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Cheng P, Pu K. Enzyme-responsive, multi-lock optical probes for molecular imaging and disease theranostics. Chem Soc Rev 2024. [PMID: 39229642 DOI: 10.1039/d4cs00335g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Optical imaging is an indispensable tool for non-invasive visualization of biomolecules in living organisms, thereby offering a sensitive approach for disease diagnosis and image-guided disease treatment. Single-lock activatable optical probes (SOPs) that specifically switch on optical signals in the presence of biomarkers-of-interest have shown both higher detection sensitivity and imaging quality as compared to conventional "always-on" optical probes. However, such SOPs can still show "false-positive" results in disease diagnosis due to non-specific biomarker expression in healthy tissues. By contrast, multi-lock activatable optical probes (MOPs) that simultaneously detect multiple biomarkers-of-interest could improve detection specificity towards certain biomolecular events or pathological conditions. In this Review, we discuss the recent advancements of enzyme-responsive MOPs, with a focus on their biomedical applications. The higher detection specificity of MOPs could in turn enhance disease diagnosis accuracy and improve treatment efficacy in image-guided disease therapy with minimal toxicity in the surrounding healthy tissues. Finally, we discuss the current challenges and suggest future applications of MOPs.
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Affiliation(s)
- Penghui Cheng
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 70 Nanyang Drive, 637457 Singapore, Singapore.
| | - Kanyi Pu
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 70 Nanyang Drive, 637457 Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore 636921, Singapore
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Kim HD, Chung BH, Yang CW, Kim SC, Kim KH, Kim SY, Kim KY, Lee J. Management of Immunosuppressive Therapy in Kidney Transplant Recipients with Sepsis: A Multicenter Retrospective Study. J Intensive Care Med 2024; 39:758-767. [PMID: 38321761 DOI: 10.1177/08850666241231495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Up to 6% of kidney transplant recipients (KTRs) experience life-threatening complications requiring intensive care unit (ICU) admission, and one of the most common medical complications requiring ICU admission is infection. This study aimed to evaluate the effect of immunosuppressive therapy (IST) modification on prognosis of KTRs with sepsis. METHODS We conducted a multicenter retrospective study in 4 university-affiliated hospitals to evaluate the effect of adjusting the IST in KTRs with sepsis. Only patients who either maintained IST after ICU admission or those who underwent immediate (within 24 h of ICU admission) reduction or withdrawal of IST following ICU admission were included in this study. "Any reduction" was defined as a dosage reduction of any IST or discontinuation of at least 1 IST. "Complete withdrawal of IST" was defined as concomitant discontinuation of all ISTs, except steroids. RESULTS During the study period, 1596 of the KTRs were admitted to the ICU, and 112 episodes of sepsis or septic shock were identified. The overall in-hospital mortality rate was 35.7%. In-hospital mortality was associated with higher sequential organ failure assessment score, simplified acute physiology score 3, non-identical human leukocyte antigen relation, presence of septic shock, and complete withdrawal of IST. After adjusting for potential confounding factors, complete withdrawal of IST remained significantly associated with in-hospital mortality (adjusted coefficient, 1.029; 95% confidence interval, 0.024-2.035) and graft failure (adjusted coefficient, 2.001; 95% confidence interval, 0.961-3.058). CONCLUSIONS Complete IST withdrawal was common and associated with worse outcomes in critically ill KTRs with sepsis.
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Affiliation(s)
- Hyung Duk Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok Chan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung Hoon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Shin Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Kyu Yean Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Shah KK, Hedley JA, Robledo KP, Wyld M, Webster AC, Morton RL. Cost-effectiveness of Accepting Kidneys From Deceased Donors With Common Cancers-A Modeling Study. Transplantation 2024; 108:e187-e197. [PMID: 38499509 DOI: 10.1097/tp.0000000000004984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The disparity between the demand for and supply of kidney transplants has resulted in prolonged waiting times for patients with kidney failure. A potential approach to address this shortage is to consider kidneys from donors with a history of common cancers, such as breast, prostate, and colorectal cancers. METHODS We used a patient-level Markov model to evaluate the outcomes of accepting kidneys from deceased donors with a perceived history of breast, prostate, or colorectal cancer characterized by minimal to intermediate transmission risk. Data from the Australian transplant registry were used in this analysis. The study compared the costs and quality-adjusted life years (QALYs) from the perspective of the Australian healthcare system between the proposed practice of accepting these donors and the conservative practice of declining them. The model simulated outcomes for 1500 individuals waitlisted for a deceased donor kidney transplant for a 25-y horizon. RESULTS Under the proposed practice, when an additional 15 donors with minimal to intermediate cancer transmission risk were accepted, QALY gains ranged from 7.32 to 20.12. This translates to an approximate increase of 7 to 20 additional years of perfect health. The shift in practice also led to substantial cost savings, ranging between $1.06 and $2.3 million. CONCLUSIONS The proposed practice of accepting kidneys from deceased donors with a history of common cancers with minimal to intermediate transmission risk offers a promising solution to bridge the gap between demand and supply. This approach likely results in QALY gains for recipients and significant cost savings for the health system.
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Affiliation(s)
- Karan K Shah
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James A Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kristy P Robledo
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Angela C Webster
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Rachael L Morton
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Shen R, Lu Y, Cai C, Wang Z, Zhao J, Wu Y, Zhang Y, Yang Y. Research progress and prospects of benefit-risk assessment methods for umbilical cord mesenchymal stem cell transplantation in the clinical treatment of spinal cord injury. Stem Cell Res Ther 2024; 15:196. [PMID: 38956734 PMCID: PMC11218107 DOI: 10.1186/s13287-024-03797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
Over the past decade, we have witnessed the development of cell transplantation as a new strategy for repairing spinal cord injury (SCI). However, due to the complexity of the central nervous system (CNS), achieving successful clinical translation remains a significant challenge. Human umbilical cord mesenchymal stem cells (hUMSCs) possess distinct advantages, such as easy collection, lack of ethical concerns, high self-renewal ability, multilineage differentiation potential, and immunomodulatory properties. hUMSCs are promising for regenerating the injured spinal cord to a significant extent. At the same time, for advancing SCI treatment, the appropriate benefit and risk evaluation methods play a pivotal role in determining the clinical applicability of treatment plans. Hence, this study discusses the advantages and risks of hUMSCs in SCI treatment across four dimensions-comprehensive evaluation of motor and sensory function, imaging, electrophysiology, and autonomic nervous system (ANS) function-aiming to improve the rationality of relevant clinical research and the feasibility of clinical translation.
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Affiliation(s)
- Ruoqi Shen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Yubao Lu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Chaoyang Cai
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Ziming Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Jiayu Zhao
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yingjie Wu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Yinian Zhang
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
| | - Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
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Dias FS, Fernandes DM, Cardoso-Fernandes A, Silva A, Basílio C, Gatta N, Roncon-Albuquerque R, Paiva JA. Potential for organ donation after controlled circulatory death: a retrospective analysis. Porto Biomed J 2024; 9:259. [PMID: 38993948 PMCID: PMC11236395 DOI: 10.1097/j.pbj.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Objectives Despite the discrepancy between demand and availability of organs for transplantation, controlled circulatory death donation has not been implemented in Portugal. This study aimed to estimate the potential increase in organ donation from implementing such a program. Material and Methods All deceased patients within the intensive care medicine department at Centro Hospitalar Universitário de São João, throughout the year 2019, were subjected to retrospective analysis. Potential gain was estimated comparing the results with the number of donors and organs collected during the same period at this hospital center. Differences in variables between groups were assessed using t tests for independent samples or Mann-Whitney U tests for continuous variables, and chi-squared tests were used for categorical variables. Results During 2019, 152 deaths occurred after withdrawal of life-sustaining therapies, 10 of which would have been potentially eligible for donation after controlled circulatory death. We can anticipate a potential increase of 10 prospective donors, a maximum 21% growth in yearly transplantation activity, with a greater impact on kidney transplantation. For most patients, the time between withdrawal of organ support and death surpassed 120 minutes, an outcome explained by variations in withdrawal of life-sustaining measures and insufficient clinical records, underestimating the potential for controlled circulatory arrest donation. Conclusion This study effectively highlights public health benefits of controlled circulatory arrest donation. Legislation allowing donation through this method represents a social gain and enables patients who will never meet brain death criteria to donate organs as part of the end-of-life process in intensive care medicine, within a framework of complete ethical alignment.
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Affiliation(s)
- Francisco Santos Dias
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Diana Martins Fernandes
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Cardoso-Fernandes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Center for Research in Health Technology and Services, Rede de Investigação em Saúde (CINTESIS@RISE), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Internal Medicine, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Adriana Silva
- Department of Intensive Care Medicine, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Carla Basílio
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Nuno Gatta
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Roberto Roncon-Albuquerque
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Artur Paiva
- Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Bongomin F, Nantale R, Kibone W, Awekonimungu B, Oyoo N, Okello J, Muzoora C, Hamer DH. Organ donation and HIV: Awareness and willingness to be a living donor among people with HIV in Uganda. Transpl Infect Dis 2024; 26:e14300. [PMID: 38809085 DOI: 10.1111/tid.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND HIV+-to-HIV+ organ transplantation has demonstrated promise and is now authorized for research purposes in certain countries. However, organ transplantation is dependent on the availability of organ donors. We assessed the awareness and willingness to donate organs among people with HIV (PWH) in Uganda. METHODS We conducted a multicenter cross-sectional study between October 2023 and January 2024 in four large HIV clinics in Northern Uganda. The study population consisted of PWH. A structured questionnaire was used to collect data regarding awareness, willingness, and beliefs regarding organ donation. Organ donation was defined as the willingness to be a living donor of a solid organ. We conducted multivariable logistic regression to assess for an association between willingness to donate organs and selected exposures. Data were analyzed in Stata version 15.0. Results are expressed as adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS A total of 232 participants were recruited. The mean age ± standard deviation of the participants was 42.2±11.8 years. All participants were on antiretroviral therapy. Sixty-two (26.7%) had a CD4 count less than or equal to 200 cells/mm3. The majority (80.6%, n = 187) had ever heard of organ donation. Slightly more than a third (34.9%, n = 81) were willing to donate organs. Factors associated with willingness to be a living organ donor included being female (AOR: 1.56; 95% CI: 1.15-2.11), having a tertiary education level (AOR: 1.79; 95% CI: 1.03-3.11), average monthly income >500 000 UGX (135.1USD) (AOR: 5.5; 95% CI: 1.97-15.40), ever heard about organ donation (AOR: 5.4; 95% CI: 1.67-17.8), and attending an organ donation campaign (AOR: 2.0; 95% CI: 1.07-3.74). CONCLUSIONS Awareness about organ donation was high but the willingness to be a living organ donor was low among PWH in Uganda. There is a need to sensitize the community about the need and benefits of organ donation with the involvement of media and the healthcare workers.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Internal Medicine, Gulu Regional Referral Hospital, Gulu, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences Mbale, Busitema University, Mbale, Uganda
- Busitema University Centre of Excellence for Maternal, Reproductive and Child Health, Mbale, Uganda
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Byron Awekonimungu
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | - Conrad Muzoora
- Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts, USA
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Hippen BE, Hart GM, Maddux FW. A Transplant-Inclusive Value-Based Kidney Care Payment Model. Kidney Int Rep 2024; 9:1590-1600. [PMID: 38899170 PMCID: PMC11184397 DOI: 10.1016/j.ekir.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 06/21/2024] Open
Abstract
In the United States, kidney care payment models are migrating toward value-based care (VBC) models incentivizing quality of care at lower cost. Current kidney VBC models will continue through 2026. We propose a future transplant-inclusive VBC (TIVBC) model designed to supplement current models focusing on patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The proposed TIVBC is structured as an episode-of-care model with risk-based reimbursement for "referral/evaluation/waitlisting" (REW, referencing kidney transplantation), "primary hospitalization to 180 days posttransplant," and "long-term graft survival." Challenges around organ acquisition costs, adjustments to quality metrics, and potential criticisms of the proposed model are discussed. We propose next steps in risk-adjustment and cost-prediction to develop as an end-to-end, TIVBC model.
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Affiliation(s)
- Benjamin E. Hippen
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, USA
| | | | - Franklin W. Maddux
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, USA
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Li S, Fan L, Viktoria U, Oleksandr P, Li Z, Zhang W, Deng B. Effect of resuscitation of cryopreserved porcine adrenal glands at 26 °C on their recovery and functioning under xenotransplantation. Cryobiology 2024; 115:104895. [PMID: 38616031 DOI: 10.1016/j.cryobiol.2024.104895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
The study is devoted to the effect of lowered resuscitation temperature (26 °C) on cryopreserved porcine adrenal glands functional activity in vitro and in vivo under xenotransplantation. The adrenals were collected from newborn pigs, cryopreserved with 5 % DMSO at a rate of 1 °C/min, resuscitated at 26 or 37 °C for 48 h (5 % CO2, DMEM), embedded into small intestinal submucosa, and transplanted to bilaterally adrenalectomized rats. It has been shown that the glands resuscitated at 26 °C have suppressed free-radical processes and can produce cortisol and aldosterone in vitro, and may lead to elevated blood levels of these hormones. Moreover, the adrenal grafts maintain blood glucose levels and promote the formation of glycogen stores. Thus, the resuscitation at 26 °C can improve the quality of grafts and favor the introduction and application of the cryopreserved organs and tissues for transplantation in clinical and experimental practice.
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Affiliation(s)
- Shasha Li
- College of Basic Medical and Forensic Medicine, Henan University of Science and Technology, 263 Kaiyuan Avenue, Luoyang City, China.
| | - Lingling Fan
- College of Basic Medical and Forensic Medicine, Henan University of Science and Technology, 263 Kaiyuan Avenue, Luoyang City, China.
| | - Ustichenko Viktoria
- Institute for Problems of Cryobiology and Cryomedicine of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine.
| | - Pakhomov Oleksandr
- Institute for Problems of Cryobiology and Cryomedicine of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine.
| | - Zhongjie Li
- College of Basic Medical and Forensic Medicine, Henan University of Science and Technology, 263 Kaiyuan Avenue, Luoyang City, China.
| | - Wenlu Zhang
- College of Basic Medical and Forensic Medicine, Henan University of Science and Technology, 263 Kaiyuan Avenue, Luoyang City, China.
| | - Bo Deng
- College of Basic Medical and Forensic Medicine, Henan University of Science and Technology, 263 Kaiyuan Avenue, Luoyang City, China.
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Olkowski B, Marczak Z, Rostkowska OM, Miszewska-Szyszkowska D, Kozińska-Przybył O, Durlik M, Żak J. Sleep Patterns in Patients After Solid Organ Transplantation Including Gender and Age Differences. Survey Results From One Transplantation Centre in Poland. Transplant Proc 2024; 56:935-947. [PMID: 38584020 DOI: 10.1016/j.transproceed.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Sleep plays a crucial role in maintaining health. Transplant patients are exposed to numerous stressors and are at risk of sleep disturbances. The aim of this study was to assess the sleep patterns of transplant patients. METHODS An anonymous paper survey was carried out among patients from one transplant center in Poland. Respondents were asked about the quality and quantity of sleep and the overall impact of the transplantation on their night rest. Data were collected from June to November 2023. RESULTS Data were obtained from 212 respondents (122 males and 90 females), aged 48.38 ± 13.68. The positive impact of transplantation on sleep hygiene was indicated by 57.4% of respondents, 28.9% observed no impact, and 13.6% rated the impact as negative. Our study showed that sleep is more satisfying in males than in females (62.8% of males and 46.7% of females). The analysis revealed that 38.9% of females need 30 minutes more than men to fall asleep. Additionally, females tend to get up half an hour later compared to men. About 71.9% of males declared good well-being the next day compared to 62.2% of females. Furthermore females declared more sleepiness the next day. The study also showed that older transplant recipients (over 50 years-of-age) report more frequent awakenings at night. CONCLUSIONS The data collected showed differences in sleep patterns according to gender and age. Females and older patients should be screened for sleep disturbances during post-transplantation care.
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Affiliation(s)
- Bartosz Olkowski
- Students' Scientific Club by the Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Marczak
- Students' Scientific Club by the Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Olga Maria Rostkowska
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Miszewska-Szyszkowska
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Olga Kozińska-Przybył
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Julia Żak
- Students' Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Mueller TF, Nagral S. Organ trafficking - a continuing challenge. Nat Rev Nephrol 2024; 20:267-268. [PMID: 38409368 DOI: 10.1038/s41581-024-00821-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India.
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Remon J, Auclin E, Zubiri L, Schneider S, Rodriguez-Abreu D, Minatta N, Gautschi O, Aboubakar F, Muñoz-Couselo E, Pierret T, Rothschild SI, Cortiula F, Reynolds KL, Thibault C, Gavralidis A, Blais N, Barlesi F, Planchard D, Besse BMD. Immune checkpoint blockers in solid organ transplant recipients and cancer: the INNOVATED cohort. ESMO Open 2024; 9:103004. [PMID: 38653155 PMCID: PMC11053286 DOI: 10.1016/j.esmoop.2024.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with solid organ transplant (SOT) and solid tumors are usually excluded from clinical trials testing immune checkpoint blockers (ICB). As transplant rates are increasing, we aimed to evaluate ICB outcomes in this population, with a special focus on lung cancer. METHODS We conducted a multicenter retrospective cohort study collecting real data of ICB use in patients with SOT and solid tumors. Clinical data and treatment outcomes were assessed by using retrospective medical chart reviews in every participating center. Study endpoints were: overall response rate (ORR), 6-month progression-free survival (PFS), and grade ≥3 immune-related adverse events. RESULTS From August 2016 to October 2022, 31 patients with SOT (98% kidney) and solid tumors were identified (36.0% lung cancer, 19.4% melanoma, 13.0% genitourinary cancer, 6.5% gastrointestinal cancer). Programmed death-ligand 1 expression was positive in 29% of tumors. Median age was 61 years, 69% were males, and 71% received ICB as first-line treatment. In the whole cohort the ORR was 45.2%, with a 6-month PFS of 56.8%. In the lung cancer cohort, the ORR was 45.5%, with a 6-month PFS of 32.7%, and median overall survival of 4.6 months. The grade 3 immune-related adverse events rate leading to ICB discontinuation was 12.9%. Allograft rejection rate was 25.8%, and risk of rejection was similar regardless of the type of ICB strategy (monotherapy or combination, 28% versus 33%, P = 1.0) or response to ICB treatment. CONCLUSIONS ICB could be considered a feasible option for SOT recipients with some advanced solid malignancies and no alternative therapeutic options. Due to the risk of allograft rejection, multidisciplinary teams should be involved before ICB therapy.
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Affiliation(s)
- J Remon
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif.
| | - E Auclin
- Department of Cancer Medicine, Hôpital Européen Georges-Pompidou, Paris, France
| | - L Zubiri
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - S Schneider
- Department Pneumology, Hôpital de Bayonne, Bayonne, France
| | - D Rodriguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - N Minatta
- Department of Oncology Hospital Italiano Buenos Aires, Buenos Aires, Argentina
| | - O Gautschi
- Department of Cancer Medicine, University of Berne and Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - F Aboubakar
- Department of Pneumology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - E Muñoz-Couselo
- Department of Oncology, Hospital Vall d'Hebron de Barcelona, VHIO Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - T Pierret
- Department of Pneumology, CHU Grenoble Alpes, Grenoble, France
| | - S I Rothschild
- Medical Oncology Department, University Hospital Basel, Basel; Division Oncology/Hematology, Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - F Cortiula
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - K L Reynolds
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - C Thibault
- Department of Cancer Medicine, Hôpital Européen Georges-Pompidou, Paris, France
| | - A Gavralidis
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, USA; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston; Salem Hospital, Salem, USA
| | - N Blais
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - F Barlesi
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
| | - D Planchard
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
| | - B M D Besse
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif
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12
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Garcia Valencia OA, Thongprayoon C, Miao J, Suppadungsuk S, Krisanapan P, Craici IM, Jadlowiec CC, Mao SA, Mao MA, Leeaphorn N, Budhiraja P, Cheungpasitporn W. Empowering inclusivity: improving readability of living kidney donation information with ChatGPT. Front Digit Health 2024; 6:1366967. [PMID: 38659656 PMCID: PMC11039889 DOI: 10.3389/fdgth.2024.1366967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Background Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods We used ChatGPT versions 3.5 and 4.0 to modify 27 questions and answers from Donate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results Originally, the FAQs had an average reading level of 9.6 ± 1.9. Post-modification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30 ± 1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible.
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Affiliation(s)
- Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, United States
| | - Shennen A. Mao
- Division of Transplant Surgery, Department of Transplant, Mayo Clinic, Jacksonville, FL, United States
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Napat Leeaphorn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Pooja Budhiraja
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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13
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Krupic F, Krupic M, Kovacevic-Prstojevic J, Custovic S, Sporisevic L, Lindström P. Prejudice and Fear as Influences in Relation to a Successful Organ Donation - Experiences of Immigrants Living in Sweden. Acta Med Acad 2024; 53:35-45. [PMID: 38984698 PMCID: PMC11237912 DOI: 10.5644/ama2006-124.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/29/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES The purpose of this study was to determine whether fear and prejudice in relation to organ donation and the transplantation of organs may influence the decision to become an organ donor. MATERIALS AND METHODS Data were collected through four group interviews using open-ended questions and qualitative content analysis. Forty participants, 16 males and 24 females from seven countries, participated in the focus group interviews. RESULTS The analysis resulted in three main categories, and nine subcategories. Fears and prejudice caused by tradition and customs, approval of organ donation by family members, perception of the body as a gift from parents, the influence of religious leaders, knowledge about the religious understanding of organ donation, influence of social ambience on respondents, knowledge of the donation process in the healthcare system, including knowing about life after eventual organ donation, were some of predictors in the decision to agree to organ donation. CONCLUSION More education on the factors that influence organ donation, more information in schools, health institutions and through the media, as well as more research with the aim of "dispelling" fears and prejudice about organ donation would significantly improve the current situation and result in a larger number of potential organ donors.
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Affiliation(s)
- Ferid Krupic
- Department of Anesthesiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital/Östra, Diagnosv. Gothenburg, Sweden
| | - Melissa Krupic
- Sahlgrenska University Hospital/Östra, Diagnosv. Gothenburg, Sweden
| | | | - Svemir Custovic
- Clinic for Orthopaedics and Traumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Lutvo Sporisevic
- Public Institution Health Center of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina
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14
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Almutairi AH, Alhassan SA, Alrajeh SA, Alqhatani SB, Alqarni AS, Aljthalin MAM, Alghannam YM, Alanazi SS, Aldhafeeri AMA, Aldhafeeri FM, Alrumaih NH, Alowain FM. Knowledge, Attitude, and Practice of Organ Donation Among the Population of Al-Majma'ah Region, Saudi Arabia. Cureus 2024; 16:e59414. [PMID: 38826602 PMCID: PMC11140156 DOI: 10.7759/cureus.59414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Organ donation plays a pivotal role in addressing the global demand for transplantable organs and saving lives. The success of organ transplantation relies not only on medical advancements but also on the willingness of communities to participate in organ donation programs. In Saudi Arabia, specifically within the Al-Majma'ah region, understanding the dynamics of knowledge, attitudes, and practices related to organ donation is crucial for promoting a sustainable and ethical organ donation system. METHODS A cross-sectional, retrospective study was utilized in this research, employing data from a sample of 564 participants from the general population of the Al-Majma'ah region, Saudi Arabia. The participants completed a self-administered questionnaire and ensured anonymity. RESULTS About 545 (96.6%) respondents were familiar with the concept of organ donation, and 455 (80.7%) participants recognized the necessity for the blood groups of the donor and recipient to match before the transplant process. About 412 (73.0%) participants agreed with the practice of organ donation with 326 (57.8%) expressing support for the practice. About 417 (73.9%) participants reported that their religion permits or endorses organ donation/transplantation. A total of 151 individuals (26.8%) had a low knowledge level, with total scores below 50% (6 or lower). In contrast, 280 people (4.7%) demonstrated a moderate level of knowledge (scoring between 50% and 75%) (7 to 9). Additionally, 133 individuals (23.5%) showcased a high level of knowledge, with scores exceeding 75% (10 or higher). The study established a statistically significant association between age, marital status with p-values < 0.05 (0.001*), and the knowledge score toward organ donation. However, gender and monthly household income were not significantly associated with knowledge score toward organ transplant with p-values (p-value > 0.05). CONCLUSION The research findings indicated a moderate level of knowledge and a positive attitude toward organ donation among the general population of the Al-Majma'ah region in Saudi Arabia. Age and marital status were found to be significantly associated with the knowledge score toward organ donation. The study noted the desire and willingness to save lives through organ donation by the residents of the Al-Majma'ah region in Saudi Arabia.
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Affiliation(s)
| | | | - Saud A Alrajeh
- College of Medicine, Majmaah University, Al Majma'ah, SAU
| | | | - Ali S Alqarni
- College of Medicine, Majmaah University, Al Majma'ah, SAU
| | | | | | - Saud S Alanazi
- College of Medicine, Majmaah University, Al Majma'ah, SAU
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15
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Sepulveda M, Rasic M, Lei YM, Kwan M, Chen L, Chen Y, Perkins D, Alegre ML. Coordinated elimination of bacterial taxa optimally attenuates alloimmunity and prolongs allograft survival. Am J Transplant 2024:S1600-6135(24)00216-8. [PMID: 38519004 DOI: 10.1016/j.ajt.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
This study aimed to dissect the relationship between specific gut commensal bacterial subgroups, their functional metabolic pathways, and their impact on skin allograft outcome and alloimmunity. We previously showed that oral broad-spectrum antibiotic (Abx) pretreatment in mice delayed skin, heart, and lung allograft rejection and dampened alloimmune responses. Here, rationally designed Abx combinations targeting major bacterial groups were used to elucidate their individual contribution to modulating alloimmune responses. Abx cocktails targeting intestinal gram-negative, gram-positive, or anaerobic/gram-positive bacteria by oral gavage, all delayed skin allograft rejection, and reduced alloreactive T cell priming to different extents. Notably, the most pronounced extension of skin allograft survival and attenuation of alloimmunity were achieved when all gut bacterial groups were simultaneously targeted. These results suggest a model in which the strength of the alloimmune response is additively tuned up by gut microbial diversity. Shotgun metagenomic sequencing enabled strain-level resolution and identified a shared commensal, Parabacteroides distasonis, as the most enriched following all Abx treatments. Oral administration of P.distasonis to mice harboring a diverse microbiota significantly prolonged skin allograft survival, identifying a probiotic with therapeutic benefit in transplantation.
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Affiliation(s)
- Martin Sepulveda
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mladen Rasic
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yuk Man Lei
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Montserrat Kwan
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Luqiu Chen
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Yang Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Perkins
- Department of Nephrology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria-Luisa Alegre
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
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16
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Xu G, Zou X, Dong Y, Alhaskawi A, Zhou H, Ezzi SHA, Kota VG, Abdulla MHAH, Alenikova O, Abdalbary SA, Lu H. Advancements in autologous peripheral nerve transplantation care: a review of strategies and practices to facilitate recovery. Front Neurol 2024; 15:1330224. [PMID: 38523615 PMCID: PMC10959128 DOI: 10.3389/fneur.2024.1330224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Autologous peripheral nerve transplantation, a pioneering technique in nerve injury treatment, has demonstrated remarkable progress. We examine recent nursing strategies and methodologies tailored to various anatomical sites, highlighting their role in postoperative recovery enhancement. Encompassing brachial plexus, upper limb, and lower limb nerve transplantation care, this discussion underscores the importance of personalized rehabilitation plans, interdisciplinary collaboration, and innovative approaches like nerve electrical stimulation and nerve growth factor therapy. Moreover, the exploration extends to effective complication management and prevention strategies, encompassing infection control and pain management. Ultimately, the review concludes by emphasizing the advances achieved in autologous peripheral nerve transplantation care, showcasing the potential to optimize postoperative recovery through tailored and advanced practices.
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Affiliation(s)
- Guoying Xu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Xiaodi Zou
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | | | | | - Olga Alenikova
- Department of Neurology, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
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17
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Majeed HM, Hassan AF, Mousa AM. Students' knowledge and attitude concerning organ donation at Iraqi nursing colleges. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:60. [PMID: 38549649 PMCID: PMC10977644 DOI: 10.4103/jehp.jehp_845_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/05/2023] [Indexed: 07/12/2024]
Abstract
BACKGROUND Organ transplantation is an effective therapy for end-stage organ failure. However, there is a large gap between the need for and the supply of donor organs. OBJECTIVES This study aimed to assess nursing students' knowledge and attitudes about organ donation. MATERIALS AND METHODS This is a descriptive cross-sectional design study. The study was conducted at four faculties of nursing, which were Baghdad, Misan, Tikrit, and Kirkuk in Iraq. The three tools included are as follows: I: Socio-Demographic Questionnaire; II: Organ-Tissue Donation and Transplantation Knowledge Scale (ODTKS); and III: Organ Donation Attitude Scale (ODAS). RESULTS More than two-thirds (71%) of the studied students have an accepted level of knowledge, while 70% of the studied students had a positive attitude toward organ donation and transplantation. There were statistically significant differences (P- value <0.05) between socio-demographic characteristics and knowledge level regarding gender, marital status, and academic year. Also, there were significant differences between socio-demographic characteristics and students' attitude levels regarding gender and academic year. CONCLUSION More than two-thirds of students had a good and fair level of knowledge and a positive attitude toward organ donation and transplantation. Providing lectures within the curriculum is needed for students to raise their knowledge and attitude about organ transplantation and donation.
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Affiliation(s)
| | - Ahmed Fleih Hassan
- Department of Adult Nursing, College of Nursing, University of Baghdad, Baghdad, Iraq
| | - Ayad Majid Mousa
- Department of Adult Nursing, College of Nursing, University of Baghdad, Baghdad, Iraq
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18
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Li S, Chen Y, Cao X, Yang C, Li W, Shen B. The application of nanotechnology in kidney transplantation. Nanomedicine (Lond) 2024; 19:413-429. [PMID: 38275168 DOI: 10.2217/nnm-2023-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Kidney transplantation is a crucial treatment option for end-stage renal disease patients, but challenges related to graft function, rejection and immunosuppressant side effects persist. This review highlights the potential of nanotechnology in addressing these challenges. Nanotechnology offers innovative solutions to enhance organ preservation, evaluate graft function, mitigate ischemia-reperfusion injury and improve drug delivery for immunosuppressants. The integration of nanotechnology holds promise for improving outcomes in kidney transplantation.
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Affiliation(s)
- Shengzhou Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, Shanghai, China
| | - Yiming Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, Shanghai, China
| | - Xiangqian Cao
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, Shanghai, China
| | - Chenkai Yang
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, Shanghai, China
| | - Wei Li
- Department of Nanomedicine & Shanghai Key Lab of Cell Engineering, Naval Medical University, 200433, Shanghai, China
| | - Bing Shen
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, Shanghai, China
- Shanghai Tenth People's Hospital of Tongji University, 200072, Shanghai, China
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19
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Strippoli GFM, Green SC. Actioning the findings of hard endpoint clinical trials as they emerge in the realm of chronic kidney disease care: a review and a call to action. Clin Kidney J 2024; 17:sfae035. [PMID: 38425707 PMCID: PMC10903297 DOI: 10.1093/ckj/sfae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
Fewer than half of patients treated with hemodialysis survive 5 years. Multiple therapeutics are used to address the complications of advanced chronic kidney disease but most have not been found to improve clinical outcomes. Clinical trials of treatment innovations for chronic kidney diseases and dialysis care have been suboptimal in number and quality. Recent trials are changing this trend. Practice and policy change when new evidence emerges remains frequently impeded by resource and organizational constraints and accordingly, clinical practice guidelines are updated years or decades after definitive evidence is produced. Ultimately, practice change in health systems is slow, leading to impaired uptake of effective medical interventions and lower value healthcare, although innovations in rapid guideline production are emerging. What can be done to ensure that conclusive evidence is taken up in practice, policy and healthcare funding? We use the example of the recently published hard endpoint study "Comparison of high-dose HDF with high-flux HD" (CONVINCE) (hemodiafiltration versus hemodialysis), to explain how a new trial can impact on medical knowledge and change in practices. We (i) assess how the trial can be placed in the context of the totality of the evidence, (ii) define whether or not further trials of convective dialysis therapies are still needed and (iii) examine whether the evidence for convective therapies is now ready to inform practice, policy and funding change. When looking at CONVINCE in the context of the totality of evidence, we show that it addresses dialysis quality improvement priorities and is consistent with other trials evaluating convective dialysis therapies, and that the evidence for convective dialysis therapies is now definitive. Once updated evidence for cost-effectiveness in specific healthcare settings and patient-reported outcomes become available, we should therefore determine whether or not clinical practice guidelines should recommend uptake of convective dialysis therapies routinely, and move on to evaluating other treatments.
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Affiliation(s)
- Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, NSW Australia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J) University of Bari Aldo Moro, Bari, Italy
| | - Suetonia C Green
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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20
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Grossi AA, Potena L, Rossano JW, Breathett K. Socioeconomic deprivation and heart transplantation: A call for progress in the United States and EUROPE. J Heart Lung Transplant 2024; 43:334-336. [PMID: 37884164 DOI: 10.1016/j.healun.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Alessandra Agnese Grossi
- Department of Human Sciences, Innovation and Territory, University of Insubria, Varese-Como, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Center, Indiana University, Indianapolis, Indiana
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21
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Reimold P, Aksoy C, Beckmann J, Zacharis A, Groeben C, Karschuck P, Eisenmenger N, Geks J, Huber J, Flegar L. Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:65. [PMID: 38300367 PMCID: PMC10834564 DOI: 10.1007/s00345-023-04740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/08/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.
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Affiliation(s)
- Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany.
| | - Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Jonas Beckmann
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Josef Geks
- Department of Surgery, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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22
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van Overdijk PAH, Grossi AA, van Delft CH, Jansen NE, van den Hoogen MWF, Paredes-Zapata D. Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100814. [PMID: 38065001 DOI: 10.1016/j.trre.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. METHODS A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. RESULTS Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). CONCLUSIONS In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.
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Affiliation(s)
- Pieter A H van Overdijk
- Bachelor Student Technical Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands.
| | - Alessandra A Grossi
- Department of Human Sciences, Innovations and Territory, University of Insubria, Via O. Rossi 9, Varese 21100, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Via O. Rossi 9, 21100 Varese, Italy
| | - Céline H van Delft
- Bachelor Student in Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Nichon E Jansen
- Senior Policy Advisor, Senior Researcher, Dutch Transplant Foundation, Postbus 2304, Leiden 2301 CH, the Netherlands
| | - Martijn W F van den Hoogen
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center Rotterdam, PO BOX 2040, Rotterdam 3000 CA, the Netherlands
| | - David Paredes-Zapata
- Consultant, Nephrologist, Donation and Transplant Coordination Section, Hospital Clinic, Associate Professor University of Barcelona, Surgical Department, C. de Villarroel, Barcelona 170 08036, Spain
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23
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Jou S, Mendez SR, Feinman J, Mitrani LR, Fuster V, Mangiola M, Moazami N, Gidea C. Heart transplantation: advances in expanding the donor pool and xenotransplantation. Nat Rev Cardiol 2024; 21:25-36. [PMID: 37452122 DOI: 10.1038/s41569-023-00902-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Approximately 65 million adults globally have heart failure, and the prevalence is expected to increase substantially with ageing populations. Despite advances in pharmacological and device therapy of heart failure, long-term morbidity and mortality remain high. Many patients progress to advanced heart failure and develop persistently severe symptoms. Heart transplantation remains the gold-standard therapy to improve the quality of life, functional status and survival of these patients. However, there is a large imbalance between the supply of organs and the demand for heart transplants. Therefore, expanding the donor pool is essential to reduce mortality while on the waiting list and improve clinical outcomes in this patient population. A shift has occurred to consider the use of organs from donors with hepatitis C virus, HIV or SARS-CoV-2 infection. Other advances in this field have also expanded the donor pool, including opt-out donation policies, organ donation after circulatory death and xenotransplantation. We provide a comprehensive overview of these various novel strategies, provide objective data on their safety and efficacy, and discuss some of the unresolved issues and controversies of each approach.
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Affiliation(s)
- Stephanie Jou
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA.
| | - Sean R Mendez
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Jason Feinman
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Lindsey R Mitrani
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA
| | - Massimo Mangiola
- Transplant Institute, New York University Langone Health, New York, NY, USA
| | - Nader Moazami
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Claudia Gidea
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, New York, NY, USA
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24
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Gripewall E, Fagerström L, Kumlien C, Mattsson J, Nyholm L, Björling G. Swedish Intensive Care Nurses' Knowledge, Attitudes, and Views on Donation After Circulatory Death Before a National Implementation. SAGE Open Nurs 2024; 10:23779608241274208. [PMID: 39185507 PMCID: PMC11342314 DOI: 10.1177/23779608241274208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 06/26/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction An increasing population and a shortage of identified potential organ donors are causing the waiting list for organ transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demand for transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigating nurses' attitudes and knowledge of DCD. Objective The objective of this study was to determine and describe intensive care nurses' (ICNs') knowledge, attitudes, and views on DCD before a national implementation in Sweden. Method This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targeting ICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed. Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman's correlation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesize the quantitative and qualitative findings. Results Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantly higher knowledge (r = .380, p = .006), were more engaged with the public debate on organ donation (r = .423, p = .002), and considered the ethical aspects of DCD more thoroughly (r = .386, p = .022). The qualitative analysis identified four key categories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions and unmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussions to prepare ICU nurses for DCD. Conclusion Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation. The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the global shortage of transplantable organs.
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Affiliation(s)
- Emilie Gripewall
- Faculty of Education and Welfare Studies, Department of Health Sciences, Åbo Akademi University, Vaasa, Finland
- National Donation Center, National Board of Health and Welfare, Stockholm, Sweden
| | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Department of Health Sciences, Åbo Akademi University, Vaasa, Finland
| | - Christine Kumlien
- Department of Care Science, Malmö University, Malmö, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Janet Mattsson
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Department of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Linda Nyholm
- Faculty of Education and Welfare Studies, Department of Health Sciences, Åbo Akademi University, Vaasa, Finland
- Department of Caring and Ethics, University of Stavanger, Stavanger, Norway
| | - Gunilla Björling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Nursing, Jönköping University, School of Health and Welfare, Jönköping, Sweden
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Anaesthesia and Intensive Care, Södertälje Hospital, Södertälje, Sweden
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25
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Machry M, Ferreira LF, Lucchese AM, Kalil AN, Feier FH. Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence. World J Transplant 2023; 13:290-298. [PMID: 38174151 PMCID: PMC10758682 DOI: 10.5500/wjt.v13.i6.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 12/15/2023] Open
Abstract
The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation. Living-donor liver transplantation (LDLT) has emerged as a viable option, expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes. An accurate evaluation of the donor liver's volumetry (LV) and anatomical study is crucial to ensure adequate future liver remnant, graft volume and precise liver resection. Thus, ensuring donor safety and an appropriate graft-to-recipient weight ratio. Manual LV (MLV) using computed tomography has traditionally been considered the gold standard for assessing liver volume. However, the method has been limited by cost, subjectivity, and variability. Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility, reduced variability, and enhanced efficiency compared to manual measurements. However, the accuracy of automated LV requires further investigation. The study provides a comprehensive review of traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches. Additionally, the study discusses the respective strengths and weaknesses of each of the aforementioned techniques. The use of artificial intelligence (AI) technologies, including machine learning and deep learning, is expected to become a routine part of surgical planning in the near future. The implementation of AI is expected to enable faster and more accurate image study interpretations, improve workflow efficiency, and enhance the safety, speed, and cost-effectiveness of the procedures. Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT. MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions. Moreover, AI has tremendous potential for LV and segmentation; however, its widespread use is hindered by cost and availability. Therefore, the integration of multiple specialties is necessary to embrace technology and explore its possibilities, ranging from patient counseling to intraoperative decision-making through automation and AI.
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Affiliation(s)
- Mayara Machry
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Luis Fernando Ferreira
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Angelica Maria Lucchese
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Antonio Nocchi Kalil
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Flavia Heinz Feier
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Postgraduation Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
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26
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Thongprayoon C, Miao J, Jadlowiec C, Mao SA, Mao M, Leeaphorn N, Kaewput W, Pattharanitima P, Valencia OAG, Tangpanithandee S, Krisanapan P, Suppadungsuk S, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Distinct clinical profiles and post-transplant outcomes among kidney transplant recipients with lower education levels: uncovering patterns through machine learning clustering. Ren Fail 2023; 45:2292163. [PMID: 38087474 PMCID: PMC11001364 DOI: 10.1080/0886022x.2023.2292163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Educational attainment significantly influences post-transplant outcomes in kidney transplant patients. However, research on specific attributes of lower-educated subgroups remains underexplored. This study utilized unsupervised machine learning to segment kidney transplant recipients based on education, further analyzing the relationship between these segments and post-transplant results. METHODS Using the OPTN/UNOS 2017-2019 data, consensus clustering was applied to 20,474 kidney transplant recipients, all below a college/university educational threshold. The analysis concentrated on recipient, donor, and transplant features, aiming to discern pivotal attributes for each cluster and compare post-transplant results. RESULTS Four distinct clusters emerged. Cluster 1 comprised younger, non-diabetic, first-time recipients from non-hypertensive younger donors. Cluster 2 predominantly included white patients receiving their first-time kidney transplant either preemptively or within three years, mainly from living donors. Cluster 3 included younger re-transplant recipients, marked by elevated PRA, fewer HLA mismatches. In contrast, Cluster 4 captured older, diabetic patients transplanted after prolonged dialysis duration, primarily from lower-grade donors. Interestingly, Cluster 2 showcased the most favorable post-transplant outcomes. Conversely, Clusters 1, 3, and 4 revealed heightened risks for graft failure and mortality in comparison. CONCLUSIONS Through unsupervised machine learning, this study proficiently categorized kidney recipients with lesser education into four distinct clusters. Notably, the standout performance of Cluster 2 provides invaluable insights, underscoring the necessity for adept risk assessment and tailored transplant strategies, potentially elevating care standards for this patient cohort.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Shennen A. Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Michael Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Napat Leeaphorn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Chakri Naruebodindra Medical Institute, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Thammasat University, Pathum Thani, Thailand
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Chakri Naruebodindra Medical Institute, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Cooper
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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27
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Niu Y, Lan G, Wang J, Yan T, Jin P. Bioequivalence evaluation and blood concentration estimation of generic and branded tacrolimus in healthy subjects under fasting: A randomized, four-periods, two-sequences, complete repeated, crossover study. Transpl Immunol 2023; 81:101933. [PMID: 37730184 DOI: 10.1016/j.trim.2023.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The demand for generic tacrolimus is enormous. Our randomized trial was an open-label single-dose testing with four-periods and two-sequences; we aimed to evaluate the bioequivalence between a generic and branded tacrolimus by establishing their area under concentration-time curve (AUC) predictive equations. For better comparison, each tacrolimus served either as test vs. reference in sequence 1 or vice versa as reference vs. test in sequence 2. METHODS Forty healthy subjects were randomized into two groups, namely a sequence 1 group (N = 20 in test-reference-test-reference) or sequence 2 (N = 20, reference-test-reference-test) received a test tacrolimus (Ruibeirong®; Chengdu Shengdi Medicine Co., Ltd.) and a reference tacrolimus (Astagraf XL®, Astellas Ireland Co., Ltd.) under the fasting condition with a wash-out period of ≥14 days between every two phases. Blood samples were collected sequentially until 120 h after oral administration of tacrolimus. RESULTS A 95% upper confidence bound was -0.05% for the peak concentration (Cmax), -0.02% for the AUC from 0 to the last time point (AUC0-t), and - 0.02% for the AUC from 0 to infinity (AUC0-∞). The geometric least square means ratio (test/reference) with 90% of confidence interval (CI)) was 96.10% (90.58%-101.95%) for Cmax, 93.80% (88.52%-99.39%) for AUC0-t, and 94.34% (89.20%-99.77%) for AUC0-∞. Meanwhile, the ratio of within-subject standard deviation of test/reference (σWT/WR) with 90% CI was 0.66 (0.50-0.86) for Cmax, 0.73 (0.55-0.96) for AUC0-t, and 0.75 (0.57-0.98) for AUC0-∞. These results fulfilled the bioequivalence criteria by the Food and Drug Administration. Both products showed acceptable safety. Moreover, the AUC predictive equations (by linear regression plus limited sampling strategy) with 2-5 sampling time point showed the high performance (all R > 0.970, predictive error (PE) >0.5%, absolute PE <5.1%, which were interchangeable between test and reference products. CONCLUSION Generic tacrolimus (Ruibeirong®) is bioequivalent to branded tacrolimus (Astagraf XL®) with tolerable safety, which AUC predictive equations work well and are interchangeable between the two products.
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Affiliation(s)
- Yulin Niu
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Gongbin Lan
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jina Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianzhong Yan
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Peng Jin
- Department of Organ Transplantation Center, Xiangya Hospital Central South University, Changsha, China.
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28
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Schoene D, Freigang N, Trabitzsch A, Pleul K, Kaiser DPO, Roessler M, Winzer S, Hugo C, Günther A, Puetz V, Barlinn K. Identification of patients at high risk for brain death using an automated digital screening tool: a prospective diagnostic accuracy study. J Neurol 2023; 270:5935-5944. [PMID: 37626244 PMCID: PMC10632197 DOI: 10.1007/s00415-023-11938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND An automated digital screening tool (DETECT) has been developed to aid in the early identification of patients who are at risk of developing brain death during critical care. METHODS This prospective diagnostic accuracy study included consecutive patients ≥ 18 years admitted to neurocritical care for primary or secondary acute brain injury. The DETECT screening tool searched routinely monitored patient data in the electronic medical records every 12 h for a combination of coma and absence of bilateral pupillary light reflexes. In parallel, daily neurological assessment was performed by expert neurointensivists in all patients blinded to the index test results. The primary target condition was the eventual diagnosis of brain death. Estimates of diagnostic accuracy along with their 95%-confidence intervals were calculated to assess the screening performance of DETECT. RESULTS During the 12-month study period, 414 patients underwent neurological assessment, with 8 (1.9%) confirmed cases of brain death. DETECT identified 54 positive patients and sent 281 notifications including 227 repeat notifications. The screening tool had a sensitivity of 100% (95% CI 63.1-100%) in identifying patients who eventually developed brain death, with no false negatives. The mean time from notification to confirmed diagnosis of brain death was 3.6 ± 3.2 days. Specificity was 88.7% (95% CI 85.2-91.6%), with 46 false positives. The overall accuracy of DETECT for confirmed brain death was 88.9% (95% CI 85.5-91.8%). CONCLUSIONS Our findings suggest that an automated digital screening tool that utilizes routinely monitored clinical data may aid in the early identification of patients at risk of developing brain death.
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Affiliation(s)
- Daniela Schoene
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Norman Freigang
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Trabitzsch
- Department of Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Konrad Pleul
- Deutsche Stiftung Organtransplantation (DSO), Frankfurt am Main, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Roessler
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- BARMER Institute for Health Care System Research (Bifg), Berlin, Germany
| | - Simon Winzer
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Hugo
- Division of Nephrology, Department of Internal Medicine III, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Albrecht Günther
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Yang X, Chen C, Geng K, Jia X, Si F, Lu X, Zhang W, Du S, Zhang X, Guo W, Yin Z. Organ donation decision-making in ICU patients: from the perspectives of organ coordinators and physicians in China - a qualitative study. BMJ Open 2023; 13:e075433. [PMID: 37914298 PMCID: PMC10626822 DOI: 10.1136/bmjopen-2023-075433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES Intensive care unit (ICU) dying patients are the most important source of organ donation. This study explores the reasons affecting organ donation in the Chinese sociocultural context from the perspectives of coordinators and physicians, and further seeks countermeasures to alleviate the shortage of organs. DESIGN AND SETTING Semistructured interviews conducted in a large tertiary hospital in China. PARTICIPANTS AND METHOD 15 respondents (including 8 organ coordinators and 7 ICU physicians) were interviewed. Participants were invited to describe the factors that influence organ donation and the underlying reasons behind it. Bronfenbrenner's socioecological system model was used as theoretical support to construct a theoretical model of the factors influencing organ donation. Respondents participated in semistructured qualitative interviews that were audio-recorded and transcribed. The relevant data were analysed using thematic analysis. RESULTS Four themes that influenced organ donation were identified including the influence of the deceased person's attributes, immediate family members, surrounding people and the environment, and the social-level factors. In addition, we obtained four strategies from the interviews to improve the organ shortage to ameliorate the current supply-demand imbalance in organ donation. These include multilevel publicity, relevant policy support, increasing other forms of supply and reducing organ demand. CONCLUSIONS Factors affecting organ donation after the death of a Chinese citizen include the personal characteristics of the donor, the decisions of family members such as immediate family members and the indirect influence of surrounding people such as collateral family members, in addition to factors related to the humanistic environment, religious beliefs and social opinion.
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Affiliation(s)
- Xi Yang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - ChaoQun Chen
- Organ Procurement Organizations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kun Geng
- Organ Procurement Organizations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuedong Jia
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - FangYing Si
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - XiaoJing Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojian Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenzhi Guo
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao Yin
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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Vanholder R, Coppo R, Bos WJ, Damato E, Fakhouri F, Humphreys A, Nistor I, Ortiz A, Pistollato M, Scheres E, Schaefer F. A Policy Call to Address Rare Kidney Disease in Health Care Plans. Clin J Am Soc Nephrol 2023; 18:1510-1518. [PMID: 37294578 PMCID: PMC10637461 DOI: 10.2215/cjn.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
Despite a large number of people globally being affected by rare kidney diseases, research support and health care policy programs usually focus on the management of the broad spectrum of CKD without particular attention to rare causes that would require a targeted approach for proper cure. Hence, specific curative approaches for rare kidney diseases are scarce, and these diseases are not treated optimally, with implications on the patients' health and quality of life, on the cost for the health care system, and society. There is therefore a need for rare kidney diseases and their mechanisms to receive the appropriate scientific, political, and policy attention to develop specific corrective approaches. A wide range of policies are required to address the various challenges that target care for rare kidney diseases, including the need to increase awareness, improve and accelerate diagnosis, support and implement therapeutic advances, and inform the management of the diseases. In this article, we provide specific policy recommendations to address the challenges hindering the provision of targeted care for rare kidney diseases, focusing on awareness and prioritization, diagnosis, management, and therapeutic innovation. In combination, the recommendations provide a holistic approach aiming for all aspects of rare kidney disease care to improve health outcomes, reduce the economic effect, and deliver benefits to society. Greater commitment from all the key stakeholders is now needed, and a central role should be assigned to patients with rare kidney disease to partner in the design and implementation of potential solutions.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance (EKHA), Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Willem J.W. Bos
- Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Internal Medicine, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Elaine Damato
- Life Sciences, Charles River Associates, Mexico City, Mexico
| | - Fadi Fakhouri
- Department of Nephrology and Hypertension, Department of Medicine, Centre hospitalier universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Ionut Nistor
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa,” Iaşi, Romania
- Nephrology Department, Dr C.I. Parhon Hospital, Iaşi, Romania
- Methodological Centre for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy “Grigore T. Popa,” Iaşi, Romania
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz; Professor of Medicine, Autonomous University of Madrid, Madrid, Spain
- Clinical Nephrology Governance, European Renal Association, Madrid, Spain
| | | | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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Ko E, Kim YH, Shin HJ, Lim CH, Kim HJ, Park HY, Jang Y, Seong H. Short-Term and Long-Term Effects of Ischemic Conditioning on Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Transplant Proc 2023; 55:2143-2158. [PMID: 37867003 DOI: 10.1016/j.transproceed.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Although liver transplantation (LT) is one of the definitive treatments for patients with end-stage liver failure, it inevitably results in ischemic reperfusion injury. It is known that prognosis is improved when temporary ischemic conditioning (IC) is applied to patients with ischemic reperfusion injury. The objective of this meta-analysis was to determine the short-term and long-term effects of IC on the clinical outcomes of LT recipients. METHODS Randomized controlled studies on IC in patients with LTs were included. Patients were compared between an IC group and a sham group. Studies were retrieved from PubMed, Embase, and Cochrane Library. The risk of bias was evaluated using RoB 2.0. Mortality, graft function, and major complications were synthesized using RevMan 5.4.1. RESULTS Among 316 papers, 17 articles (1196 patients) were included. There was an insignificant increase in short-term mortality (risk ratio [RR]: 3.00, 95% CI: 0.32-28.14, P = .34). However, long-term mortality was lower in the IC group than in the sham group, but not significantly (RR: 0.75; 95% CI: 0.47-1.20, P = .23). Short-term graft function (acute graft rejection and primary graft non-function) was not improved by IC. One-year graft loss tended to show better results in the IC group (RR: 0.53, 95% CI: 0.26-1.07, P = .08). CONCLUSION Ischemic conditioning did not have a beneficial effect on LT. Although long-term outcomes appear to be better in the IC group than in the sham group, further randomized controlled trials are needed.
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Affiliation(s)
- Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Yun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Changwon Hanmaeum Hospital, Changwon, South Korea.
| | - Hyeon-Ju Shin
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea.
| | - Choon-Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Ha Yeon Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Yookyung Jang
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
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Alghamdi A, Alsaleh AA, Alfozan OA, Qutob R, Alaryni A, Bukhari A, Hakami OA, Alhusaini BA, Alzmamy SA, Alhudayris FS, Alshuaibi LK, Alenazi AM, Alhosaini LS, Aljarba NK, AlShammari SH. Awareness, Attitude, and Beliefs Regarding Organ Donation Among the General Public in Saudi Arabia. Int J Gen Med 2023; 16:4973-4989. [PMID: 37928959 PMCID: PMC10625388 DOI: 10.2147/ijgm.s434589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
Background Organ donation is a lifesaving option to rescue many patients with end-stage organ failure from possible morbidities and mortalities. Unfortunately, due to a shortage of donors, many patients suffering from their illnesses are waiting for an organ. This study aimed to determine the awareness, attitude, and beliefs toward organ donation among the Saudi population. Patients and Methods This is an online cross-sectional survey that was conducted in Saudi Arabia between July and September 2022. A self-administered questionnaire was distributed to the general public using an online platform. The questionnaire consists of two sections: the first is about demographic data, and the second is about questions to assess awareness, attitude, and beliefs regarding organ donation. The Chi-squared test was used to examine the differences in participants' awareness, attitude, and beliefs towards organ donation. A binary logistic regression analysis was used to identify predictors of a positive attitude towards organ donation. Results A total of 3507 individuals participated in this study. Around 68.1% were aged between 18 and 30 years. Twenty-four percent of them knew of the legislative body for organ donation; 58.5% believed that organ donation should be promoted; and 66.1% had a positive attitude toward donating body organs. Younger age (31-50 years), male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. Conclusion Although there was a positive attitude and belief about organ donation, awareness was suboptimal. Younger age, male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. It is necessary to address the gaps in knowledge, and social media as well as mass media may have an important role in bridging the gaps.
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Affiliation(s)
- Abdullah Alghamdi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | - Rayan Qutob
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Alaryni
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah Bukhari
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Osamah A Hakami
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Saad Abdullah Alzmamy
- Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Lama Khalid Alshuaibi
- Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ahad Marei Alenazi
- Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Lama Shaya Alhosaini
- Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Najd Khalid Aljarba
- Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Zhang H, Cavazzoni CB, Podestà MA, Bechu ED, Ralli G, Chandrakar P, Lee JM, Sayin I, Tullius SG, Abdi R, Chong AS, Blazar BR, Sage PT. IL-21-producing effector Tfh cells promote B cell alloimmunity in lymph nodes and kidney allografts. JCI Insight 2023; 8:e169793. [PMID: 37870962 PMCID: PMC10619486 DOI: 10.1172/jci.insight.169793] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Follicular helper T (Tfh) cells have been implicated in controlling rejection after allogeneic kidney transplantation, but the precise subsets, origins, and functions of Tfh cells in this process have not been fully characterized. Here we show that a subset of effector Tfh cells marked by previous IL-21 production is potently induced during allogeneic kidney transplantation and is inhibited by immunosuppressive agents. Single-cell RNA-Seq revealed that these lymph node (LN) effector Tfh cells have transcriptional and clonal overlap with IL-21-producing kidney-infiltrating Tfh cells, implicating common origins and developmental trajectories. To investigate the precise functions of IL-21-producing effector Tfh cells in LNs and allografts, we used a mouse model to selectively eliminate these cells and assessed allogeneic B cell clonal dynamics using a single B cell culture system. We found that IL-21-producing effector Tfh cells were essential for transplant rejection by regulating donor-specific germinal center B cell clonal dynamics both systemically in the draining LN and locally within kidney grafts. Thus, IL-21-producing effector Tfh cells have multifaceted roles in Ab-mediated rejection after kidney transplantation by promoting B cell alloimmunity.
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Affiliation(s)
- Hengcheng Zhang
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia B. Cavazzoni
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manuel A. Podestà
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elsa D. Bechu
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Garyfallia Ralli
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pragya Chandrakar
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeong-Mi Lee
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ismail Sayin
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, Illinois, USA
| | - Stefan G. Tullius
- Division of Transplant Surgery & Transplant Surgery Research Laboratory, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Abdi
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anita S. Chong
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, Illinois, USA
| | - Bruce R. Blazar
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Peter T. Sage
- Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Defilippis EM, Batra J, Blumer V, Peoples IA, Taylor CN, Oren D, Lopez J, Sauer AJ, Ibrahim NE. Organ Donation and Transplantation among Non-US Citizens: Opportunities to Improve Global Equity in Heart Transplantation. J Card Fail 2023; 29:1383-1393. [PMID: 37088281 DOI: 10.1016/j.cardfail.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Non-US citizens/non-US residents (NCNR) are a unique and growing population. Patterns of heart donation and heart transplantation (HT) within this subgroup have not been described fully. The purpose of this study was to evaluate the use of organs from NCNR donors and the characteristics and outcomes of NCNR HT recipients. METHODS All adult donors whose hearts were recovered for HT and all primary adult HT recipients from 2013 to 2020 were identified using the United Network for Organ Sharing. Donors and recipients were categorized as citizens, residents, or NCNR. NCNR were further categorized by reason for travel to the United States. Outcomes included mortality, infection, and rejection at 1-year after transplantation. RESULTS NCNR accounted for 0.4% (n = 77) of heart donors. Most NCNR donors identified as Hispanic (61%), were predominately recovered from the South and Southwest United States, and were less likely to express written documentation to be a donor compared with citizens and residents. NCNR accounted for 0.7% (n = 147) of all HT recipients. The majority identified as non-Hispanic White individuals (57.1%). Compared with citizens and residents, NCNR recipients seemed to be sicker, as evidenced by higher intra-aortic balloon pump use before HT and higher priority United Network for Organ Sharing status. Of NCNR recipients, 63% traveled to the United States for HT, predominately from Kuwait (29.9%) and Saudi Arabia (20%). At 1-year after transplant, there were no differences in mortality, infection, or rejection between the groups. CONCLUSIONS A growing subgroup of NCNR travel from countries with low HT rates to the United States for HT. This finding highlights the need for strategies to improve equitable access to HT domestically and abroad.
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Affiliation(s)
- Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jaya Batra
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | | | | | | | - Daniel Oren
- New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jose Lopez
- Department of Internal Medicine, HCA Florida Aventura Hospital, Aventura, Florida
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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Olsacher A, Bade C, Ehlers J, Fehring L. How to effectively communicate health information on social media depending on the audience's personality traits: An experimental study in the context of organ donation in Germany. Soc Sci Med 2023; 335:116226. [PMID: 37734177 DOI: 10.1016/j.socscimed.2023.116226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE The shortage of organs donated for transplantation is a global concern. Even though increasing awareness can boost organ donation registration rates (thus leading to a higher number of available organ transplants), public organ donation campaigns lack effectiveness and are rarely tailored to audiences. To further enhance the effectiveness of digital health (i.e., organ donation) communication, we assessed the perception of social media organ donation campaign strategies (i.e., transformational, informational, neutral) as a function of personality traits (i.e., Big Five). METHOD Data was collected through an online experiment with 1000 participants (i.e., German citizens between 18 and 70 years) who were recruited via Facebook and Prolific between Jun-Aug 2022. Perceived message effectiveness of the organ donation posts was measured on a 5-point Likert scale applying the AIDA model and consequently analyzed using multiple regression analyses. RESULTS Messaging strategy applied in the social media campaigns served as a predictor for message effectiveness depending on the personality traits of the audience when controlling for demographics and donor status. Extraversion was positively associated with higher message effectiveness of the transformational post while neuroticism showed a significant positive association with informational content. Agreeableness was positively correlated with transformational as well as informational post effectiveness. Furthermore, higher perceived post effectiveness increased the likelihood to sign-up for further organ donation information. CONCLUSION Our results show that Instagram in Germany is an underleveraged but potentially effective platform to spread organ donation knowledge. Based on our results, we urge public health authorities to revisit and start tailoring their (digital) health (i.e., organ donation) campaigns to audiences (i.e., personality traits) to increase their effectiveness.
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Affiliation(s)
- Alexandra Olsacher
- Didactics and Educational Research in Health Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Germany
| | - Celina Bade
- Faculty of Health, School of Medicine, Witten/Herdecke University, Germany
| | - Jan Ehlers
- Didactics and Educational Research in Health Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Germany
| | - Leonard Fehring
- Faculty of Health, School of Medicine, Witten/Herdecke University, Germany; Helios Universitätsklinik Wuppertal, Klinik für Gastroenterologie, Hepatologie, Endokrinologie und Diabetologie, Wuppertal, Germany.
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Cheng P, Wang R, He S, Yan P, Huang H, Chen J, Shen J, Pu K. Artificial Urinary Biomarkers for Early Diagnosis of Acute Renal Allograft Rejection. Angew Chem Int Ed Engl 2023; 62:e202306539. [PMID: 37431650 DOI: 10.1002/anie.202306539] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/12/2023]
Abstract
Acute renal allograft rejection (ARAR) after kidney transplantation associated with reduced graft survival and eventual graft failure is poorly diagnosed in hospitals. Here, we report the development of Artificial bioMarker Probes (AMPros) for sensitive urinalysis of ARAR in murine models. AMPros spontaneously go to the kidneys after systemic administration, specifically react with the prodromal immune biomarkers to activate their near-infrared fluorescence signals to report cell-mediated rejection, and efficiently undergo renal excretion into urine. Thus, AMPros enable convenient optical urinalysis that detects ARAR prior to histological manifestation of rejection, which is also earlier than current diagnostic methods measuring proinflammatory cytokines and peripheral blood lymphocyte mRNAs. Due to the high kidney specificity, AMPros-based urinalysis discriminates allograft rejection against other non-alloimmune specific diseases, which is unattainable by measurement of serological biomarkers. Such a noninvasive and sensitive urine test holds great promise in continuous monitoring of renal allograft conditions at low resource settings for timely clinical interventions.
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Affiliation(s)
- Penghui Cheng
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 70 Nanyang Drive, 637457, Singapore, Singapore
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, P. R. China
- Organ Donation and Coordination Office, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, P. R. China
| | - Shasha He
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 70 Nanyang Drive, 637457, Singapore, Singapore
| | - Pengpeng Yan
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, P. R. China
| | - Hongfeng Huang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, P. R. China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, P. R. China
| | - Jia Shen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, P. R. China
| | - Kanyi Pu
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 70 Nanyang Drive, 637457, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, Singapore, 636921, Singapore
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Uzuntarla Y. Adaptation of Organ Donation Attitude Survey: Reliability and Validity Maintained as Demonstrated in a Turkish Population. Transplant Proc 2023; 55:1504-1510. [PMID: 37419735 DOI: 10.1016/j.transproceed.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Inadequate organ donation has become a major public health concern for society, particularly for patients with chronic organ failure. This study aims to regulate the validity and reliability of the Organ Donation Attitude Survey scale in the Turkish population, which was developed by Rumsey et al in 2003. METHODS The study was conducted on 1088 students studying at the faculty of nursing and vocational school of health services. Data were analyzed using SPSS 26.0 and AMOS 24.0. After language adaptation, Exploratory Factor Analysis and Confirmatory Factor Analysis were made. The Composite Reliability and Cronbach α (CA) values were used to evaluate the reliability and structure reliability of the scales used in the study. RESULTS The mean age of the participants was 20.34 ± 1.48 years. Of the participants, 764 (70.2%) were female, and 324 (29.8%) were male. The Composite Reliability coefficients for Supporting Organ Donation, Positive Belief for Organ Donation, and all of the Organ Donation Attitude Survey scale were 0.916, 0.755, and 0.932, respectively. The Cronbach α coefficients were 0.913, 0.750, and 0.906, respectively. Analyses results revealed that the Turkish version of the scale had 2 subdimensions (Supporting Organ Donation and Positive Belief for Organ Donation) and 14 items (χ2/df = 3.111, Goodness of Fit Index= 0.985, Adjustment Goodness of Fit Index = 0.980, Normed Fit Index = 0.979, Relative Fit Index = 0.975). CONCLUSIONS Fit indices and reliability coefficients were acceptable. In conclusion, the Turkish version of the Organ Donation Attitude Survey is valid and reliable and can be used in future studies.
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Affiliation(s)
- Yasin Uzuntarla
- Department of Health Management and Organ Transplantation Center, Gulhane Training and Research Hospital, Ankara, Türkiye.
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He W, Wu Y, Gong C, Xu Y, Liu X, Xie X, Chen J, Yu Y, Guo Z, Sun Q. Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors. Quant Imaging Med Surg 2023; 13:6014-6025. [PMID: 37711792 PMCID: PMC10498204 DOI: 10.21037/qims-23-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023]
Abstract
Background Acute kidney injury (AKI) is frequently found in deceased donors; however, few studies have reported the use of imaging to detect and identify this phenomenon. The purpose of this study was to detect renal microcirculatory perfusion in brain-dead donors using contrast-enhanced ultrasonography (CEUS), investigate the value of CEUS in identifying AKI, and analyze the correlation between CEUS and preimplantation biopsy results and early post-transplant renal function of grafts. Methods This prospective study recruited 94 kidneys from brain-dead donors (AKI =44, non-AKI =50) from August 2020 to November 2022. The inclusion criteria were age ≥18 years and brain death. The exclusion criteria encompassed donors maintained with extracorporeal membrane oxygenation (ECMO) and the presence of irregular kidney anatomy. The mean age of the donors was 45.1±10.4 [standard deviation (SD)] years, and the majority were male (86.2%). CEUS was performed prior to organ procurement, and time-intensity curves (TICs) were constructed. The time to peak (TTP) and peak intensity (PI) of kidney segmental artery (KA), kidney cortex (KC), and kidney medulla (KM) were calculated using TIC analysis. Results Arrival time (AT) of KA (P<0.001) and TTP of kidney cortex (TTPKC) (P<0.001) of the non-AKI group were significantly shorter than those of the AKI group. The PI of the KA (P=0.003), KM (P=0.005), and kidney cortex (PIKC; P<0.001) of the non-AKI group were significantly higher than those of the AKI group. Multivariable logistic regression analysis showed that serum creatinine [odds ratio (OR) =1.06; 95% CI: 1.03-1.1; P<0.001], TTPKC (OR =1.38; 95% CI: 1.03-1.84; P=0.03), and PIKC (OR =0.95; 95% CI: 0.91-1; P=0.046) were the independent factors of AKI. The area under the receiver operating characteristic curve (AUC) for identifying AKI for TTPKC and PIKC was 0.73 and 0.71, respectively. TTPKC showed a weak correlation with interstitial fibrosis (r=0.23; P=0.03), PIKC showed a weak correlation with arterial intimal fibrosis ((r=-0.29; P=0.004) and arteriolar hyalinosis (r=-0.27; P=0.008), and PIKC showed the strongest correlation with eGFR on postoperative day 7 (r=-0.46; P=0.046) in the donor kidneys with AKI. Conclusions CEUS can be used to identify AKI in brain-dead donors. Furthermore, there is a correlation between CEUS-derived parameters and pretransplant biopsy results and early preimplantation renal function of grafts.
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Affiliation(s)
- Weiming He
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yuqiang Wu
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Chaoyang Gong
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yuguang Xu
- Ultrasound Imaging Department, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Xiaozhen Liu
- Ultrasound Imaging Department, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Xi Xie
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Jiazhen Chen
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Yi Yu
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Sun
- Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s Hospital, Zhongshan, China
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Grossi AA, Puoti F, Masiero L, Troni A, Cianchi T, Maggiore U, Cardillo M. Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention. Transpl Int 2023; 36:11216. [PMID: 37636900 PMCID: PMC10450150 DOI: 10.3389/ti.2023.11216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023]
Abstract
Immigrants from outside Europe have increased over the past two decades, especially in Southern European countries including Italy. This influx coincided with an increased number of immigrants with end-stage organ diseases. In this narrative review, we reviewed evidence of the gaps between native-born and immigrant populations in the Organ Donation and Transplantation (ODT) process in Italy. Consistent with prior studies, despite the availability of a publicly funded health system with universal healthcare coverage, non-European-born individuals living in Italy are less likely to receive living donor kidney transplantation and more likely to have inferior long-term kidney graft function compared with EU-born and Eastern European-born individuals. While these patients are increasingly represented among transplant recipients (especially kidney and liver transplants), refusal rates for organ donation are higher in some ethnic groups compared with native-born and other foreign-born referents, with the potential downstream effects of prolonged waiting times and inferior transplant outcomes. In the process, we identified gaps in relevant research and biases in existing studies. Given the Italian National Transplant Center's (CNT) commitment to fighting inequities in ODT, we illustrated actions taken by CNT to tackle inequities in ODT among immigrant communities in Italy.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Alessia Troni
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Tiziana Cianchi
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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Zavala-Rodríguez MG, González-Velázquez ND, Guzmán-Delgado NE, Carranza-Rosales P, Quezada-Elvira VJ. [Educational intervention on organ and tissue donation at UMAE No. 34]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:482-488. [PMID: 37540635 PMCID: PMC10484546 DOI: 10.5281/zenodo.8200426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/01/2023] [Indexed: 08/06/2023]
Abstract
Background The lack of information associated with donation is devastating for those patients in need of a transplant and requires a solution based on changing social perception through educational interventions. Objective Determine the level of knowledge of the general population after an educational intervention about organ and tissue donation at the Hospital de Cardiología UMAE No. 34. Methods Educational intervention study with measurement before and after, prospective. Instrument validated using the Kuder-Richardson formula with a reliability coefficient of 0.74. The study population was made up of the general population in the waiting rooms at UMAE No. 34, only the associations with values of p < 0.05 were considered statistically significant. Results 266 evaluation instruments were applied to 133 participants. The educational intervention contributed to an increase in the level of knowledge (p = 0.0001). The level of knowledge after the intervention was higher in the younger participants (p = 0.013) and in those with a university studies (p = 0.0001). The relation between age and the level of subsequent knowledge showed favorable significance in the intention to donate in younger participants with high subsequent knowledge (p = 0.046). Conclusions An educational intervention on donation of organs and tissues for transplant purposes is an effective strategy to increase and reinforce the knowledge of the general population.
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Affiliation(s)
- Mariana Guadalupe Zavala-Rodríguez
- Instituto Mexicano del Seguro Social, Hospital de Cardiología No. 34, Coordinación Hospitalaria de Donación de Órganos y Tejidos con Fines de Trasplante. Monterrey, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Nelly Daniela González-Velázquez
- Instituto Mexicano del Seguro Social, Hospital de Cardiología No. 34, Coordinación Hospitalaria de Donación de Órganos y Tejidos con Fines de Trasplante. Monterrey, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Nancy Elena Guzmán-Delgado
- Instituto Mexicano del Seguro Social, Hospital de Cardiología No. 34, División de Investigación. Monterrey, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Pilar Carranza-Rosales
- Instituto Mexicano del Seguro Social, Centro de Investigación Biomédica Noreste, División de Investigación. Monterrey, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Víctor Javier Quezada-Elvira
- Instituto Mexicano del Seguro Social, Hospital de Cardiología No. 34, Coordinación Hospitalaria de Donación de Órganos y Tejidos con Fines de Trasplante. Monterrey, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Pisani S, Mauri V, Negrello E, Mauramati S, Alaimo G, Auricchio F, Benazzo M, Dorati R, Genta I, Conti B, Ferretti VV, De Silvestri A, Pietrabissa A, Marconi S. Assessment of different manufacturing techniques for the production of bioartificial scaffolds as soft organ transplant substitutes. Front Bioeng Biotechnol 2023; 11:1186351. [PMID: 37441194 PMCID: PMC10333585 DOI: 10.3389/fbioe.2023.1186351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction: The problem of organs' shortage for transplantation is widely known: different manufacturing techniques such as Solvent casting, Electrospinning and 3D Printing were considered to produce bioartificial scaffolds for tissue engineering purposes and possible transplantation substitutes. The advantages of manufacturing techniques' combination to develop hybrid scaffolds with increased performing properties was also evaluated. Methods: Scaffolds were produced using poly-L-lactide-co-caprolactone (PLA-PCL) copolymer and characterized for their morphological, biological, and mechanical features. Results: Hybrid scaffolds showed the best properties in terms of viability (>100%) and cell adhesion. Furthermore, their mechanical properties were found to be comparable with the reference values for soft tissues (range 1-10 MPa). Discussion: The created hybrid scaffolds pave the way for the future development of more complex systems capable of supporting, from a morphological, mechanical, and biological standpoint, the physiological needs of the tissues/organs to be transplanted.
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Affiliation(s)
- Silvia Pisani
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Mauri
- SC General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Negrello
- SC General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Mauramati
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Alaimo
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rossella Dorati
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | | | - Annalisa De Silvestri
- SSD Biostatistica e Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Pietrabissa
- SC General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Surgery, University of Pavia, Pavia, Italy
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Carola V, Morale C, Vincenzo C, Cecchi V, Errico L, Nicolais G. Organ donation: psychosocial factors of the decision-making process. Front Psychol 2023; 14:1111328. [PMID: 37303924 PMCID: PMC10252116 DOI: 10.3389/fpsyg.2023.1111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/04/2023] [Indexed: 06/13/2023] Open
Abstract
Organ donation has a crucial impact on patient care and survival, of which the worldwide gap between organ demand and supply is currently one of the most challenging issues. Brain-dead patients are the main source of organs that can be donated, but donation requires the consent of family members-a choice that is often complex and stressful and leads to refusal of consent. This mini-review aims to provide an overview of the current knowledge on the impact of certain psychosocial factors on the decision-making process with regard to organ donation by family members. In particular, the influence of several aspects is emphasized, such as sociodemographic factors, knowledge of the organ donation process, religious beliefs, concerns that are related to the choice to donate, and mode of communication. Consistent with this evidence, we emphasize the need to examine these aspects further through interventions and guidelines that improve the organ donation application process and ensure a positive experience for the family that has to make the decision.
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Affiliation(s)
- Valeria Carola
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Chiara Morale
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Cristina Vincenzo
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Valentina Cecchi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Livia Errico
- Coordination of Organ and Tissue Donation, Anesthesia Intensive Care Unit, Sant’Andrea Hospital, Rome, Italy
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Olsacher A, Bade C, Ehlers J, Freitag B, Fehring L. Messaging strategies for communicating health-related information in social media-a content and effectiveness analysis of organ donation posts on Instagram in Germany. BMC Public Health 2023; 23:867. [PMID: 37170189 PMCID: PMC10176822 DOI: 10.1186/s12889-023-15736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Although organ transplantation is a very effective clinical solution to save the lives of patients suffering from organ failure, the supply of donated organs still cannot meet its growing demand. Educating the society about organ donation is a critical success factor in increasing donation rates, especially in countries that require potential donors to proactively register and opt-in (e.g., Germany). While social media has emerged as an effective tool for disseminating health information, recent evidence suggests that published organ donation content (both online and offline), aimed at raising awareness, still lacks effectiveness. To develop recommendations for optimizing organ donation messaging via social media, this study not only examines the current state of organ donation communication on Instagram, but also identifies factors that contribute to message effectiveness. METHODS We conducted a retrospective content analysis to in-depth assess organ donation-related content published on Instagram in Germany between January and March 2022. Systematic coding allowed to identify common themes, sentiments, and communication strategies, which were analyzed for their effectiveness using linear regression analyses. RESULTS Of the 500 organ donation posts, 57% were published by institutional authors while the remainder was shared by private accounts. Most content was aimed at the general population and shared neutral (80%) or positive sentiments (17%). Transformative messages, positive emotions, posts published by the transplant recipient and the image of a human served as predictors for post effectiveness measured in terms of likes (p < 0.001) and comments (p < 0.01). Sharing personal experiences (p < 0.01) and highlighting the meaning of organ donations (p < 0.05) resulted in significantly higher audience engagement than any other topic discussed. CONCLUSION Our findings highlight the need for health officials to work closely with organ transplant recipients to publicly advocate for organ donations by sharing personal and transformative messages. The high share of posts published by transplant recipients indicates a certain openness to share personal experiences with broad audiences. Different message characteristics served as predictors for message effectiveness (i.e., increased audience engagement) which can likely be extrapolated to other health-related use cases (e.g., cancer screening).
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Affiliation(s)
- Alexandra Olsacher
- Witten/Herdecke University, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 45, Witten, 58455, Germany
| | - Celina Bade
- Witten/Herdecke University, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 45, Witten, 58455, Germany
| | - Jan Ehlers
- Witten/Herdecke University, Faculty of Health, School of Medicine, Didactics and Educational Research in Health Care, Witten, Germany
| | - Bettina Freitag
- Witten/Herdecke University, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 45, Witten, 58455, Germany
| | - Leonard Fehring
- Witten/Herdecke University, Faculty of Health, School of Medicine, Alfred-Herrhausen-Straße 45, Witten, 58455, Germany.
- Helios Universitätsklinik Wuppertal, Klinik Für Gastroenterologie, Hepatologie, Endokrinologie Und Diabetologie, Wuppertal, Germany.
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El Masri J, Afyouni A, Ghazi M, Baroud T, Al Majdalany D, Saleh A, El Assaad H, Salameh P. Current state of clinical trials on xenograft. Xenotransplantation 2023:e12801. [PMID: 37144505 DOI: 10.1111/xen.12801] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Xenotransplantation is a worth investing branch of science, since it aims to fulfil the demand on human cells, tissues and organs. Despite decades of consistent work in preclinical assessments, clinical trials on xenotransplantation are far from reaching the targeted goal. Our study aims to track the characteristics, assess the content and summarize the plan of each trial on skin, beta-island, bone marrow, aortic valve and kidney xenografts, leading to a clear sorting of efforts made in this field. METHODS In December 2022, we searched clinicaltrial.gov for interventional clinical trials related to xenograft of skin, pancreas, bone marrow, aortic valve and kidney. A total of 14 clinical trials are included in this study. Characteristics on each trial were gathered. Linked publications were searched using Medline/PubMed and Embase/Scopus. Content of trials was reviewed and summarized. RESULTS Only 14 clinical trials met our study's criteria. The majority were completed, and most of the trials' enrolment was between 11 and 50 participants. Nine trials used a xenograft of porcine origin. Six trials targeted skin xenotransplantation, four targeted β-cells, two targeted bone marrow and one trial targeted each of the kidney and aortic valve. The average length of trials was 3.38 years. Four trials were conducted in the United States and two trials in each of Brazil, Argentina and Sweden. Of all the included trials, none had any results provided and only three had published work. Phases I, III, and IV had only one trial each. A total of 501 participants were enrolled in these trials. CONCLUSION This study sheds the light on the current state of clinical trials on xenograft. Characteristically, trials on this field are of low number, low enrolment, short duration, few related publications and no published results. Porcine organs are the most used in these trials, and skin is the most studied organ. An extension of the literature is highly needed due to the variety of conflicts mentioned. Overall, this study sheds the light on the necessity of managing research efforts, leading to the initiation of more trials targeting the field of xenotransplantation.
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Affiliation(s)
- Jad El Masri
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, Neuroscience Research Center, Lebanese University, Beirut, Lebanon
- iNSPECT-LB (Intitut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
| | - Ahmad Afyouni
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Maya Ghazi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Tarek Baroud
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | | | - Aalaa Saleh
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hadi El Assaad
- Trauma Surgery Department, Hannover Medical School, Hannover, Germany
| | - Pascale Salameh
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
- iNSPECT-LB (Intitut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- School of Medicine, University of Nicosia, Nicosia, Cyprus
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Atia GAN, Shalaby HK, Ali NG, Morsy SM, Ghobashy MM, Attia HAN, Barai P, Nady N, Kodous AS, Barai HR. New Challenges and Prospective Applications of Three-Dimensional Bioactive Polymeric Hydrogels in Oral and Craniofacial Tissue Engineering: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:702. [PMID: 37242485 PMCID: PMC10224377 DOI: 10.3390/ph16050702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Regenerative medicine, and dentistry offers enormous potential for enhancing treatment results and has been fueled by bioengineering breakthroughs over the previous few decades. Bioengineered tissues and constructing functional structures capable of healing, maintaining, and regenerating damaged tissues and organs have had a broad influence on medicine and dentistry. Approaches for combining bioinspired materials, cells, and therapeutic chemicals are critical in stimulating tissue regeneration or as medicinal systems. Because of its capacity to maintain an unique 3D form, offer physical stability for the cells in produced tissues, and replicate the native tissues, hydrogels have been utilized as one of the most frequent tissue engineering scaffolds during the last twenty years. Hydrogels' high water content can provide an excellent conditions for cell viability as well as an architecture that mimics real tissues, bone, and cartilage. Hydrogels have been used to enable cell immobilization and growth factor application. This paper summarizes the features, structure, synthesis and production methods, uses, new challenges, and future prospects of bioactive polymeric hydrogels in dental and osseous tissue engineering of clinical, exploring, systematical and scientific applications.
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Affiliation(s)
- Gamal Abdel Nasser Atia
- Department of Oral Medicine, Periodontology, and Diagnosis, Faculty of Dentistry, Suez Canal University, Ismailia P.O. Box 41522, Egypt
| | - Hany K. Shalaby
- Department of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Suez University, Suez P.O. Box 43512, Egypt
| | - Naema Goda Ali
- Department of Oral Medicine, Periodontology, and Diagnosis, Faculty of Dentistry, Suez Canal University, Ismailia P.O. Box 41522, Egypt
| | - Shaimaa Mohammed Morsy
- Department of Oral Medicine, Periodontology, and Diagnosis, Faculty of Dentistry, Suez Canal University, Ismailia P.O. Box 41522, Egypt
| | - Mohamed Mohamady Ghobashy
- Radiation Research of Polymer Chemistry Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo P.O. Box 13759, Egypt
| | - Hager Abdel Nasser Attia
- Department of Molecular Biology and Chemistry, Faculty of Science, Alexandria University, Alexandria P.O. Box 21526, Egypt
| | - Paritosh Barai
- Department of Biochemistry and Molecular Biology, Primeasia University, Dhaka 1213, Bangladesh
| | - Norhan Nady
- Polymeric Materials Research Department, Advanced Technology and New Materials Research Institute (ATNMRI), City of Scientific Research and Technological Applications (SRTA-City), New Borg Elarab, Alexandria P.O. Box 21934, Egypt
| | - Ahmad S. Kodous
- Department of Radiation Biology, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority (EAEA), Cairo P.O. Box 13759, Egypt
| | - Hasi Rani Barai
- Department of Mechanical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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Hedley JA, Kelly PJ, Wyld M, Shah K, Morton RL, Byrnes J, Rosales BM, De La Mata NL, Wyburn K, Webster AC. Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting. Transplant Direct 2023; 9:e1474. [PMID: 37090124 PMCID: PMC10118354 DOI: 10.1097/txd.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 04/25/2023] Open
Abstract
Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors' medical history and their absolute transmission risk or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare, and prolonging waiting time for recipients is harmful. Methods We assessed the cost-effectiveness of increasing utilization of potential deceased donors with brain cancer using a Markov model simulation of 1500 patients waitlisted for a kidney transplant, based on linked transplant registry data and with a payer perspective (Australian government). We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk, improved cancer classification accuracy with real-time data-linkage to hospital records and cancer registries, and increased risk tolerance to allow intermediate-risk donors (up to 6.4% potential transmission risk). Results Compared with current practice, decision support provided 0.3% more donors with an average transmission risk of 2%. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk). Interventions were dominant (improved QALYs and saved costs) in 78%, 80%, and 87% of simulations, respectively. The largest benefit was from increasing risk tolerance (mean +18.6 QALYs and AU$2.2 million [US$1.6 million] cost-savings). Conclusions Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.
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Affiliation(s)
- James A. Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Patrick J. Kelly
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - Karan Shah
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Juliet Byrnes
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Brenda M. Rosales
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nicole L. De La Mata
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Wyburn
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Renal Unit, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Angela C. Webster
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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Walton P, Pérez-Blanco A, Beed S, Glazier A, Ferreira Salomao Pontes D, Kingdon J, Jordison K, Weiss MJ. Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1416. [PMID: 37138558 PMCID: PMC10150845 DOI: 10.1097/txd.0000000000001416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 05/05/2023] Open
Abstract
Consent model and intent to donate registries are often the most public facing aspects of an organ and tissue donation and transplantation (OTDT) system. This article describes the output of an international consensus forum designed to give guidance to stakeholders considering reform of these aspects of their system. Methods This Forum was initiated by Transplant Québec and cohosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This article describes the output of the consent and registries domain working group, which is 1 of 7 domains from this Forum. The domain working group members included administrative, clinical, and academic experts in deceased donation consent models in addition to 2 patient, family, and donor partners. Topic identification and recommendation consensus was completed over a series of virtual meetings from March to September 2021. Consensus was achieved by applying the nominal group technique informed by literature reviews performed by working group members. Results Eleven recommendations were generated and divided into 3 topic groupings: consent model, intent to donate registry structure, and consent model change management. The recommendations emphasized the need to adapt all 3 elements to the legal, societal, and economic realities of the jurisdiction of the OTDT system. The recommendations stress the importance of consistency within the system to ensure that societal values such as autonomy and social cohesion are applied through all levels of the consent process. Conclusions We did not recommend one consent model as universally superior to others, although considerations of factors that contribute to the successful deployment of consent models were discussed in detail. We also include recommendations on how to navigate changes in the consent model in a way that preserves an OTDT system's most valuable resource: public trust.
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Affiliation(s)
- Phil Walton
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | | | | | | | - Jennifer Kingdon
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Kim Jordison
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
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50
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Zaza G, Neri F, Bruschi M, Granata S, Petretto A, Bartolucci M, di Bella C, Candiano G, Stallone G, Gesualdo L, Furian L. Proteomics reveals specific biological changes induced by the normothermic machine perfusion of donor kidneys with a significant up-regulation of Latexin. Sci Rep 2023; 13:5920. [PMID: 37041202 PMCID: PMC10090051 DOI: 10.1038/s41598-023-33194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/08/2023] [Indexed: 04/13/2023] Open
Abstract
Renal normothermic machine perfusion (NMP) is an organ preservation method based on the circulation of a warm (35-37 °C) perfusion solution through the renal vasculature to deliver oxygen and nutrients. However, its biological effects on marginal kidneys are unclear. We therefore used mass spectrometry to determine the proteomic profile of kidney tissue and urine from eight organs reconditioned for 120 min using a Kidney Assist device. Biopsies were taken during the pre-implantation histological evaluation (T-1), at the start of back table preparation (T0), and after 60 and 120 min of perfusion (T60, T120). Urine samples were collected at T0 (urine produced in the first 15 min after the beginning of normothermic reperfusion), T30, T60 and T120. Multiple algorithms, support vector machine learning and partial least squares discriminant analysis were used to select the most discriminative proteins during NMP. Statistical analysis revealed the upregulation of 169 proteins and the downregulation of 196 during NMP. Machine learning algorithms identified the top 50 most discriminative proteins, five of which were concomitantly upregulated (LXN, ETFB, NUDT3, CYCS and UQCRC1) and six downregulated (CFHR3, C1S, CFI, KNG1, SERPINC1 and F9) in the kidney and urine after NMP. Latexin (LXN), an endogenous carboxypeptidase inhibitor, resulted the most-upregulated protein at T120, and this result was confirmed by ELISA. In addition, functional analysis revealed that the most strongly upregulated proteins were involved in the oxidative phosphorylation system and ATP synthesis, whereas the downregulated proteins represented the complement system and coagulation cascade. Our proteomic analysis demonstrated that even brief periods of NMP induce remarkable metabolic and biochemical changes in marginal organs, which supports the use of this promising technique in the clinic.
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Affiliation(s)
- Gianluigi Zaza
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University-Hospital of Foggia, Via L. Pinto 1, 71122, Foggia, Italy.
| | - Flavia Neri
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Simona Granata
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University-Hospital of Foggia, Via L. Pinto 1, 71122, Foggia, Italy
| | - Andrea Petretto
- Core Facilities - Proteomica E Metabolomica Clinica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Martina Bartolucci
- Core Facilities - Proteomica E Metabolomica Clinica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Caterina di Bella
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University-Hospital of Foggia, Via L. Pinto 1, 71122, Foggia, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
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