Recipient Selection Research Articles

Recipient selection for lung transplantation: perspective in decision-making.

To determine the conditions that prevented transplant in patients referred to our center due to end-stage lung disease. Descriptive study. Department of lung transplant clinic, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey, from December 2017 to January 2022. Patients with end-stage lung disease referred to our clinic were retrospectively evaluated with regard to reasons for exclusion, diagnosis, and demographic data. The Karnofsky Performance Status scoring scale was used to measure the functional status of the patients. A total of 311 patients were evaluated during the study period. The mean age was 44.2 (range 4-73) years. There were 207 (66.6%) male patients. The most common indications were idiopathic interstitial pneumonia in 104 (33.4%) patients, chronic obstructive pulmonary disease in 53 (17%) patients, bronchiectasis in 49 (15.7%) patients, and cystic fibrosis in 28 (9%) patients. Of the patients, 106 (34%) were not appropriate candidates for a lung transplant. The most common reasons for refusal were preventable situations such as activity limitation and poor performance in 53 (50%) patients, weight in 49 (46.2%) patients, and smoking in 10 (9.4%) patients. Impaired performance status was the most common cause of lung transplant exclusion. Weight and smoking were preventable causes of exclusion. Implementing pulmonary rehabilitation in very few patients was the most important handicap. It is believed that providing optimal treatment with a multidisciplinary approach and timely referral to transplant centers will significantly reduce the reasons for exclusion. Key message What is already known on this topic? Referring lung transplant candidates to clinics at the earliest stage is essential for assessing their condition and exploring treatment options. What this study adds? Factors like smoking, obesity, and muscle loss can hinder the transplantation process; thus, timely interventions are crucial. The primary reason for excluding candidates from lung transplantation is the decline in performance status. How this study might affect research, practice or policy? Programs focused on smoking cessation, weight management, and muscle strengthening can play a vital role in enhancing patients' health before transplantation. It is imperative to expand and enhance the accessibility of pulmonary rehabilitation programs.

PENERAPAN FUZZY C-Means CLUSTERING sebagai PENDUKUNG SISTEM KEPUTUSAN SELEKSI PENERIMA BANTUAN SOSIAL: Desa Sukau Kayo, Lebong, Bengkulu, Indonesia

Abstract. Frequently the occurrence of discrepancies in selecting eligible candidates for social assistance programmes. Thus, the research aims for creating a support system for making decisions in the selection of prospective recipients of social assistance programmes by applying the Fuzzy C-Means (FCM) method for direct assistance recipients who are eligible or not. The results obtained after testing of system on the 91% questionnaire results are very helpful in taking a decision.

Personal Viewpoint: Navigating Challenges in Recipient Selection for End-Chain Kidneys

As a result of the increasing number of transplants being facilitated by kidney paired donation, and newer initiatives such as voucher donation, end-chain kidneys now constitute a considerable proportion of kidney paired donation transplants in the United States. Data on end-chain kidneys are limited. They may be lower in quality compared to non-end chain living donor kidneys. However, they can provide unique opportunities for recipient candidates without living donors. There are no data or algorithms available to guide recipient selection for end-chain kidneys accepted by a transplant center. Considering the ethical principles of utility, justice, and respect for persons that underlie organ allocation, we discuss three potential approaches for recipient selection: 1) adherence to the Kidney Allocation System, 2) utility maximization and 3) priority to high-risk candidates, along with examples from our own center’s experience. Similar considerations are also relevant to selection of recipients for non-directed donor organs, and to out-of-sequence allocation for deceased organ donors. Since end-chain kidneys represent an increasingproportion of kidney paired donation-facilitated living kidney donor transplantation in the United States, and will likely get more medically and surgically complex over time, ongoing research on their utilization and outcomes is needed.

Outcomes of Donation After Circulatory Death (DCD) and Ex-Vivo Lung Perfusion (EVLP) Lung Transplantation

BackgroundDonation after circulatory death (DCD) and ex-vivo lung perfusion (EVLP) have been adopted to expand the donor pool in lung transplantation, but outcomes data have been conflicting. This study explores mid-term outcomes of DCD lung transplantation in the modern era, with a focus on EVLP and risk factors for graft failure. MethodsThe United Network for Organ Sharing (UNOS) database was queried for adult lung transplants from 1/1/2015 to 3/1/2023. Loss to follow-up, multiorgan and prior lung transplants were excluded. DCD vs DBD (donation after brain death) lung transplants were compared, with subgroup analysis +/- EVLP. Outcomes were survival and postoperative complications. Overall survival was analyzed separately for an early era (2015-2018) and modern era (2019-2023). ResultsThe study included 1103 DCD (221 with EVLP, and 882 without) and 17973 donation after brain death (DBD) lung transplants (524 with EVLP, and 17449 without). Median follow-up was 3 years. DCD donors were less likely to be CDC high risk (19.3% vs 24.1%, p<0.001), have purulence on bronchoscopy (13.3% vs 18.3%, p<0.001) or infiltrates on chest x-ray (66.7% vs 67.8%, p=0.013). EVLP was more likely to be used for DCD transplants (20.0% vs 2.9%, p<0.001).After transplant, DCD recipients were more likely to be reintubated (24.3% vs 18.5%, p<0.001) and require ECMO within 72 hours (14.9% vs 7.8%, p<0.001), and DCD donation was an independent risk factor for these complications on multivariable logistic regression. Overall survival did not differ significantly between DCD and DBD transplants on adjusted survival analysis in the early or modern era (p=0.774 and p=0.468 respectively). On multivariable Cox regression, DCD and EVLP were not independent risk factors for mortality.On subgroup analysis, the DCD+EVLP cohort had significantly worse survival in the modern era, which remained significant after adjusting for donor and recipient factors (p=0.005). EVLP was an independent risk factor for graft failure in the DCD cohort (HR 1.33, 95% CI 1.00-1.77, p=0.047), but did not significantly affect DBD graft survival (p=0.870). Risk factors for graft failure and mortality in the DCD+EVLP cohort included pulmonary hypertension (HR 77.5, 95% CI 6.15-979, p<0.001), transfusion prior to transplant (HR 2.60, 95% CI 1.07-6.31, p=0.035), elevated creatinine (HR 2.82, 95% CI 1.34-5.90, p=0.006), and higher allocation score (HR 1.02, 95% CI 1.00-1.04, p=0.017) ConclusionStudy findings suggest increased risks of mortality and perioperative complications following transplantation with DCD lungs that have undergone EVLP. DCD lung transplantation without EVLP confers equivalent survival but with some increase in perioperative complications. Further investigation and careful recipient selection is warranted to optimize the use of these extended criteria donors in the modern era.

Implementation of the Smart Indonesia Card Scholarship (KIP) Acceptance Using the K-NN Method (Case Study: Politeknik Siber Cerdika Internasional)

This study discusses the implementation of the K-Nearest Neighbor (K-NN) method in the process of receiving the Smart Indonesia Card (KIP) scholarship at the Cerdika International Cyber Polytechnic. The main purpose of this study is to improve accuracy and efficiency in the selection of KIP scholarship recipients. The K-NN method was chosen because of its ability to classify data based on the proximity of features between samples. This research involves analyzing data on prospective scholarship recipients which includes variables such as academic achievement, economic conditions, and extracurricular activities. The results of the implementation of the K-NN method show that this method can be used as an effective tool in the selection process of KIP scholarship recipients, with a fairly high level of accuracy compared to traditional methods. This finding is expected to help the Polytechnic in increasing transparency and fairness in providing scholarships.

Intracranial bypass for giant aneurysms treatment assessed by computational fluid dynamics (CFD) analysis

Unruptured giant intracranial aneurysms (GIA) are those with diameters of 25 mm or greater. As aneurysm size is correlated with rupture risk, GIA natural history is poor. Parent artery occlusion or trapping plus bypass revascularization should be considered to encourage intra-aneurysmal thrombosis when other treatment options are contraindicated. The mechanistic background of these methods is poorly studied. Thus, we assessed the potential of computational fluid dynamics (CFD) and fluid–structure interaction (FSI) analyses for clinical use in the preoperative stage. A CFD investigation in three patient-specific flexible models of whole arterial brain circulation was performed. A C6 ICA segment GIA model was created based on CT angiography. Two models were then constructed that simulated a virtual bypass in combination with proximal GIA occlusion, but with differing middle cerebral artery (MCA) recipient vessels for the anastomosis. FSI and CFD investigations were performed in three models to assess changes in flow pattern and haemodynamic parameters alternations (wall shear stress (WSS), oscillatory shear index (OSI), maximal time averaged WSS (TAWSS), and pressure). General flow splitting across the entire domain was affected by virtual bypass procedures, and any deficiency was partially compensated by a specific configuration of the circle of Willis. Following the implementation of bypass procedures, a reduction in haemodynamic parameters was observed within the aneurysm in both cases under analysis. In the case of the temporal MCA branch bypass, the decreases in the studied parameters were slightly greater than in the frontal MCA branch bypass. The reduction in the magnitude of the chosen area-averaged parameters (averaged over the aneurysm wall surface) was as follows: WSS 35.7%, OSI 19.0%, TAWSS 94.7%, and pressure 24.2%. FSI CFD investigation based on patient-specific anatomy models with subsequent stimulation of virtual proximal aneurysm occlusion in conjunction with bypass showed that this method creates a pro-thrombotic favourable environment whilst reducing intra-aneurysmal pressure leading to shrinking. MCA branch recipient selection for optimum haemodynamic conditions should be evaluated individually in the preoperative stage.

100 Impact of luteal blood perfusion and estrus expression on pregnancy rates of beef cows exposed to embryo transfer

Abstract This study aimed to evaluate the impact of luteal blood perfusion and estrus expression on pregnancy rates of beef cows exposed to fixed-timed embryo transfer (FTET). Postpartum beef cows (n = 763) from 22 locations were exposed to a 7-d Select Synch + controlled internal drug releasing (CIDR) and breeding indicator patches were affixed upon CIDR removal. Estrus expression was assessed twice daily for 72 h and a 100-µg injection of gonadotropin-releasing hormone was administered to cows that failed to express estrus 72 h after CIDR removal. Brightness mode ultrasonography of the corpus luteum (CL) was conducted to select recipients for FTET 9 d after CIDR removal. Suitable recipients were assigned to receive a single fresh or frozen embryo derived from either in vitro (IVF) or in vivo (IVD) method. After embryo recipient selection, CL morphometries and blood perfusion (BP) were then assessed at the time of embryo transfer via transrectal ultrasonography. Embryo recipients were categorized according to CL area [small (&amp;lt; 3 cm²), medium (3 to 4 cm²), or large (&amp;gt; 4 cm²)] and based on the percentage of luteal area with blood perfusion signals [low (&amp;lt; 25%), medium (25 to 45%), or high (&amp;gt; 45%)]. Pregnancy diagnoses were performed between d 60 and 90 of gestation. Cows that failed to express estrus prior FTET had decreased (P ≤ 0.02) luteal area, luteal diameter, and pregnancy rates compared with cows that expressed estrus. Luteal area category had no effect (P = 0.61) on pregnancy rates. Embryo recipients that expressed estrus had similar (P = 0.12) luteal blood perfusion compared with recipients that failed to express estrus. Embryo recipients with high (P = 0.02) and medium (P = 0.05) BP had greater pregnancy rates compared with embryo recipients with low BP. There was no interaction between estrus expression and luteal BP (P = 0.84). In summary, estrus expression and luteal BP positively impacted pregnancy rates to embryo transfer and may be used to facilitate embryo recipient selection.

SP6.8 - Predicting Determinants of Successful Transplantation Using Supra-Marginal (DRI-Donor Risk Index &amp;gt;1.5) Deceased Donor Kidneys

Abstract Objective To develop machine-learning-models with national registry data to predict factors associated with favourable outcomes using supra-marginal ( DRI -Donor Risk Index &amp;gt;1,5) deceased donor kidneys Design A retrospective cohort study using UK Transplant Registry data from 2000-2019 Setting National registry administered by NHS Blood and Transplant in the United Kingdom. Participants Adult recipients (n = 6254) of first kidney-alone transplants from very supra-marginal deceased-donors (DRI≥1.5) Main Outcome Measures Death-censored graft failure and patient mortality Predictors Comprehensive recipient, donor, and transplant characteristics. Statistical Analysis Bayesian neural networks, gradient boosting machines, random forest, and SMOTE-balanced bagging classifiers tuned using Bayesian optimisation Cox regression, competing risk analysis, and calibration plots Results Overall 5-year graft survival was 81%. The random-forest-model had excellent predictive performance for graft failure (AUC 0.88, 95% CI 0.87-0.89; RMSE 0.29). recipient age &amp;gt; 75-years (SHR 1.02, 95% CI 1.01-1.03), recipient-BMI &amp;gt;30 (SHR 1.04, 95% CI 1.02-1.07), HLA mismatches &amp;gt;4 (SHR 1.09, 95% CI 1.01-1.17), donor-creatinine &amp;gt;120mmol/L (SHR 1.002, 95% CI 1.001-1.003), and rejection- within 3-months (SHR 1.56, 95% CI 1.32-1.85) were key determinants of poor survival. Prolonged cold-ischemia-time &amp;gt;14hrs (SHR 1.01, 95% CI 1.007-1.015) was detrimental Conclusions Supra-marginal deceased-donor-kidneys can achieve excellent 5-year outcomes with careful recipient selection. Machine-learning accurately predicted factors associated with success. Adjusted predictors of graft failureVariableSHR95% CIp-valueRecipient-age &amp;gt; 75 years1.021.01-1.03&amp;lt;0.001Recipient-BMI &amp;gt;301.041.02-1.070.002HLA-mismatches &amp;gt;41.091.01-1.170.03Creatinine at offer &amp;gt;120 mmol/L/ 1.4 mg/dl1.0021.001-1.003&amp;lt;0.001Rejection at 3 month1.561.32-1.85&amp;lt;0.001Cold-ischemia-time &amp;gt;14 hrs1.011.007-1.015&amp;lt;0.001SHR: subdistribution hazard ratio;

Risk evaluation and recipient selection in adult liver transplantation: A mixed-methods survey

Background: Liver transplant (LT) is the definitive treatment for end-stage liver disease. Limited resources and important post-operative implications for recipients compel judicious risk stratification and patient selection. However, little is known about the factors influencing physicians’ assessment regarding patient selection for LT and risk evaluation. Methods: We conducted a mixed-methods, cross-sectional survey involving Canadian hepatologists, anesthesiologists, LT surgeons, and French anesthesiologists. The survey contained quantitative questions and a vignette-based qualitative substudy about risk assessment and patient selection for LT. Descriptive statistics and qualitative content analyses were used. Results: We obtained answers from 129 physicians, and 63 participated in the qualitative substudy. We observed considerable variability in risk assessment prior to LT and identified many factors perceived to increase the risk of complications. Clinicians reported that the acceptable incidence of at least 1 severe post-operative complication for a LT program was 20% (95% CI: 20-30%). They identified the presence of any comorbidity as increasing the risk of different post-operative complications, especially acute kidney injury and cardiovascular complications. Frailty and functional disorders, severity of the liver disease, renal failure and cardiovascular comorbidities prior to LT emerged as important risk factors for post-operative morbidity. Most respondents were willing to pursue LT in patients with grade III acute-on-chronic liver failure but were less often willing to do so when faced with the uncertainty of a clinical example. Conclusions: Clinicians had a heterogeneous appraisal of the post-operative risk of complications following LT, as well as factors considered in risk assessment.

Surgical Strategies for Renal Transplantation: A Pictorial Essay.

This pictorial essay aims to navigate through the complexities and challenges of renal transplantation (RT), by weaving together visual imagery with clinical insights within a comprehensive illustrative surgical guide. Herein, we provide a detailed visual exploration of the intricate anatomy and surgical processes necessary for both renal graft retrieval from the donor and also for an adequate implantation in the recipient. Regarding graft retrieval, after reviewing the relevant retroperitoneal surgical anatomy, and donor nephrectomy techniques, graft preservation and optimal backbench graft dissection principles were meticulously analyzed. Thereafter, the recipient surgical strategy for graft implantation was addressed, focusing on preoperative preparations, the site of implantation selection, exposure, operative bed dissection, graft revascularization, and urinary tract reconstruction. Careful donor and recipient selection, meticulous surgical execution, and rigorous postoperative management clearly hold a pivotal role in optimizing patient outcomes. Fostering a deeper understanding of the surgical nuances and clinical management practices that contribute to successful results post-RT, we hope to provide a useful practical tool for clinicians about to embark on the treacherous road of RT surgery. Innovative technologies and surgical practices that have already significantly improved the safety and effectiveness of RT stand testament to the importance of further scientific inquiry, conceptual developments, and clinical integration. Moving forward, it is essential that the medical community continues to refine these strategies and advocate for equitable access to transplantation, ensuring that advancements in the field translate into real-world benefits for all patients grappling with ESRD. The collaborative efforts of multidisciplinary teams are essential in addressing the complex clinical challenges associated with RT, with the ultimate goal of improving patient survival, enhancing graft longevity, and reducing healthcare disparities.

PENERAPAN METODE TOPIS PADA PENERIMAAN BANTUAN LANGSUNG TUNAI DANA DESA

The selection of prospective recipients for Direct Cash Assistance (BLT) from Village Funds often faces the complex problem of determining the individuals who truly need assistance. This problem arises due to the limitations of the data and criteria used, as well as the lack of transparency in the selection process. This research aims to overcome these problems by applying the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method in a decision support system for selecting BLT prospective recipients. The TOPSIS method is chosen because of its ability to handle multi-attribute criteria and different weights. The data used in this research is village population data that has been surveyed and verified by the village government. The criteria used in the selection of BLT prospective recipients include poverty level, living conditions, age, Marital Status, health. The results of the study show that the TOPSIS method is able to produce a more objective and accountable ranking of BLT prospective recipients compared to conventional methods. The application of this method is expected to assist village governments in distributing assistance effectively and minimizing the potential misuse of BLT funds.

Comparison of the Results of the Edas and Vikor Methods in the Decision Support System for KIP Scholarship Recipients at Malikussaleh University

Many high school graduates do not go on to higher education due to the high cost of education. To address this issue, the government, educational institutions and related parties can work together to find solutions to reduce financial barriers and increase access to higher education. In finding prospective students who are eligible to receive scholarships, the government must be fair and precise in making decisions regarding KIP scholarship recipients. This research uses EDAS and VIKOR methods in the selection of prospective KIP scholarship recipients at Malikussaleh University. This study uses historical data of previous KIP scholarship recipients as test data, where there are 6 criteria used, namely parent status, parent income, number of parent dependents, parent employment, parent home ownership, and parent home area. The application of the EDAS method resulted in Fauzi (230510004) as the first rank with an AS value of 0.850; then Hernita Ceria (230180023) as the second rank with an AS value of 0.791; and Ipadayan (230340033) as the third rank with an AS value of 0.789. In the application of the VIKOR method results, Halimah Murni (230210176) as the first rank with a Q value of 0.000; then Nauval Alzabar (230110077) as the second rank with a Q value of 0.015; and Muhammad Bukhari (230110040) as the third rank with a Q value of 0.024. 4. The results of this study state that the EDAS and VIKOR methods are methods that have different types. The EDAS method ranks alternatives based on their distance from the average solution, resulting in a ranking of alternatives based on how close they are to the optimal solution. While the VIKOR method ranks alternatives and provides the best compromise solution that best matches the applied criteria.

The Centennial Allograft: Cumulative Kidney and Liver Function for More Than 100 Years

The maximum cumulative life span of kidneys and livers first in donors and then in transplant recipients has not been established. The purpose of this study was to determine if cumulative organ function for more than 90 years is possible for transplanted kidneys and livers. This study included kidney and liver transplants from living or deceased donors ≥55 years. Cumulative organ function (COF) = Organ Age at Donation [Years] + Tx Allograft Function [Years]. Univariate and multivariable methods were used to describe characteristics and outcomes. Between 1987 and 2022, a total of 81,807 kidney and 37,099 liver transplants were included in this study. Of all kidney grafts 2.7% but 16.6% of all liver grafts reached the 90-year COF mark. There were only 2 living donor kidneys that surpassed the 100-year mark versus 29 deceased liver grafts. The longest kidney function was 104 years and longest liver function 108 years. Multivariate analysis showed that optimal donor and recipient selection and management are predictors for allograft longevity. COF in organs exceeding 100 physiologic years is possible. Extended organ longevity was 5 times more common for livers than kidneys. These analyses support that age alone should not exclude older kidney and liver donors from consideration for transplantation.

Uterine tone: A neglected criterion for the selection of bovine embryo transfer recipients.

This study evaluated the relationship between CL features assessed by ultrasound (luteal tissue area and blood flow, BF) or rectal palpation (size), uterine tone (UT), plasma progesterone (P4) concentration on Day 7 (D7) and subsequent pregnancy outcomes in bovine embryo recipients. A total of 163 cows and heifers were included in this study. The expected day of ovulation after the synchronization protocol was designated as D0. On D7, ovaries and uterus were examined by ultrasonography and rectal palpation, and subjective scores (1-3 scale) were assigned for CL size, area and BF, and for UT. Blood samples were collected for further P4 analysis. Each embryo recipient then received a grade I frozen-thawed invivo-produced blastocyst, which was transferred to the uterine horn ipsilateral to the CL. Pregnancy diagnosis was performed on D35, and the results were retrospectively compared with the assigned scores for CL and UT. We observed a significant (p < .02) interaction between CL size and UT, with a progressive increase in the likelihood of pregnancy for recipients bearing a large CL among those with turgid UT. Ultrasound scoring of the CL using B-mode and Doppler-mode did not significantly predict pregnancy rates on D35 (p < .6 and p < .5, respectively). However, logistic regression analysis revealed a trend towards a quadratic effect (p < .08 and p < .06) indicating that the probability of pregnancy varied according to the area of luteal tissue and P4 concentrations, respectively. No significant (p > .05) association was found between the probability of pregnancy and the BF area of the CL. In summary, UT before embryo transfer may reflect successful recipient synchronization. Elevated P4 levels, assessed by CL size, may offset uterine contractility, mitigating adverse effects. Additionally, the CL area may be more important than its vascularization area when evaluating recipients D7 after ovulation.

Implementation Of Decision Tree Algorithm For Classification Of Eligibility In Social Assistance Fund Distribution

This study examined the use of decision tree algorithms, specifically C4.5, in classifying the eligibility for social assistance fund distribution in Kelurahan Bangka Belitung Laut, Kecamatan Pontianak Tenggara. Inaccuracies in distribution were caused by recipient selection based on village officials' recommendations, which only considered the type of occupation. To address this issue, this study developed a system based on the C4.5 algorithm to process economic census data. This research used a quantitative method with a descriptive analytical approach, collecting data through literature studies and economic census, and processing data using the Rapid Miner application. The classification model generated was evaluated using 10-fold cross-validation to ensure high accuracy. The results showed that the C4.5 algorithm achieved 100% accuracy, precision, and recall. The decision tree model indicated that the main attributes determining eligibility were occupation and income. Some rules derived from this model, such as those who are unemployed with an income below Rp29,500 being eligible for assistance, provided clear guidelines for policymakers. The implementation of this algorithm is expected to improve fairness and effectiveness in the distribution of social assistance funds in Kelurahan Bangka Belitung Laut, reduce public dissatisfaction, and prevent potential social conflicts. This study recommended adopting the model in other areas with adjustments to local data to enhance broader fairness in aid distribution.

Ultrasound in Microsurgery: Current Applications and New Frontiers.

Ultrasound has revolutionized reconstructive microsurgery, offering real-time imaging and enhanced precision allowing for preoperative flap planning, recipient vessel identification and selection, postoperative flap monitoring, and lymphatic surgery. This narrative review of the literature provides an updated evidence-based overlook on the current applications and emerging frontiers of ultrasound in microsurgery, focusing on free tissue transfer and lymphatic surgery. Color duplex ultrasound (CDU) plays a pivotal role in preoperative flap planning and design, providing real-time imaging that enables detailed perforator mapping, perforator suitability assessment, blood flow velocity measurement, and, ultimately, flap design optimization. Ultrasound also aids in recipient vessel selection by providing assessment of caliber, patency, location, and flow velocity of recipient vessels. Postoperatively, ultrasound enables real-time monitoring of flap perfusion, providing early detection of potential flap compromise and improved flap survival rates. In lymphatic surgery, ultra-high frequency ultrasound (UHFUS) offers precise mapping and evaluation of lymphatic vessels, improving efficacy and efficiency by targeting larger dilated vessels. Integrating ultrasound into reconstructive microsurgery represents a significant advancement in the utilization of imaging in the field. With growing accessibility of devices, improved training, and technological advancements, using ultrasound as a key imaging tool offers substantial potential for the evolution of reconstructive microsurgery.

On the problem of improving methods for recruiting potential bone marrow donors in the Russian population

BACKGROUND: To achieve the number of potential bone marrow donors in Russian registries to a level sufficient for effective selection of recipients in need of transplantation, it is important to find the most effective ways to recruit Russians as potential bone marrow donors. AIM: To identify areas for improving methods of recruiting potential bone marrow donors in the Russian population. MATERIAL AND METHODS: An electronic survey was conducted: the questionnaire included 27 questions, the respondents were participants in the register of potential bone marrow donors of the Vasya Perevoshchikov National Register of Bone Marrow Donors Charitable Foundation, expert validation and a preliminary pilot survey were used. The focus was on factors that determine the population’s readiness to donate, preferred methods of donating biomaterial and territorial accessibility of recruitment centers, opportunities and obstacles to recruiting bone marrow donors. 6,314 people took part in the survey. The work used frequency analysis methods and the Pearson χ2 statistical criterion; the data was processed in the SPSS Statistics program. RESULTS: The most common channels of information about bone marrow donation in the process of involving potential registry participants were mass media (33.6%), social media (18.9%) and the social environment (18.4%). Among the respondents, 30% had experience in human blood donation. The social environment of donors included people who had experience in donating blood: among those surveyed, 48.5% indicated that their relatives served as blood donors; 67.7% noted that their friends were blood donors. For 40% of the registry participants, the method of submitting biospecimens was important. The majority (87%) of respondents indicated that submitting biospecimens at medical centers was the most convenient mechanism for joining the registry. CONCLUSION: The media serve as an effective channel for informing the population; the role of new social media (Internet resources, social networks) is increasing. A significant factor in involvement in the register is the social environment, including people who have experience in donating blood.

Preoperative Risk Assessment of Early Kidney Graft Loss.

A large proportion of potential organ donors are not utilized for kidney transplantation out of risk of early allograft loss because of donor-related characteristics. These can be summarized using kidney donor profile index (KDPI). Because KDPI affects the choice of the recipient, the predictive ability of KDPI is tied to recipient attributes. These have been questioned to explain most of the predictive ability of KDPI. This study aims to quantify the effect of the donor on early graft loss (EGL) by accounting for nonrandom allocation. This study included patients undergoing kidney transplantation from deceased donors between 2014 and 2020 from the Scientific Registry of Transplantation Recipients. EGL, defined as a return to dialysis or retransplantation during the first posttransplant year, was the primary endpoint. Nonrandom allocation and donor-recipient matching by KDPI necessitated the use of inverse probability treatment weighting, which served to assess the effect of KDPI and mitigate selection bias in a weighted Cox regression model. The study comprised 89 290 transplantations in 88 720 individual patients. Inverse probability treatment weighting resulted in a good balance of recipient covariates across values of continuous KDPI. Weighted analysis showed KDPI to be a significant predictor for short-term outcomes. A comparable (in terms of age, time on dialysis, previous transplants, gender, diabetes status, computed panel-reactive antibodies, and HLA mismatches) average recipient, receiving a kidney from a donor with KDPI 40-60 had a 3.5% risk of EGL increased to a risk of 7.5% if received a kidney from a KDPI >95 donor (hazard ratio, 2.3; 95% confidence interval, 1.9-2.7). However, for all-cause survival KDPI was less influential. The predictive ability of KDPI does not stem from recipient confounding alone. In this large sample-sized study, modeling methods accounting for nonindependence of recipient selection verify graft quality to effectively predict short-term transplantation outcomes.

Organ donation and organ assessment after primary circulatory death and secondary brain death

The global organ shortage is the biggest obstacle to expand urgently needed liver transplantation activities. In addition to donation after brain death (DBD), donation after primary circulatory death (DCD) has also been introduced in many European countries to increase the number of donated organs. This article summarizes the legal and ethical aspects of DCD, the practical donation process of DCD, the clinical results of DCD liver transplantation with aspecial focus on organ assessment before a planned DCD liver transplantation. In Europe 11countries have active DCD liver transplantation programs and atotal of 1230 DCD liver transplantations were performed in Europe in 2023. The highest proportion of DCD liver transplantations were recorded in Belgium (52.8%), the Netherlands (42.8%) and Switzerland (32.1%). The adequate selection of donors and recipients is crucial in DCD transplantation and the use of DCD livers particularly depends on the preparedness of the healthcare system for routine machine perfusion. The leaders are Belgium, France and Italy which implant around 68-74% of DCD organs. With an adequate organ assessment, the long-term results of DBD and DCD liver transplantations are comparable. To assess mitochondrial damage and thus organ quality, hypothermic oxygenated machine perfusion (HOPE) was introduced and has the secondary benefit of mitochondrial protection through oxygenation. The establishment of aerobic metabolism in mitochondria under hypothermia leads to areduction of toxic metabolites and the restoration of ATP storage, which subsequently leads to areperfusion light during implantation. Expanding the donor pool with DCD donors can counteract the global organ shortage. With adequate patient selection and routine organ assessment short-term and also long-term outcomes of DBD and DCD liver transplantation are comparable.

The impact of donor human leukocyte antigen-Bw4 allele on natural killer cell reconstitution and transplant-related mortality in haploidentical transplantation

Objective: To investigate the impact of donor human leukocyte antigen (HLA) -Bw4 expression on natural killer (NK) cell reconstitution and transplant outcomes in recipients undergoing haploidentical hematopoietic stem cell transplantation (HSCT) from maternal or related donors without ex vivo T-cell depletion. Methods: This study prospectively enrolled 32 patients who received T-replete haploidentical HSCT from maternal or collateral donors (cohort 1) to evaluate the facilitating effect of donor HLA-Bw4 expression on NK cell reconstitution. Furthermore, a retrospective analysis was conducted on 278 patients who underwent T-replete haploidentical HSCT from maternal or collateral donors (cohort 2) to analyze the impact of donor HLA-Bw4 expression on HSCT outcomes. Thus, a comparison was made between the effects of donor HLA-Bw4 expression on HSCT outcomes in patients receiving or not receiving post-transplant cyclophosphamide (PT-Cy) conditioning. Results: Donors expressing HLA-Bw4 alleles facilitated NK cell reconstitution and functional recovery, which remained unaffected by PT-Cy. Donors with HLA-Bw4 expression were associated with reduced transplant-related mortality (TRM), particularly mortality related to infections. The use of PT-Cy did not impact the ability of donor HLA-Bw4 to decrease TRM. Conclusion: In haploidentical HSCT from maternal or related donors without ex vivo T-cell depletion, the presence of donor HLA-Bw4 expression promotes rapid NK cell reconstitution and functional recovery and is significantly associated with lower TRM, especially infection-related mortality. These findings underscore the clinical significance of donor HLA-Bw4 expression in patients who underwent HSCT. Hence, the consideration of donor HLA-Bw4 in recipient selection and HSCT strategies holds important clinical implications.