RESUMO
The number of liver transplant candidates with concomitant renal disease has been steadily rising since the implementation of MELD-based allocation in 2002. Consequently, the number of simultaneous liver-kidney (SLK) transplants being performed each year has also increased. However, the establishment of well-defined criteria for when to choose SLK over liver transplant alone has lagged behind. The lack of clear guidelines has worsened an already large shortage of transplantable kidneys. This article further explores the rationale for and outlines the implementation of the SLK allocation policy.
Assuntos
Transplante de Rim , Transplante de Fígado , Insuficiência Renal Crônica , Feminino , Humanos , Rim , Fígado , Masculino , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/cirurgiaRESUMO
BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) and donation after circulatory death (DCD) kidneys are viable sources of organs. The outcomes of renal transplantation from DCD donors with AKI are not known. METHODS: A retrospective review of deceased donor renal transplants performed from 2006 to 2016 was conducted using the United Network for Organ Sharing dataset. Donors were stratified by DCD or brain dead status and by AKI stage. Recipients were followed until graft failure or the end of study. Cox regression was used to adjust for donor, recipient, and transplant covariates known to affect the incidence of delayed graft function and graft survival. RESULTS: A total of 135 644 patients were included in the study. The odds of delayed graft function among DCD recipients were significantly higher across all donor AKI stages. The unadjusted risk of overall and death-censored graft failure were similar between the 2 groups. After adjusting for covariates, there was a significant increase in the risk of overall graft failure in recipients of DCD allografts from donors with stage 2 AKI. There was also a higher risk of death-censored graft failure among stage 1 and 2 AKI DCD recipients. CONCLUSIONS: DCD renal allografts from donors experiencing stage 1 and 2 AKI have a higher adjusted risk of death-censored graft failure than AKI stage-matched donation after brain death renal allografts. Their use, however, is still associated with improved outcomes compared with waitlist mortality.
Assuntos
Injúria Renal Aguda , Morte Encefálica , Seleção do Doador , Transplante de Rim , Doadores de Tecidos/provisão & distribuição , Adulto , Tomada de Decisão Clínica , Função Retardada do Enxerto/etiologia , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Listas de Espera/mortalidadeRESUMO
Using the type III restriction-modification enzyme EcoP15I, we isolated sequences flanking sites digested by the methylation-sensitive HpaII enzyme or its methylation-insensitive MspI isoschizomer for massively parallel sequencing. A novel data transformation allows us to normalise HpaII by MspI counts, resulting in more accurate quantification of methylation at >1.8 million loci in the human genome. This HELP-tagging assay is not sensitive to sequence polymorphism or base composition and allows exploration of both CG-rich and depleted genomic contexts.
