Saturday, April 4, 2015

Recent transplantation news

The latest issue of the American Journal of Transplantation (Volume 15, Issue 4 Pages 851 - 1129, April 2015) has a number of interesting articles and news notes. Here are some that caught my eye:

According to a report published in January 2015, OPTN/UNOS records of more than 1.1 million patients indicate that approximately 2.2 million years of life were saved via transplantation from 1987 to 2012:
  • Kidney transplant: 1.3 million years of life saved;
  • Liver transplant: 465,296 years saved;
  • Heart transplant: 269,715 years saved;
  • Lung transplant: 64,575 years saved;
  • Pancreas–kidney transplant: 79,198 years saved;
  • Pancreas transplant: 14,903 years saved; and
  • Intestine transplant: 4,402 years saved.
The report says that the shortage of donors continues to hamper the field of transplantation: Only 47.9% of patients on the waitlist during the 25-year study period underwent a transplant.
Reference: Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States [March 2015, Vol 150, No. 3 ]. JAMA Surg. doi: 10.1001/jamasurg.2014.2038.

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

  1. T. N. Machuca, 
  2. O. Mercier, 
  3. S. Collaud, 
  4. J. Tikkanen, 
  5. T. Krueger, 
  6. J. C. Yeung, 
  7. M. Chen, 
  8. S. Azad, 
  9. L. Singer, 
  10. K. Yasufuku, 
  11. M. de Perrot, 
  12. A. Pierre, 
  13. T. K. Waddell, 
  14. S. Keshavjee and
  15. M. Cypel*
Article first published online: 13 MAR 2015
 (If I understand this one, it is involved with the observation that the cells in your lungs get oxygen from the air in your lungs, not from your blood, and so your lungs can stay pink and transplantable after your circulatory system shuts down..._)

Socioeconomic Status and Ethnicity of Deceased Donor Kidney Recipients Compared to Their Donors

  1. J. T. Adler1,2
  2. J. A. Hyder1,3
  3. N. Elias2,4
  4. L. L. Nguyen1,4,5
  5. J. F. Markmann2,4
  6. F. L. Delmonico2,4 and
  7. H. Yeh2,4,*


Public perception and misperceptions of socioeconomic disparities affect the willingness to donate organs. To improve our understanding of the flow of deceased donor kidneys, we analyzed socioeconomic status (SES) and racial/ethnic gradients between donors and recipients. In a retrospective cohort study, traditional demographic and socioeconomic factors, as well as an SES index, were compared in 56,697 deceased kidney donor and recipient pairs transplanted between 2007 and 2012. Kidneys were more likely to be transplanted in recipients of the same racial/ethnic group as the donor (p < 0.001). Kidneys tended to go to recipients of lower SES index (50.5% of the time, p < 0.001), a relationship that remained after adjusting for other available markers of donor organ quality and SES (p < 0.001). Deceased donor kidneys do not appear to be transplanted from donors of lower SES to recipients of higher SES; this information may be useful in counseling potential donors and their families regarding the distribution of their organ gifts.

The Impact of the Israeli Transplantation Law on the Socio-Demographic Profile of Living Kidney Donors

H. Boas1E. Mor2R. Michowitz2B. Rozen-Zvi3 and R. Rahamimov

    The Israeli transplantation law of 2008 stipulated that organ trading is a criminal offense, and banned the reimbursement of such transplants by insurance companies, thus decreasing dramatically transplant tourism from Israel. We evaluated the law's impact on the number and the socio-demographic features of 575 consecutive living donors, transplanted in the largest Israeli transplantation center, spanning 5 years prior to 5 years after the law's implementation. Living kidney donations increased from 3.5 ± 1.5 donations per month in the pre-law period to 6.1 ± 2.4 per month post-law (p < 0.001). This was mainly due to a rise in intra-familial donations from 2.1 ± 1.1 per month to 4.6 ± 2.1 per month (p < 0.001). In unrelated donors we found a significant change in their socio-demographic characteristics: mean age increased from 35.4 ± 7.4 to 39.9 ± 10.2 (p = 0.001), an increase in the proportion of donors with college level or higher education (31.0% to 63.1%; p < 0.001) and donors with white collar occupations (33.3% to 48.3%, p = 0.023). In conclusion, the Israeli legislation that prohibited transplant tourism and organ trading in accordance with Istanbul Declaration, was associated with an increase in local transplantation activity, mainly from related living kidney donors, and a change in the profile of unrelated donors into an older, higher educated, white collar population.

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