Pushing the envelope for obese kidney donor candidates

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149706/1/tri13427.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149706/2/tri13427_am.pd

DonorNet and the Potential Effects on Organ Utilization

The evolution of communication as donor data flows from organ procurement organization to transplant centers has evolved with the incorporation of DonorNet 2007 ® into the UNet SM system. The ensuing study looks at DonorNet's impact on this process. We established defined time periods for comparison purposes. The study looked at match number for organ placement and overall organ utilization with a focus on ischemia time and graft outcomes. The results of the study demonstrate no significant change in the median match number of organ placement in liver or kidney transplantation. Changes in discard rates were varied amongst transplanted organs and there were noticeable changes in organ sharing with an increase in local allocation for kidney and liver and an ensuing decrease in regional and national distribution. There were no significant differences in the outcomes of livers and kidneys with low offer numbers compared with those with high offer numbers. Overall the study suggests a modest impact by DonorNet on organ placement and utilization, but a longer term study would need to be done to fully evaluate its impact.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79141/1/j.1600-6143.2010.03036.x.pd

Response: DonorNet and the Potential Effects on Organ Utilization

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79092/1/j.1600-6143.2010.03230.x.pd

Efficacy of plasmapheresis on donor‐specific antibody reduction by HLA specificity in post–kidney transplant recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111098/1/trf12923.pd

Systematic Evaluation of Pancreas Allograft Quality, Outcomes and Geographic Variation in Utilization

Pancreas allograft acceptance is markedly more selective than other solid organs. The number of pancreata recovered is insufficient to meet the demand for pancreas transplants (PTx), particularly for patients awaiting simultaneous kidney-pancreas (SPK) transplant. Development of a pancreas donor risk index (PDRI) to identify factors associated with an increased risk of allograft failure in the context of SPK, pancreas after kidney (PAK) or pancreas transplant alone (PTA), and to assess variation in allograft utilization by geography and center volume was undertaken. Retrospective analysis of all PTx performed from 2000 to 2006 (n = 9401) was performed using Cox regression controlling for donor and recipient characteristics. Ten donor variables and one transplant factor (ischemia time) were subsequently combined into the PDRI. Increased PDRI was associated with a significant, graded reduction in 1-year pancreas graft survival. Recipients of PTAs or PAKs whose organs came from donors with an elevated PDRI (1.57–2.11) experienced a lower rate of 1-year graft survival (77%) compared with SPK transplant recipients (88%). Pancreas allograft acceptance varied significantly by region particularly for PAK/PTA transplants (p < 0.0001). This analysis demonstrates the potential value of the PDRI to inform organ acceptance and potentially improve the utilization of higher risk organs in appropriate clinical settings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78607/1/j.1600-6143.2009.02996.x.pd

Kidney and Pancreas Transplantation in the United States, 1996–2005

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73647/1/j.1600-6143.2006.01781.x.pd

Organ Donation and Utilization in the United States, 1997–2006

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75743/1/j.1600-6143.2008.02171.x.pd

Possible wormholes in a brane world

The condition R=0, where R is the four-dimensional scalar curvature, is used for obtaining a large class (with an arbitrary function of r) of static, spherically symmetric Lorentzian wormhole metrics. The wormholes are globally regular and traversable, can have throats of arbitrary size and can be both symmetric and asymmetric. These metrics may be treated as possible wormhole solutions in a brane world since they satisfy the vacuum Einstein equations on the brane where effective stress-energy is induced by interaction with the bulk gravitational field. Some particular examples are discussed.Comment: 7 pages, revtex4. Submitted to Phys. Rev.

Determinants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73820/1/j.1600-6143.2008.02157.x.pd

The impact of intraoperative fluid management during laparoscopic donor nephrectomy on donor and recipient outcomes

BackgroundIntraoperative fluid management during laparoscopic donor nephrectomy (LDN) may have a significant effect on donor and recipient outcomes. We sought to quantify variability in fluid management and investigate its impact on donor and recipient outcomes.MethodsA retrospective review of patients who underwent LDN from July 2011 to January 2016 with paired kidney recipients at a single center was performed. Patients were divided into tertiles of intraoperative fluid management (standard, high, and aggressive). Donor and recipient demographics, intraoperative data, and postoperative outcomes were analyzed.ResultsOverall, 413 paired kidney donors and recipients were identified. Intraoperative fluid management (mL/h) was highly variable with no correlation to donor weight (kg) (R = 0.017). The aggressive fluid management group had significantly lower recipient creatinine levels on postoperative day 1. However, no significant differences were noted in creatinine levels out to 6 months between groups. No significant differences were noted in recipient postoperative complications, graft loss, and death. There was a significant increase (P < 0.01) in the number of total donor complications in the aggressive fluid management group.ConclusionsAggressive fluid management during LDN does not improve recipient outcomes and may worsen donor outcomes compared to standard fluid management.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149691/1/ctr13542_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149691/2/ctr13542.pd