Donor exchange programs in kidney transplantation: rationale and operational details from the north central donor exchange cooperative

The increasing need for kidney transplants has led to innovations such as donor exchange programs. These programs offer transplant recipients with incompatible donors an opportunity to receive a compatible kidney. They also provide an alternative to costly desensitization protocols that have unproven long-term outcomes. Donor exchange programs have multiple options including simple two-pair exchanges to the more complicated domino exchanges or chain donations. The United States is currently limited by regional programs that provide for kidney donor exchanges. However, with the increasing public interest and need for kidney transplants, general nephrologists will be approached with questions about these donor exchange programs. The goal of this review is to discuss donor exchange programs including their role in expanding the donor pool, the various types of exchanges, regional centers that provide these programs, and the process involved in patient enrollment. A general knowledge of donor exchange programs will help providers in discussing options with patients approaching end-stage kidney disease and transplantation

Relationship of unilateral total Lund-Mackay score and ipsilateral ophthalmic parameters in patients with chronic sinusitis.

<p>Relationship of unilateral total Lund-Mackay score and ipsilateral ophthalmic parameters in patients with chronic sinusitis.</p

Baseline characteristics of study population.

<p>Baseline characteristics of study population.</p

Ophthalmic characteristics according to the presence or absence of chronic sinusitis.

<p>Ophthalmic characteristics according to the presence or absence of chronic sinusitis.</p

Association between ophthalmic parameters and grade of specific sinus opacification in patients with chronic sinusitis.

<p>Association between ophthalmic parameters and grade of specific sinus opacification in patients with chronic sinusitis.</p

Ophthalmic parameters among groups according to relationship between the sphenoid sinus, posterior ethmoid sinus, and the optic nerve in eyes with ipsilateral chronic sinusitis (n = 51).

<p>Ophthalmic parameters among groups according to relationship between the sphenoid sinus, posterior ethmoid sinus, and the optic nerve in eyes with ipsilateral chronic sinusitis (n = 51).</p

Case.

<p>(A) The optic discs appear normal on fundus photography (upper, right eye; lower, left eye). (B) On the OCT RNFL map, there is subtle thinning of the superior aspect of the retinal nerve fiber layer in the right eye (upper, right eye; lower, left eye). OCT GCIPL map shows normal finding. (C) Reliable automated perimetry demonstrates generalized decreased sensitivity in both eyes (upper, right eye; lower, left eye) (mean deviation -4.62 dB, pattern standard deviation 5.40 dB in his right eye; mean deviation -7.85 dB, pattern standard deviation 5.68 dB in his left eye). (D) The ostiomeatal CT image shows sinusitis of the posterior ethmoid and sphenoid sinuses. In addition, the optic nerve protrudes into a well pneumatized posterior ethmoid sinus (Onodi cell) with some bony dehiscence.</p

Laser interferometry scan in chronic sinusitis patients.

<p>(A) The location of the peripapillary scan with regards to the sagittal and coronal section of the ostiomeatal unit CT. OCT maps showing the retinal nerve fiber layer thickness (T = temporal, S = superior, N = nasal, and I = inferior). (B) The location of the macular scan with regards to the ostiomeatal unit CT. OCT maps showing the ganglion cell-inner plexiform layer thickness.</p

Multivariable-adjusted relationship between the Lund-Mackay score and ophthalmic functional parameters.

<p>(A) Visual field mean deviation (beta = -0.027, SE = 0.052, P = 0.607). (B) Visual field pattern standard deviation (beta = 0.042, SE = 0.024, P = 0.083).</p

K-Ras activity is increased in cells with let-7a inhibition.

<p>Cell lysates were collected following 72 h incubation and subjected to a Raf-pull down assay which measures K-Ras activity. Data shown represents three experiments done in triplicate. Error bars show SD. *p<0.05.</p