ObjectiveTo examine the impact of laparoscopic nephrectomy and recipient education on the proportion of kidney recipients who could identify a potential live donor, and on the live donor (LD) transplantation rate.
Summary Background DataLaparoscopic donor nephrectomy (LDN) results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery than the standard open donor nephrectomy (ODN). The authors hypothesized that the availability of this less invasive surgical technique would enhance the willingness of family and friends to donate.
MethodsThe study population consisted of 3,298 end-stage renal disease patients referred for kidney transplant evaluation between November 1991 and February 2000, divided into three groups. The first group received no formal LD education and had only ODN available. The second group received formal education about the LD process and had only ODN available. The third group had both formal LD education and LDN available. Records were examined to determine what proportion of each group had any potential donors tissue-typed, and the rate at which they received an LD transplant.
ResultsBefore LDN availability and formal LD education, only 35.1% of referrals found a potential donor, and only 12.2% received an LD transplant within 3 years. Institution of a formal education program increased the volunteer rate to 39.0%, and 16.5% received an LD transplant. When LDN became available, 50% of patients were able to find at least one potential donor, and within 3 years 24.7% received an LD transplant. Regression analysis indicated that availability of LDN was independently associated with a 1.9 relative risk of receiving an LD transplant. Kaplan-Meier death-censored 1-and 3-year graft survival rates for ODN transplants were 95.8% and 90.6%, versus 97.5% and 94.8% for LDN.
ConclusionsThe availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.
A positive cross-match is not necessarily a contraindication to LD transplantation, especially for patients with low donor-specific alloantibody titers.
A mesocosm study was carried out to determine whether flooding affected soil microbial structure and function. Over a 24 day period soils were either flooded or remained dry and changes in the microbial community structure, microbial metabolic activity (determined by looking at soil respiration rates and exo-enzyme activity), community level physiological profiles and soil carbon speciation were examined. Flooding induced significant changes in the microbial community structure and increased soil respiration and enzymatic degradation rates. Shifts occurred in carbon speciation after flooding and increases in 'labile' carbon fractions were observed. The duration of flooding was also important for carbon dynamics and microbial community structure. Based on the results of the mesocosm experiment a conceptual model of floodplain soils response to flooding over time was formulated. The findings of this mesocosm study illustrate the importance of flooding to floodplain soil functioning.
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.