RESUMO
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.
Assuntos
Transplante de Rim , Rim/patologia , Obtenção de Tecidos e Órgãos , Adulto , Idoso , Biópsia , Cadáver , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
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.
Assuntos
Envelhecimento , Encefalopatias/fisiopatologia , Desenvolvimento Infantil , Recém-Nascido/crescimento & desenvolvimento , Sistema Nervoso/crescimento & desenvolvimento , Encefalopatias/complicações , Estudos de Coortes , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Curva ROC , Convulsões/etiologia , Convulsões/fisiopatologiaRESUMO
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 Assuntos
Ácido Aspártico/análogos & derivados
, Asfixia Neonatal/diagnóstico
, Hipóxia Fetal/diagnóstico
, Espectroscopia de Ressonância Magnética
, Índice de Apgar
, Ácido Aspártico/análise
, Colina/análise
, Estudos de Coortes
, Humanos
, Lactente
, Recém-Nascido
, Valor Preditivo dos Testes
, Prótons
, Fatores Socioeconômicos