Proposal of categorization of expanded criteria donors in renal transplantation.

INTRODUCTION: Transplantation of renal allografts that have been procured from expanded criteria donors (ECD) have prevailed in an attempt to expand the donor pool. Even though ECD is an acceptable source of donors, the wide range of age along with the presence or not of risk factors necessitates further categorization. The aim of this study was to analyze the allograft and recipient survival of the ECD renal grafts and to propose an ECD categorization model. PATIENTS AND METHODS: We reviewed the medical records of renal transplant recipients from January 2002 to July 2012, who received renal allografts from expanded and standard criteria donors (SCD) without risk factors such as hypertension, cerebrovascular disease or impaired renal function. RESULTS: During the study period, 310 renal transplantations were performed in our Transplant Unit, of which 86 and 114 renal grafts were procured from ECD and SCD respectively. ECD renal graft survival the first, third and fifth year was 92%, 82% and 70% while respective recipient survival was 95%, 87% and 82%. Comparison with the control group of SCD showed that ECD renal graft survival after the third post-transplant year was significantly inferior (P < .0001). Donor age was a considerable prognostic factor of long-term renal graft function. Serum creatinine of ECD grafts was the first and third year 1.86 ± 0.6 mg/dL and 1.91 ± 0.8 mg/dL, respectively, showing significant difference to that of SCD grafts (P < .0001). Further categorization of ECD showed that renal allografts procured from donors above 60 years old without risk factors had better renal graft survival and function compared to grafts procured from donors aged 50-59 with 2 or 3 risk factors. CONCLUSIONS: Renal transplantation from ECD offers acceptable graft survival rates, however they are inferior compared to renal grafts from optimal kidney donors. ECD kidney grafts have to be categorized, taking into consideration the independent risk factors.

Impact of intensive agricultural practices on drinking water quality in the Evros region (NE Greece) by GIS analysis.

Chemical fertilizers are used extensively in modern agriculture, in order to improve yield and productivity of agricultural products. However, nutrient leaching from agricultural soil into groundwater resources poses a major environmental and public health concern. The Evros region is one of the largest agricultural areas in Northern Greece, extending over 1.5 million acres of cultivated land. Many of its drinking water resources are of groundwater origin and lie within agricultural areas. In order to assess the impact of agricultural fertilizers on drinking water quality in this region, tap-water samples from 64 different locations were collected and analyzed for the presence of nitrates (NO(3)(-)), nitrites (NO(2)(-)), ammonium (NH(4)(+)), sulfate (SO(4)(-2)) and phosphate (PO(4)(-3)). These chemicals were selected based on the information that ammonium nitrate, ammonium sulfate and inorganic phosphate were the primary fertilizers used in local crop production. NO(3)(-), SO(4)(-2) and PO(4)(-3) levels exceeding accepted values were recorded in 6.25, 4.70 and 9.38% of all sampling points, respectively. NO(2)(-) and NH(4)(+) concentrations, on the other hand, were inside the permitted range. The data generated were introduced into a geographic information system (GIS) program for computer analysis and projection maps representing afflicted areas were created. Our results indicate a profound geographic correlation in the surface distribution of primary contaminants in areas of intensified agricultural production. Thus, drinking water pollution in these areas can be attributed to excessive fertilizer use from agricultural sources.

Prognostic factors in Greek patients with small cell lung cancer (SCLC). A Hellenic Cooperative Oncology Group study.

BACKGROUND: Prognostic factors among Greek patients with SCLC were evaluated. PATIENTS AND METHODS: Data from 516 patients with SCLC treated by the Hellenic Cooperative Oncology Group were analyzed. Multivariate analysis was performed. RESULTS: Complete response (CR) was achieved in 26.8% and partial response in 40.1% of patients. The median duration of response was 7.4 months, the median survival 10.5 months and the 2-year survival rate 12%. The stage of the disease was a dominant prognostic factor for survival and response. PS 0-1 was a major prognostic factor for survival, duration of response and CR. Female gender was a favorable predictor for CR. Superior vena cava syndrome was a poor prognostic factor for survival and duration of response. Weight loss and age > or = 60 were poor predictors for response. The sites of metastases affected survival, duration of response and response. Normal alkaline phosphatase was a favorable prognostic factor for survival, duration of response and response. Normal lactate dehydrogenase and thoracic irradiation were favorable prognostic factors for survival and duration of response.

Burkitt's lymphoma in Greek adults. A study of the Hellenic co-operative oncology group.

Non-African Burkitt's lymphoma is a rare disease among adults without AIDS. Among 1352 Greek adult patients with non-Hodgkin's lymphoma, 24 cases (1.8%) were classified as Burkitt's (BL) or Burkitt-like (BLL) lymphoma. Eleven cases fulfilled the criteria of BL and 13 of BLL. No statistical differences were found in the general characteristics of the two groups at the time of diagnosis. Extranodal involvement was a common finding in both groups and bulky disease (>10 cm) was observed in almost one half of the patients. The majority of the patients were treated with intensive, although different, protocols. After induction treatment, complete remission (CR) was achieved in 14 patients (60.8%). CR was reached in all cases with stage I-II, while in stage IV the CR rate was 30.4%. The median overall survival was 27 months. The median survival for BL was 13 months compared to 27 months in the BLL group (P=0.34). The data of the present retrospective analysis, indicated that there were not significant clinical differences between BL and BLL variants. Since BLL is still a non-reproducible category in the REAL classification, all BL variants must be treated uniformly with intensive protocols.

Paclitaxel (175 mg/m2) plus carboplatin (6 AUC) versus paclitaxel (225 mg/m2) plus carboplatin (6 AUC) in advanced non-small-cell lung cancer (NSCLC): a multicenter randomized trial. Hellenic Cooperative Oncology Group (HeCOG).

PURPOSE: The combination of paclitaxel and carboplatin has become a widely used regimen in NSCLC due to phase II reports of moderate toxicity, reasonable activity and easy outpatient administration. Purpose of our present prospective study was to evaluate the dose response relationship of paclitaxel. PATIENTS AND METHODS: Since July 1996, 198 patients with non-operable NSCLC and measurable disease without previous chemotherapy entered the trial. Ninety nine patients (group A) were randomized to receive paclitaxel 175 mg/m2 in three-hour infusion plus carboplatin dosed to an area under the concentration-time curve of 6 every 3 weeks and 99 (group B) to receive the same regimen with paclitaxel increased to 225 mg/m2. Eligibility criteria included WHO performance status 0-2, documented inoperable stage IIIA and IIIB, IV, no brain metastasis, no prior chemotherapy and adequate renal and hepatic function. Patients in both groups were well-matched with baseline disease characteristics. RESULTS: In group A with 90 evaluable patients, the response rate was 25.6% (6 CR, 17 PR) whereas in group B with 88 evaluable patients, the response rate was 31.8% (3 CR, 25 PR), P = 0.733. Median time to progression favored the high-dose paclitaxel (4.3 vs. 6.4 months, P = 0.044). The median survival was 9.5 months for group A versus 11.4 months for group B (P = 0.16). The one-year survival was 37% for group A and 44% for group B (P = 0.35). The best prognostic factor for one-year survival was the response rate (P < 0.0001). With a relative dose intensity of paclitaxel 0.94 in both groups, neurotoxicity (P = 0.025) and leucopenia (P = 0.038) were more pronounced in group B patients. No toxic death was observed. CONCLUSIONS: Higher dose paclitaxel prolongs the median time to progression but causes more neurotoxicity and leucopenia. The better response rate, the longer overall and better one-year survival seen with the higher dose of paclitaxel are not statistically significant.