Transplantation
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Comparative Study
iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment.
Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. ⋯ The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.
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Randomized Controlled Trial Comparative Study
Sevoflurane Versus Desflurane on the Incidence of Postreperfusion Syndrome During Living Donor Liver Transplantation: A Randomized Controlled Trial.
Various interventions to reduce postreperfusion syndrome during liver transplantation have been explored, but the effect of volatile anesthetics used during liver transplantation on the incidence of postreperfusion syndrome has not been evaluated. A randomized controlled trial was performed to compare the incidence of postreperfusion syndrome between 2 commonly used volatile anesthetics, sevoflurane and desflurane. ⋯ When using volatile anesthetics for elective living donor liver transplantation, sevoflurane seems to be a better option than desflurane for reducing the incidence of postreperfusion syndrome.
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Kidney transplant centers are distributed unevenly throughout 58 donor service areas (DSAs) in the United States. Market competition and transplant center density may affect transplantation access and outcomes. We evaluated the role of spatial organization of transplant centers in conjunction with market competition in the conduct of kidney transplantation. ⋯ After controlling for market characteristics, larger numbers of kidney transplant centers were associated with more kidney transplants and increased utilization of deceased donor kidneys. This underlines the importance of understanding geography as well as competition in improving access to kidney transplantation.
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Comparative Study
Cold Crystalloid Perfusion Provides Cardiac Preservation Superior to Cold Storage for Donation After Circulatory Death.
We previously showed that donation after circulatory death (DCD) canine hearts can be resuscitated if perfused with warm blood. However, clinical application of this technique is complex and difficult. We have developed a simplified system of cold crystalloid perfusion and compared it with standard cold storage for DCD heart preservation. ⋯ Continuous cold crystalloid perfusion in a canine model of DCD: (1) facilitates aerobic metabolism and resuscitates the DCD heart, (2) provides functional and metabolic recovery superior to cold storage, (3) shows promise for improved clinical preservation of DCD and marginal donor hearts.