Shifting Paradigms in Live Kidney Donation and Transplantation

__Abstract__ Although patients with end-stage renal disease (ESRD) can be successfully treated with haemodialysis or peritoneal dialysis, kidney transplantation is by far the best therapeutic option for the majority of patients with ESRD. Regretfully, the shortage in donor organs prevails. Despite an impressive societal and governmental investment, the number of deceased donor kidneys that becomes available for transplantation remains insufficient to meet the demand. One of the solutions to this problem is live kidney donation. The advantages of live donor kidney transplantation are numerous and include, among others, that it is an elective operation with short ischemia times. Furthermore, in this way, transplant professionals are able to select good quality kidneys of healthy donors. A uniform approach in the selection of live kidney donors is especially important since the community is seeking for options to further expand the donor pool. Currently, there is a tendency towards acceptin

The Effect of High and Low Antiepileptic Drug Dosage on Simulated Driving Performance in Person’s with Seizures: A Pilot Study

Background: Prior studies examining driving performance have not examined the effects of antiepileptic drugs (AED’s) or their dosages in persons with epilepsy. AED’s are the primary form of treatment to control seizures, but they are shown to affect cognition, attention, and vision, all which may impair driving. The purpose of this study was to describe the characteristics of high and low AED dosages on simulated driving performance in persons with seizures. Method: Patients (N = 11; mean age 42.1 ± 6.3; 55% female; 100% Caucasian) were recruited from the Epilepsy Monitoring Unit and had their driving assessed on a simulator. Results: No differences emerged in total or specific types of driving errors between high and low AED dosages. However, high AED drug dosage was significantly associated with errors of lane maintenance (r = .67, p \u3c .05) and gap acceptance (r = .66, p \u3c .05). The findings suggest that higher AED dosages may adversely affect driving performance, irrespective of having a diagnosis of epilepsy, conversion disorder, or other medical conditions. Conclusion: Future studies with larger samples are required to examine whether AED dosage or seizure focus alone can impair driving performance in persons with and without seizures

Characterization of AGN and their hosts in the Extended Groth Strip: a multiwavelength analysis

We have employed a reliable technique of classification of Active Galactic Nuclei (AGN) based on the fit of well-sampled spectral energy distributions (SEDs) with a complete set of AGN and starburst galaxy templates. We have compiled ultraviolet, optical, and infrared data for a sample of 116 AGN originally selected for their X-ray and mid-infrared emissions (96 with single detections and 20 with double optical counterparts). This is the most complete compilation of multiwavelength data for such a big sample of AGN in the Extended Groth Strip (EGS). Through these SEDs, we are able to obtain highly reliable photometric redshifts and to distinguish between pure and host-dominated AGN. For the objects with unique detection we find that they can be separated into five main groups, namely: Starburst-dominated AGN (24 % of the sample), Starburst-contaminated AGN (7 %), Type-1 AGN (21 %), Type-2 AGN (24 %), and Normal galaxy hosting AGN (24 %). We find these groups concentrated at different redshifts: Type-2 AGN and Normal galaxy hosting AGN are concentrated at low redshifts, whereas Starburst-dominated AGN and Type-1 AGN show a larger span. Correlations between hard/soft X-ray and ultraviolet, optical and infrared luminosities, respectively, are reported for the first time for such a sample of AGN spanning a wide range of redshifts. For the 20 objects with double detection the percentage of Starburst-dominated AGN increases up to 48%.Comment: 38 pages, 8 figures, 5 tables. Accepted by A

On the Radio and Optical Luminosity Evolution of Quasars II - The SDSS Sample

We determine the radio and optical luminosity evolutions and the true distribution of the radio loudness parameter R, defined as the ratio of the radio to optical luminosity, for a set of more than 5000 quasars combining SDSS optical and FIRST radio data. We apply the method of Efron and Petrosian to access the intrinsic distribution parameters, taking into account the truncations and correlations inherent in the data. We find that the population exhibits strong positive evolution with redshift in both wavebands, with somewhat greater radio evolution than optical. With the luminosity evolutions accounted for, we determine the density evolutions and local radio and optical luminosity functions. The intrinsic distribution of the radio loudness parameter R is found to be quite different than the observed one, and is smooth with no evidence of a bi-modality in radio loudness. The results we find are in general agreement with the previous analysis of Singal et al. 2011 which used POSS-I optical and FIRST radio data.Comment: 16 pages, 17 figures, 1 table. Updated to journal version. arXiv admin note: substantial text overlap with arXiv:1101.293

Body mass index and outcome in renal transplant recipients:a systematic review and meta-analysis

BACKGROUND: Whether overweight or obese end stage renal disease (ESRD) patients are suitable for renal transplantation (RT) is often debated. The objective of this review and meta-analysis was to systematically investigate the outcome of low versus high BMI recipients after RT. METHODS: Comprehensive searches were conducted in MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and CENTRAL (the Cochrane Library 2014, issue 8). We reviewed four major guidelines that are available regarding (potential) RT recipients. The methodology was in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and written based on the PRISMA statement. The quality assessment of studies was performed by using the GRADE tool. A meta-analysis was performed using Review Manager 5.3. Random-effects models were used. RESULTS: After identifying 5,526 studies addressing this topic, 56 studies were included. We extracted data for 37 outcome measures (including data of more than 209,000 RT recipients), of which 26 could be meta-analysed. The following outcome measures demonstrated significant differences in favour of low BMI (<30) recipients: mortality (RR = 1.52), delayed graft function (RR = 1.52), acute rejection (RR = 1.17), 1-, 2-, and 3-year graft survival (RR = 0.97, 0.95, and 0.97), 1-, 2-, and 3-year patient survival (RR = 0.99, 0.99, and 0.99), wound infection and dehiscence (RR = 3.13 and 4.85), NODAT (RR = 2.24), length of hospital stay (2.31 days), operation duration (0.77 hours), hypertension (RR = 1.35), and incisional hernia (RR = 2.72). However, patient survival expressed in hazard ratios was in significant favour of high BMI recipients. Differences in other outcome parameters were not significant. CONCLUSIONS: Several of the pooled outcome measurements show significant benefits for ‘low’ BMI (<30) recipients. Therefore, we postulate that ESRD patients with a BMI >30 preferably should lose weight prior to RT. If this cannot be achieved with common measures, in morbidly obese RT candidates, bariatric surgery could be considered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-015-0340-5) contains supplementary material, which is available to authorized users

Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

Background The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals. Methods An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide. Results 331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging. Conclusions Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based

What are the benefits of preemptive versus non-preemptive kidney transplantation? A systematic review and meta-analysis

Opting for a preemptive kidney transplant (PKT) can help avoid costs and morbidity associated with dialysis. However, while multiple studies have shown clinical benefits of PKT, other studies have not demonstrated this, leading to controversy in the literature regarding the exact benefits of PKT. Therefore, this study aimed to determine the clinical outcomes of PKT versus non-preemptive kidney transplantation (nPKT) in adult patients. Multiple databases were searched up to May 4, 2022. Independent reviewers selected studies for inclusion and extracted relevant data. Risk of bias was assessed using the Downs and Black checklist. Eighty-seven studies including 859,715 adult kidney transplant patients were included the review. The risk of patient death (relative risk [95% confidence interval] 0.74 [0.60–0.91]) was significantly lower in PKT versus nPKT patients for living donor (LD) transplants, whereas the risk of overall graft loss was significantly lower in PKT compared to nPKT patients for both LD (0.72 [0.62–0.83]) as well as deceased donor (DD) transplants (0.80 [0.69–0.92]). The evidence suggests that LD PKT patients have a lower risk of patient death and graft loss compared to nPKT patients, and DD PKT patients have a lower risk of graft loss than nPKT patients.</p

The impact of cold ischaemia time on outcomes of living donor kidney transplantation: a systematic review and meta-analysis

Studies have been carried out to investigate the effect of a prolonged cold ischaemia time (CIT) on the outcomes of living donor kidney transplantation (LDKT). There is no clear consensus in the literature about the effects of CIT on LDKT outcomes, and therefore, we performed a systematic review and meta-analysis to provide evidence on this subject. Searches were performed in five databases up to 12 July 2021. Articles comparing different CIT in LDKT describing delayed graft function (DGF), graft and patient survival, and acute rejection were considered for inclusion. This study is registered with PROSPERO, CRD42019131438. In total, 1452 articles were found, of which eight were finally eligible, including a total of 164,179 patients. Meta-analyses showed significantly lower incidence of DGF (odds ratio (OR) = 0.61, p < 0.01), and significantly higher 1-year graft survival (OR = 0.72, p < 0.001) and 5-year graft survival (OR = 0.88, p = 0.04), for CIT of less than 4 h. Our results underline the need to keep CIT as short as possible in LDKT (ideally < 4 h), as a shorter CIT in LDKT is associated with a statistically significant lower incidence of DGF and higher graft survival compared to a prolonged CIT. However, clinical impact seems limited, and therefore, in LDKT programmes in which the CIT might be prolonged, such as kidney exchange programmes, the benefits outweigh the risks. To minimize these risks, it is worth considering including CIT in kidney allocation algorithms and in general take precautions to protect high risk donor/recipient combinations

Vascular multiplicity should not be a contra-Indication for live kidney donation and transplantation

Background: Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate. Methods: Data from all live kidney donors from 2006-2013 (n=951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied. Results: In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity