ABSTRACT
UNLABELLED: Biopsy of cadaver renal allografts may aid in the assessment of marginal allografts. However, the use of this approach is not clear. This study presents the outcome of institution of a protocol for back table biopsy of renal allografts during organ procurement. METHODS: Data from Lifelink Organ Donation Network records and the ANZDATA registry were analysed. RESULTS: The biopsy rate of renal allografts increased from 0.8% to 15.6% (P=0.01). The discardment rate of potential renal allografts increased slightly with 1.9% being discarded based on the biopsy result and 3.8% being discarded for other reasons. Under the biopsy protocol, 28/40 (70%) of donors with renal allograft biopsies had <20% glomerulosclerosis. The incidence of both delayed graft function and non-function was higher (P=0.014 and P=0.033, respectively) for the protocol biopsied allografts compared with the other non-biopsied allografts. One-year renal allograft survival was not significantly different between the protocol biopsied allografts versus the other non-biopsied allografts. CONCLUSIONS: A biopsy protocol for marginal potential renal allografts leads to acceptable allograft outcomes without significantly increasing allograft discardment.
Subject(s)
Kidney Transplantation , Kidney/pathology , Tissue and Organ Procurement , Adult , Aged , Biopsy , Cadaver , Female , Graft Survival , Humans , Male , Middle Aged , Transplantation, HomologousABSTRACT
OBJECTIVE: This study was undertaken to determine the value of a neonatal encephalopathy score (ES) and the presence of seizures for predicting 30-month neurodevelopmental outcome. STUDY DESIGN: In a cohort study, 68 term newborn infants with encephalopathy were evaluated with an ES based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity (range: 0-6). Seizures were noted as present or absent clinically. Significant cognitive deficits (Mental Development Index <70), motor disability (spastic triplegia/quadriplegia), or death were abnormal outcomes. RESULTS: Twenty-two newborn infants (32%) had abnormal outcomes. With the use of maximum ES and presence of seizures from days 1 to 3 of life, 87% of newborn infants were correctly classified (area under receiver operating curve 0.93). By using ES and presence of seizures on day 1 only, 87% of newborn infants were correctly classified (area under receiver operating curve 0.89). CONCLUSION: The severity of neonatal encephalopathy and the presence of seizures are valuable predictors of 30-month neurodevelopmental outcome, as early as the first day of life.
Subject(s)
Aging , Brain Diseases/physiopathology , Child Development , Infant, Newborn/growth & development , Nervous System/growth & development , Brain Diseases/complications , Cohort Studies , Female , Humans , Male , Prognosis , Prospective Studies , ROC Curve , Seizures/etiology , Seizures/physiopathologyABSTRACT
The objective was to determine in infants with perinatal depression whether the relative concentrations of N-acetylaspartate and lactate in the neonatal period are associated with (1) neurodevelopmental outcome at 30 mo of age or (2) deterioration in outcome from age 12 to 30 mo; and to determine whether socioeconomic factors are associated with deterioration in outcome. Thirty-seven term neonates were prospectively studied with single-voxel proton magnetic resonance spectroscopy of the basal nuclei and intervascular boundary zones. Thirty-month outcomes were classified as normal [if Mental Development Index of the Bayley Scales of Infant Development (MDI) >85 and neuromotor scores (NMS) <3; n = 15], abnormal [if MDI Subject(s)
Aspartic Acid/analogs & derivatives
, Asphyxia Neonatorum/diagnosis
, Fetal Hypoxia/diagnosis
, Magnetic Resonance Spectroscopy
, Apgar Score
, Aspartic Acid/analysis
, Choline/analysis
, Cohort Studies
, Humans
, Infant
, Infant, Newborn
, Predictive Value of Tests
, Protons
, Socioeconomic Factors