Center Volume Is Associated With Outcome After Pancreas Transplantation Within the Eurotransplant Region

Background. Outcome after surgery depends on several factors, among these, the annual volume-outcome relationship. This might also be the case in a highly complex field as pancreas transplantation. No study has investigated this relationship in a European setting. Methods. All consecutive pancreas transplantations from January 2008 until December 2013 were included. Donor-, recipient-, and transplant-related factors were analyzed for their association with patient and graft survivals. Centers were classified in equally sized groups as being low volume (= 13/year). Results. In the study period, 1276 pancreas transplantations were included. Un-adjusted 1-year patient survival was associated with center volume and was best in high volume centers, compared with medium and low volume: 96.5%, 94% and 92.3%, respectively (P = 0.017). Pancreas donor risk index (PDRI) was highest in high volume centers: 1.38 versus 1.21 in medium and 1.25 in low volume centers (P < 0.001). Pancreas graft survival at 1 year did not differ significantly between volume categories: 86%, 83.2%, and 81.6%, respectively (P = 0.114). After multivariate Cox-regression analysis, higher PDRI (hazard ratio [HR], 1.60;P < 0.001), retransplantation (HR, 1.91;P = 0.002), and higher recipient body mass index (HR, 1.04;P = 0.024) were risk factors for pancreas graft failure. High center volume was protective for graft failure (HR, 0.70;P = 0.037) compared with low center volume. Conclusion. Patient and graft survival after pancreas transplantation are superior in higher volume centers. High volume centers have good results, even though they transplant organs with the highest PDRI

Towards a standardised informed consent procedure for live donor nephrectomy: The PRINCE (Process of Informed Consent Evaluation) project-study protocol for a nationwide prospective cohort study

Introduction: Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary per centre, and even per individual healthcare professional. The basis for a standardised, uniform surgical informed consent procedure for live donor nephrectomy can be created by assessing what information donors need to hear to prepare them for the operation and convalescence. Methods and analysis: The PRINCE (Process of In formed Consent Evaluation) project is a prospective, multicentre cohort study, to be carried out in all eight Dutch kidney transplant centres. Donor knowledge of the procedure and postoperative course will be evaluated by means of pop quizzes. A baseline cohort (prior to receiving any information from a member of the transplant team in one of the transplant centres) will be compared with a control group, the members of which receive the pop quiz on the day of admission for donor nephrectomy. Donor satisfaction will be evaluated for all donors who completed the admission pop-quiz. The primary end point is donor knowledge. In addition, those elements that have to be included in the standardized format informed consent procedure will be identified. Secondary end points are donor satisfaction, current informed consent practices in the different centres (eg, how many visits, which personnel, what kind of information is di

Towards a standardised informed consent procedure for live donor nephrectomy:the PRINCE (Process of Informed Consent Evaluation) project-study protocol for a nationwide prospective cohort study

Introduction: Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary per centre, and even per individual healthcare professional. The basis for a standardised, uniform surgical informed consent procedure for live donor nephrectomy can be created by assessing what information donors need to hear to prepare them for the operation and convalescence. Methods and analysis: The PRINCE (Process of Informed Consent Evaluation) project is a prospective, multicentre cohort study, to be carried out in all eight Dutch kidney transplant centres. Donor knowledge of the procedure and postoperative course will be evaluated by means of pop quizzes. A baseline cohort (prior to receiving any information from a member of the transplant team in one of the transplant centres) will be compared with a control group, the members of which receive the pop quiz on the day of admission for donor nephrectomy. Donor satisfaction will be evaluated for all donors who completed the admission pop-quiz. The primary end point is donor knowledge. In addition, those elements that have to be included in the standardised format informed consent procedure will be identified. Secondary end points are donor satisfaction, current informed consent practices in the different centres (eg, how many visits, which personnel, what kind of information is disclosed, in which format, etc) and correlation of donor knowledge with surgeons' estimation thereof. Ethics and dissemination: Approval for this study was obtained from the medical ethical committee of the Erasmus MC, University Medical Center, Rotterdam, on 18 February 2015. Secondary approval has been obtained from the local ethics committees in six participating centres. Approval in the last centre has been sought. Results: Outcome will be published in a scientific journal

Early Steroid Withdrawal Compared With Standard Immunosuppression in Kidney Transplantation - Interim Analysis of the Amsterdam-Leiden-Groningen Randomized Controlled Trial

BACKGROUND: The optimal immunosuppressive regimen in kidney transplant recipients, delivering maximum efficacy with minimal toxicity, is unknown. METHODS: The Amsterdam, LEiden, GROningen trial is a randomized, multicenter, investigator-driven, noninferiority, open-label trial in 305 kidney transplant recipients, in which 2 immunosuppression minimization strategies-one consisting of early steroid withdrawal, the other of tacrolimus minimization 6 months after transplantation-were compared with standard immunosuppression with basiliximab, corticosteroids, tacrolimus, and mycophenolic acid. The primary endpoint was kidney function. Secondary endpoints included death, primary nonfunction, graft failure, rejection, discontinuation of study medication, and a combined endpoint of treatment failure. An interim analysis was scheduled at 6 months, that is, just before tacrolimus minimization. RESULTS: This interim analysis revealed no significant differences in Modification of Diet in Renal Disease between the early steroid withdrawal group and the standard immunosuppression groups (43.2 mL/min per 1.73 m2 vs 45.0 mL/min per 1.73 m2, P = 0.408). There were also no significant differences in the secondary endpoints of death (1.0% vs 1.5%; P = 0.737), primary nonfunction (4.1% vs 1.5%, P = 0.159), graft failure (3.1% vs 1.5%, P = 0.370), rejection (18.6% vs 13.6%, P = 0.289), and discontinuation of study medication (19.6% vs 12.6%, P = 0.348). Treatment failure, defined as a composite endpoint of these individual secondary endpoints, was more common in the early steroid withdrawal group (P = 0.027), but this group had fewer serious adverse events and a more favorable cardiovascular risk profile. CONCLUSIONS: Based on these interim results, early steroid withdrawal is a safe short-term immunosuppressive strategy. Long-term outcomes, including a comparison with tacrolimus minimization after 6 months, will be reported in the final 2-year analysis

Clasina Maria Ringers Furstner

Clasina Maria Ringers Furstner was the daughter of Jan Ringers and Magda Furstner. Jan's father was the Minister of Public Works in the 1945-1946 Cabinet and Magda's father was the Minister of Navy affairs in the Dutch exile cabinet in London 1940-1945.Card in Envelope announcing the birth of Clasina Maria Ringers Furstner. She was born on 17 March 1943. Original size 70mm x 100mm. Scanned on HP5300C scanner at 150dpi. The card is in an envelope addressed to Ms Van Gybland Oosterhoff with stamp and date

Pregnancy and coma:More than a dilemma

A previously healthy 33-year-old woman presented at 13 weeks gestation in a comatose state after a new onset of seizures. Evaluation revealed an intraventricular haemorrhage from an arterioventricular malformation. Coma in pregnancy is a rare event. The moral, legal and medical aspects of prolongation of pregnancy, termination, withdrawal of medical treatment and organ donation are discussed.</p

Pregnancy and coma:More than a dilemma

A previously healthy 33-year-old woman presented at 13 weeks gestation in a comatose state after a new onset of seizures. Evaluation revealed an intraventricular haemorrhage from an arterioventricular malformation. Coma in pregnancy is a rare event. The moral, legal and medical aspects of prolongation of pregnancy, termination, withdrawal of medical treatment and organ donation are discussed.</p

Effect of surgery for chronic pancreatitis on pancreatic function: Pancreatico-jejunostomy and duodenum-preserving resection of the head of the pancreas

Background. Resection and drainage procedures are performed for chronic Pancreatitis. After resection, pancreatic function deteriorates, however, little is known about the effect of drainage procedures. Methods. Pancreatic function was evaluated prospectively before and after surgery in 2 7 patients with duodenum-preserving resection of the head of the pancreas (DPRHP), and in 12 patients with pancreatico-jejunostomy (P-JS); 18 patients with chronic pancreatitis served as controls. Results of the 2 groups were not compared because of differences in patient characteristics and indications for surgery. Endpoints were exocrine function (fecal fat excretion, urinary PABA recovery), endocrine function (oral glucose tolerance test, serum C-Peptide concentrations), and pancreatic polypeptide secretion. Results. Groups were not different with respect to age and duration of symptoms. Median urinary PABA recovery was not altered significantly after surgery: DPRHP, from 40% to 31%; P-JS, from 52% to 44%; and controls, from 43% to 48%. Median fecal fat also did not change significantly: DPRHP, from 6 to, 12 g/24 h; P-JS, from 9 to 5 g/24 h,- and controls, from 6 to 7 g/24 h. Although the integrated blood glucose value did not change after DPRHP, the integrated serum C-peptide value decreased after DPRHP (P <. 02). After P:[S, the integrated blood glucose value decreased (P <. 02), but there was no change in integrated serum C-peptide secretion. Neither integrated blood. glucose nor C peptide values were affected in controls. Insulin dependency increased (22% to 33%) after DPRHP. Pancreatic polypeptide secretion decreased only after DFRHP (P =.003). Conclusions. Surgery for chronic pancreatitis does not influence exocrine pancreatic function after either a drainage (P-JS) or a resection procedure (DPRHP). Clinical endocrine function is not affected after DPRHP but improves after P-J

The rescue of DCD rodent livers grafts: Is there HOPE?

Transplant surger