.031), donor history of pancreatitis (HR7.39, p=< 0.001), donor Cr≥2.5 (HR3.06, p=0.002), preservation time >20 hours (HR1.82, p=0.002), donor age>50 (HR2.08, p=0.010), donor BMI≥30 (HR1.75, p=0.007), donor history of alcohol abuse (HR1.69, p=0.058), and donor mechanism of death other than head trauma (HR1.45, p=0.049). Bladder drainage (HR0.69, p=0.052) and alemtuzumab induction (HR0.63, p=0.093) were protective. Significant factors were included in the full Cox multivariate model. Of these, alcohol abuse, donor cause of death, alemtuzumab induction, and SPK transplant were not significant (all p >0.2). In the reduced Cox model, predictors of TF included donor pancreatitis (HR15.69, CI4.59-53.65, p< 0.001); preservation time>20 hours (HR2.14, CI1.41-3.23, p< 0.001); donor age>50 (HR1.75, CI0.94-3.24, p=0.077); donor BMI>30 (HR1.95, CI1.26-3.03, p=0.003); and Cr≥2.5 (HR3.12, CI1.39-7.03, p=0.006). Bladder drainage was protective (HR0.54, CI0.34-0.81, p=0.003) We compiled a composite risk model for transplants with one or more risk factors (donor Cr≥2.5, preservation time>20 hours, donor age>50, donor BMI≥30). Donor pancreatitis and bladder drainage were included as confounding factors but were not included in the composite score. Transplants with a single risk factor were insignificant (HR1.267, CI0.80-2.00, p=0.309). Two risk factors resulted in a 3.8-fold risk of TF (HR3.81, CI2.24-6.48, p< 0.001). Three risk factors increased the rate of TF greater than 8-fold (HR8.04, CI3.40-19.04, p< 0.001). Conclusion: TF remains a considerable risk in pancreas transplantation. A composite risk model incorporating donor age, BMI, Cr, and preservation time can predict TF following transplant. One risk factor is likely acceptable, but two or more results in a significantly increased risk for TF.Figure: [Composite Model]

The Registry of the International Society for Heart and Lung Transplantation: Fifteenth Pediatric Heart Transplantation Report—2012

The Registry of the International Society for Heart and Lung Transplantation: Fifteenth Pediatric Heart Transplantation Report—2012

Factors Associated With Patient and Graft Survival Using Kidneys From Cadaveric Donors in Transplanted Patients Over 18 Years of Age in Argentina

BackgroundWith improvements in short-term kidney graft and patient survival, focus has shifted to understand patient and graft features that affect long-term survival. Materials and methodsThis retrospective analysis from January 1998 to December 2009 employed Kaplan-Meier analysis to evaluate survival ratios at 30 days as well as 1, 5, and 10 years. A multivariable Cox regression model considered variables of donor and recipient, gender and age, cold ischemia time (CIT), chronic renal failure etiology, time on dialysis (TD) and cause of donor death. The mismatch (MM) value was coded according to the number of antigens shared by both the donor and the recipient for HLA-A, B, and DR. The MM values ranged between 0 and 6. Two groups were analyzed according the number of shared antigens: 0 to 3 versus 4 to 6. ResultsAmong 3030 (55.85%) males and 2395 (44.15%) females, the overall mean age was 46.9 ± 13.9 years. Median follow-up was 4 years (max 13 years). Patient survival rate (SR) was 97.5% at 30 days, 87.5% at 1 year, 74.5% at 5 years, and 59.2% at 10 years. Using Cox analysis, patient SR was affected by: diabetic nephropathy (DN) hazard ratio (HR) 1.55 (95% confidence interval [CI 95%] 1.21–1.97) P = .0005; head trauma (HT) cause of donor death HR 0.83 (0.73–0.95) P = .0005 and donor age (DA) compared by 18 to 44 years: 45 to 59 years HR 1.44 (CI95% 1.00–1.30) P = .043, >60 years HR 1.41 (CI95% 1.17–1.70) P = .0004. In addition relevant factors were recipient age (RA) compared by 18 to 44 years: 45 to 59 HR 1.99 (CI95% 1.74–2.27) P < .0001, >60 years HR 3.24 (CI95% 2.79–3.75) P < .0001 and DT >7 years HR 1.33 (CI95% 1.19–1.48) P = .0001. MM HLA 0 to 3 level HR 0.78 (CI95% 0.69–0.88) P < .0001. Graft SR was 95% at 30 days, 81.6% at 1 year, 64.7% at 5 years, and 47.3% at 10 years. The relevant factors were: DN HR 1.26 (CI95% 1.01–1.57) P = .04; HT HR 0.82 (0.74–0.91) P = .0004; DA compared by 18 to 44 years: 45–59 years HR 1.19 (CI95% 1.07–1.32) P = .002, >60 years HR 1.53 (CI95% 1.30–1.80) P < .0001; RA compared by 18 to 44 years: 45–59 HR 1.33 (CI95% 1.19–1.47) P < .0001, >60 years HR 1.84 (CI95% 1.63–2.09) P < .0001; DT > 7 years HR 1.22 (CI95% 1.11–1.35) P = .0001; CIT >24 hours HR 1.13 (CI95% 1.03–1.23) P = .009 and MM HLA 0 to 3 HR 0.82 (CI95% 0.74–0.91) P = .0002. ConclusionHT as the cause of donor death and MM between 0 and 3 were associated with better patient and graft SR, DN, TD over 7 years, DA and RA over 45 were associated with lower patient SR. CIT > 24 hours, DN, TD over 7 years, as well as donor and recipient ages over 45 yr were associated with a lower graft SR.

Early Lung Retransplantation in a Patient Affected by Cystic Fibrosis Correlated With Donor Cause of Death: A Case Report

The relationship between donor cause of death and lung transplantation outcomes remains unclear. We report a case of lung transplantation in a young patient affected by cystic fibrosis. Immediately after lung reperfusion a pulmonary hypertension was observed that was intractable with maximal medical therapy requiring surgical resection of the left lower lobe which became congested after a few days. The donor had died from suicidal hanging; the authors attributed the posttransplantation pulmonary hypertension which is an uncommon form of primary graft dysfunction to this cause of death. The patient was treated with early bilateral lung retransplantation which required a long, troublesome hospital stay. In conclusion, the authors warn against the use of lungs from donors who die due to hanging even when the gas exchanges were ideal.

Survival of Lupus Nephritis Patients After Renal Transplantation In Malaga

BackgroundStudies have shown that the survival of patients with lupus nephritis (LN) who receive a transplant has results similar to those of nondiabetic control subjects. ObjectiveThe aim of this study was to evaluate the survival of lupus patients who received a transplant at our center, and to determine risk factors for mortality and graft loss. MethodsThis case-control (1:2) study comprised patients with chronic kidney disease secondary to LN who received a kidney transplant (n = 32) in the Malaga area from 1985 to 2010. The controls subjects (n = 64) were matched by age, sex, and transplant period. We analyzed graft and patient survivals and risk factors compared with long-term transplant patients without LN. ResultsNo differences were found in the variables analyzed between groups, except for the most frequent cause of donor death, which was almost significant: stroke in LN and traumatic brain injury in control subjects (P = .05). of the whole study sample, 45% lost the graft, primarily owing to chronic kidney disease (53.5%), followed by vascular thrombosis (16.3%); P = .57. Censored graft losses occurred in 63% of the patients transplanted before 2000, whereas it occurred in 20% of those transplanted after 2000 (P < .001). Censored graft survival was similar between the groups throughout the followup, as was patient survival. Cox regression showed that only acute rejection was associated with a 2-fold increased risk of graft loss. ConclusionsOur lupus transplant population showed no differences in graft or patient survival compared with control subjects. Those patients who received a transplant from 2000 had better results, which may be related to several factors, such as immunosuppression, correction of cardiovascular conditions, or other factors. Risk factors for death and graft loss were similar to the control population.

Deceased Donor Renal Transplantation from Older Donors to Increase the Donor Pool

Background Use of kidneys from donors aged 70 years and older is controversial. Organ shortage has led many transplant centers to accept kidneys from old, suboptimal deceased donors and make increasing use of old-for-old allocation systems. We describe our institutional experience with outcomes from transplanting deceased-donor kidneys from older donors (≥70 years). Material and methods 20 deceased donor renal transplants (DDRTx) were performed at our center using grafts from deceased donors 70 years and older between June 2004 and September 2011. Kidneys were allocated to dual or single grafting according to pre-transplant biopsy. Mean age of recipients was 47.60 ± 11.38 years, 13 of whom were males. Mean donor age was 76.49 ± 4.9 years; 10 of whom were males. The most common cause of donor death was cerebrovascular/road traffic accidents. Mean dialysis duration pre-transplantation was 19.5 ± 6.5 months. Mean HLA (Human Leukocyte Antigens) match was 1 ± 0.8. Most common recipient diseases leading to ESRD were chronic glomerulonephritis (25%), diabetes (20%), and hypertension (20%). Post-transplant immunosuppression consisted of a calcineurin inhibitor-based regimen. Results Over a mean follow-up of 2.8 ± 1.7 years, patient and graft survival rates were 75% (n = 15) and 80% (n = 16), respectively, with a mean serum creatinine of 1.78 ± 0.56 mg/dl; 20% of the patients had biopsy-proven acute rejection episodes. A total of 25% (n = 5) patients died, mainly due to infections. Conclusions DDRTx from older donors achieves acceptable graft function with patient/graft survival, provided that organs are allocated to dual or single grafting according to pre-transplant biopsy. These findings encourage the use of this approach even in low-income countries.

Combined Liver-Kidney Transplantation Is Preferable to Liver Transplant Alone for Cirrhotic Patients With Renal Failure

The role of combined liver-kidney transplantation (CLKT) for cirrhotic patients with renal failure (RF) is controversial. Since the model for end-stage liver disease era, there has been a rise in the number of CLKT. Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, this study was undertaken to compare outcomes of cirrhotic patients with RF who received either liver transplant alone (LTA) or CLKT between 2002 and 2008. Analysis was limited to cirrhotic patients 18 years old or older, with serum creatinine level 2.5 mg/dL or higher at the time of orthotopic liver transplantation (OLT) or who received dialysis at least twice during the week before OLT. Patients who received CLKT were categorized based on the cause of their underlying RF. Overall liver allograft and patient survival rates of LTA patients were significantly lower compared with CLKT patients (P<0.001). CLKT patients with hepatorenal syndrome showed significantly higher patient and liver allograft survival rates. Liver allograft survival was superior among CLKT patients irrespective of whether they received dialysis. Prevalence of posttransplantation RF was higher for LTA patients at 6 months and 3 years of follow-up (P<0.001). LTA was a significant risk factor both for graft loss and mortality. Recipient hepatitis C virus seropositivity, donor age, donor cause of death, and life support at the time of OLT were also risk factors for graft loss and death. Cirrhotic patients with RF, in particular with hepatorenal syndrome, CLKT is preferable to LTA because it improves liver allograft and patient survival.

Deceased donor renal transplantation from older donors to increase the donor pool

Use of kidneys from donors aged 70 years and older is controversial. Organ shortage has led many transplant centers to accept kidneys from old, suboptimal deceased donors and make increasing use of old-for-old allocation systems. We describe our institutional experience with outcomes from transplanting deceased-donor kidneys from older donors (=70 years). 20 deceased donor renal transplants (DDRTx) were performed at our center using grafts from deceased donors 70 years and older between June 2004 and September 2011. Kidneys were allocated to dual or single grafting according to pre-transplant biopsy. Mean age of recipients was 47.60 ± 11.38 years, 13 of whom were males. Mean donor age was 76.49 ± 4.9 years; 10 of whom were males. The most common cause of donor death was cerebrovascular/road traffic accidents. Mean dialysis duration pre-transplantation was 19.5 ± 6.5 months. Mean HLA (Human Leukocyte Antigens) match was 1 ± 0.8. Most common recipient diseases leading to ESRD were chronic glomerulonephritis (25%), diabetes (20%), and hypertension (20%). Post-transplant immunosuppression consisted of a calcineurin inhibitor-based regimen. Over a mean follow-up of 2.8 ± 1.7 years, patient and graft survival rates were 75% (n = 15) and 80% ( n = 16), respectively, with a mean serum creatinine of 1.78 ± 0.56 mg/dl; 20% of the patients had biopsy-proven acute rejection episodes. A total of 25% (n = 5) patients died, mainly due to infections. DDRTx from older donors achieves acceptable graft function with patient/graft survival, provided that organs are allocated to dual or single grafting according to pre-transplant biopsy. These findings encourage the use of this approach even in low-income countries.

The New Zealand National Eye Bank Study

To evaluate trends in the acquisition, storage, and utilization of donated corneal tissue in New Zealand, 2000 to 2009. The New Zealand National Eye Bank records were analyzed for the decade January 2000 to December 2009. Variables analyzed included donor demographics (age, sex, and ethnicity), donor source, donor cause of death, death-to-preservation interval (DPI), corneal storage time, tissue contamination, endothelial assessment, cornea suitability for transplantation, and corneal tissue utilization. A total of 1268 eye donors were identified during the 10-year period. Overall, 36% (n = 457) were female and 64% male (n = 813). Median donor age was 67 years, and 23% of donors were younger than 50 years (range, 5-90 years). There was a decrease in donor age over the decade (P = 0.006). The median DPI was 18.5 hours. No relationship was identified between cornea suitability for transplantation and DPI (P = 0.28) or donor gender (P = 0.54). There was a low microbial contamination rate (1%). Human immunodeficiency virus, hepatitis B, or hepatitis C serology was positive in 48 donors (4%). Overall, 90% of corneas were suitable for transplantation with a high utilization rate (88%). A novel association was identified between male sex and lower corneal endothelial cell density (P = 0.03). This New Zealand National Eye Bank analysis identified trends in the acquisition, storage, and utilization of donated corneal tissue throughout New Zealand over the past decade and provides valuable additional information to the international eye bank data.

The effect of steroid pretreatment of deceased organ donors on liver allograft function: A blinded randomized placebo-controlled trial

Background & AimsBrain death-associated inflammatory response contributes to increased risk of impaired early liver allograft function, which might be counterbalanced by steroid pretreatment of the organ donor. The aim of this randomized controlled trial was to elucidate whether steroid pretreatment of liver donors improves early liver allograft function, prevents rejection and prolongs survival.MethodsA placebo-controlled blinded randomized clinical trial was performed in three different centers in Austria and Hungary between 2006 and 2008. Ninety deceased organ donors received either 1000 mg of methylprednisolone or placebo 6 h before recovery of organs. The primary end point was the concentration slope of transaminases within the first week. The secondary end point included survival and biopsy-confirmed acute rejection (BCAR) within 3 years after transplantation.ResultsOf the 90 randomized donors, 83 recipients were eligible for study. The trajectories of ALT and AST were not different between treatments (p = 0.40 and p = 0.13, respectively). Eight subjects died in the steroid and 13 in the placebo group within 3 years after engraftment (RR = 0.63 95% CI [0.29, 1.36], p = 0.31). Eleven recipients experienced biopsy-confirmed rejection (BCAR) in the steroid and 11 in the placebo group (RR = 1.02 95% CI [0.50, 2.10], p = 1.00). No effect modification could be identified in the predefined strata of donor age, sex, cold ischemic time, and cause of donor death.ConclusionsSteroid pretreatment of organ donors did not improve outcomes after liver transplantation.

The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report—2011

This Twenty-eighth Report of the International Society for Heart and Lung Transplantation (ISHLT) Transplant Registry is based on data submitted by participating transplant centers worldwide. A total of 388 heart transplant centers have contributed information to the Registry. This year we have also achieved another important milestone: the 100,000 heart transplant recipient was registered in the database. This report reviews important statistics for the entire cohort of patients registered in the database. However, similar to prior reports, many of the more detailed analyses will focus on recent transplant recipients, exploring information relevant to contemporary heart transplantation practice. The first part of the report reviews important donor, recipient, and medical center demographics. The second part provides an overview of immunosuppressive therapies used after transplantation. The third part examines survival, mortality risk factors, and causes of death after adult heart transplantation. The last section focuses on quality of life after transplant.

Baseline Factors Related to Endothelial Cell Loss Following Penetrating Keratoplasty

To identify baseline (donor, recipient, and operative) factors that affect endothelial cell loss following penetrating keratoplasty for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic or aphakic corneal edema). In a subset (n = 567) of Cornea Donor Study participants, preoperative and postoperative endothelial cell densities (ECDs) were determined by a central reading center. Multivariate regression analyses were performed to examine which baseline factors correlated with ECD over time. Larger grafts (P < .001), younger donor age (P < .001), and female donor (P = .004) were significantly associated with higher ECD during follow-up. Median endothelial cell loss at 5 years was 68% for grafts larger than 8.0 to 9.0 mm in diameter, 75% for grafts 7.0 mm to smaller than 8.0 mm in diameter, and 74% for grafts 8.0 mm in diameter. Grafts from female donors experienced a 67% cell loss compared with a 72% cell loss among grafts from male donors. Method of tissue retrieval, donor cause of death, history of diabetes, and time from death to preservation or to surgery were not significantly associated with changes in ECD over time. Following penetrating keratoplasty for endothelial dysfunction conditions, larger donor graft size, younger donor age, and female donor were associated with higher ECD over 5 years. These data warrant exploring the possibility that similar associations may exist following endothelial keratoplasty. clinicaltrials.gov Identifier: NCT00006411.

How to choose the best available homograft to reconstruct the right ventricular outflow tract

How to choose the best available homograft to reconstruct the right ventricular outflow tract

Orthotopic heart transplantation with donors greater than or equal to 60 years of age: a single-center experience

Heart transplantation is the best therapeutic option for patients suffering from end-stage heart failure, but donor organ availability still represents a major problem. This had led to a shift toward extended donor criteria. The aim of the present study is to analyze the short- and long-term results of heart transplantation in patients with donor age ≥ 60 years. Since November 1985, 890 patients have been transplanted at our center. We consider, for the present study, only primary adult heart transplantations performed after 1990, totaling 761 patients, mean age at transplantation 49.8 years, and 616 patients being male (81%). We compare the short- and long-term results of patients transplanted with donors younger than 60 years or ≥ 60 years. Since 1990, at our center, 711 patients have been heart transplanted with a donor younger than 60 years, while 50 patients received a heart from a donor older than 60 years. No differences have been reported in the etiology of cardiomyopathy, previous surgery, or mean ischemic time. Patients transplanted with donors ≥ 60 years of age were significantly older compared to the younger donors' group. Donor cause of death was a cerebrovascular accident in 82% of donors ≥ 60 years versus 41% in younger donors. Patients' heart transplanted with donors ≥ 60 years had a higher incidence of acute graft failure with a hospital mortality of 32% (16 patients) significantly higher compared with 10.2% for the other group. No differences were noticed in the incidence of renal failure, acute rejection treated, coronary allograft vasculopathy, and neoplasm during long-term follow-up. It was possible to expand the cardiac donor pool by accepting allografts from donors ≥ 60 years of age in selected cases by performing a coronary angiogram. A meticulous donor evaluation and a careful risk assessment between the risk of death on the waiting list and probable increased hospital mortality are needed.

Donor Cause of Brain Death in Renal Transplantation: A Predictive Factor for Graft Function?

Purpose Our aim was to evaluate the influence of donor cause of brain death on the results of kidney transplantation. Methods This retrospective study included 896 consecutive deceased-donor renal transplantations performed between January 1, 2000, and December 31, 2009. We compared outcomes of grafts from donors after cerebrovascular accident (CVA; n = 371) versus head trauma (HT; n = 525). Results Univariate analysis of pretransplantation data showed statistically significant differences ( P < .05): among the following variables for the HT versus CVA groups respectively: recipient age (43.63 ± 13.2 y vs 49.80 ± 12.5 y); donor age (36.06 ± 16.6 y vs 52.57 ± 13.2 y) and time on dialysis (50.67 ± 45.034 mo vs 59.39 ± 46.3 mo). Regarding transplantation results, we observed that mean serum creatinine was significantly lower among HT recipient, at 1, 3, 6, 12, and 24 months after transplantation ( P < .05). Chronic allograft nephropathy (CAN) and delayed graft function were higher among the CVA group. HT group kidneys showed significantly longer mean survival times than CVA group kidneys (102.7 ± 3.9 mo vs 94.8 ± 5.6 mo; log rank: P = .04). Upon multivariate analysis donor cause of death was not identified as an independent risk factor for graft survival or occurrence of chronic allograft nephropathy. Conclusions Transplantation results were better among the HT group. However multivariate regression analysis indicated that donor cause of death was not an independent risk factor for graft survival or occurrence of chronic allograft nephropathy.

Donor and surgical risk factors for primary graft failure following Descemet's stripping automated endothelial keratoplasty in Asian eyes

BackgroundDescemet’s stripping automated endothelial keratoplasty (DSAEK) has been shown to have superior refractive and visual results compared with penetrating keratoplasty, but higher rates of primary graft failure (PGF). This paper presents donor and surgical risk factors for PGF in DSAEK cases in Asian eyes.DesignRetrospective case-control study.ParticipantsAll consecutive patients who underwent DSAEK at a tertiary referral teaching hospital from March 2006–December 2008.MethodsDonor details analyzed were: age of donor, cause of donor death, death to harvesting time, donor storage time, distribution distance of tissue, preoperative endothelial cell count. Surgical factors analyzed were: donor diameter, donor thickness, and method of donor insertion. These risk factors in cases of PGF were compared with patients with successful DSAEK as the control group.Main outcome measurePGF.ResultsA total of 124 DSAEK procedures were performed. Six DSAEK procedures (five eyes of five patients; one eye with two failures) resulted in PGF (4.8%). Significant risk factors were found for PGF to include graft insertion using a folding technique (odds ratio [OR], 34.03; 95% confidence interval [CI], 3.75–314.32; P = 0.0017) and a small donor diameter (OR, 39.94; 95% CI, 2.18–732.17; P = 0.013).ConclusionThe results of this study suggest that in Asian eyes with shallow anterior chambers, surgical trauma relating to the technique of donor insertion, and the use of a small donor are major risk factors for PGF following DSAEK.

The donor mortality in living related liver transplantation

To investigate the cause of donor death in living donor liver transplantation(LDLT), we reviewed all published articles in English on LDLT from the Foreign Medical Journal Full-Text Service (FMJS) and searched the literature for donor deaths before 2008. We identified 12 donor deaths. The rate of donor death is 0.2%. Any donor death would be a catastrophe for the donor's family and for the medical team. It is imperative to avoid donor death in LDLT. Key words: Living related liver transplantation; Donor; Death

Vascular Thrombosis After Kidney Transplantation: Predisposing Factors and Risk Index

Early graft thrombosis is an uncommon complication, but the vast majority of cases are unrecoverable. The aims of this study were to assess the variables involved in the development of this complication and to create a prognostic index to define which transplants, by virtue of a combination of variables, show a higher risk of thrombosis. We retrospectively analyzed a cohort of 577 cadaveric renal transplants performed between 1992 and 2009, excluding those with hypercoagulability before transplantation. The overall incidence of thrombosis was 6%. The distribution of thrombosis was examined according to recipient variables, differences in dialysis within 24 hours before transplantation (0 no dialysis, 13.8% dialysis out of hospital, and 4.2% dialysis in hospital; P = .029) and iliac vascular pathology (10% yes vs 5% no; P < .04). The donor-related factors were age above or below 60 years (11% vs 5%; P = .01), stroke versus traumatic death cause (9.3% vs 4.7%; P = .049), and graft atheroma (16.7% yes vs 5.1% no; P = .042). Immunotherapeutic factors were tacrolimus versus cyclosporine (7.4% vs 2.3%; P = .001) and use of sequential therapy (10.7% yes vs 3.3% no; P = .001). The odds ratio (OR) of thrombosis for the use of basiliximab adjusted for donor age, recipient age, and graft atheroma was 2.6 (95% CI, 1.03 to 6.63). Upon multivariate analysis, the predictive equation consisted of: stroke donor death, OR 3.88; recipient iliac vascular pathology, OR 2.81; and graft atheroma, OR 3.63. The predictive validity by receiver operating characteristic curve provided an area of 0.769 (95% CI, 0.67 to 0.87; P < .0001). The thrombosis risk index suggested that transplantation into a recipient with iliac vascular pathology, stroke as the cause of donor death, and graft atheroma multiplied the risk by 16 compared with a standard recipient without iliac vascular pathology with a traumatic cause of donor death, and without graft atheroma.

Multicenter Analysis of Novel and Established Variables Associated with Successful Human Islet Isolation Outcomes

Islet transplantation is a promising therapy used to achieve glycometabolic control in a select subgroup of individuals with type I diabetes. However, features that characterize human islet isolation success prior to transplantation are not standardized and lack validation. We conducted a retrospective analysis of 806 isolation records from 14 pancreas‐processing laboratories, considering variables from relevant studies in the last 15 years. The outcome was defined as postpurification islet equivalent count, dichotomized into yields ≥315 000 or ≤220 000. Univariate analysis showed that donor cause of death and use of hormonal medications negatively influenced outcome. Conversely, pancreata from heavier donors and those containing elevated levels of surface fat positively influence outcome, as did heavier pancreata and donors with normal amylase levels. Multivariable logistic regression analysis identified the positive impact on outcome of surgically intact pancreata and donors with normal liver function, and confirmed that younger donors, increased body mass index, shorter cold ischemia times, no administration of fluid/electrolyte medications, absence of organ edema, use of University of Wisconsin preservation solution and a fatty pancreas improves outcome. In conclusion, this multicenter analysis highlights the importance of carefully reviewing all donor, pancreas and processing parameters prior to isolation and transplantation.

Improvement in late renal allograft survival between 1990 and 2002 in Spain: results from a multicentre case-control study

Epidemiological studies have failed to show an improvement in graft survival beyond 1 year after kidney transplantation possibly because of an increased number of expanded donors and older recipients. Thus, we performed a case-control study matching patients transplanted in different eras by donor and recipient characteristics. We considered renal transplant recipients included in the database of the Spanish Chronic Allograft Dysfunction Study Group in 1990, 1994, 1998 and 2002 (n = 4842). We matched patients from these cohorts considering the following variables: donor and recipient age, cause of donor death, hepatitis C virus, panel reactive antibodies and re-transplantation. We identified a total of 896 patients distributed in four cohorts of 224 matched patients. Between 1990 and 2002, the use of cyclosporin decreased (96%, 94%, 80% and 23% respectively, P = 0.001), while the use of tacrolimus increased (0%, 1%, 15% and 63% respectively, P = 0.001) and the prevalence of acute rejection decreased (46%, 37.9%, 20.6% and 15.8% respectively, P < 0.001). One-year serum creatinine was 1.63 +/- 0.66, 1.64 +/- 0.70, 1.44 +/- 0.52 and 1.38 +/- 0.75 respectively, P = 0.001. Graft survival beyond the first year between 1990 and 2002 significantly improved while patient survival did not. Transplant outcome has improved between 1990 and 2002 when donors and recipients of similar characteristics are compared.