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Ambagtsheer F, Annema C, Forsythe J, Jansen N, Paredes-Zapata D. Ethical and Legal Aspects of Organ Donation and Transplantation. Transpl Int 2024; 37:13011. [PMID: 38655205 PMCID: PMC11036411 DOI: 10.3389/ti.2024.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - John Forsythe
- Department of Health and Social Services, Implementation Steering Group for Organ Utilisation, London, United Kingdom
| | - Nichon Jansen
- Department of Policy, Dutch Transplant Foundation, Leiden, Netherlands
| | - David Paredes-Zapata
- Donation and Transplant Coordination Section, Hospital Clínic, Barcelona, Spain
- Surgical Department, University of Barcelona, Barcelona, Spain
- Donation and Transplantation Institute Foundation, Barcelona, Spain
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2
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Mihály S, Smudla A, Dominguez-Gil B, Pérez A, Procaccio F, Cozzi E, López Fraga M, Avsec D, Rahmel A, Forsythe J, Immer F, Jushinskis J, Manara A. Approaching the Families of Potential Deceased Organ Donors: An Overview of Regulations and Practices in Council of Europe Member States. Transpl Int 2023; 36:11498. [PMID: 37767527 PMCID: PMC10520243 DOI: 10.3389/ti.2023.11498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
The primary aim of this study was to describe regulations and practices concerning the family approach to discuss donation, specifically after the neurological determination of death, one of the most challenging steps in the donation pathway. A secondary objective was to assess the impact of legislation on consent rates for organ donation. The Council of Europe surveyed 39 member states about national regulations, practices, and consent rates; 34 replied. Opt-out legislation is present in 19, opt-in in 9 and a mixed system in six countries. An opt-out register is kept by 24 countries and an opt-in register by 18 countries, some keeping both. The mean consent rate was 81.2% of all family approaches. Most countries regulate how death using neurological criteria is confirmed (85.3%), while regulation of other aspects of the deceased donation pathway varies: the timing of informing the family about brain death (47.1%) and organ donation (58.8%), the profile of professional who discusses both topics with the family (52.9% and 64.7%, respectively) and the withdrawal of treatment after brain death (47.1%). We also noted a mismatch between what regulations state and what is done in practice in most countries. We suggest possible reasons for this disparity.
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Affiliation(s)
- Sándor Mihály
- Hungarian National Blood Transfusion Service, Budapest, Hungary
| | - Anikó Smudla
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Alicia Pérez
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | - Emanuele Cozzi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Marta López Fraga
- European Directorate for the Quality of Medicines and HealthCare (EDQM), Strasbourg, France
| | - Danica Avsec
- Institute for Transplantation of Organs and Tissues of the Republic of Slovenia, Slovenija-Transplant, Ljubljana, Slovenia
| | - Axel Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main, Germany
| | | | - Franz Immer
- Swisstransplant, National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | | | - Alex Manara
- The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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3
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Ushiro-Lumb I, Forsythe J, Haywood B, Geoghegan C, Maddox V, Ijaz S, Manas D, Thorburn D. Impact of Hepatitis E Virus Screening in the UK Deceased Organ Donor Population. Transpl Int 2023; 36:11673. [PMID: 37727381 PMCID: PMC10505649 DOI: 10.3389/ti.2023.11673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 09/21/2023]
Abstract
Universal Hepatitis E Virus (HEV) screening of deceased organ donors was implemented by the UK national organ procurement organisation in October 2017. Donor testing for HEV infection is done post-transplant; detection of HEV ribonucleic acid (RNA) in donor plasma is therefore not a contra-indication for organ donation, with the result being used to inform recipient management. Immediate post-transplant detection of donor HEV viraemia triggers notification to transplant centres. Follow up of liver and kidney recipients has shown that transmission through solid organs is very efficient, particularly through liver grafts, as expected; no other organ types were transplanted in this cohort. Although donors with higher plasma viral load (VL > 103 IU/mL) were invariably associated with recipient infection, transmission was also documented at lower VL levels. Knowledge of donor HEV status has led to identification of transmission of infection via solid organ grafts followed by close patient monitoring and informed clinical management decisions. The purpose of this strategy is to allow early detection of infection and recurrence and treatment to circumvent the risk of accelerated liver damage from chronic HEV infection due to undiagnosed, inadvertent donor-derived transmission of infection.
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Affiliation(s)
- Ines Ushiro-Lumb
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
- UK Health Security Agency (UKHSA), London, United Kingdom
- Microbiology Services Laboratory, NHS Blood and Transplant, London, United Kingdom
| | - John Forsythe
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Becky Haywood
- UK Health Security Agency (UKHSA), London, United Kingdom
| | | | - Victoria Maddox
- Microbiology Services Laboratory, NHS Blood and Transplant, London, United Kingdom
| | - Samreen Ijaz
- UK Health Security Agency (UKHSA), London, United Kingdom
| | - Derek Manas
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Douglas Thorburn
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
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Williment C, Jones J, Forsythe J, Mumford L, Powis S. Excellence in Organ Utilisation-A Quantitative and Qualitative Evidence Base for a New Approach in the UK. Transpl Int 2023; 36:11641. [PMID: 37727386 PMCID: PMC10505655 DOI: 10.3389/ti.2023.11641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
The Department of Health and Social Care in England established an Organ Utilisation Group, to collate and analyse evidence regarding the organ transplantation care pathway, make recommendations on how to reduce inequity of access, make the best use of available resources, and drive innovation in organ transplantation. The group consulted with national and international experts and stakeholders, sought views from service providers across the transplant care pathway, and heard from over 600 people, including over 250 patients, carers, and donors. The group uncovered new evidence about where improvements are needed-particularly in relation to patient experience and inequities in access. The final report suggests a new direction for organ transplantation services in the United Kingdom, with action required at local, regional, and national levels. Ultimately, it is expected to increase transplant activity through increased organ utilisation and improve patient experience, outcomes, and empowerment whilst also supporting the transplant clinical community.
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Affiliation(s)
| | | | | | - Lisa Mumford
- NHS Blood and Transplant, Filton, United Kingdom
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Messer S, Rushton S, Simmonds L, Macklam D, Husain M, Jothidasan A, Large S, Tsui S, Kaul P, Baxter J, Osman M, Mehta V, Russell D, Stock U, Dunning J, Saez DG, Venkateswaran R, Curry P, Ayton L, Mukadam M, Mascaro J, Simmonds J, Macgowan G, Clark S, Jungschleger J, Reinhardt Z, Quigley R, Speed J, Parameshwar J, Jenkins D, Watson S, Marley F, Ali A, Gardiner D, Rubino A, Whitney J, Beale S, Slater C, Currie I, Armstrong L, Foley J, Ryan M, Gibson S, Quinn K, Macleod AM, Spence S, Watson CJE, Catarino P, Clarkson A, Forsythe J, Manas D, Berman M. A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom. J Heart Lung Transplant 2023; 42:1120-1130. [PMID: 37032222 DOI: 10.1016/j.healun.2023.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. METHODS This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. RESULTS From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). CONCLUSION During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.
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Affiliation(s)
- Simon Messer
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Sally Rushton
- National Health Service Blood and Transplant, Bristol, UK
| | - Lewis Simmonds
- National Health Service Blood and Transplant, Bristol, UK
| | - Debbie Macklam
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | - Stephen Large
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Steven Tsui
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Pradeep Kaul
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mohamed Osman
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | - Derval Russell
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - Uli Stock
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - John Dunning
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | | | - Philip Curry
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Lynne Ayton
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | | | | | | | - Guy Macgowan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Stephen Clark
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Zdenka Reinhardt
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Jane Speed
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - David Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Watson
- National Health Service England, Highly Specialised Services, London, UK
| | - Fiona Marley
- National Health Service England, Highly Specialised Services, London, UK
| | - Ayesha Ali
- National Health Service England, Highly Specialised Services, London, UK
| | - Dale Gardiner
- National Health Service Blood and Transplant, Bristol, UK
| | - Antonio Rubino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK
| | - Julie Whitney
- National Health Service Blood and Transplant, Bristol, UK
| | - Sarah Beale
- National Health Service Blood and Transplant, Bristol, UK
| | | | - Ian Currie
- National Health Service Blood and Transplant, Bristol, UK
| | - Liz Armstrong
- National Health Service Blood and Transplant, Bristol, UK
| | - Jeanette Foley
- National Health Service Blood and Transplant, Bristol, UK
| | - Marian Ryan
- National Health Service Blood and Transplant, Bristol, UK
| | - Sharon Gibson
- National Health Service Blood and Transplant, Bristol, UK
| | - Karen Quinn
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | | | - Pedro Catarino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - John Forsythe
- National Health Service Blood and Transplant, Bristol, UK
| | - Derek Manas
- National Health Service Blood and Transplant, Bristol, UK
| | - Marius Berman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK.
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6
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Ibrahim M, Mehew J, Martin K, Forsythe J, Johnson RJ, Callaghan C. Outcomes of Declined Deceased Donor Kidney Offers That Are Subsequently Implanted: A UK Registry Study. Transplantation 2023; 107:1348-1358. [PMID: 36706063 DOI: 10.1097/tp.0000000000004467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Deceased donor kidneys are often declined for ≥1 patients but then implanted into another. Studies are needed to guide transplant clinicians and patients, especially given the increasing age and comorbidity of donors. This study compares outcomes of recipients of transplanted kidneys that were initially declined with outcomes of patients who remained on the waiting list. METHODS This UK Transplant Registry study examined named-patient, adult donation after brain death donor single kidney-only offers that were declined for donor- or organ-related reasons (DORRs), in which the kidney was subsequently transplanted from January 1, 2010, to December 31, 2018. Outcomes included graft function and survival of kidneys transplanted following DORR decline, survival and transplant status of patients who had a kidney declined, and intercenter decline rates. RESULTS A total of 4722 kidneys declined for DORRs, which eventually resulted in single kidney-only transplants, were examined. One year after the offer decline, 35% of patients for whom the organ was declined remained on the list, 55% received a deceased donor transplant at a median of 174 d after the initial offer decline, and 4% had been removed or died. For patients transplanted following offer decline, there was no significant difference in 5-y graft survival when comparing the outcomes to those recipients who received the declined kidney. There was significant variation in DORR decline rates between UK transplant units (17%-54%). CONCLUSIONS This study shows reasonable outcomes of kidneys previously declined for DORRs and supports the utilization of those considered to be of higher risk for carefully selected recipients.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Jennifer Mehew
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Kate Martin
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Rachel J Johnson
- NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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7
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Johnston-Webber C, Mah J, Prionas A, Streit S, Wharton G, Forsythe J, Mossialos E, Papalois V. Solid Organ Donation and Transplantation in the United Kingdom: Good Governance is Key to Success. Transpl Int 2023; 36:11012. [PMID: 37305339 PMCID: PMC10249499 DOI: 10.3389/ti.2023.11012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
The United Kingdom (UK) supports a highly successful organ donation and transplantation program. While the UK originally had one of the lowest organ donation rates in Europe, sustained reforms have resulted in steady improvement. Of note, the UK nearly doubled its rate of deceased donations between 2008 and 2018. In this report, we present a case study of the UK organ donation and transplantation program as an example of a complete system with sound and inclusive governing structures that are strongly integrated with critical programs focused on training and research. This study was based on an initial targeted review of the literature led by a UK expert that included guidelines, national reports, and academic papers. Feedback solicited from other European experts was incorporated into our findings via an iterative process. Overall, the study highlights the stepwise evolution of the UK program that ultimately became successful largely due to ongoing collaborative efforts carried out at all levels. Centralized coordination of all aspects of the program remains a key driver of improved rates of organ donation and transplantation. The designation and empowerment of expert clinical leadership have helped to maintain focus and promote ongoing quality improvement.
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Affiliation(s)
- Charlotte Johnston-Webber
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Apostolos Prionas
- Department of Surgery, Imperial College, London, United Kingdom
- Department of General Surgery, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Simon Streit
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - George Wharton
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - John Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Vassilios Papalois
- Department of Surgery, Imperial College, London, United Kingdom
- Renal and Transplant Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Greenhall GHB, Ushiro-Lumb I, Pavord S, Hunt BJ, Sharma H, Mehra S, Calder F, Kessaris N, Kilbride H, Jones G, Motallebzadeh R, Arslan Z, Marks SD, Graetz K, Pettigrew GJ, Torpey N, Watson C, Roy D, Casey J, Oniscu GC, Currie I, Sutherland A, Clancy M, Dor F, Willicombe M, Sandhu B, Nath J, Weston C, van Dellen D, Roberts DJ, Madden S, Ravanan R, Forsythe J, Khurram MA, Mohamed I, Callaghan CJ. Kidney Transplantation From Deceased Donors With Vaccine-induced Immune Thrombocytopenia and Thrombosis: An Updated Analysis of the UK Experience. Transplantation 2022; 106:1824-1830. [PMID: 35821588 DOI: 10.1097/tp.0000000000004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The emergence and attendant mortality of vaccine-induced immune thrombocytopenia and thrombosis (VITT) as a consequence of vaccination against severe acute respiratory syndrome coronavirus 2 have resulted in some patients with VITT being considered as deceased organ donors. Outcomes after kidney transplantation in this context are poorly described. Because the disease seems to be mediated by antiplatelet factor 4 antibodies, there is a theoretical risk of transmission via passenger leukocytes within the allograft. METHODS We analyzed the experience of kidney transplantation from donors with VITT in the United Kingdom between January and June 2021. We followed-up all recipients of kidney-only transplants from donors with VITT to detect major postoperative complications or features of disease transmission and assess graft survival and function. RESULTS There were 16 kidney donors and 30 single kidney transplant recipients in our study period. Of 11 preimplantation biopsies, 4 showed widespread glomerular microthrombi. After a median of 5 mo, patient and graft survival were 97% and 90%, respectively. The median 3-mo estimated glomerular filtration rate was 51 mL/min/1.73 m 2 . Two recipients had detectable antiplatelet factor 4 antibodies but no evidence of clinical disease after transplantation. Major hemorrhagic complications occurred in 3 recipients, all of whom had independent risk factors for bleeding, resulting in the loss of 2 grafts. The involvement of VITT could not be completely excluded in one of these cases. CONCLUSIONS The UK experience to date shows that favorable outcomes are possible after kidney transplantation from donors with VITT but highlights the need for ongoing vigilance for donor-related complications in these patients.
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Affiliation(s)
- George H B Greenhall
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Ines Ushiro-Lumb
- Department of Haematology, Oxford University Hospitals, Oxford, United Kingdom
| | - Sue Pavord
- Thrombosis and Haemophilia Centre, Guy's and St.Thomas' NHS Foundation Trust, London, United Kingdom
| | - Beverley J Hunt
- vDepartment of Nephrology and Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hemant Sharma
- Department of Transplant and Vascular Access Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Sanjay Mehra
- Department of Transplant and Vascular Access Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Francis Calder
- vDepartment of Nephrology and Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nicos Kessaris
- vDepartment of Nephrology and Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hannah Kilbride
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Gareth Jones
- UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Reza Motallebzadeh
- UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Zainab Arslan
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust London, United Kingdom
| | - Stephen D Marks
- Nephrology Department, Great Ormond Street Hospital, London, United Kingdom
| | - Keith Graetz
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Gavin J Pettigrew
- Wessex kidney centre, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Nicholas Torpey
- Wessex kidney centre, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Chris Watson
- University of Cambidge Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Debabrata Roy
- University of Cambidge Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - John Casey
- Department of Clinical Nephrology and Transplantation, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Gabriel C Oniscu
- Department of Clinical Nephrology and Transplantation, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ian Currie
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Andrew Sutherland
- Department of Clinical Nephrology and Transplantation, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Marc Clancy
- Renal transplant unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Frank Dor
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Michelle Willicombe
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Bynvant Sandhu
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jay Nath
- Renal transplant unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Charles Weston
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - David van Dellen
- Department of Renal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - David J Roberts
- Renal unit, Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
| | - Susanna Madden
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rommel Ravanan
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - John Forsythe
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Muhammad A Khurram
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ismail Mohamed
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Chris J Callaghan
- Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
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9
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Counter C, Owen R, Sinha S, Muthusamy A, Drage M, Callaghan C, Elker D, Harper S, Sutherland A, Van Dellen D, Johnson P, Manas D, Shaw J, Forsythe J, Wilson C, Hughes S, Casey J, White S. O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era. Br J Surg 2022; 109:znac242.007. [PMCID: PMC9384530 DOI: 10.1093/bjs/znac242.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Methods Results Conclusion Take-home message
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Affiliation(s)
| | - R Owen
- NHSBT Pancreas Advisory Group
| | - S Sinha
- NHSBT Pancreas Advisory Group
| | | | - M Drage
- NHSBT Pancreas Advisory Group
| | | | - D Elker
- NHSBT Pancreas Advisory Group
| | | | | | | | | | - D Manas
- NHSBT Pancreas Advisory Group
| | - J Shaw
- NHSBT Pancreas Advisory Group
| | | | | | | | - J Casey
- NHSBT Pancreas Advisory Group
| | - S White
- NHSBT Pancreas Advisory Group
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10
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Cozzi E, Álvarez M, Carmona M, Mahíllo B, Forsythe J, Lomero M, López-Fraga M, Sapir-Pichhadze R, Cardillo M, Domínguez-Gil B. An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation. Transpl Int 2022; 35:10322. [PMID: 35928348 PMCID: PMC9343585 DOI: 10.3389/ti.2022.10322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.
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Affiliation(s)
- Emanuele Cozzi
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, Transplant Immunology Unit, Padua University Hospital, University of Padua, Padua, Italy
- *Correspondence: Emanuele Cozzi,
| | - Marina Álvarez
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | - Mar Carmona
- Organizacion Nacional de Trasplantes (ONT), Madrid, Spain
| | | | - John Forsythe
- NHS Blood and Transplant (NHSBT), Bristol, United Kingdom
| | - Mar Lomero
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Massimo Cardillo
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
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11
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Hann A, Hartog H, Nutu A, Quist K, Sanabria-Mateos R, Greenhall GHB, Ushiro-Lumb I, Nicolson PLR, Cain O, Oo YH, Chauhan A, Lester W, Pollok JM, Prachalias A, Isaac JR, Thorburn D, Forsythe J, Sharif K, Neil DAH, Mirza DF, Perera MTPR. Liver graft outcomes from donors with vaccine induced thrombosis and thrombocytopenia (VITT): United Kingdom multicenter experience. Am J Transplant 2022; 22:996-998. [PMID: 34662508 DOI: 10.1111/ajt.16869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Angus Hann
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Hermien Hartog
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
| | - Anisa Nutu
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Ines Ushiro-Lumb
- National Health Service Blood and Transplant Service, Bristol, UK
| | | | - Owen Cain
- Department of Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ye H Oo
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Abhishek Chauhan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Joerg-Matthias Pollok
- Liver Unit, Royal Free Hospital, London, UK.,Department of surgery & Interventional Science, University College London, London, UK
| | | | - John R Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Douglas Thorburn
- Liver Unit, Royal Free Hospital, London, UK.,National Health Service Blood and Transplant Service, Bristol, UK
| | - John Forsythe
- National Health Service Blood and Transplant Service, Bristol, UK
| | | | - Desley A H Neil
- Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK.,Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for liver and gastrointestinal research, Institute of Immunology and Immunotherapy, NIHR Birmingham BRC, University of Birmingham, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
| | - M Thamara P R Perera
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK
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13
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Masson S, Taylor R, Whitney J, Adair A, Attia M, Gibbs P, Grammatikopoulos T, Isaac J, Marshall A, Mirza D, Prachalias A, Watson S, Manas D, Forsythe J, Thorburn D. A coordinated national UK liver transplant program response, prioritising waitlist recipients with the highest need, provided excellent outcomes during the first wave of the COVID-19 pandemic. Clin Transplant 2021; 36:e14563. [PMID: 34913525 DOI: 10.1111/ctr.14563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
Abstract
Healthcare provision has been severely affected by COVID-19, with specific challenges in organ transplantation. Here, we describe the coordinated response to, and outcomes during the first wave, across all UK liver transplant (LT) centres. Several policy changes affecting the liver transplant processes were agreed upon. These included donor age restrictions and changes to offering. A 'high-urgency' (HU) category was established, prioritising only those with UKELD >60, HCC reaching transplant criteria, and others likely to die within 90 days. Outcomes were compared with the same period in 2018 & 2019. The retrieval rate for deceased donor livers (71% vs 54%; p<0.0001) and conversion from offer to completed transplant (63% vs 48%; p<0.0001) was significantly higher. Paediatric LT activity was maintained; there was a significant reduction in adult (42%) and total (36%) LT. Almost all adult LT were super-urgent (n = 15) or HU (n = 133). We successfully prioritised those with highest illness severity with no reduction in 90-day patient (p = 0.89) or graft survival (p = 0.98). There was a small (5% compared with 3%; p = 0.0015) increase in deaths or removals from the waitlist, mainly amongst HU cohort. We successfully prioritised LT recipients in highest need, maintaining excellent outcomes, and waitlist mortality was only marginally increased. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Steven Masson
- Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust NE7 7DN, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julie Whitney
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Anya Adair
- Edinburgh Transplant Centre, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Magdy Attia
- Leeds Transplant Unit, Leeds Teaching Hospitals Trust, St James's University Hospital, Leeds, UK
| | - Paul Gibbs
- Department of Surgery, Cambridge Universities Hospital Trust, Cambridge, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, Gastrointestinal & Nutrition Centre and Mowat Labs, King's College Hospital, London, UK
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Aileen Marshall
- Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Darius Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Liver Unit, Birmingham Children's Hospital, Birmingham, UK
| | | | - Sarah Watson
- Highly Specialised Services, NHS England and NHS Improvement, London, UK
| | - Derek Manas
- Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust NE7 7DN, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Douglas Thorburn
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK.,Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
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14
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Greenhall GHB, Ushiro‐Lumb I, Pavord S, Currie I, Perera MTPR, Hartog H, Hill QA, Mohamed I, Khurram MA, Motallebzadeh R, Jones G, Marshall A, Pollok J, Torpey N, Pettigrew GJ, Mehra S, Sharma H, Calder F, Kessaris N, Nath J, Roy D, Oniscu GC, Clancy M, Santhanakrishnan K, Mascaro J, Lim S, Berman M, Madden S, Mumford L, Mirza D, Watson C, McGowan O, Thorburn D, Ravanan R, Hunt BJ, Callaghan CJ, Roberts DJ, Forsythe J. Organ transplantation from deceased donors with vaccine-induced thrombosis and thrombocytopenia. Am J Transplant 2021; 21:4095-4097. [PMID: 34214257 PMCID: PMC8441635 DOI: 10.1111/ajt.16735] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/25/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Clancy
- Queen Elizabeth University HospitalGlasgowUK
| | | | | | - Sern Lim
- Queen Elizabeth HospitalBirminghamUK
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15
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Ravanan R, Mumford L, Ushiro-Lumb I, Callaghan C, Pettigrew G, Thorburn D, Gardiner D, Forsythe J. Two Doses of SARS-CoV-2 Vaccines Reduce Risk of Death Due to COVID-19 in Solid Organ Transplant Recipients: Preliminary Outcomes From a UK Registry Linkage Analysis. Transplantation 2021; 105:e263-e264. [PMID: 34310530 PMCID: PMC8549134 DOI: 10.1097/tp.0000000000003908] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Rommel Ravanan
- NHS Blood and Transplant, Filton, Bristol, United Kingdom
| | - Lisa Mumford
- NHS Blood and Transplant, Filton, Bristol, United Kingdom
| | | | | | | | | | - Dale Gardiner
- NHS Blood and Transplant, Filton, Bristol, United Kingdom
| | - John Forsythe
- NHS Blood and Transplant, Filton, Bristol, United Kingdom
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16
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Aubert O, Yoo D, Zielinski D, Cozzi E, Cardillo M, Dürr M, Domínguez-Gil B, Coll E, Da Silva MI, Sallinen V, Lemström K, Midtvedt K, Ulloa C, Immer F, Weissenbacher A, Vallant N, Basic-Jukic N, Tanabe K, Papatheodoridis G, Menoudakou G, Torres M, Soratti C, Hansen Krogh D, Lefaucheur C, Ferreira G, Silva HT, Hartell D, Forsythe J, Mumford L, Reese PP, Kerbaul F, Jacquelinet C, Vogelaar S, Papalois V, Loupy A. COVID-19 pandemic and worldwide organ transplantation: a population-based study. Lancet Public Health 2021; 6:e709-e719. [PMID: 34474014 PMCID: PMC8460176 DOI: 10.1016/s2468-2667(21)00200-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients. METHODS In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256. FINDINGS Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost. INTERPRETATION We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years. FUNDING French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.
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Affiliation(s)
- Olivier Aubert
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniel Yoo
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Dina Zielinski
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Michael Dürr
- Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karl Lemström
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Camilo Ulloa
- Nephrology Department, Clínica Alemana de Santiago-UDD, Santiago, Chile
| | | | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Vallant
- Department of Transplant Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Martin Torres
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carlos Soratti
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Daniela Hansen Krogh
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carmen Lefaucheur
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gustavo Ferreira
- Department of Medicine, Santa Casa de Juiz de Fora, Juiz de Fora, Brazil
| | - Helio Tedesco Silva
- Division of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Peter P Reese
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, Netherlands
| | - Vassilios Papalois
- Department of Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Alexandre Loupy
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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17
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Pérez-Blanco A, López-Fraga M, Forsythe J, Pires Silva AM, Cardillo M, Novotná P, Tullius SG, Cozzi E, Ashkenazi T, Delmonico FL, Domínguez-Gil B, Brix-Zuleger M, Colenbie L, Tsoneva D, Bušić M, Nicolaos M, Adamec M, Makisalo H, Arrabal S, Pérel Y, Cantrelle C, Legeai C, Rahmel A, Menoudakou G, Sándor M, Lavee J, Bellis L, Ciaccio P, Gembutiene V, Abela C, Codrenau I, Kaminski A, Kratka M, Avsec D, Alvarez M, Carmona M, Beyeler F, Thaqi A, Haase B, Ünsal İ, Gardiner D, McGowan O, Branger P, Ericzon BG, Birrell L. Access of non-residents to transplantation of deceased donor organs: practices and strategies in the European setting. Transpl Int 2021; 34:2112-2121. [PMID: 34553794 DOI: 10.1111/tri.14113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
The access of non-resident patients to the deceased donor waiting list (DDWL) poses different challenges. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) has studied this phenomenon in the European setting. A questionnaire was circulated among the Council of Europe member states to inquire about the criteria applied for non-residents to access their DDWL. Information was compiled from 28 countries. Less than 1% of recipients of deceased donor organs were non-residents. Two countries never allow non-residents to access the DDWL, four allow access without restrictions and 22 only under specific conditions. Of those, most give access to non-resident patients already in their jurisdictions who are in a situation of vulnerability (urgent life-threatening conditions). In addition, patients may be given access: (i) after assessment by a specific committee (four countries); (ii) within the framework of official cooperation agreements (15 countries); and (iii) after patients have officially lived in the country for a minimum length of time (eight countries). The ethical and legal implications of these policies are discussed. Countries should collect accurate information about residency status of waitlisted patients. Transparent criteria for the access of non-residents to DDWL should be clearly defined at national level.
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Affiliation(s)
| | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | - Ana M Pires Silva
- Instituto Português de Sangue e da Transplantação (IPST), Lisbon, Portugal
| | - Massimo Cardillo
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
| | - Petra Novotná
- Koordinační středisko transplantací (KST), Prague, Czech Republic
| | - Stefan G Tullius
- Division of Transplant Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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18
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Ushiro-Lumb I, Callaghan C, Parmar J, Olsburgh J, Berman M, Currie I, Forsythe J, Gardiner D. Screening for SARS-CoV-2 in potential deceased organ donors. Am J Transplant 2021; 21:3204-3205. [PMID: 33756065 PMCID: PMC8251101 DOI: 10.1111/ajt.16577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Ines Ushiro-Lumb
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Correspondence: Ines Ushiro-Lumb Email:
| | - Chris Callaghan
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Department of Nephrology and Transplantation, Guy’s Hospital, London, UK
| | - Jasvir Parmar
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Department of Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s Hospital, London, UK
| | - Marius Berman
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Department of Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Ian Currie
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John Forsythe
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK
| | - Dale Gardiner
- Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Bristol, UK,Adult Critical Care Unit, Nottingham University Hospital, Nottingham, UK
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19
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Nachum E, Laurence C, Osman M, Hogan J, Baxter J, Quigley R, Messer S, Large S, Kaul P, Forsythe J, Henwood S, Fenton M, Davies B, Berman M, Simmonds J. Pediatric Heart Transplantation Following Donation after Circulatory Death, Distant Procurement and Ex-Situ Perfusion. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Liu H, Sama GR, Robinson A, Mountford S, E Thompson P, Rodda A, Forsythe J, Mornane PJ, Pasic P, Thissen H, Byrne M, Kaye DM, Dear AE. Design, Development, In Vitro and Preliminary In Vivo Evaluation of a Novel Photo-Angioplasty Device: Lumi-Solve. Cardiovasc Eng Technol 2021; 12:466-473. [PMID: 33709249 DOI: 10.1007/s13239-021-00525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Paclitaxel (PTX)-coated drug eluting balloon catheters (DEBc) used in the management of neointimal hyperplasia (NIH) have been associated with safety concerns. Alternative coating agents and targeted delivery systems may improve safety and DEBc efficacy. Utilizing a multi-platform approach we designed, developed and evaluated Lumi-Solve, a novel DEBc, coated with ultraviolet (UV) 365 nm-activated caged metacept-3 (c-MCT-3), an epigenetic agent from the histone deacetylase inhibitor (HDACi) class. METHODS In vitro catheter and contrast media transmission of UV365nm was evaluated spectroscopically. UV365nm conversion of c-MCT-3 to MCT-3 was evaluated chromatographically. Cellular toxicity and HDACi activity of c-MCT-3 ∓UV365nm was evaluated in vitro. In vivo UV365nm conversion of c-MCT-3 to MCT-3 was evaluated in an ovine carotid artery model. RESULTS Catheter material and dilute contrast media did not attenuate UV365nm transmission or c-MCT-3 activation. c-MCT-3 demonstrated less cellular toxicity than MCT-3 and PTX. UV365nm-activated c-MCT-3 demonstrated HDACi activity. In vivo activation of c-MCT-3 produced MCT-3. CONCLUSIONS Lumi-Solve, a novel DEBc device developed utilizing a combination of chemical, fibre-optic and catheter based technology platforms, demonstrated potential for targeted delivery of bioactive HDACi to the blood vessel wall supporting direct application to the management of NIH and warranting additional in vivo studies.
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Affiliation(s)
- HongBin Liu
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Gopal R Sama
- Department of Chemistry, Monash University, Clayton, Australia
| | - Andrea Robinson
- Department of Chemistry, Monash University, Clayton, Australia
| | - Simon Mountford
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, Australia
| | - Philip E Thompson
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, Australia
| | - Andrew Rodda
- Monash Institute of Medical Engineering, Monash University, Clayton, Australia
| | - John Forsythe
- Monash Institute of Medical Engineering, Monash University, Clayton, Australia
| | | | - Paul Pasic
- CSIRO Biomedical Translational Facility, Melbourne, Australia
| | - Helmut Thissen
- CSIRO Biomedical Translational Facility, Melbourne, Australia
| | - Melissa Byrne
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Anthony E Dear
- Eastern Health Clinical School, Monash University, Box Hill, Australia.
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21
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Thorburn D, Taylor R, Whitney J, Adair A, Attia M, Gibbs P, Grammatikopoulos T, Isaac JR, Masson S, Marshall A, Mirza DF, Prachalias A, Watson S, Manas DM, Forsythe J. Resuming liver transplantation amid the COVID-19 pandemic. Lancet Gastroenterol Hepatol 2020; 6:12-13. [PMID: 33308431 PMCID: PMC7833625 DOI: 10.1016/s2468-1253(20)30360-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Douglas Thorburn
- Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK; NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | | | - Julie Whitney
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Anya Adair
- Edinburgh Transplant Centre, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Magdy Attia
- Liver Transplant Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Paul Gibbs
- Department of Surgery, Cambridge Universities Hospital Trust, Cambridge, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, Gastrointestinal, Nutrition Centre and Mowat Labs, King's College Hospital, London, UK
| | - John R Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Steven Masson
- Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle University, Newcastle NE7 7DN, UK.
| | - Aileen Marshall
- Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; Liver Unit, Birmingham Children's Hospital, Birmingham, UK
| | | | - Sarah Watson
- Highly Specialised Services, NHS England and NHS Improvement, UK
| | - Derek M Manas
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK; Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle University, Newcastle NE7 7DN, UK
| | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
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22
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Gibbons A, Cinnirella M, Bayfield J, Watson CJE, Oniscu GC, Draper H, Tomson CRV, Ravanan R, Johnson RJ, Forsythe J, Dudley C, Metcalfe W, Bradley JA, Bradley C. Changes in quality of life, health status and other patient‐reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK‐wide programme. Transpl Int 2020; 33:1230-1243. [DOI: 10.1111/tri.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit Royal Holloway University of London London UK
- Department of Psychology University of Winchester Winchester UK
| | - Marco Cinnirella
- Psychology Department Royal Holloway University of London London UK
| | - Janet Bayfield
- Health Psychology Research Unit Royal Holloway University of London London UK
| | - Christopher J. E. Watson
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Gabriel C. Oniscu
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - Heather Draper
- Health Sciences Warwick Medical School University of Warwick Coventry UK
| | | | - Rommel Ravanan
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | | | - John Forsythe
- Transplant Unit Royal Infirmary of Edinburgh Edinburgh UK
- Organ Donation and Transplantation NHS Blood and Transplant Bristol UK
| | - Chris Dudley
- Richard Bright Renal Unit Southmead HospitalNorth Bristol NHS Trust Bristol UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre Royal Infirmary of Edinburgh Edinburgh UK
| | - J. Andrew Bradley
- Department of Surgery NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation University of Cambridge and the NIHR Cambridge Biomedical Research CentreUniversity of CambridgeAddenbrooke’s Hospital Cambridge UK
| | - Clare Bradley
- Health Psychology Research Unit Royal Holloway University of London London UK
- Health Psychology Research Ltd Egham UK
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23
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Wallace D, Robb M, Hughes W, Johnson R, Ploeg R, Neuberger J, Forsythe J, Cacciola R. Outcomes of Patients Suspended From the National Kidney Transplant Waiting List in the United Kingdom Between 2000 and 2010. Transplantation 2020; 104:1654-1661. [PMID: 32732844 DOI: 10.1097/tp.0000000000003033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United Kingdom, 1 in 3 patients on the National Kidney Transplant Waiting List (NKTWL) is suspended from the list at least once during their wait. The mortality of this large cohort of patients remains underreported and poorly described. METHODS We linked patient records from the UK transplant registry to mortality data from the Office of National Statistics and evaluated the impact of a clinically induced suspension event by estimating hazard ratios (HRs) that compared mortality and graft survival between those who had experienced a suspension event and those who had not. RESULTS Between January 1, 2000, and December 31, 2010, 16.7% (2221/13 322) of all patients registered on the NKTWL were suspended. Forty-eight percent (588/1225) of those who were suspended and who were never transplanted died, most often from cardiothoracic causes. A suspension event was associated with increased mortality from the time of listing (adjusted HR [aHR], 1.79; 1.64-1.95) and from the time of transplantation (aHR, 1.20; 1.06-1.37; P = 0.005). Graft survival was also poorer in those who had been suspended (aHR, 1.13; 1.01-1.28; P = 0.04). CONCLUSIONS Patients suspended on the NKTWL have a significantly higher rate of mortality both on the waiting list and following transplantation. Earlier prioritization of patients at risk of experiencing a suspension event may improve their outcomes.
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Affiliation(s)
- David Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Robb
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Winter Hughes
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rutger Ploeg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - James Neuberger
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - John Forsythe
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
- Transplant Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Roberto Cacciola
- Department of Surgical Sciences, Transplant Unit, Tor Vergata University, Rome, Italy
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24
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Manara A, Shemie SD, Large S, Healey A, Baker A, Badiwala M, Berman M, Butler AJ, Chaudhury P, Dark J, Forsythe J, Freed DH, Gardiner D, Harvey D, Hornby L, MacLean J, Messer S, Oniscu GC, Simpson C, Teitelbaum J, Torrance S, Wilson LC, Watson CJE. Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal. Am J Transplant 2020; 20:2017-2025. [PMID: 31922653 PMCID: PMC7540256 DOI: 10.1111/ajt.15775] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/27/2019] [Accepted: 12/29/2019] [Indexed: 01/25/2023]
Abstract
There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post-mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.
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Affiliation(s)
| | - Sam D. Shemie
- McGill University Health Centre & Research InstituteMontrealQCCanada,Canadian Blood ServicesOttawaONCanada
| | | | - Andrew Healey
- Trillium Gift of Life NetworkTorontoONCanada,Department of MedicineDivision of Emergency MedicineMcMaster UniversityHamiltonONCanada
| | - Andrew Baker
- Department of Critical CareTrauma & Neurosurgery ProgramSt. Michael’s HospitalTorontoOntarioCanada
| | - Mitesh Badiwala
- Peter Munk Cardiac CentreToronto General HospitalTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | | | - Andrew J. Butler
- Department of SurgeryUniversity of CambridgeCambridgeUK,Addenbrooke’s HospitalCambridgeUK
| | - Prosanto Chaudhury
- McGill University Health Centre & Research InstituteMontrealQCCanada,Royal Victoria HospitalMontrealQCCanada
| | - John Dark
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - John Forsythe
- NHS Blood and Transplant Organ Donation and Transplantation DirectorateBristolUK
| | - Darren H. Freed
- Physiology and Biomedical EngineeringDivision of Cardiac SurgeryUniversity of AlbertaEdmontonABCanada
| | - Dale Gardiner
- NHS Blood and TransplantWatfordUK,Nottingham University Hospitals NHS TrustNottinghamUK
| | - Dan Harvey
- NHS Blood and TransplantWatfordUK,Nottingham University Hospitals NHS TrustNottinghamUK
| | - Laura Hornby
- Canadian Blood ServicesOttawaONCanada,Pediatric Critical CareChildren's Hospital of Eastern Ontario Research InstituteOttawaONCanada
| | | | | | - Gabriel C. Oniscu
- Edinburgh Transplant CentreRoyal Infirmary of EdinburghEdinburghUK,University of EdinburghEdinburghUK
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25
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Ibrahim M, Greenhall GHB, Summers DM, Mumford L, Johnson R, Baker RJ, Forsythe J, Pettigrew GJ, Ahmad N, Callaghan CJ. Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:1320-1329. [PMID: 32690721 PMCID: PMC7480543 DOI: 10.2215/cjn.02060220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups. RESULTS During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m2; P<0.001). CONCLUSIONS Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom .,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Lisa Mumford
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Richard J Baker
- Department of Nephrology, St James's University Hospital, The Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gavin J Pettigrew
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Niaz Ahmad
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.,National Health Service Blood and Transplant, Bristol, United Kingdom
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26
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Madden S, Collett D, Walton P, Empson K, Forsythe J, Ingham A, Morgan K, Murphy P, Neuberger J, Gardiner D. The effect on consent rates for deceased organ donation in Wales after the introduction of an opt-out system. Anaesthesia 2020; 75:1146-1152. [PMID: 32372409 PMCID: PMC7496553 DOI: 10.1111/anae.15055] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 01/19/2023]
Abstract
Organ transplantation saves and transforms lives. Failure to secure consent for organ retrieval is widely regarded as the single most important obstacle to transplantation. A soft opt‐out system of consent for deceased organ donation was introduced into Wales in December 2015, whilst England maintained the existing opt‐in system. Cumulative data on consent rates in Wales were compared with those in England, using a two‐sided sequential procedure that was powered to detect an absolute difference in consent rates between England and Wales of 10%. Supplementary risk‐adjusted logistic regression analysis examined whether any difference in consent rates between the two nations could be attributed to variations in factors known to influence UK consent rates. Between 1 January 2016 and 31 December 2018, 8192 families of eligible donors in England and 474 in Wales were approached regarding organ donation, with overall consent rates of 65% and 68%, respectively. There was a steady upward trend in the proportion of families consenting to donation after brain death in Wales as compared with England and after 33 months, this reached statistical significance. No evidence of any change in the donation after circulatory death consent rate was observed. Risk‐adjusted logistic regression analysis revealed that by the end of the study period the probability of consent to organ donation in Wales was higher than in England (OR [95%CI] 2.1 [1.26–3.41]). The introduction of a soft opt‐out system of consent in Wales significantly increased organ donation consent though the impact was not immediate.
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Affiliation(s)
- S Madden
- NHS Blood and Transplant, Bristol, UK
| | - D Collett
- NHS Blood and Transplant, Bristol, UK
| | - P Walton
- NHS Blood and Transplant, Bristol, UK
| | - K Empson
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - A Ingham
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - K Morgan
- Public Health Wales, Cardiff, UK
| | - P Murphy
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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27
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Ibrahim M, Vece G, Mehew J, Johnson R, Forsythe J, Klassen D, Callaghan C, Stewart D. An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other? Am J Transplant 2020; 20:1309-1322. [PMID: 31758833 DOI: 10.1111/ajt.15719] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 01/25/2023]
Abstract
In transplant, meaningful international comparisons in organ utilization are needed. This collaborative study between the United Kingdom (UK) and the United States (US) aimed to develop a kidney utilization metric allowing for legitimate intercountry comparisons. Data from the UK and US transplant registries, including all deceased donor kidneys recovered from 2006 to 2017, were analyzed. To identify a potentially comparable kidney utilization rate (UR), several denominators were assessed. We discovered that the proportion of transplanted kidneys from elderly donors in the UK (10.7%) was 18 times greater than that in the US (0.6%). Conversely, en bloc pediatric kidney transplant was more common in the US. Donation after circulatory death utilization has risen in both countries but is twice as prevalent in the UK (39% of transplants) vs the US (20%). In addition, US and UK URs are not directly comparable due to fundamental system differences. However, using a suite of URs revealed practice areas likely to yield the most benefit if improved, such as efforts to increase kidney offer acceptance in the US and to reduce postacceptance discard in the UK. Methods used in this study, including novel intracountry risk-adjusted UR trend logistic regression analyses, can be translated to other international transplant registries in pursuit of further global learning opportunities.
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Affiliation(s)
- Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Health Service Blood and Transplant, Bristol, UK
| | - Gabe Vece
- United Network for Organ Sharing, Richmond, Virginia
| | - Jenny Mehew
- National Health Service Blood and Transplant, Bristol, UK
| | - Rachel Johnson
- National Health Service Blood and Transplant, Bristol, UK
| | - John Forsythe
- National Health Service Blood and Transplant, Bristol, UK
| | - David Klassen
- United Network for Organ Sharing, Richmond, Virginia
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Health Service Blood and Transplant, Bristol, UK
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28
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Broughton B, Modarresi M, Rupasinghe S, Hollands C, Kemp-Harper B, Aguilar M, Forsythe J. Bacterial Peptidoglycan and Leukocyte Reactivity in the Brain Following Ischaemic Stroke. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.07324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Reed MJ, Currie I, Forsythe J, Young I, Stirling J, Logan L, Clegg GR, Oniscu GC. Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK. Emerg Med J 2019; 37:155-161. [PMID: 31757833 DOI: 10.1136/emermed-2019-208650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/03/2022]
Abstract
Worldwide there is a shortage of available organs for patients requiring transplants. However, some countries such as France, Italy and Spain have had greater success by allowing donations from patients with unexpected and unrecoverable circulatory arrest who arrive in the ED. Significant advances in the surgical approach to organ recovery from donation after circulatory death (DCD) led to the establishment of a pilot programme for uncontrolled DCD in the ED of the Royal Infirmary of Edinburgh. This paper describes the programme and discusses the lessons learnt.
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Affiliation(s)
- Matthew James Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian Currie
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John Forsythe
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Irene Young
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - John Stirling
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lesley Logan
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Gareth R Clegg
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Gabriel C Oniscu
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
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30
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Lomero M, Gardiner D, Coll E, Haase‐Kromwijk B, Procaccio F, Immer F, Gabbasova L, Antoine C, Jushinskis J, Lynch N, Foss S, Bolotinha C, Ashkenazi T, Colenbie L, Zuckermann A, Adamec M, Czerwiński J, Karčiauskaitė S, Ström H, López‐Fraga M, Dominguez‐Gil B, Sarkissian A, Liashchuk S, Tsvetkova E, Bušić M, Michael N, Ilkjaer LB, Dmitriev P, Makisalo H, Rahmel A, Tomadze G, Ioannis B, Mihály S, Carella C, Codreanu I, Jansen N, Konijn C, França A, Zota V, Žilinská Z, Avsec D, Gautier S, Sánchez‐Ibáñez J, Terrón C, Vidal C, Beyeler F, Weiss J, Ilbars T, Forsythe J, Johnson R, Enckevort A. Donation after circulatory death today: an updated overview of the European landscape. Transpl Int 2019; 33:76-88. [DOI: 10.1111/tri.13506] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/28/2019] [Accepted: 08/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Mar Lomero
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
| | - Dale Gardiner
- National Clinical Lead for Organ Donation NHS Blood and Transplant Watford UK
| | | | | | - Francesco Procaccio
- Italian National Transplant Centre Italian National Institute of Health Rome Italy
| | - Franz Immer
- Swisstransplant The Swiss National Foundation for Organ Donation and Transplantation Bern Switzerland
| | - Lyalya Gabbasova
- Ministry of Health of the Russian Federation Moscow Russian Federation
| | | | | | - Nessa Lynch
- Organ Donation Transplant Ireland Dublin Ireland
| | | | - Catarina Bolotinha
- National Transplantation Coordination Instituto Português do Sangue e da Transplantação Lisboa Portugal
| | - Tamar Ashkenazi
- Israel Transplant Center State of Israel Ministry of Health Tel‐Aviv Israel
| | - Luc Colenbie
- DG Health Care Organs Embryo's and Bio‐Ethics Brussels Belgium
| | | | - Miloš Adamec
- Koordinační Středisko Transplantací Prague Czech Republic
| | | | - Sonata Karčiauskaitė
- National Transplant Bureau Under the Ministry of Health of the Republic Lithuania Vilnius Lithuania
| | - Helena Ström
- Department for Knowledge‐Based Policy of Health Care National Donation Centre Stockholm Sweden
| | - Marta López‐Fraga
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
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Schröder M, Lockhoff M, Fell F, Forsythe J, Trent T, Bennartz R, Borbas E, Bosilovich MG, Castelli E, Hersbach H, Kachi M, Kobayashi S, Kursinski ER, Loyola D, Mears C, Preusker R, Rossow WB, Saha S. The GEWEX Water Vapor Assessment archive of water vapour products from satellite observations and reanalyses. Earth Syst Sci Data 2018; 10:1093-1117. [PMID: 30510599 PMCID: PMC6267991 DOI: 10.5194/essd-10-1093-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Global Energy and Water cycle Exchanges (GEWEX) Data and Assessments Panel (GDAP) initiated the GEWEX Water Vapor Assessment (G-VAP), which has the main objectives to quantify the current state of art in water vapour products being constructed for climate applications and to support the selection process of suitable water vapour products by GDAP for its production of globally consistent water and energy cycle products. During the construction of the G-VAP data archive, freely available and mature satellite and reanalysis data records with a minimum temporal coverage of 10 years were considered. The archive contains total column water vapour (TCWV) as well as specific humidity and temperature at four pressure levels (1000, 700, 500, 300 hPa) from 22 different data records. All data records were remapped to a regular longitude/latitude grid of 2°x2°. The archive consists of four different folders: 22 TCWV data records covering the period 2003-2008, 11 TCWV data records covering the period 1988-2008, as well as seven specific humidity and seven temperature data records covering the period 1988-2009. The G-VAP data archive is referenced under the following digital object identifier (doi): http://dx.doi.org/10.5676/EUM SAF CM/GVAP/V001. Within G-VAP, the characterisation of water vapour products is, among other ways, achieved through intercomparisons of the considered data records, as a whole and grouped into three classes of predominant retrieval condition: clear-sky, cloudy-sky and all-sky. Associated results are shown using the 22 TCWV data records. The standard deviations among the 22 TCWV data records have been analysed and exhibit distinct maxima over central Africa and the tropical warm pool (in absolute terms) as well as over the poles and mountain regions (in relative terms). The variability in TCWV within each class can be large and prohibits conclusions on systematic differences in TCWV between the classes.
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Affiliation(s)
- Marc Schröder
- Satellite-Based Climate Monitoring, Deutscher etterdienst,
63067 Offenbach, Germany
| | - Maarit Lockhoff
- Satellite-Based Climate Monitoring, Deutscher etterdienst,
63067 Offenbach, Germany
| | | | - John Forsythe
- Cooperative Institute for Research in the Atmosphere,
Colorado State University, Fort Collins CO, USA
| | - Tim Trent
- Earth Observation Science, Department of Physics and
Astronomy, University of Leicester, University Road, Leicester, LE1 7RH, UK
- National Centre for Earth Observation, Department of
Physics and Astronomy, University of Leicester, University Road, Leicester, LE1 7RH,
UK
| | - Ralf Bennartz
- Earth & Environmental Sciences Department, Vanderbilt
University, Nashville TN, USA
- Cooperative Institute for Meteorological Satellite Studies,
Space Science and Engineering Center, University of Wisconsin - Madison, USA
| | - Eva Borbas
- Cooperative Institute for Meteorological Satellite Studies,
Space Science and Engineering Center, University of Wisconsin - Madison, USA
| | - Michael G. Bosilovich
- Global Modelling and Assimilation Office, Goddard Space
Flight Center, National Aeronautics and Space Administration, Greenbelt MD,
USA
| | - Elisa Castelli
- Institute of Atmospheric Sciences and Climate, National
Research Council of Italy, Bologna, Italy
| | - Hans Hersbach
- European Centre for Medium-Range Weather Forecasts,
Reading, UK
| | - Misako Kachi
- Earth Observation Research Center, Japan Aerospace
Exploration Agency, Tsukuba, Japan
| | | | | | - Diego Loyola
- Remote Sensing Technology Institute, German Aerospace
Center, Oberpfaffenhofen, Germany
| | - Carl Mears
- Remote Sensing Systems, Santa Rosa CA, USA
| | - Rene Preusker
- Institute for Space Sciences, Free University of Berlin,
Berlin, Germany
| | - William B. Rossow
- CUNY Remote Sensing Science and Technology Institute,
City College of New York, New York NY, USA
| | - Suranjana Saha
- Environmental Modeling Center, NCEP/NWS/NOAA, NCWCP,
College Park MD, USA
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32
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Ramage LE, Akyol M, Fletcher AM, Forsythe J, Nixon M, Carter RN, van Beek EJR, Morton NM, Walker BR, Stimson RH. Glucocorticoids Acutely Increase Brown Adipose Tissue Activity in Humans, Revealing Species-Specific Differences in UCP-1 Regulation. Cell Metab 2016; 24:130-41. [PMID: 27411014 PMCID: PMC4949380 DOI: 10.1016/j.cmet.2016.06.011] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/06/2016] [Accepted: 06/15/2016] [Indexed: 01/07/2023]
Abstract
The discovery of brown adipose tissue (BAT) in adult humans presents a new therapeutic target for metabolic disease; however, little is known about the regulation of human BAT. Chronic glucocorticoid excess causes obesity in humans, and glucocorticoids suppress BAT activation in rodents. We tested whether glucocorticoids regulate BAT activity in humans. In vivo, the glucocorticoid prednisolone acutely increased (18)fluorodeoxyglucose uptake by BAT (measured using PET/CT) in lean healthy men during mild cold exposure (16°C-17°C). In addition, prednisolone increased supraclavicular skin temperature (measured using infrared thermography) and energy expenditure during cold, but not warm, exposure in lean subjects. In vitro, glucocorticoids increased isoprenaline-stimulated respiration and UCP-1 in human primary brown adipocytes, but substantially decreased isoprenaline-stimulated respiration and UCP-1 in primary murine brown and beige adipocytes. The highly species-specific regulation of BAT function by glucocorticoids may have important implications for the translation of novel treatments to activate BAT to improve metabolic health.
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Affiliation(s)
- Lynne E Ramage
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Murat Akyol
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland, UK
| | - Alison M Fletcher
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - John Forsythe
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland, UK
| | - Mark Nixon
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Roderick N Carter
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Nicholas M Morton
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Brian R Walker
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - Roland H Stimson
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK.
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33
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Xu B, Li Y, Zhu C, Cook WD, Forsythe J, Chen Q. Fabrication, mechanical properties and cytocompatibility of elastomeric nanofibrous mats of poly(glycerol sebacate). Eur Polym J 2015. [DOI: 10.1016/j.eurpolymj.2014.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nair SS, Forsythe J, Winther-Jensen B. Directing the growth of ZnO nano structures on flexible substrates using low temperature aqueous synthesis. RSC Adv 2015. [DOI: 10.1039/c5ra15453g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
c-Axis versus a-axis growth in seed-mediated grown ZnO nanowires controlled by the physical position of the substrate in the growth-solution.
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Affiliation(s)
| | - John Forsythe
- Department of Materials Engineering
- Monash University
- Australia
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Forsythe J. Streptococcal toxic shock syndrome following total thyroidectomy. Ann R Coll Surg Engl 2014; 96:254-5. [PMID: 24780814 DOI: 10.1308/003588414x13814021679555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hung JA, Rajeev P. Streptococcal toxic shock syndrome following total thyroidectomy. Ann R Coll Surg Engl 2013; 95: 457–460 doi 10.1308/003588413X13629960048118
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Ravichandran R, Venugopal JR, Sundarrajan S, Mukherjee S, Forsythe J, Ramakrishna S. Click chemistry approach for fabricating PVA/gelatin nanofibers for the differentiation of ADSCs to keratinocytes. J Mater Sci Mater Med 2013; 24:2863-2871. [PMID: 23999881 DOI: 10.1007/s10856-013-5031-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
Every year, millions of people suffer from dermal wounds caused by heat, fire, chemicals, electricity, ultraviolet radiation or disease. Tissue engineering and nanotechnology have enabled the engineering of nanostructured materials to meet the current challenges in skin treatments owing to such rising occurrences of accidental damages, skin diseases and defects. The abundance and accessibility of adipose derived stem cells (ADSCs) may prove to be novel cell therapeutics for skin regeneration. The nanofibrous PVA/gelatin/azide scaffolds were then fabricated by electrospinning using water as solvent and allowed to undergo click reaction. The scaffolds were characterized by SEM, contact angle and FTIR. The cell-scaffold interactions were analyzed by cell proliferation and the results observed that the rate of cell proliferation was significantly increased (P ≤ 0.05) on PVA/gelatin/azide scaffolds compared to PVA/gelatin nanofibers. In the present study, manipulating the biochemical cues by the addition of an induction medium, in combination with environmental and physical factors of the culture substrate by functionalizing with click moieties, we were able to drive ADSCs into epidermal lineage with the development of epidermis-like structures, was further confirmed by the expression of early and intermediate epidermal differentiation markers like keratin and filaggrin. This study not only provides an insight into the design of a site-specific niche-like microenvironment for stem cell lineage commitment, but also sheds light on the therapeutic application of an alternative cell source-ADSCs, for wound healing and skin tissue reconstitution.
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Affiliation(s)
- Rajeswari Ravichandran
- Healthcare and Energy Materials Laboratory, Nanoscience and Nanotechnology Initiative, Faculty of Engineering, National University of Singapore, Block E3, #05-12, 2 Engineering Drive 3, Singapore, 117576, Singapore
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Marchesan S, Waddington L, Easton CD, Winkler DA, Goodall L, Forsythe J, Hartley PG. Unzipping the role of chirality in nanoscale self-assembly of tripeptide hydrogels. Nanoscale 2012; 4:6752-60. [PMID: 22955637 DOI: 10.1039/c2nr32006a] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Change of chirality is a useful tool to manipulate the aqueous self-assembly behaviour of uncapped, hydrophobic tripeptides. In contrast with other short peptides, these tripeptides form hydrogels at a physiological pH without the aid of organic solvents or end-capping groups (e.g. Fmoc). The novel hydrogel forming peptide (D)Leu-Phe-Phe ((D)LFF) and its epimer Leu-Phe-Phe (LFF) exemplify dramatic supramolecular effects induced by subtle changes to stereochemistry. Only the d-amino acid-containing peptide instantly forms a hydrogel in aqueous solution following a pH switch, generating long fibres (>100 μm) that entangle into a 3D network. However, unexpected nanostructures are observed for both peptides and they are particularly heterogeneous for LFF. Structural analyses using CD, FT-IR and fluorescent amyloid staining reveal anti-parallel beta-sheets for both peptides. XRD analysis also identifies key distances consistent with beta-sheet formation in both peptides, but suggests additional high molecular order and extended molecular length for (D)LFF only. Molecular modelling of the two peptides highlights the key interactions responsible for self-assembly; in particular, rapid self-assembly of (D)LFF is promoted by a phenylalanine zipper, which is not possible because of steric factors for LFF. In conclusion, this study elucidates for the first time the molecular basis for how chirality can dramatically influence supramolecular organisation in very short peptide sequences.
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Affiliation(s)
- Silvia Marchesan
- CSIRO Materials Science and Engineering, Bayview Avenue, Clayton, VIC 3168, Australia.
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Khan MS, Fon D, Li X, Tian J, Forsythe J, Garnier G, Shen W. Biosurface engineering through ink jet printing. Colloids Surf B Biointerfaces 2010; 75:441-7. [DOI: 10.1016/j.colsurfb.2009.09.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/28/2009] [Accepted: 09/15/2009] [Indexed: 11/30/2022]
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Fuggle S, Johnson R, Mumford L, Forsythe J, Bradley A, Rudge C. 14-P: HLA matching in the 2006 UK national kidney allocation scheme: Patients benefit from a revised approach. Hum Immunol 2009. [DOI: 10.1016/j.humimm.2009.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Gore SR, Harms CA, Kukanich B, Forsythe J, Lewbart GA, Papich MG. Enrofloxacin pharmacokinetics in the European cuttlefish, Sepia officinalis, after a single i.v. injection and bath administration. J Vet Pharmacol Ther 2005; 28:433-9. [PMID: 16207305 DOI: 10.1111/j.1365-2885.2005.00684.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enrofloxacin pharmacokinetics were studied in European cuttlefish, Sepia officinalis, after a single 5 mg/kg i.v. injection or a 2.5 mg/L 5 h bath. A pilot study with two animals was also performed following a 10 mg/kg p.o. administration. The concentration of enrofloxacin in hemolymph was assayed using high-performance liquid chromatography (HPLC) and pharmacokinetic parameters were derived from compartmental methods. In the i.v. study, the terminal half-life (t(1/2)), apparent volume of distribution, and systemic clearance were respectively 1.81 h, 385 mL/kg, and 4.71 mL/min/kg. Following bath administration the t(1/2), peak hemolymph concentration (C(max)), and area under the curve to infinity (AUC(0-infinity)) were 1.01 h, 0.5 +/- 0.12 mug/mL, and 0.98 microg.h/mL, respectively. After oral administration, the t(1/2), C(max), and AUC(0-infinity) were 1.01 h, 10.95 microg/mL, 26.71 mug.h/mL, respectively. The active metabolite of enrofloxacin, ciprofloxacin, was not detected in any samples tested. The hemolymph concentration was still above minimum inhibitory concentration (MIC) values for shrimp and fish bacterial isolates at 6 h after i.v. administration, therefore, a dose of 5 mg/kg i.v. every 8-12 h is suggested for additional studies of efficacy. The C(max) value for the water bath was lower than for the i.v. study, but a bath of 2.5 mg/L for 5 h once to twice daily is suggested for additional studies to test efficacy against highly susceptible organisms. Although only two animals were used for the oral study, a dose of 10 mg/kg produced hemolymph concentrations of enrofloxacin that were in a range consistent with therapeutic efficacy in other species.
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Affiliation(s)
- S R Gore
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
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42
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Harrison E, McNally S, Forsythe J. Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative; Kidney for Sale by Owner: Human Organs, Transplantation, and the Market. West J Med 2005. [DOI: 10.1136/bmj.331.7514.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fenouillot F, Hedreul C, Forsythe J, Pascault JP. Reaction and miscibility of two diepoxides with poly(ethylene terephthalate). J Appl Polym Sci 2003. [DOI: 10.1002/app.11615] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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45
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Cameron S, Forsythe J. How can we improve organ donation rates? Research into the identification of factors which may influence the variation. Nefrologia 2002; 21 Suppl 5:68-77. [PMID: 11881418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Abstract
Obesity is a relative contraindication for heart and lung transplantation at most transplant centers. Surgical risks are higher for obese patients, and 1 study suggests that obesity is significantly correlated with higher posttransplant death rates in cardiac transplantation. Obesity is a restrictive disease that contributes to exercise intolerance in patients with lung disease. A weight management group was formed at a transplant center to help obese patients with heart and/or lung disease lose weight and maintain their goal weight, with the hope of decreasing their waiting time to be listed for transplantation and their incidence of weight-related complications. Some patients experienced symptomatic improvement, which delayed their need for heart or lung transplantation.
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Forsythe J. Tacrolimus and mycophenolate mofetil in cadaveric renal transplant recipients. The European Multicentre Tacrolimus/MMF Study Group. Transplant Proc 1999; 31:69S-71S. [PMID: 10576049 DOI: 10.1016/s0041-1345(99)00799-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, UK.
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48
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Vanrenterghem Y, Squifflet JP, Forsythe J, Heeman U, Bäckman L, Taube D, Morales JM, Ekberg H, van Hooff J, Zanker B, Dietl KH, Talbot D, Hauser I, Tydén G, Claesson K, Mühlbacher F. Co-administration of tacrolimus and mycophenolate mofetil in cadaveric renal transplant recipients. Transplant Proc 1998; 30:1290-1. [PMID: 9636523 DOI: 10.1016/s0041-1345(98)00245-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Perkins SL, Doelle H, Escares E, Forsythe J, Pronovost C, Taylor-Clapp S. Laboratory and clinical evaluation of two glucose meters for the neonatal intensive care unit. Clin Biochem 1998; 31:67-71. [PMID: 9622768 DOI: 10.1016/s0009-9120(97)00169-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the analytical and clinical performance of the One Touch II and Advantage glucose meters for use in neonatal specimens. DESIGN AND METHODS For the laboratory evaluation, a total of 96 umbilical cord whole blood specimens were analyzed on the One Touch II and/or Advantage meters. Samples were centrifuged after analysis on the meters and plasma glucose was determined on the Hitachi 917. For the clinical evaluation, a total of 64 infants had specimens analyzed on each of the meters as well as on the laboratory analyzer. RESULTS In the laboratory and clinical evaluations, both meters correlated well (r > 0.9, p < 0.001) with the plasma values for the Hitachi 917. However, the mean difference between the Advantage and Hitachi 917 was lower than that of the One Touch II in both the laboratory (-0.23 vs -0.64 mmol/L) and the clinical evaluations (-0.08 vs -0.60 mmol/L). 53.1% of One Touch and 26.6% of Advantage results from the clinical study had a discrepancy of > 0.5 mmol/L from the laboratory value. CONCLUSIONS For neonatal specimens, glucose meters must have good low end precision, sensitivity and accuracy, In this study, the Advantage meter had fewer discordant results and better correlation with the Hitachi 917. Overall, nursing and laboratory staff preferred the performance and characteristics of the Advantage meter.
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Affiliation(s)
- S L Perkins
- Department of Laboratory Medicine, Ottawa Civic Hospital, Canada
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50
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Oestmann DJ, Scimeca JM, Forsythe J, Hanlon R, Lee P. Special considerations for keeping cephalopods in laboratory facilities. Contemp Top Lab Anim Sci 1997; 36:89-93. [PMID: 16426030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- D J Oestmann
- National Resource Center for Cephalopods, University of Texas Medical Branch, Marine Biomedical Institute, Galveston 77555-1163, USA
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