Data tables were generated from the OHSU transplant Datamart, which contains key data elements for each OHSU kidney transplant. Additional data elements were integrated from the UNOS's Review of Organ offers report which provides additional data about the organ donor and non-identifiable outcomes of other transplants from the same donor. The incidence of DGF was calculated; univariate and multivariate analysis were performed on recipient, donor, and other variables. Chart review was performed on cases with DGF to identify possible recipient causes.RESULTS: Between 1/1/2012-12/31/2016, 326 patients received deceased donor kidney transplants at OHSU. The overall number of DGF was 31 (9.5%). The rate of DGF decreased from 20.8% in 2012 to 2.7% in 2016. Univariate analysis revealed that male sex, donation after circulatory death (DCD), DGF in the mate kidney, increased donor age, higher KDPI, cold ischemia time, and earlier transplant year were associated with increased risk of DGF. On multivariate analysis, DCD, KDPI, DGF in the mate kidney, cold ischemia time >15hrs, pulsatile perfusion were associated with increased risk of DGF. In the 31 patients that had DGF, recipient causes such as myocardial infarction, severe perioperative hypotension, cardiac arrhythmia, simultaneous heart transplant, vascular complications, rejection, and recurrence of disease accounted for 11 of the 31 (35%) patients with DGF.CONCLUSIONS: Rates of DGF in deceased donor kidney transplant at OHSU are lower than rates that are commonly reported. This may suggest that DGF rates may be modifiable through relatively simple interventions such as use of pulsatile perfusion or protocolled procurement. Recipient factors, especially cardiovascular hemodynamic status, may be responsible for DGF in about 3% of all transplants which may be represent an additional area for research and quality improvement.
The aim of this study is to analyze effect and adverse event of rituximab as induction therapy in living-donor renal transplantation.METHODS: Ninety-two recipients undergoing living-donor renal transplantation in our institution from May 2009 to August 2018 were retrospectively evaluated. We excluded 4 recipients who were followed less than 3 months after renal transplantation. Indications of preoperative rituximab (200mg/body) are the following; 1. ABO major mismatch, 2. ABO minor mismatch, 3. de novo donor-specific antihuman leukocyte antigens antibodies (DSA) positive, 4. Focal segmental glomerulosclerosis (FSGS). This study was approved by Ethical Committee of Okayama University Hospital and the informed consent of the patients.RESULTS: There were 68 in rituximab group (Rit), and 20 in non-rituximab group (non-Rit). Median follow-up was 40 months. There were significant differences between two groups in age (median; 32 vs 47, p[0.01), but were no significant differences in sex (male: 68% vs 65% p[0.83), FSGS (0% vs 4%, p[0.35) or primary cytomegalovirus (CMV) infection (30% vs 15%, p[0.15). Serum creatinine did not demonstrate significant differences between two groups except 3 months after transplantation (median; 1.4 mL/min in Rit group vs 1.1 mL/min in non-Rit group, p[0.02). Acute injection (5% vs 7%, p[0.72), the use of G-CSF (25% vs 34%, p[0.54), CMV infection (26% vs 13%, p[0.15) and graft loss (11% vs 8%, p[0.15) demonstrated no significant differences between two groups.CONCLUSIONS: Rituximab induction therapy is effective in immunological high risk recipients. It does not increase adverse event.
Background The use of plaque incision and graft techniques (PIG) for the treatment of severe Peyronie’s disease (PD), may lead to erectile dysfunction (ED); graft size is 1 of the contributing factors for post-PIG ED. Recently the iGrafter software APP was introduced using a mathematical algorithm to distribute the incisions along the penile length resulting in a smaller grafting area. Aim Compare 2 PIG techniques, the Double-Y(DY) and iGrafter, in 3 main aspects: (i) Total grafting area; (ii) The variation in calculating the grafting to be used; (iii) time to perform the PIG. Methods Six urologists with expertise in sexual medicine performed both techniques twice using four 3-D validated training models for PD with a standard 60° uniplanar dorsal curvature. Outcomes The graft areas and operative partial and total time for each step of the operation were recorded for each procedure. Unpaired t-test and the coefficient of variation for graft area across surgeons was calculated comparing both techniques. Results For all surgeons, the use of iGrafter resulted in 2 grafts, for the DY technique in 1 graft. Overall, TT for the iGrafter was significantly longer than for DY technique (49.4 ± 11 vs 40.7 ± 5.7 minute; P = .02), The iGrafter grafting area was significantly smaller (11.6 ± 1.2 vs 23.3 ± 5.4 cm2; P: .01), representing a 50.2% area reduction when compared to the DY. The variation of graft area, using the iGrafter also yielded a more consistent graft across all surgeons (CV = 10.56% vs 23.28%). Clinical Significance The iGrafter, when compared to DY technique, reduced the graft area by 50%, which potentially means less erectile dysfunction. Strengths and Limitations Our study eliminates anatomical variations found in a real clinical case making it possible to compare surgical techniques with the same penile anatomy. However, the 3D-printed model cannot replicate the living human tissue property preventing a simulation close to actual surgery. Conclusion The use of the iGrafter software for PIG surgery has shown to be a promising technique for severe PD management resulting in smaller graft size (about 50% smaller when compared to the DY), although it might be more time-consuming.
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