Practices in the evaluation of potential kidney transplant recipients who are elderly: A survey of U.S. transplant centers

Limited data exist regarding the evaluation and selection of older candidates for transplantation. To help guide the development of program protocols and help define research questions in this area, we surveyed U.S. transplant centers regarding their current practices in the evaluation of older kidney transplant candidates. We emailed a 28‐question survey to the medical and surgical directors of 190 adult kidney transplant programs in the USA. We received usable responses from 59 programs, a 31.1% response rate. Most (76.3%) programs do not have absolute age cutoffs for listing patients, but for the 22.0% of programs that do have cutoffs, the mean age was 79, range 70‐90. Nearly one‐third (29.2%) of programs require a minimum life expectancy to list for transplant, reporting a mean of 4.5 years life expectancy, (range 2‐10). Programs vary significantly in evaluating candidates living in a nursing home or with cognitive impairments. Practices regarding the evaluation of older transplant candidates vary widely between U.S. programs. Further studies are needed on the impact of age and other comorbidities on transplant outcomes, to help guide decisions on which older patients are most appropriate for transplant listing.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138933/1/ctr13088_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138933/2/ctr13088.pd

Solid‐Organ Transplantation in Older Adults: Current Status and Future Research

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93680/1/j.1600-6143.2012.04245.x.pd

Die Skelette aus dem frühmittelalterlichen Gräberfeld von Pitten, p. B. Neunkirchen

In einer mehrjährigen Grabungskampagne hat das Niederösterreichische Landesmuseum in Pitten, N.Ö., ein ausgedehntes Gräberfeld freigelegt, in dem Schichten mehrerer Epochen entdeckt wurden. Die anthropologische Bearbeitung der frühmittelalterlichen Skelette dieses Gräberfeldes wird mithin vorgelegt. Insgesamt standen 137 Skelette, davon 32 männliche, 44 weibliche und 61 kindliche zur Verfügung. Ihr Erhaltungszustand war größtenteils gut, sodaß eine große Zahl von Individualdaten nach den standartisierten anthropologischen Methoden erhoben werden konnte, aus denen die gruppenstatistischen Parameter berechnet wurden. Wesentlich mehr Einzelmerkmale deuten auf eine nähere Verwandtschaft der Pittener Population mit denen von Mikulcice, Lupka und Pobedin (CSSR) hin, als mit den awarenzeitlichen Gruppen von Zwölfaxing (NÖ), Feherto-A, Allätyan-Tulant und Adorjan (Ungarn), mit denen sich nur wenige Ähnlichkeiten fanden. Dieses Ergebnis wurde noch durch das Resultat einer Varianzanalyse erhärtet. Typisch mongoloide Schädel, wie sie in geringer Zahl im awarenzeitlichen Gräberfeld von Zwölfaxing festgestellt wurden, scheinen in unserer Serie nicht auf. Einige Merkmale mit mongoloider Tendenz finden sich zwar bei einem weiblichen Schädel, doch reichen unsere Kentnisse über die Variabilität der Pittener Population nicht aus, um ihn mit Sicherheit zu den Mongoliden stellen zu können. Die morphologisch-metrische Gesamtbeurteilung über die mögliche rassische Zugehörigkeit des vorliegenden untersuchten Teiles des Pittener Gräberfeldes bestätigt mit großer Wahrscheinlichkeit die, auf Grund der kulturellen Beigaben vermutete slawische Herkunft dieser Population. Demographische Berechnungen und Untersuchungen über Beziehungen innerhalb des Gräberfeldes wie Familien- oder Sippenähnlichkeiten, Unterschiede bezüglich der beiden Haupt-Bestattungsrichtungen N-S u. W-O, konnten keine Ergebnisse bringen, da das Gräberfeld teilweise zerstört war, bzw. großteils gar nicht gehoben werden konnte. Die in den wichtigen Merkmalen auswertbare Schädelserie war außerdem zu klein um noch sinnvolle Unterteilungen durchführen zu können

Outcome after renal transplantation in a "senior" program: the croatian experience

BACKGROUND: The Eurotransplant "senior" program allocates kidneys from elderly donors to patients >65 years old. It aims to increase the number of renal transplantations. Kidneys are allocated locally without human leukocyte antigen (HLA) matching to decrease the cold ischemia time. Croatia has introduced its own "senior" program based on HLA matching. We compared results with those from Eurotransplant. ----- METHODS: We identified and prospectively followed all patients aged of >/=65 years who underwent a first renal transplantation. We recorded their HLA matching, cold ischemia time, renal function, surgical and medical complications, and duration of hospitalization. ----- RESULTS: Through October 2007, 22 elderly patients received an allograft from donors who were >65 years old. There were 8 female and 14 male patients of mean age at transplantation of 67.4 years. Mean donor age was 66 years. The number of HLA mismatches ranged from 1 to 5, and cold ischemia time from 7 to 15 hours. One-year patient survival was 95.4%, and graft survival was 81.8%. Delayed graft function, defined as the need for dialysis for >7 days after transplantation, occurred in 63.6% of patients. Older recipients required prolonged hospitalization after transplantation (45 days; range, 16-131). Frequent posttransplant complications included posttransplant diabetes mellitus in 1 patient, delayed wound healing in 5 patients, and lymphocoel in 2 patients. Maligancies occurred in 3 patients, neoplasm of the native kidney, posttransplant lymphoproliferative disease, and skin cancer. One patient experienced acute rejection that was successfully treated with steroids. Seventeen patients experienced 20 viral infections. There was only 1 serious infection (pulmonary tuberculosis). The major problems were cardiovascular complications which occurred in 40.9% of patients. ----- CONCLUSION: Renal transplantation in elderly patients is associated with increased incidence of posttransplant surgical and medical complications which demand prolonged hospitalization. Incidence of acute rejections in elderly patients is significantly decreased with HLA matching, without prolongation of the cold ischemia time. Good results justify renal transplantation in this group of patients

Fractal analysis of cervical intraepithelial neoplasia.

INTRODUCTION: Cervical intraepithelial neoplasias (CIN) represent precursor lesions of cervical cancer. These neoplastic lesions are traditionally subdivided into three categories CIN 1, CIN 2, and CIN 3, using microscopical criteria. The relation between grades of cervical intraepithelial neoplasia (CIN) and its fractal dimension was investigated to establish a basis for an objective diagnosis using the method proposed. METHODS: Classical evaluation of the tissue samples was performed by an experienced gynecologic pathologist. Tissue samples were scanned and saved as digital images using Aperio scanner and software. After image segmentation the box counting method as well as multifractal methods were applied to determine the relation between fractal dimension and grades of CIN. A total of 46 images were used to compare the pathologist's neoplasia grades with the predicted groups obtained by fractal methods. RESULTS: Significant or highly significant differences between all grades of CIN could be found. The confusion matrix, comparing between pathologist's grading and predicted group by fractal methods showed a match of 87.1%. Multifractal spectra were able to differentiate between normal epithelium and low grade as well as high grade neoplasia. CONCLUSION: Fractal dimension can be considered to be an objective parameter to grade cervical intraepithelial neoplasia