Abstract:Introduction In 2021, over 100 000 people were awaiting solid organ transplantation, yet only 44 634 transplants were performed. The aim of this study is to evaluate trends in donor availability, waitlist additions, and transplants performed in the United States from 2001 to 2021. Methods This was a retrospective analysis to evaluate trends in donor availability, waitlist additions, and solid organ transplants for the 4 most common organs requiring transplants (kidney, liver, heart, and lung) between 2001 and … Show more
“…This may further suggest that management of complications and co‐morbidities play a crucial role in post‐LT prognosis. Careful identification and management of vulnerabilities and patient co‐morbidities may therefore allow for expansion of the pool of viable donor livers to meet the increasing demand for organs 20 . Han et al.…”
Section: Discussionmentioning
confidence: 99%
“…The need for hepatic grafts is growing and the proportion of the population impacted by hepatic steatosis is expanding; it is important to consider the use of steatotic hepatic grafts in the setting of limited optimal donor organs, especially given the high risk of mortality from end‐stage hepatic dysfunction 20,27 . This study importantly identifies prognostic and mortality factors that pose a risk to LT recipients of steatotic grafts.…”
Background and AimsThe presence of steatosis in a donor liver and its relation to post‐transplantation outcomes are not well defined. This study evaluates the effect of the presence and severity of micro‐ and macro‐steatosis of a donor graft on post‐transplantation outcomes.MethodsThe UNOS‐STAR registry (2005–2019) was used to select patients who received a liver transplant graft with hepatic steatosis. The study cohort was stratified by the presence of macro‐ or micro‐vesicular steatosis, and further stratified by histologic grade of steatosis. The primary endpoints of all‐cause mortality and graft failure were compared using sequential Cox regression analysis. Analysis of specific causes of mortality was further performed.ResultsThere were 9184 with no macro‐steatosis (control), 150 with grade 3 macro‐steatosis, 822 with grade 2 macro‐steatosis and 12 585 with grade 1 macro‐steatosis. There were 10 320 without micro‐steatosis (control), 478 with grade 3 micro‐steatosis, 1539 with grade 2 micro‐steatosis and 10 404 with grade 1 micro‐steatosis. There was no significant difference in all‐cause mortality or graft failure among recipients who received a donor organ with any evidence of macro‐ or micro‐steatosis, compared to those receiving non‐steatotic grafts. There was increased mortality due to cardiac arrest among recipients of a grade 2 macro‐steatosis donor organ.ConclusionThis study shows no significant difference in all‐cause mortality or graft failure among recipients who received a donor liver with any degree of micro‐ or macro‐steatosis. Further analysis identified increased mortality due to specific aetiologies among recipients receiving donor organs with varying grades of macro‐ and micro‐steatosis.
“…This may further suggest that management of complications and co‐morbidities play a crucial role in post‐LT prognosis. Careful identification and management of vulnerabilities and patient co‐morbidities may therefore allow for expansion of the pool of viable donor livers to meet the increasing demand for organs 20 . Han et al.…”
Section: Discussionmentioning
confidence: 99%
“…The need for hepatic grafts is growing and the proportion of the population impacted by hepatic steatosis is expanding; it is important to consider the use of steatotic hepatic grafts in the setting of limited optimal donor organs, especially given the high risk of mortality from end‐stage hepatic dysfunction 20,27 . This study importantly identifies prognostic and mortality factors that pose a risk to LT recipients of steatotic grafts.…”
Background and AimsThe presence of steatosis in a donor liver and its relation to post‐transplantation outcomes are not well defined. This study evaluates the effect of the presence and severity of micro‐ and macro‐steatosis of a donor graft on post‐transplantation outcomes.MethodsThe UNOS‐STAR registry (2005–2019) was used to select patients who received a liver transplant graft with hepatic steatosis. The study cohort was stratified by the presence of macro‐ or micro‐vesicular steatosis, and further stratified by histologic grade of steatosis. The primary endpoints of all‐cause mortality and graft failure were compared using sequential Cox regression analysis. Analysis of specific causes of mortality was further performed.ResultsThere were 9184 with no macro‐steatosis (control), 150 with grade 3 macro‐steatosis, 822 with grade 2 macro‐steatosis and 12 585 with grade 1 macro‐steatosis. There were 10 320 without micro‐steatosis (control), 478 with grade 3 micro‐steatosis, 1539 with grade 2 micro‐steatosis and 10 404 with grade 1 micro‐steatosis. There was no significant difference in all‐cause mortality or graft failure among recipients who received a donor organ with any evidence of macro‐ or micro‐steatosis, compared to those receiving non‐steatotic grafts. There was increased mortality due to cardiac arrest among recipients of a grade 2 macro‐steatosis donor organ.ConclusionThis study shows no significant difference in all‐cause mortality or graft failure among recipients who received a donor liver with any degree of micro‐ or macro‐steatosis. Further analysis identified increased mortality due to specific aetiologies among recipients receiving donor organs with varying grades of macro‐ and micro‐steatosis.
“…Organ transplantation has been increasing worldwide, although the availability of organs for transplantation remains limited [ 1 , 2 ]. Over the past few decades, the number of patients added to the organ donor waitlist has increased substantially, with reports as high as 154% between 2001 and 2021 [ 3 ]. Some also estimate that for every 10 minutes that pass, one patient is added to the transplant list, and 20 patients die per day waiting for a transplant [ 4 ].…”
Many patients are unable to receive organ transplantation as there is an expanding gap between the number of patients waiting for an organ and the number who receive it. Organ procurement from the brain-dead can address this expanding gap, especially because one brain-dead patient can potentially donate multiple organs to several recipients. Here, we describe a rare case of a previously healthy 26-year-old male who was declared brain dead after a motor vehicle accident but underwent hemodialysis to treat his acute kidney injury and hyperkalemia before successfully donating his heart and left kidney.
“…In part due to the continued rise in the prevalence of end-stage renal disease, additions to the kidney transplant waitlist continue to outpace rates of transplantation. 1,2 Thus, clinical care paradigms have persistently evolved to tackle the growing waitlist times and opportunity for improved performance of existing risk prediction models. 8,9 While traditional factors such as chronologic age and comorbidities have been used to estimate operative risk, more recent work suggested frailty to be a better predictor of postoperative outcomes.…”
Section: Introductionmentioning
confidence: 99%
“…In part due to the continued rise in the prevalence of end‐stage renal disease, additions to the kidney transplant waitlist continue to outpace rates of transplantation 1,2 . Thus, clinical care paradigms have persistently evolved to tackle the growing waitlist times and aging pool of transplant candidates 3–6 .…”
IntroductionAlthough not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post‐transplant outcomes following kidney transplantation (KT) are lacking.MethodsThis was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator.ResultsOf an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in‐hospital mortality (AOR 2.17, 95% CI: 1.33–3.57) compared to their non‐frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non‐frail counterparts. Frailty was also associated with greater adjusted risk of non‐home discharge.ConclusionsFrailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post‐transplantation care of the growing frail cohort undergoing KT.
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