Transplanting Hepatitis C–Positive Kidneys Reese, Peter P; Abt, Peter L; Blumberg, Emily A ...
The New England journal of medicine,
07/2015, Letnik:
373, Številka:
4
Journal Article
Recenzirano
New antiviral therapies for hepatitis C virus infection, with cure rates exceeding 95%, should prompt transplant-community leaders to view HCV-positive organs as a valuable opportunity for transplant ...candidates with or without preexisting HCV infection.
The scarcity of kidneys for transplantation and high mortality among patients on the waiting list have led some patients to accept kidney transplants that carry elevated risks of transmitting infections or cancer. In certain cases, such as the transmission of cytomegalovirus, physicians can anticipate these events and institute preventive measures. But transplant teams often discard kidneys from donors with hepatitis C virus (HCV) infection because of the many complications and historical barriers to successful treatment of HCV. We believe, however, that new antiviral therapies with cure rates exceeding 95%
1
should prompt transplant leaders to view HCV-positive organs as a valuable . . .
An open-label pilot trial involving 10 patients shows that hepatitis C virus genotype 1–infected kidneys transplanted into HCV-negative recipients, followed by direct-acting antiviral therapy, can ...result in excellent allograft function with cure of HCV infection.
To the Editor:
Waiting times for kidney transplants exceed 3 to 5 years in many parts of the United States.
1
Yet more than 500 high-quality kidneys from deceased donors with hepatitis C virus (HCV) infection are discarded annually.
2
,
3
Direct-acting antiviral agents, which are associated with high HCV cure rates and manageable side effects, have created the potential to substantially increase the number of kidney transplants by making HCV-infected kidneys available to HCV-negative candidates on the waiting list.
4
,
5
In this open-label, single-group, pilot trial at the University of Pennsylvania (Transplanting Hepatitis C Kidneys into Negative Kidney Recipients THINKER; ClinicalTrials.gov . . .
Diffusion MRI of Complex Neural Architecture Tuch, David S.; Reese, Timothy G.; Wiegell, Mette R. ...
Neuron (Cambridge, Mass.),
12/2003, Letnik:
40, Številka:
5
Journal Article
Recenzirano
Odprti dostop
While functional brain imaging methods can locate the cortical regions subserving particular cognitive functions, the connectivity between the functional areas of the human brain remains poorly ...understood. Recently, investigators have proposed a method to image neural connectivity noninvasively using a magnetic resonance imaging method called diffusion tensor imaging (DTI). DTI measures the molecular diffusion of water along neural pathways. Accurate reconstruction of neural connectivity patterns from DTI has been hindered, however, by the inability of DTI to resolve more than a single axon direction within each imaging voxel. Here, we present a novel magnetic resonance imaging technique that can resolve multiple axon directions within a single voxel. The technique, called q-ball imaging, can resolve intravoxel white matter fiber crossing as well as white matter insertions into cortex. The ability of q-ball imaging to resolve complex intravoxel fiber architecture eliminates a key obstacle to mapping neural connectivity in the human brain noninvasively.
The safety and efficacy of direct-acting antiviral therapies have allowed the transplantation of organs from hepatitis C virus (HCV)–viremic donors into uninfected recipients. This novel strategy ...contrasts with the previous standard-of-care practice of limiting the transplantation of HCV infected–donor organs to HCV-infected recipients, or all too often, discarding viable organs. In this review, we summarize the published literature about the safety and feasibility of transplanting organs from HCV-viremic donors, the challenges that hinder wider adoption of this strategy, and future research needs.
People tend to belong to multiple social circles, which construct and reflect a person's social identity. Group affiliation is embodied and may be expressed by personal adornment. Personal adornment ...in general has multiple functions in human societies, among them the assimilation and transmission of different aspects of personal and collective, social and cultural identity. Beads in general, including shell beads, often constitute parcels of composite adornment, and as such are used in different configurations to portray these messages. The shared use of similar bead types by different individuals and communities indicates the mutual affiliation of the sharing parties to the same cultural circles and reflects social ties and relationships. The Pre-Pottery Neolithic B (PPNB) period in the Levant is a time of pivotal changes to human lifeways necessitating profound adjustments in all aspects of life, including social relations and networks. Here we use the shell bead assemblage from the cultic-mortuary aggregation site of Kfar HaHoresh, in comparison to shell bead assemblages from multiple other sites in the Levant, as a proxy for the exploration of local and regional networks and connections between PPNB communities. Multivariate analyses of shell bead type distribution patterns across the Levant demonstrate that some types were widely shared among different communities, characterising different geographic regions, while others were rare or unique, highlighting relationships between sites and regions, which are occasionally independent of geographic proximity. Specific occurrences of shared shell bead types between Kfar HaHoresh and compared sites further illuminate the web of connections between PPNB communities in the Levant and the varying breadths of sharing-patterns reflect the hierarchical nature of the underlying social circles. Outlining these widening social affiliations sheds light on the complex structure of Neolithic social identity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Organs from hepatitis C virus (HCV)-infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy ...Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk.
To describe 12-month HCV treatment outcomes, estimated glomerular filtration rate (eGFR), and quality of life for the 10 kidney recipients in THINKER-1 and 6-month data on 10 additional recipients.
Open-label, nonrandomized trial. (ClinicalTrials.gov: NCT02743897).
Single center.
20 HCV-negative transplant candidates.
Participants underwent transplant with kidneys infected with genotype 1 HCV and received elbasvir-grazoprevir on posttransplant day 3.
The primary outcome was HCV cure. Exploratory outcomes included 1) RAND-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) quality-of-life scores at enrollment and after transplant, and 2) posttransplant renal function, which was compared in a 1:5 matched sample with recipients of HCV-negative kidneys.
The mean age of THINKER participants was 56.3 years (SD, 6.7), 70% were male, and 40% were black. All 20 participants achieved HCV cure. Hepatic and renal complications were transient or were successfully managed. Mean PCS and MCS quality-of-life scores decreased at 4 weeks; PCS scores then increased above pretransplant values, whereas MCS scores returned to baseline values. Estimated GFRs were similar between THINKER participants and matched recipients of HCV-negative kidneys at 6 months (median, 67.5 vs. 66.2 mL/min/1.73 m2; 95% CI for between-group difference, -4.2 to 7.5 mL/min/1.73 m2) and 12 months (median, 72.8 vs. 67.2 mL/min/1.73 m2; CI for between-group difference, -7.2 to 9.8 mL/min/1.73 m2).
Small trial.
Twenty HCV-negative recipients of HCV-infected kidneys experienced HCV cure, good quality of life, and excellent renal function. Kidneys from HCV-infected donors may be a valuable transplant resource.
Merck.
Procedures for testing organic solar cell devices and modules with respect to stability and operational lifetime are described. The descriptions represent a consensus of the discussion and ...conclusions reached during the first 3 years of the international summit on OPV stability (ISOS). The procedures include directions for shelf life testing, outdoor testing, laboratory weathering testing and thermal cycling testing, as well as guidelines for reporting data. These procedures are not meant to be qualification tests, but rather generally agreed test conditions and practices to allow ready comparison between laboratories and to help improving the reliability of reported values. Failure mechanisms and detailed degradation mechanisms are not covered in this report.
Display omitted
► The consensus of ISOS-3 with respect to stability of organic solar cells is presented. ► Recommended procedures for measuring and reporting the stability of polymer solar cells is presented. ► Protocols were developed at 3 different levels: basic, intermediate, and advanced. ► Protocol categories include: dark, outdoor, and simulated laboratory weathering.
Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor ...HCV-viremia or recipient HCV-serostatus.
We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants.
Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m
,
=0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m
,
=0.056) after transplantation of HCV-viremic kidneys.
By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.
We sought to assess consent rates for organ donation from potential brain-dead donors, and to identify factors associated with variation in consent for donation that could guide the development of ...targeted interventions to increase organ consent rates.
We used data provided by the Organ Procurement and Transplantation Network to analyze the 35,823 organ procurement organization-reported eligible deaths (potential brain-dead donors ≤ 70 yr of age) from January 1, 2008, to October 31, 2011.
Excluding cases where donation authorization was based on prior patient documentation (e.g., donor registry), consent was obtained on 21,601 (68.9%), not obtained on 8,727 (27.8%), and not requested on 1,080 (3.4%) eligible deaths. There were substantial differences in consent rates among racial/ethnic groups (77.0% in whites, 67.5% in Hispanics, 54.9% in blacks, and 48.1% in Asians) and organ procurement organizations (median interquartile range: 72.4% 67.5-87.3). In generalized estimating equation models, with whites and patients ages 18-39 yr as the respective reference groups, consent for donation was less likely to be obtained among Hispanics (odds ratio 0.54; 95% confidence interval 0.44-0.65), blacks (odds ratio 0.35; 95% confidence interval 0.31-0.39), Asians (odds ratio 0.31; 95% confidence interval 0.25-0.37), and eligible donors ages 55-64 (odds ratio 0.72; 95% confidence interval 0.67-0.77), and ≥ 65 yr (odds ratio 0.58; 95% confidence interval 0.52-0.64).
In presenting the first published analyses of consent rates among all eligible deaths, this study confirms smaller and regional studies that showed significant differences in consent rates between whites and racial/ethnic minorities (blacks, Hispanics, and Asians). The study also identifies considerable variation in consent rates between age groups and between organ procurement organizations. Critical care physicians are usually the front-line providers for potential brain-dead donors and their next-of-kin, and these data highlight the need for further research to identify the causes of variation in consent rates and mechanisms to increase rates where appropriate.
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