Donor Type Research Articles

Prevalence, risk factors, and severity of erectile dysfunction following renal transplantation.

Sexual dysfunction is common among dialysis and transplant patients. Our study evaluated the prevalence, risk factors, and severity of erectile dysfunction (ED) post-transplant in a single center. We conducted a single-centre, observational, non-interventional study of adult male renal graft recipients. Sociodemographic and clinical data were collected, and erectile function was assessed with the International Index of Erectile Function (IIEF) questionnaire. 179 patients transplanted between 1995 and 2021 were enrolled (170 answered the questionnaire). Mild, moderate, and severe ED was noted in 33.5%, 20.6% and 10.6% of cases, respectively. ED prevalence increased with age (42.6% of patients < 40, 47.4% of patients aged 40-60, 78.9% of patients > 60). The total mean IIEF score was 16.32 ± 6.93 (erectile function 19.22 ± 7.9, orgasmic function 6.8 ± 2.9, sexual desire 6.43 ± 2.1, intercourse satisfaction 8.96 ± 3.7, overall satisfaction 6.78 ± 2.6). Age, alcohol consumption, type, time on dialysis pre-transplant, and donor type were significantly associated with erectile dysfunction (p < 0.05). Most patients (93.5%) were treated for comorbidities in addition to immunosuppression. Severe ED was significantly more common among patients taking alpha blockers and non-steroidal anti-inflammatory drugs. Self-reported erectile dysfunction post renal transplantation seems influenced by age, alcohol intake, dialysis history, donor type and certain drugs, but not by comorbidities (hypertension, diabetes, heart disease).

Attitude towards blood donation and its associated factors, types of blood donation, willingness, and feeling towards blood donation among potential blood donors in Ethiopia: systematic review and meta-analysis, observational study.

Blood donation is crucial for certain populations, such as pregnant mothers, anemic patients, traumatized patients, and individuals undergoing surgery. The imbalance between the number of blood donors and the demand for blood in Ethiopia is a serious public health concern. Having a favorable attitude towards blood donation could aid in correcting this imbalance. Therefore, this study aimed to assess the proportion of favorable attitudes, types of blood donation, willingness, and feelings towards blood donation in Ethiopia. Several databases were searched to retrieve the available articles. Heterogeneity and publication bias were assessed using the Galbraith plot with Cochrane I2 statistics and funnel plot with Egger's test, respectively. Subgroup analysis was done to identify the cause of the substantial heterogeneity. The pooled prevalence of favorable attitudes about blood donation was 65.28% (60.10-70.47). A higher prevalence was reported among studies conducted after 2020, in Northern Ethiopia and among health care professionals: 72.66%, 68.45%, and 69.41%, respectively. The percentages of people who had good feelings, willing to donate, and encouraged others to donate are 83.99%, 74.23%, and 77.96%, respectively. Conversely, 42.84% of participants believe that risk will happen following donation. There was an association between knowledge and attitude towards blood donation (AOR = 1.76; 95% CI: 1.48-2.99). The findings of this study may imply the preparation of a blood donation campaign that helps the community. Concerned bodies from governmental and non-governmental organizations may arrange and design community education, which may increase the number of voluntary donors.

Outcomes of Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation Utilizing Extended Criteria Donor Grafts

Background: The deceased donor shortage in the United States has led to increased utilization extended criteria donor (ECD) liver grafts. Centers often utilize ECD grafts in patients with low Model for End-Stage Liver Disease scores, like patients with hepatocellular carcinoma (HCC). However, few studies have directly examined outcomes of using ECD grafts in HCC patients. Methods: Adults receiving liver transplantation (LT) for HCC between 2010-2020 were identified in the Organ Procurement and Transplantation Network database. Recipients were categorized according to donor type: standard criteria (SCD), extended criteria, donation after brain death (ECD-DBD), and donation after circulatory death (DCD). Multivariable Cox regression analysis identified variables associated with overall or graft survival at 3 years post-LT. Results: Most patients received ECD-DBD grafts (51.4%); only 8.3% received DCD grafts. Time on waitlist was similar for ECD and SCD recipients (p=0.79). SCD recipients had higher 5-year overall survival post-LT than ECD-DBD or DCD recipients (79.1%, 77.1%, and 76.8%, respectively, p<0.001). Similarly, 5-year graft survival was also highest in SCD recipients (SCD, 77.8%; ECD-DBD, 75.7%; DCD, 72,.2%; p<0.001). In multivariable analysis, DCD grafts increased mortality risk (HR, 1.33; 95% CI, 1.12-1.57; p=0.001), but ECD-DBD grafts did not (HR, 1.10; 95% CI, 1.00-1.22; p=0.052). Conclusions: DCD and ECD-DBD recipients had significantly lower overall and graft survival. However, the survival benefit of liver transplantation for HCC patients greatly outweighs the small differences in patient and graft survival from using ECD grafts. Further research should investigate whether treatment of ECD grafts with machine perfusion may ameliorate this discrepancy.

From pandemic to participation: A two-year follow-up of blood donors in the Netherlands who registered during the first wave of the COVID-19 pandemic.

During the height of the COVID-19 pandemic (2020-2021), people were urged to minimize movements. Nevertheless, the Netherlands observed a huge increase in new donor registrations in early 2020. It is unclear whether such "pandemic" donors are willing to become repeat donors. The aim of this study was to analyze the donation behavior of these "pandemic" donors during 2 years after registration. All donors registered in weeks 11-20 of 2020 were followed for 2 years and their turnout for the new donor screening (NDS), their first-time donation (FTD), their donation(s) in the follow-up period, and their availability at the end of the follow-up period was compared with donors registered in weeks 11-20 of the previous years, 2017-2019. Totally 26,463 donors registered during week 11-20 in 2020; more than double as in the same period in previous years. Their turnout for the NDS (80%) and FTD (60%) was like donors registered in 2017-2019. On the longer term, we saw lower donor availability with a shift in number of whole blood and plasma donations. During the first phase of the pandemic, more people registered than usual. Their show rates for the NDS and the FTD were comparable with previous years, suggesting that "pandemic" donors show identical behavior as regular donors. On the long term, however, donation behavior differed (lower return rates and shift in donation types). Further research is needed to disentangle impacts of the pandemic especially on the long-term changes as they happened simultaneously with policy and recruitment changes.

Geospatial Distribution of HIV Seroprevalence Among Blood Donors in South Asian Countries: A Systematic Review and Meta-Analysis.

The reliance on replacement blood donors in developing countries has led to an increased prevalence of transfusion-transmitted infections (TTIs), including HIV. This systematic review and meta-analysis aimed to assess the seroprevalence of HIV among blood donors in South Asian countries and disseminate the findings in choropleth maps. In addition, gender-specific prevalence or the yearly trend of HIV prevalence among blood donors was also investigated. Following the PRISMA guidelines, we searched PubMed, Scopus, CAB abstracts, CINAHL, and Google Scholar for articles published between January 2000 and December 2022. The DerSimonian-Laird effect model was used due to the high heterogeneity of the data. Data analysis was performed using R Studio version 4.1.0, ArcGIS, and GraphPad Prism 7.0. The pooled seroprevalence of HIV among blood donors in South Asian countries was found to be 0.13%, with the highest prevalence of 0.19% in India and the lowest prevalence of 0.02% in Bangladesh and Bhutan. Female blood donors had a higher seroprevalence than their male counterparts (0.24%, vs. 0.17%). In contrast to voluntary blood donors with an HIV seroprevalence of 0.13%, replacement blood donors have a higher HIV prevalence of 0.26%. The observed high heterogeneity was attributed to variations in country, gender, type of blood donors, and study year. This study demonstrates a significant burdenof HIV among blood donors in South Asia, emphasizing the need forenhanced donor screening protocols, targeted interventions and educational campaigns to ensure the safety of blood transfusionservices.Future research should explore additional risk factors and focus on expanding screening methods, particularly in resource-limited settings.

Sydnthiones are versatile bioorthogonal hydrogen sulfide donors

Hydrogen sulfide (H2S) is an important endogenous gasotransmitter, but the bioorthogonal reaction triggered H2S donors are still rare. Here we show one type of bioorthogonal H2S donors, sydnthiones (1,2,3-oxadiazol-3-ium-5-thiolate derivatives), which was designed with the aid of density functional theory (DFT) calculations. The reactions between sydnthiones and strained alkynes provide a platform for controllable, tunable and mitochondria-targeted release of H2S. We investigate the reactivity of sydnthiones‒dibenzoazacyclooctyne (DIBAC) reactions and their orthogonality with two other bioorthogonal cycloaddition pairs: tetrazine‒norbornene (Nor) and tetrazine‒monohydroxylated cyclooctyne (MOHO). By taking advantage of these mutually orthogonal reactions, we can realize selective labeling or drug release. Furthermore, we explore the role of H2S, which is released from the sydnthione-DIBAC reaction, on doxorubicin-induced cytotoxicity. The results demonstrate that the viability of H9c2 cells can be significantly improved by pretreating with sydnthione 1b and DIBAC for 6 h prior to exposure to Dox.

Severe Primary Graft Dysfunction in Heart Transplant Recipients Using Donor Hearts After Circulatory Death: United States Experience

ObjectiveThis study compares the incidence of severe Primary Graft Dysfunction (PGD) in a contemporaneous cohort of donors after circulatory death (DCD) and brain death (DBD) heart transplant recipients. MethodThe United Network for Organ Sharing database was queried for isolated adult heart transplant recipients from 9/2023 to 6/2024. Heart recipients were stratified based on the organ donation type (DCD vs DBD). DCD heart recipients were further categorized based on the procurement method: time between circulatory death to cross-clamp: ≤ 30 minutes (Direct Procurement and Preservation, DPP), >30 minutes (Normothermic Regional Perfusion, NRP). Outcomes of interest included: severe PGD (Left/Bi-Ventricular; LV/BiV) at 24 hours and Severe Graft Dysfunction at 72 hours (patients with severe PGD at 24 hours that remain on mechanical support at 72 hours). ResultsA total of 2,590 adult heart transplant recipients were identified, of which 17.1% underwent DCD heart transplantation. DCD heart recipients were less likely to be on inotrope (36.7% vs 41.6%, p=0.046) and ECMO (4.1% vs 9.9%, p<0.001) prior to transplant than DBD heart recipients. DCD heart recipients were more likely than DBD heart recipients to develop severe PGD (LV/BiV) at 24 hours (9.5% vs 5.1%, p<0.001). The Severe Graft Dysfunction at 72 hours (2.3% vs 2.9%, p=0.67) and 30-day mortality were similar between the 2 groups. Recipients of DCD heart procured with DPP or NRP had similar severe PGD (LV/BiV) at 24 hours (9.4% vs 9.7%, p=0.93). ConclusionSevere PGD at 24 hours is higher among the DCD than DBD heart recipients, but Graft Dysfunction improves by 72 hours.

Reappraising the prognostic relevance of cytogenetic risk in patients with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation.

This study aimed to investigate the prognostic relevance of cytogenetic risk in 9826 adults with acute myeloid leukemia (AML) who underwent allogeneic hematopoietic cell transplantation (HCT) during the first or second complete remission. The 5-year probabilities of overall survival (OS) were 66%, 61%, and 47% (P < 0.001), the cumulative incidences of relapse were 14%, 19%, and 32% (P < 0.001), and the cumulative incidences of non-relapse mortality (NRM) were 23%, 23%, and 25% (P = 0.208) in patients with favorable (n = 1418), intermediate (n = 6747), and poor cytogenetic risk (n = 1661), respectively. The significant effect of cytogenetic risk on OS was strong in all subgroups stratified by age, sex, performance status, disease status, donor type, conditioning intensity, graft-versus-host disease prophylaxis, and transplantation period (P < 0.001 for all). The evaluation of trends in posttransplant outcomes for patients in each cytogenetic risk category indicated that the risk of relapse declined in patients with favorable and intermediate cytogenetics and that the risk of NRM decreased in those with intermediate and poor cytogenetics. Therefore, patients with intermediate cytogenetics experienced the best OS improvement. These results confirm cytogenetic risk as a universal prognostic factor in patients with AML undergoing allogeneic HCT while highlighting the requirement for further improvements in posttransplant OS by reducing NRM in patients with favorable cytogenetics and by reducing relapse in patients with poor cytogenetics.

Clinical outcomes of autologous adipose-derived mesenchymal stem cell combined with high tibial osteotomy for knee osteoarthritis are correlated with stem cell stemness and senescence

BackgroundMesenchymal stem cells (MSCs) have been proposed to treat osteoarthritis (OA) for many years. However, clinical outcomes have been inconsistent due to biological variation between patients, differences in tissue source and preparation of the MSCs, and type of donor (e.g. allogenic versus autologous). Here, we test the hypothesis that inconsistent clinical outcomes are related to variations in the stemness and senescence of the injected autologous adipose-derived (AD) MSCs.MethodsIn the prospective randomized trial, 45 knee OA patients were divided into two groups: Group 1 (n = 22) patients treated with high tibial osteotomy (HTO) alone and Group 2 (n = 23) patients treated with HTO followed by intra-articular injection of autologous AD-MSCs (HTO + AD-MSCs). MRI and X-ray were performed pre-operation and 12 months post-operation. WOMAC and VAS score were collected four times, every 6 months over a 24-month follow-up. We observed the proliferation and stemness of AD-MSCs selected from the 5 patients showing the most improvement and from the 5 patients with the least improvement, and completed further in vitro experiments including beta-galactosidase activity, reactive oxygen species and bioinformatic analysis.ResultsThe results showed that patients treated with HTO + AD-MSCs had a significant reduction in knee OA severity as compared to patients treated with HTO alone. Moreover, we discovered that proliferation and colony forming efficiency of AD-MSCs selected from the 5 patients showing the most improvement performed significantly better than cells selected from the 5 patients with the least improvement. AD-MSCs from the patients with the most improvement also had lower amounts of senescent cells and intracellular reactive oxygen species.ConclusionsClinical outcomes of autologous AD-MSCs therapy in knee osteoarthritis are correlated with stem cell stemness and senescence. Our study highlights emerging opportunities and trends in precision medicine that could potentially improve autologous MSC-based therapies.

Highly Efficient Aggregation‐Induced Chiral TADF Molecules Exhibiting Prolonged Lifetime in Living Cells under Hypoxic Stress

AbstractThermally activated delayed fluorescence (TADF) materials have garnered significant attention as potential candidates for biological photoluminescence imaging. However, the achievement of tunable chiral TADF materials through aggregated and self‐assembled processes remains a formidable challenge. In this study, four donor–acceptor–donor type chiral TADF molecules, designed by directly linking electron‐donating moieties (phenoxazine, phenothiazine or 1‐phenyl‐1,2,3,4‐tetrahydroisoquinoline) with an electron‐acceptor unit (diphenyl sulfone), as promising candidates for luminescent imaging applications are presented. The experimental investigation reveals that these chiral TADF materials possess remarkably small ΔEST values, promoting efficient reverse intersystem crossing (RISC). Additionally, they exhibit aggregation‐induced emission and long‐delayed luminescent lifetimes affected by the aggregated and self‐assembled state. Moreover, deoxygenation significantly enhances the emission, enabling high‐contrast hypoxia probing, which shows great potential for high‐contrast photoluminescence imaging in living cells. This work not only offers a molecular design strategy for chiral TADF materials but also extends the diverse biological applications of high‐contrast hypoxia detection in the biological field.

9,10-Bis(5H-dibenzo[b,f]azepino)anthracene

The title compound with a donor–π–donor (D–π–D) type triad structure was synthesized by Buchwald–Hartwig amination using 9,10-dibromoanthracene and 5H-dibenzo[b,f]azepine, and characterized by 1H, 13C{1H} NMR, HRMS, and X-ray diffraction analysis. The azepine–anthracene–azepine units are nearly orthogonal to each other, with a torsion angle of 88°. A broad and weak absorption band around 410–480 nm and the low emission character (ΦF = 0.01) suggest the weak intramolecular charge transfer from the azepine to the anthracene unit due to the twisted structure.

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact.

While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example. A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions. At CKD stage5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9kg carbon dioxide equivalents (CO2e) per session depending on dialysis modality, and 336-2022kgCO2e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4-143.6kgCO2e), followed by a 1-day hospital stay (28.8-63.9kgCO2e) and an 8-h emergency room visit (14.4-27.5kgCO2e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO2e emissions. Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.

Fear of donation-related stimuli across different levels of donation experience and types of donation (whole-blood and plasma): A cross-sectional study in Italian donors.

Donation-related fears are prevalent even among regular donors and can hinder both recruitment and retention. This cross-sectional study aimed to estimate the prevalence of these fears in Italian whole-blood and plasma donors, across different levels of donation experience. A sample of 615 voluntary, unpaid donors from Italy (64.1% male, mean age 45.42 ± 11.80 years) completed an online survey assessing their fear of common donation-related stimuli (fear of blood, needles, pain, and fainting), experience of vasovagal symptoms at the last donation, and their intention to donate again. Donors were grouped based on donation history and their most recent donation type (whole-blood or plasma). A significant negative relationship was found between donation history and most types of donation-related fears, suggesting that greater experience corresponds to reduced fear. Plasma donors reported lower levels of fear across all stimuli compared to whole-blood donors. Despite this, nearly one-third of the most experienced whole-blood donors and 20% of plasma donors still reported some level of fear. Greater fear was associated with increased reports of pain and vasovagal symptoms during donation, regardless of donation type. However, no significant association emerged between donation-related fears and the intention to donate again. Donation-related fear persists even among experienced donors, for both whole-blood and plasma donors. Given its potential to impact donor comfort and retention, the assessment and management of donation-related fears should be integrated into donor care, with appropriate strategies to help donors regulate their fear throughout their donation careers.

Genetic analysis of a blood donor with combined FUT1 and ABO dual blood group gene variants resulting in para-Bombay and A2 subtype blood types and a literature review

To investigate the serological and molecular genetic characteristics of a voluntary blood donor with combined FUT1 and ABO blood group gene variants causing para-Bombay and A2 subtype, and to review relevant literature on para-Bombay blood types carrying alleles such as FUT101W.37 and FUT101W.23. A blood donor with para-Bombay and A2 subtype who participated in voluntary blood donation at the Dongguan Blood Center in August 2023 was selected as the study subject. Serological tests were performed to identify the ABO blood group, Lewis blood group antigens, and unexpected serum antibodies in the donor. Adsorption-elution test was conducted to detect trace antibodies in the blood donor's plasma to trace the A, B and H antigens on the red blood cell surface. Sanger sequencing was carried out to analyze the sequences of the FUT1 and ABO genes. Using keywords such as "para-Bombay" "FUT1*01W.37" and "FUT1*01W.23" both in Chinese and English, relevant literature on para-Bombay blood type subjects carrying FUT1*01W.37 and FUT1*01W.23 alleles was retrieved from the CNKI, Wanfang Data Knowledge Service Platform, and PubMed databases, and the retrieval time was set as from the establishment of database to December 2022. This study has been approved by the Ethics Committee of Dongguan Blood Center (No. 2022005), and informed consent of blood donation was obtained from the blood donor. Serological testing of the blood donor revealed inconsistent results between forward and reverse ABO blood typing, negative H antigen on the red blood cell surface, Le(a-b+) secretor type for Lewis blood group, and unexpected anti-H antibodies in the plasma, indicating a suspected para-Bombay type. Absorption-elution test suggested the blood type of the blood donor to be para-Bombay and A subtype. Sanger sequencing showed that the donor has harbored homozygous FUT1*(c.35T+c.803A)/(c.35T+c.803A) variant, with the FUT1*(c.35T+c.803A) allele containing a dual nucleotide variant unrecorded by the International Society of Blood Transfusion (ISBT) FUT1 gene variant database, which was similar to the weakly functional allele of FUT101W. 37(c.803G>A) as recorded by the ISBT database. The ABO genotype was heterozygous ABOA2.05/O.01.02. Combining the results of serological and genetic testing, the blood type of the blood donor was determined to be para-Bombay and A2 subtypes. Literature review has identified a pregnant women from Qingdao carrying the FUT1*01W.37 allele and 2 individuals carrying a heterozygous FUT1*01W.23 allele. This study has discovered a blood donor with coexisting para-Bombay and ABO subtype blood groups. Based on the characteristics of red blood cell surface antigens, the FUT1*01W.37 as classified as an FUT1 null allele.

Incidence and impact of invasive fungal infection comparing post-transplant cyclophosphamide with cyclosporine plus methotrexate GVHD prophylaxis in allogeneic HSCT

BackgroundIn recent years, haploidentical hematopoietic stem cell transplantation (haploHSCT) with post-transplant cyclophosphamide (PTCy) has become increasingly prevalent. However, the precise impact of invasive fungal disease (IFD) in relation to graft-versus-host disease (GVHD) prophylaxis and donor type remains to be elucidated. MethodsIn this study, we analyzed data from 580 HSCT patients, comprising 80 patients who received haploidentical grafts and 500 patients who received grafts from other donor types. PTCy was exclusively administered to haploidentical HSCT recipients, while cyclosporine A (CsA) in combination with short-course methotrexate (scMTX) was used for patients receiving grafts from other donors. ResultsThe IFD rate by PTCy and CsA plus scMTX was 15 % and 15.6 %, respectively. At 6 months and 1 year post-transplant, the cumulative incidence of IFD was 9.4 % and 14.8 % for the PTCy group, and 7.9 % and 12.3 % for the CsA plus scMTX group, respectively. Both groups exhibited poor survival outcomes associated with IFD. Identified risk factors for IFD included age ≥ 45 years, disease relapse, and grade III-IV acute GVHD. Aspergillus spp. and Candida spp. were the most commonly isolated pathogens. High rate of cytomegalovirus reactivation was also noticed in PTCy or CsA plus scMTX group, but not a risk factor for IFD. ConclusionThe similar IFD rate between haploHSCT with PTCy and others with CsA plus scMTX was documented, with Aspergillus spp. and Candida spp. as the most common pathogens. Further research is needed to investigate IFD following haploHSCT with PTCy and to explore differences with other types of allogeneic HSCT.

Thio-ProTide strategy: A novel H2S donor–drug conjugate (DDC) alleviates hepatic injury via innate lysosomal targeting

Hydrogen sulfide (H2S) is a gas signaling molecule with versatile bioactivities; however, its exploitation for disease treatment appears challenging. This study describes the design and characterization of a novel type of H2S donor–drug conjugate (DDC) based on the thio-ProTide scaffold, an evolution of the ProTide strategy successfully used in drug discovery. The new H2S DDCs achieved hepatic co-delivery of H2S and an anti-fibrotic drug candidate named hydronidone, which synergistically attenuated liver injury and resulted in more sufficient intracellular drug exposure. The potent hepatoprotective effects were also attributed to the H2S-mediated multipronged intervention in lipid peroxidation both at the whole cellular and lysosomal levels. Lysosomal H2S accumulation and H2S DDC activation were facilitated by the hydrolysis through the specific lysosomal hydrolase, representing a distinct mechanism for lysosomal targeting independent of the classical basic moieties. These findings provided a novel pattern for the design of optimally therapeutic H2S DDC and organelle-targeting functional molecules.

Early Complications in Kidney Donors and Course of Health-related Quality of Life 12 mo After Donation: An Analysis of the Swiss Organ Living-Donor Health Registry.

Since 1998, the Swiss Organ Living-Donor Health Registry (SOL-DHR) has recorded peri- and postoperative complications of living kidney (LK) donors, as reported by all Swiss transplant centers and has collected follow-up data prospectively. We analyzed the early complications of 2379 consecutive individuals who donated a kidney between January 1998 and June 2022 and assessed their health-related quality of life (HRQoL) 1 y after donation. In total, 447 early complications in 404/2379 LK donors (17.0%) were reported to the SOL-DHR. The frequency of donors with major complications (ie, Dindo-Clavien classification 3/4) was 2.4%. In total, 31 donors needed reoperation, and in 13/31 (42%), donors reoperation was necessary because of bleeding complications. Independent risk factors for major early complications were older donor age (P = 0.005) and type of surgical approach (ie, the laparoscopic retroperitoneal compared with laparoscopic transabdominal surgery; P = 0.01), but not sex. We observed a U-shaped association of body mass index, where very low/high body mass indexes had higher odds of major early complications, without reaching statistical significance. Although HRQoL was affected by kidney donation, 96.5% of donors indicated that they would donate their kidney again. The only independent risk factor for low HRQoL based on mental health scores was worsening EB after living kidney donation (P < 0.0001). Overall, living kidney donation is a safe procedure, however, donor age and type of surgical approach affect the risk of complications. A decline in emotional bonding with the recipient after donation may worsen the quality of life of the donor.

Ex Vivo Lung Perfusion in Donation after Cardiac and Brain Death Donation

Allografts from donation after circulatory death (DCD) or brain death donors may be evaluated by ex vivo lung perfusion (EVLP) to assess quality for transplantation. We sought to determine the association of donor type with transplantation outcomes at a national level. The United Network for Organ Sharing database was queried for lung transplant recipients, which were stratified into: DCD EVLP, brain death EVLP, standard DCD and standard brain death, followed by an unadjusted analysis. 1:1 propensity matching based on donor and recipient characteristics was used to compare DCD v DCD EVLP, brain death v brain death EVLP and brain death v DCD EVLP. The cohorts were assessed with comparative statistics. Finally, static and portable EVLP were compared to determine independent association with increased mortality. The unadjusted DCD EVLP group had significantly higher incidence of post-operative morbidity and mortality. 3-year survival was significantly lower in the DCD EVLP group, 65.3% (p=0.026). Following matching, the EVLP groups had significantly higher morbidity, and in-hospital mortality (DCD EVLP v brain death), but mid-term survival was no longer significantly different. However, the DCD EVLP group had about ∼6% lower survival than the DCD group (p=0.05) and about ∼7% lower survival than the brain death group (p=0.12). Within the EVLP groups, static and portable EVLP were not independently associated with increased mortality. Expansion of DCD EVLP allografts increases organ access, though providers should be aware of potential increases in complications and mortality as compared to DCD alone.

Knowledge Gaps and Educational Needs in Organ Transplantation: A Study of Portuguese Medical Students

ObjectiveKidney transplantation has been a life-changing procedure for patients with end-stage renal disease (ESRD). Portugal ranks high globally in transplantation, benefiting from an “opt-out” system that presumes consent for organ donation. The effectiveness of transplantation programs depends significantly on public knowledge and the willingness to donate, where medical students play a crucial role. This study assesses the knowledge and educational needs of medical students regarding organ transplantation and donation. DesignA cross-sectional survey was conducted using a structured questionnaire distributed to fifth-year medical students from 2 universities in Porto, Portugal, affiliated with different hospital centers during the 2022-2023 academic year. ResultsA total of 427 students responded, with a response rate of 85.0%, higher at Center 1 (93.0%) compared to Center 2 (70.0%) (P-value < .001). The majority were aware of the opt-out legislation (92.3%) and recognized ESRD as the primary cause of kidney transplantation (96.1%). Knowledge of donation types was high, particularly for brain death (92.6%) and living donation (91.5%), but lower for donation after circulatory death (73.1%). Awareness of donation after circulatory death was significantly higher among respondents from Center 1 (79.4%) than Center 2 (59.1%; P < .001). Only a minority were familiar with immunosuppressive drugs (36.0%) and had practical exposure to transplant-related activities. Satisfaction with transplantation education was low (8.2%), with significant differences between the centers. ConclusionThe findings suggest that medical schools should enhance educational content and provide more experiences to prepare future healthcare providers adequately.

Shallow but Wide, or Deep but Narrow: Does the Type of Donation Causes Impact the Donation Allocation Strategy’ Preference?

Shallow but Wide, or Deep but Narrow: Does the Type of Donation Causes Impact the Donation Allocation Strategy’ Preference?