Impact of the establishment of waiting list committee on recipient evaluation for kidney transplantation: experience of the Budapest Centre

The aim of this study was to assess the impact of the establishment of waiting list committee on recipient evaluation for kidney transplantation. Studies on this issue have not been previously reported. Methods: Data of 714 patients were collected between September 1, 2007 and April 20, 2010. Of the 714 patients 354 were transplanted. Data from the first 16 months period were compared to those obtained during the second 16 months period. Results: During the first period 171 patients (47.9%) were unfit for transplantation [129 patients (36.1%) were refused after telephone information and 42 patients (11.8%) after clinical investigation]. During the second period 141 (39.5%) patients were found to be unsuitable [80 patients (22.4%) after telephone information and 61 patients (17.1)] after clinical examination. During the two periods of the study 44% of patients were unfit for transplantation. A considerable number of patients were refused because of cardiologic reasons. The percent of fit patients was 52.1% in the first period and 60.5% in the second period. In addition, the percent of unfit patients who were unsuitable for kidney transplantation after telephone information decreased from 36.1% to 22.4%, while the percent of unfit patients after clinical evaluation increased from 11.% to 17.1%. Conclusions: Authors conclude that waiting list committee made an effective work. Orv. Hetil., 2011, 152, 190–195.

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COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽

10.3390/pathogens10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Simone C. Boedecker ◽

Pascal Klimpke ◽

Daniel Kraus ◽

Stefan Runkel ◽

Peter R. Galle ◽

...

Keyword(s):

Kidney Transplantation ◽

Waiting List ◽

Smoking History ◽

Immunocompromised Patients ◽

Dialysis Patients ◽

Vaccination Programs ◽

Mild Disease ◽

Probability Of Survival ◽

Number Of Patients ◽

Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

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INDUSTRIAL ACTIVITY REVIEW OF THE FRENCH NETWORK OF PEDIATRIC CLINICAL INVESTIGATION CENTERS (FN-PCIC) 2008–2013

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.33 ◽

2015 ◽

Vol 101 (1) ◽

pp. e1.27-e1

Author(s):

Elsa Maksooud ◽

Evelyne Jacqz-Aigrain

Keyword(s):

Clinical Trials ◽

Clinical Investigation ◽

European Medicines Agency ◽

University Hospitals ◽

European Regulation ◽

Clinical Investigations ◽

Number Of Patients ◽

Inclusion Rate ◽

The Impact ◽

Drug Studies

IntroductionThe French Network of Pediatric Clinical Investigations Centers (FN-PCIC) created in 2000 includes today 16 CIC grouped under the auspices of the INSERM and the corresponding public university hospitals. In response to the European pediatric regulation published in 2007, all pharmaceuticals laboratories, in order to complete their drug profile, must conduct pediatric clinical trials according to the Pediatric Clinical Investigation Plan and validated by the European Medicines Agency (EMA). This network plays a major role in facilitating and optimizing the conduction of nation-wide pediatric clinical trials. Therefore, the PN-CIC plays a major role to response to this acute demand in the pediatric field. The purpose of this review is to sum up the activity of the FN-PCIC between 2008 and 2013 and to analyze the impact of the European regulation.MethodsOnly the industrial protocols will be analyzed, for every protocol a certain number of information was collected such as the pharmaceutical industry, the therapeutic fields, the phase of the study, the duration of the study, the methodology, and the number of patients needed.Results261 protocols were active during this period by 90 different sponsors. 218 were interventional studies and 43 were observational or non-drug studies (registers, post-AMM). The number of active studies was at 127 in 2013 compared to 76 in 2008. Furthermore, the total number of participations were 242 for 16 CIC in 2013 compared to 110 in 2008. The mean inclusion rate was 87%. The percentage of the common studies rises from 36% in 2008 to 50% in 2013. In addition, the feasibility study demands increased and were as high as 57, an average of one demand per week The inclusion percentage calculated using the data of the closed studies is at 87%. The therapeutic fields concerned were nephrology and oncology (15%), then neurology and pneumology (13%).ConclusionActivity increased, linked to the national coverage now including 16 centers and high quality procedures to perform pediatric research trials under high ethical and quality standards.

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The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

Journal of Transplantation ◽

10.1155/2014/219789 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Eleazar Chaib ◽

Eduardo Massad ◽

Bruno Butturi Varone ◽

Andre Leopoldino Bordini ◽

Flavio Henrique Ferreira Galvão ◽

...

Keyword(s):

Liver Transplantation ◽

Deceased Donor ◽

Sao Paulo ◽

Meld Score ◽

Waiting List ◽

São Paulo ◽

Clear Trend ◽

Number Of Patients ◽

Liver Transplantations ◽

The Impact

Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of São Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997–2005) and after MELD (2006–2012) in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr), the incidence of new patients on the list (I), and the number of patients who died while being on the waitlist (D) from 1997 to 2005 (the pre-MELD era) and from 2006 to 2012 (the post-MELD era). The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores.

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Impact of Pancreas Transplantation on the Patient Survival—An Analysis of the Japanese Pancreas Transplants Registry

Journal of Clinical Medicine ◽

10.3390/jcm9072134 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2134

Author(s):

Taihei Ito ◽

Takashi Kenmochi ◽

Naohiro Aida ◽

Hajime Matsushima ◽

Kei Kurihara ◽

...

Keyword(s):

Kidney Transplantation ◽

Pancreas Transplantation ◽

Patient Survival ◽

Survival Rates ◽

Multivariable Analysis ◽

Waiting List ◽

Life Prognosis ◽

Transplant Registry ◽

End Stage ◽

The Impact

Background: The impact of pancreas transplantation, including kidney transplantation on patients’ life prognoses, is unclear in Japan. An analysis of the data of the Japan Pancreas Transplant Registry was performed to compare the patient survival between on the waiting list and after pancreas transplantation, and investigate the factors that affect the patient survival after pancreatic transplantation. Methods: The life prognoses of 361 patients who underwent pancreas transplantation from 2000 to December 2018 were examined. Results: The survival rates at 1, 5, and 10 years on the waiting list were 98.4%, 90.3%, and 78.1%, respectively, while those after transplantation were significantly improved (p = 0.029) at 100%, 97.5%, and 88.9%, respectively. Furthermore, the survival rates of patients waiting for simultaneous pancreas and kidney transplantation (SPK) at 1, 5, and 10 years were 98.2%, 89.4%, and 75.4%, respectively, while those after SPK were also significantly improved (p = 0.026) at 100%, 94.6%, and 88.8%. The multivariable analysis revealed that the duration of diabetes before surgery was the only independent risk factor (hazard ratio = 1.095, p = 0.012) that affected the patient survival after SPK. Conclusion: Pancreas transplantation was found to improve the life prognosis of patients with type 1 diabetes, especially those with end-stage renal failure waiting for SPK.

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P1662COMMERCIAL KIDNEY TRANSPLANTATION: PARTICIPANTS' ATTITUDES AND PERCEPTIONS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1662 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Fatma AlRahbi ◽

Issa Alsalmi

Keyword(s):

Kidney Transplantation ◽

Kidney Disease ◽

Family Member ◽

Administrative Support ◽

College Level ◽

Multiple Choice Questions ◽

End Stage Kidney Disease ◽

Number Of Patients ◽

End Stage ◽

The Impact

Abstract Background and Aims Kidney transplantation is the gold standard for patients with end-stage kidney disease. In view of shortages of available organs, long wait times for possible transplantation, and strict regulation, many patients opt for commercial transplantation. The national diseased program must be a priority with full financial and administrative support. All government agencies including religious affairs must work together to support the program and to provide the citizens with a good transplantation service and ameliorate the impact of commercial transplantation. This study elicits the reasons and motivations for patients with end-stage kidney disease to elect for commercial transplant. Method A questionnaire-based evaluation was conducted during the period from July 2015 until late December 2015. It consisted of 28 multiple choice questions and was distributed to all patients who underwent commercial kidney transplantation. Results One hundred and fifty patients were approached to participate and 106 agreed. Of the participants, 60% were male with an average age of 41.5 (SD 14.8) years and ranged from 18 to 83 years. The majority (82%) of our participants were educated ranging from primary to college level. The major reason (71%) for these participants to obtain commercial transplants was stated as the unavailability of a live related donor. Thirteen percent stated that they objected to getting a kidney donated from a family member, and 9% stated that they were worried about taking a kidney from a family member. Finally, 3% of participants stated that they needed prompt transplant and could not wait for a long time for transplant investigations and the workup associated with this program. Conclusion Even considering the ongoing ethical debates, number of patients undergoing commercial transplantation is on the rise. The study showed that the most common underlying cause for seeking commercial transplantation is the unavailability of a national transplant program, particularly transplantation from cadaveric sources.

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Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

10.21203/rs.3.rs-891852/v1 ◽

2021 ◽

Author(s):

Varlei Antonoio Serratto ◽

Dora Pedroso Kowacs ◽

Sérgio Candido Kowalski

Keyword(s):

Public Health ◽

Health System ◽

Waiting Time ◽

Public Health System ◽

Waiting List ◽

Waiting Period ◽

Rheumatologic Diseases ◽

Number Of Patients ◽

Specialized Care ◽

The Impact

Abstract Background In recent years, due to the increased incidence of rheumatologic diseases, the demand for consultations in rheumatology has risen. In the Brazilian public health system, patients with rheumatologic complaints are referred from primary care to specialized consultation, and must wait in a waiting list for the specialized care. In 2015, the waiting time for the first consultation in rheumatology, in Curitiba- Brazil, was 600 days. In attempt to reduce this time, in-person and remote screening was implemented that same year in a healthcare service in Curitiba. From 2015 to 2019 the variation in the number of patients in waiting lists for their first rheumatology consultation and the length of the waiting period for their first referral was evaluated. Methods Observational study in a time series. The patients in the study were referred to a primary healthcare center for an assessment of rheumatology in Curitiba, Brazil. The data was analyzed based on the first consultation with the rheumatologist. The variables were the number of patients in the waiting list and the waiting period for the appointment with the doctor. The research was carried out through a computerized system called “e-saude”[electronic health] runed by the Health Secretary of the Municipality of Curitiba. A comparison was made between the period of 2013–2015, in a model for treatment without screening, and 2015–2019, when the in-person and remote screening first began. Results Between 2015 and 2019 there was a reduction in the waiting list of 6,429 patients to 25 patients, while there was an average of 56.5 patients in the last two years;. With regard to the waiting period for the first appointment with the rheumatologist in 2019, there was a reduction of 600 days to a minimum of 4 days and a maximum of 52 days. Conclusion Both in-person and remote screening for asynchronous electronic consultations for rheumatologist in Curitiba led to a reduction in the waiting time and number of patients for the first appointment with the rheumatologist, proving to be a useful method for reducing the time and number of patients in the waiting list for a specialized consultation.

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Comparison of functional and morphological changes of transplanted kidneys from marginal and ideal donors

Orvosi Hetilap ◽

10.1556/oh.2012.29486 ◽

2012 ◽

Vol 153 (45) ◽

pp. 1793-1796

Author(s):

Bernadett Borda

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Serum Creatinine ◽

Kidney Function ◽

Interstitial Fibrosis ◽

Number Of Patients ◽

Significant Difference ◽

One Year ◽

The Impact ◽

Marginal Donors

Introduction: Despite an increased number of cadaver donors and organ transplantations, there is a marked increase in the number of patients included in the transplantation waiting list. Aim and method: The aim of the study was to evaluate functional and morphologic changes of kidney allografts obtained from marginal (n = 63) and “ideal” donors (n = 186). In patients with kidneys from marginal donors, the impact of donor age and the presence of hypertension in donors on kidney function were also studied. Results: One year after kidney transplantation, kidney function was similar in patients transplanted with kidneys from marginal and “ideal” donors, although significant morphologic differences were observed between the two groups. However, five years after transplantation serum creatinine (p = 0.0001) and eGFR (p = 0.003) were significantly different between patients transplanted with kidneys from marginal and “ideal” donors. There was also a significant difference in serum creatinine level of patients who received kidneys from donors older than 55 years of age compared to patients whose kidney allografts were obtained form donor who has hypertension (p = 0.0003). Acute rejection episodes (p = 0.0004) and interstitial fibrosis/tubular atrophy (p = 0.002) occurred more frequently in patients with kidneys from marginal compared to those from “ideal” donors. Conclusion: One year after kidney transplantation renal function is similar in patients transplanted with kidneys from marginal and „ideal” donors, but patients with kidneys from marginal donors have significantly more impaired renal function five years after kidney transplantation. Orv. Hetil., 2012, 153, 1793–1796.

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The Right to Housing: Challenges Associated with the ‘Waiting List System’ Ekurhuleni Metropolitan Municipality V Various Occupiers, Eden Park Extension 5 2014 3 SA 23 (SCA)

Southern African Public Law ◽

10.25159/2522-6800/3531 ◽

2017 ◽

Vol 30 (1) ◽

pp. 112-121

Author(s):

Shamier Ebrahim

Keyword(s):

Supreme Court ◽

Waiting Lists ◽

The State ◽

Waiting List ◽

Allocation Process ◽

The Supreme Court ◽

The Right ◽

The Impact ◽

Court Of Appeal

The right to adequate housing is a constitutional imperative which is contained in section 26 of the Constitution. The state is tasked with the progressive realisation of this right. The allocation of housing has been plagued with challenges which impact negatively on the allocation process. This note analyses Ekurhuleni Metropolitan Municipality v Various Occupiers, Eden Park Extension 51 which dealt with a situation where one of the main reasons provided by the Supreme Court of Appeal for refusing the eviction order was because the appellants subjected the unlawful occupiers to defective waiting lists and failed to engage with the community regarding the compilation of the lists and the criteria used to identify beneficiaries. This case brings to the fore the importance of a coherent (reasonable) waiting list in eviction proceedings. This note further analyses the impact of the waiting list system in eviction proceedings and makes recommendations regarding what would constitute a coherent (reasonable) waiting list for the purpose of section 26(2) of the Constitution.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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