Standardized Outcomes in Nephrology-Transplantation: A Global Initiative to Develop a Core Outcome Set for Trials in Kidney Transplantation.

BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy. This diminishes the value of trials in supporting treatment decisions that require individual-level multiple tradeoffs between graft survival and the risk of side effects, adverse events, and mortality. The Standardized Outcomes in Nephrology-Transplantation initiative aims to develop a core outcome set for trials in kidney transplantation that is based on the shared priorities of all stakeholders. METHODS: This will include a systematic review to identify outcomes reported in randomized trials, a Delphi survey with an international multistakeholder panel (patients, caregivers, clinicians, researchers, policy makers, members from industry) to develop a consensus-based prioritized list of outcome domains and a consensus workshop to review and finalize the core outcome set for trials in kidney transplantation. CONCLUSIONS: Developing and implementing a core outcome set to be reported, at a minimum, in all kidney transplantation trials will improve the transparency, quality, and relevance of research; to enable kidney transplant recipients and their clinicians to make better-informed treatment decisions for improved patient outcomes

The “conscious pilot”—dendritic synchrony moves through the brain to mediate consciousness

Cognitive brain functions including sensory processing and control of behavior are understood as “neurocomputation” in axonal–dendritic synaptic networks of “integrate-and-fire” neurons. Cognitive neurocomputation with consciousness is accompanied by 30- to 90-Hz gamma synchrony electroencephalography (EEG), and non-conscious neurocomputation is not. Gamma synchrony EEG derives largely from neuronal groups linked by dendritic–dendritic gap junctions, forming transient syncytia (“dendritic webs”) in input/integration layers oriented sideways to axonal–dendritic neurocomputational flow. As gap junctions open and close, a gamma-synchronized dendritic web can rapidly change topology and move through the brain as a spatiotemporal envelope performing collective integration and volitional choices correlating with consciousness. The “conscious pilot” is a metaphorical description for a mobile gamma-synchronized dendritic web as vehicle for a conscious agent/pilot which experiences and assumes control of otherwise non-conscious auto-pilot neurocomputation

Transmission of toxoplasmosis in two renal allograft recipients receiving an organ from the same donor

© 2008 John Wiley & Sons A/SToxoplasma gondii is a ubiquitous protozoan parasite. After acute infection it continues to exist as cysts in the muscles and brain. Recipients of organ allografts are susceptible to the disease as a result of reactivation of quiescent infection either by transmission from the organ donor or by consumption of undercooked meat. We describe 2 cases of fatal toxoplasmosis in renal allograft recipients who received their organs from the same cadaveric donor. Both recipients died 5 weeks after renal transplantation, within days of each other. Multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite was found in the transplanted kidney, either at the time of insertion or at autopsy. Neither recipient had serologic evidence of previous exposure to T. gondii. The donor had positive IgG but indeterminate IgM antibodies suggesting acute infection at the time of death; there was no clinical suspicion that the donor died from acute toxoplasmosis. We conclude that toxoplasmosis was transmitted by the donor kidneys. In an attempt to minimize the possibility of future transmission, donors are now tested for anti-toxoplasma IgM antibodies and recipients are treated with trimethoprim/sulfamethoxazole for the first 6 months after renal transplantation.N.M. Rogers, C.-A. Peh, R. Faull, M. Pannell, J. Cooper and G.R. Rus