Identification of risk factors influencing graft survival may lead to the development of models to predict graft outcome. Such models may provide guidance for immunosuppressive therapy, measure posttransplantation outcome, and eventually improve graft survival in high-risk patients. A major risk factor influencing graft survival is allosensitization. However, due to the lack of standardization of lymphocytotoxicity assays, the detection of alloantibodies utilizing this current methodology may not correlate with posttransplant events. Recently, a novel standardized enzyme-linked immunosorbent assay (ELISA) for the detection of anti-HLA class I IgG antibodies was developed. To evaluate the predictive value of this diagnostic test, a retrospective analysis of 124 renal allograft recipients with an 18-month follow-up time was performed. A highly significant (P=0.01) correlation between pre-transplant ELISA panel reactive antibody (PRA) results and graft loss was observed. Patients with pre-transplant ELISA PRA of >10% had a three times higher risk of graft loss compared with patients who tested negative. No such correlation was observed with complement-dependent cytotoxicity results independent of the reduction of IgM antibodies with dithiothreitol. Similarly, a highly significant correlation of ELISA results with the occurrence of early graft dysfunction was observed. Almost all patients (88%) with a pretransplant ELISA PRA of >50% required posttransplant dialysis, compared with 45% of patients with a pretransplant ELISA PRA of 10-50% and 27% of patients with a pretransplant ELISA PRA of <10%. No such difference was observed with complement-dependent cytotoxicity %PRA values. Analysis of posttransplant specimens by ELISA demonstrated a strong correlation of assay results with graft rejection and graft dysfunction. In summary, these results suggest that detection of anti-HLA class I antibodies by ELISA identifies patients at high risk for graft loss. No other single risk factor of such magnitude has been identified so far.
PurposeThis study focuses on the reasons leading health organisations to adopt a cooperation strategy and the benefits they can draw from that inter-organisational relation.Design/methodology/approachTo this end, a mixed research approach – qualitative and quantitative – was adopted, taking a real case between a Health Centre Group in inland Portugal (ACeS-CB) and the Faculty of Health Sciences at a university situated in the same region (FCS-UBI). To gather information, a questionnaire survey was directed to medical students in this faculty, together with semi-structured interviews with those in charge of both types of organisation in the inter-organisational cooperation studied here.FindingsAfter content analysis of the interviews and descriptive analysis of the questionnaires, it was concluded that this cooperation is based on a relation of a formal nature, as each organisation is independent from the other, as are their administrative and management organs. The benefits obtained from this cooperative relation regard mainly the share of human resources, particularly elements of the clinical staff in ACeS-CB who have taken on teaching duties at FCS-UBI.Practical implicationsArticulation of theoretical training with clinical practice and the exchange of knowledge were other benefits identified. The study also reveals that students perceive this inter-organisational cooperation as satisfactory, corresponding to what was defined by those in charge of the institutions as its main objectives.Originality/valueThis study focuses on the reasons leading health organisations to adopt a strategy of cooperation with other organisations in the same sector and the benefits they can obtain from that relation. It represents a tool to support managers in health organisations and other stakeholders in an inter-organisational cooperation relation, in planning strategies and understanding the impact of this type of cooperation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.