Normothermic Ex Vivo Kidney Perfusion Following Static Cold Storage-Brief, Intermediate, or Prolonged Perfusion for Optimal Renal Graft Reconditioning?

Normothermic ex vivo kidney perfusion (NEVKP) demonstrated superior results compared to hypothermic storage in donation after circulatory death (DCD) kidney transplantation. It is unknown whether an optimal perfusion time exists following hypothermic storage to allow for the recovery of renal grafts from cold ischemic injury. In a porcine model of DCD kidney autotransplantation, the impact of initial static cold storage (SCS) (8 h) followed by various periods of NEVKP recovery was investigated: group A, 8 hSCS only (control); group B, 8 hSCS + 1 hNEVKP (brief NEVKP); group C, 8 hSCS + 8 hNEVKP (intermediate NEVKP); and group D, 8 hSCS + 16 hNEVKP (prolonged NEVKP). All grafts were preserved and transplanted successfully. One animal in group D was sacrificed and excluded by postoperative day 3 due to hind limb paralysis, but demonstrated good renal function. Postoperative graft assessment during 8 days' follow-up demonstrated lowest levels of peak serum creatinine for intermediate (C) and prolonged (D) NEVKP (p = 0.027). Histological assessment on day 8 demonstrated a significant difference in tubular injury (p = 0.001), with highest values for group B. These results suggest that longer periods of NEVKP following SCS are feasible and safe for postponing surgical transplant procedure and superior to brief NEVKP, reducing the damage caused during cold ischemic storage of renal grafts.

[Evaluation of moderate and severe visual impairments in patients attending an ophthalmology clinic. A prospective study of 1,172 patients]. / Evaluation des handicaps visuels modérés et sévères dans une population de consultants en ophtalmologie. Etude prospective sur 1,172 patients.

PURPOSE: Data on blindness and visual impairment in patients attending ophthalmology clinics at the Orleans regional hospital center serving a semi-rural area in France were prospectively studied to examine prevalence of visual impairment. MATERIAL AND METHODS: Clinical data on 1,172 consecutive and different patients attending the ophthalmology department during half-days over a 3-month period were collected and analyzed using a computerized system. RESULTS: Prevalence of visual impairment (20/30 or less in the better eye) was 3% in subjects under 60 years of age and rose to 13.7% and 35.9% for patients in the 60-79 age range and over 80 years respectively. For patients under 60, the prevalence of severe visual impairment (20/200 or less in the better eye) was 1.2% and rose dramatically in older patients: 5.8% and 14.6% in the 60-79 year old patients and the over 80 patients respectively. There was no significant difference in the prevalence of visual impairment by sex. Leading causes of severe visual impairment among patients aged 60 years or older were macular degeneration (40%), diabetic retinopathy (16.6%) and cataract (13.3%). The prevalence of irreversible severe visual impairment was 7.4% among patients 60years of age or older. CONCLUSION: A large number of patients attending our ophthalmology clinic have severe visual impairment, particularly those over 60 years of age. Our findings are comparable with extrapolations for population-based studies in English speaking countries and can be used to evaluate the prevalence of visual impairment in French rural areas. As the population ages, need for eye health care becomes more and more evident. It is important to organize systematic visual examination in subjects aged 70 to 80 years and to implement educational programs as part of local national health care policies for helping the visually impaired.