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The number of ABO-incompatible solid organ transplantations (ABOi SOTs) has markedly increased worldwide since the early 2000s. We investigated the choice of ABO group for blood component transfusion in ABOi SOT. We conducted a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea, among whom 34 responded to the survey. In major ABOi SOT, for red blood cells (RBCs), the recipient's type (70.6%) was the most common choice, followed by group O (29.4%); for platelets, group AB (50.0%) was the most common choice, followed by the donor type (38.2%); for plasma, group AB (55.9%) was the most common choice, followed by the donor type (32.4%). In bidirectional ABOi SOT, for RBCs, the recipient's type (55.9%) was the most common choice, followed by group O (44.1%); for platelets and plasma, group AB was the most common choice (94.1% and 97.1%, respectively). The policies for transfusion in ABOi SOT were diverse. We suggest a guideline on the choice of ABO group for transfusion in ABOi SOT to secure patient health and enable an efficient use of blood components.

The article presents the main principles of dialoguing with the family of a transplant donor; attention is paid to the key points that ensure the highest number of consents to the explantation of organs and tissues., В статье представлены основные принципы ведения диалога с семьей трансплантат-донора, уделяется внимание ключевым моментам, обеспечивающим наиболее высокое количество согласий на эксплантацию органов и тканей., У статті надані основні принципи ведення діалогу з сім’єю трансплантат-донора, приділяється увага ключовим моментам, що забезпечують найбільш високу кількість згод на експлантацію органів і тканин.

Worldwide, lung transplantation has been a therapeutic option for select end-stage lung disease patients who are on optimized medical regimens, but the underlying clinical condition continues to progress. For any successful lung transplantation program, it is important to have a robust donor lung management program. Lungs are commonly affected by the various factors related to trauma or neurogenic in brain stem death donors. This article would focus on the basic protocols to optimize donor lungs which would help in increasing donor pool. It would also elaborate COVID-specific points for donor lung evaluation. This article would also describe the criteria for ideal as well as marginal donor lungs. A comprehensive literature search was performed using PubMed to review various articles related to donor lung management.

Rice is a valuable agricultural crop that is used as food for more than half of the world's population. The development of highly productive varieties and hybrids with high product quality assumes the utilization of new initial material from different countries in the breeding process. The purpose of the current research was to conduct an ecological testing of the rice varieties from Uganda in the Proletarsky district of the Rostov region in Russia and use them in the breeding process. There were studied the Ugandan rice samples ‘Nerica 1’, ‘Nerica 4’, ‘Komboka’, ‘Wita 9’, ‘Namche 1’, ‘Namche 2’, ‘Namche 3’, ‘Namche 4’, ‘Namche 5’, ‘Namche 6’ (NaCRRI) in comparison with the Russian variety ‘Komandor’ (FSBSI “ARC “Donskoy”). The study of the Ugandan rice varieties according to a number of economically valuable traits and biological properties showed that the vegetation period from soil flooding to rice maturing took 100–113 days, the standard variety ‘Komandor’ needed 83 days. The varieties ‘Komboka’ and ‘Wita 9’ did not bear blossom. All samples had a short habit, with 63-95 cm of plant height. The long drooping panicles of 18.5–22.3 cm carried from 122 to 213 seeds. The caryopses were elongated, the length of the caryopses varied from 9.0 to 9.5 mm, and the width ranged from 2.7 to 3.1 mm. 1000 seed weight varied from 26 to 34 g, number of seeds per panicle ranged from 122 to 213 pieces. Genetic analysis of the second generation hybrids ‘Kontakt × Nerica 1’ and ‘Boyarin × Nerica 4’ showed different types of traits’ inheritance, from negative dominance (vegetation period) through the absence of dominance (caryopses size) to overdominance (plant height, seed weight per panicle and number of seeds per panicle).

STUDY QUESTION What are the sperm and egg donor rejection rates after expanded carrier screening (ECS)? SUMMARY ANSWER Using an ECS panel looking at 46/47 genes, 17.6% of donors were rejected. WHAT IS KNOWN ALREADY The use of ECS is becoming commonplace in assisted reproductive technology, including testing of egg and sperm donors. Most national guidelines recommend rejection of donors if they are carriers of a genetic disease. If the use of ECS increases, there will be a decline in the number of donors available. STUDY DESIGN, SIZE, DURATION A review of the current preconception ECS panels available to donors was carried out through an online search. The genetic testing results of donors from Cryos International were analysed to determine how many were rejected on the basis of the ECS. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on gamete donors and their carrier status was provided by Cryos International, who screen donors using their own bespoke ECS panel. The ECS panels identified through the review were compared to the Cryos International panel and data. MAIN RESULTS AND THE ROLE OF CHANCE A total of 16 companies and 42 associated ECS panels were reviewed. There were a total of 2673 unique disorders covered by the panels examined, with a mean of 329 disorders screened. None of these disorders were common to all panels. Cryos International screen 46 disorders in males and 47 in females. From 883 candidate donors, 17.6% (155/883) were rejected based on their ECS result. Carriers of alpha-thalassaemia represented the largest proportion of those rejected (19.4%, 30/155), then spinal muscular atrophy (15.5%, 24/155) and cystic fibrosis (14.8%, 23/155). LIMITATIONS, REASONS FOR CAUTION Panel information was found on company websites and may not have been accurate. WIDER IMPLICATIONS OF THE FINDINGS This study highlights the need for consistent EU regulations and guidelines that allow genetic matching of gamete donors to their recipients, preventing the need to reject donors who are known carriers. A larger ECS panel would be most beneficial; however, this would not be viable without matching of donors and recipients. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained. J.C.H. is the founder of Global Women Connected, a platform to discuss women’s health issues and the Embryology and PGD Academy, who deliver education in clinical embryology. She has been paid to give a lecture by Cryos in 2019. A-B.S. is an employee of Cryos International. TRIAL REGISTRATION NUMBER N/A

Background: Renal angiomyolipoma (AML) is the most frequent mesenchymal tumor of the kidney. Although there is a rare possibility of malignant transformation of AML, this risk has not been studied in immunosuppressed patients. The safety of donors with AML and their kidney transplant recipients has not been well established. Methods: A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane databases from inception through May 15, 2018 (updated on October 2019). We included studies that reported the outcomes of kidney donors with AML or recipients of donor with AML. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095157). Results: Fourteen studies with a total of 16 donors with AML were identified. None of the donors had a diagnosis of tuberous sclerosis complex (TSC), pulmonary lymphangioleiomyomatosis (LAM), or epithelioid variant of AML. Donor age ranged from 35 to 77 years, and recipient age ranged from 27 to 62 years. Ninety-two percent of the donors were female. Only 8% were deceased donor renal transplant. The majority underwent ex vivo resection (65%) before transplantation, followed by no resection (18%), and the remaining had in vivo resection. Tumor size varied from 0.4 cm to 7 cm, and the majority (87%) were localized in the right kidney. Follow-up time ranged from 1 to 107 months. Donor creatinine prenephrectomy ranged 0.89–1.1 mg/dL and postnephrectomy creatinine 1.0–1.17 mg/dL. In those who did not have resection of the AML, tumor size remained stable. None of the donors with AML had end-stage renal disease or died at last follow-up. None of the recipients had malignant transformation of AML. Conclusion: These findings are reassuring for the safety of donors with AML (without TSC or LAM) as well as their recipients without evidence of malignant transformation of AML. As such, this can also positively impact the donor pool by increasing the number of available kidneys.

We bring to you our viewpoint and a snapshot of the journey of convalescent plasma therapy (CPT) in the management of ongoing coronavirus disease 2019 (COVID-19) pandemic. We also discuss how best to use the updated data on this important treatment option and maximize benefit for our patients, thereby saving lives, especially in resource constraint settings.

Background Dengue virus (DENV) infection is increasingly common in southern China and can be transmitted through blood transfusion but is not currently part of donor screening throughout the region. We assessed DENV prevalence among donors at the Xishuangbanna Blood Center, Yunnan, to support development of DENV screening strategies. Methods Blood samples were collected randomly between June 2019 and August 2019. These were screened for anti-DENV IgG and IgM using enzyme-linked immunosorbent assay (ELISA). Then, all reactive samples and some randomly-chosen non-reactive samples were used to detect DENV RNAs using real-time polymerase-chain-reaction (RT-PCR) assays. After RT-PCR, samples were further tested for soluble nonstructural protein 1 (NS1) using the colloidal gold method. Donors demographics were also collected and assessed. Results Over the study period, 2254 donor samples were collected and tested for anti-DENV IgG and IgM by ELISA. This revealed 598 anti-DENV IgG and/or IgM reactive samples, a serological prevalence of 26.53%. Of these, 26 were RT-PCR positive and/or NS1 positive. Significant differences in DENV prevalence were noted by occupation (P = 0.001), education (P ), and ethnicity (P = 0.026). Conclusion The prevalence of DENV in Xishuangbanna Blood Center was higher than most other blood centers that have implemented DENV donor screening. Our study provides first-hand data about the prevalence of DENV and allows the development of a screening strategy for clinical use.

Patients receiving a hematopoietic cell transplant are thought to be at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus infectious disease 2019. Transplant activities at our center continue, and notably, no patient has been infected with SARS-CoV-2. Indeed, social distancing, masking, and education for patients and donors are major pillars of prevention. We recommend potential transplant recipients and donors to be tested for SARS-CoV-2 with qRT-PCR, serum antibody detection, and a lung CT scan pretransplant. If possible, stem cells from HLA-matched unrelated donors by local processing laboratories should be cryopreserved and shipped before initiating pretransplant conditioning. An alternative HLA-haplotype-matched related donor should be identified and evaluated as a backup. The interval immediately after discharge is the time of greatest risk for SARS-CoV-2 infection because of travel and exposure to infected persons. We recommend self-isolation and minimal contact with family members. Nonessential clinic visits should be deferred or substituted with telemedicine consultations if possible. These recommendations are based on our experience at a major transplant center in China. Although some recommendations are evidence based, other recommendations are not and warrant validation in controlled trials.

Contains fulltext : 229465.pdf (Publisher’s version ) (Closed access) BACKGROUND: Deceased donor kidneys are preserved in cold hypoxic conditions. Providing oxygen during preservation might improve post-transplant outcomes, particularly for kidneys subjected to greater degrees of preservation injury. This study aimed to investigate whether supplemental oxygen during hypothermic machine perfusion (HMP) could improve the outcome of kidneys donated after circulatory death. METHODS: This randomised, double-blind, paired, phase 3 trial was done in 19 European transplant centres. Kidney pairs from donors aged 50 years or older, donated after circulatory death, were eligible if both kidneys were transplanted into two different recipients. One kidney from each donor was randomly assigned using permuted blocks to oxygenated hypothermic machine perfusion (HMPO(2)), the other to HMP without oxygenation. Perfusion was maintained from organ retrieval to implantation. The primary outcome was 12-month estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation in pairs of donated kidneys in which both transplanted kidneys were functioning at the end of follow-up. Safety outcomes were reported for all transplanted kidneys. Intention-to-treat analyses were done. This trial is registered with the ISRCTN Registry, ISRCTN32967929, and is now closed. FINDINGS: Between March 15, 2015, and April 11, 2017, 197 kidney pairs were randomised with 106 pairs transplanted into eligible recipients. 23 kidney pairs were excluded from the primary analysis because of kidney failure or patient death. Mean eGFR at 12 months was 50·5 mL/min per 1·73 m(2) (SD 19·3) in the HMPO(2) group versus 46·7 mL/min per 1·73m(2) (17·1) in HMP (mean difference 3·7 mL/min per 1·73m(2), 95% CI -1·0 to 8·4; p=0·12). Fewer severe complications (Clavien-Dindo grade IIIb or more) were reported in the HMPO(2) group (46 of 417, 11%, 95% CI 8% to 14%) than in the HMP group (76 of 474, 16%, 13% to 20%; p=0·032). Graft failure was lower with HMPO(2) (three [3%] of 106) compared with HMP (11 [10%] of 106; hazard ratio 0·27, 95% CI 0·07 to 0·95; p=0·028). INTERPRETATION: HMPO(2) of kidneys donated after circulatory death is safe and reduces post-transplant complications (grade IIIb or more). The 12-month difference in eGFR between the HMPO(2) and HMP groups was not significant when both kidneys from the same donor were still functioning 1-year post-transplant, but potential beneficial effects of HMPO(2) were suggested by analysis of secondary outcomes. FUNDING: European Commission 7th Framework Programme.

Transplant programs have been severely disrupted by the COVID-19 pandemic. Italy was one of the first countries with the highest number of deaths in the world due to SARS-CoV-2. Here we propose a management model for the reorganization of liver transplant (LT) activities and policies in a local intensive care unit (ICU) assigned to liver transplantation affected by restrictions on mobility and availability of donors and recipients as well as health personnel and beds. We describe the solutions implemented to continue transplantation activities throughout a given pandemic: management of donors and recipients’ LT program, ICU rearrangement, healthcare personnel training and monitoring to minimize mortality rates of patients on the waiting list. Transplantation activities from February 22, 2020, the data of first known COVID-19 case in Italy’s Emilia Romagna region to June 30, 2020, were compared with the corresponding period in 2019. During the 2020 study period, 38 LTs were performed, whereas 41 were performed in 2019. Patients transplanted during the COVID-19 pandemic had higher MELD and MELD-Na scores, cold ischaemia times, and hospitalization rates (p < 0.05); accordingly, they spent fewer days on the waitlist and had a lower prevalence of hepatocellular carcinoma (p < 0.05). No differences were found in the provenance area, additional MELD scores, age of donors and recipients, BMI, re-transplant rates, and post-transplant mortality. No transplanted patients contracted COVID-19, although five healthcare workers did. Ultimately, our policy allowed us to continue the ICU’s operations by prioritizing patients hospitalized with higher MELD without any case of transplant infection due to COVID-19.

Background Although recipients and donors in living kidney transplantation experience psychological distress—including depression and anxiety—during the pre-operative period, very few studies have evaluated the related psychological reactions. This study aimed to determine the characteristics and correlations of the mood states and personality of recipients and donors (genetically related and unrelated) of living kidney transplantations. Methods A total of 66 pairs of living donors and recipients were enrolled from April 2008 to June 2019 in this study, of whom 53 eligible pairs of living donors and recipients were included in the retrospective analysis of their psychological assessments in the pre-transplantation states. While participants’ personality patterns were assessed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), mood states were evaluated via both the State-Trait Anxiety Inventory (STAI) and The Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analysis was performed using paired t-tests and Spearman’s correlation analyses. Results The recipient group showed significantly higher scores for Hypochondriasis (t = − 4.49, p = .0001), Depression (t = − 3.36, p = .0015), and Hysteria (t = − 3.30, p = .0018) of MMPI-2 and CES-D (t = − 3.93, p = .0003) than the donor group. The biologically unrelated recipient group reported higher scores of Hypochondriasis (t = − 3.37, p = .003) and Depression (t = − 2.86, p = 0.0098) than the unrelated donor group. Higher scores for Hypochondriasis (t = − 3.00, p = 0.0054) and CES-D (t = − 3.53, p = .0014) were found in the related recipient group. A positive association was found for Hypomania (r = .40, p = .003) of MMPI-2, STAI-S (r = .36, p = .009), and CES-D (r = .36, p = .008) between the recipient and donor groups. Conclusions Recipients suffered from a higher level of depression and somatic concerns than donors before living kidney transplantation. Psychological problems like depression and anxiety can occur in both living kidney transplantation donors and recipients. This study suggests that clinicians must pay attention to mood states not only in recipients but also in donors because of emotional contagion.

One of the main objectives of the European health policy framework is to ensure equitable access to high-quality health services across Europe. Here we examined country-specific kidney transplantation and graft failure rates in children and explore their country- and patient-level determinants. Patients under 20 years of age initiating kidney replacement therapy from January 2007 through December 2015 in 37 European countries participating in the ESPN/ERA-EDTA Registry were included in the analyses. Countries were categorized as low-, middle-, and high-income based on gross domestic product. At five-years of follow-up, 4326 of 6909 children on kidney replacement therapy received their first kidney transplant. Overall median time from kidney replacement therapy start to first kidney transplantation was 1.4 (inter quartile range 0.3-4.3) years. The five-year kidney transplantation probability was 48.8% (95% confidence interval: 45.9-51.7%) in low-income, 76.3% (72.8-79.5%) in middle-income and 92.3% (91.0-93.4%) in high-income countries and was strongly associated with macro-economic factors. Gross domestic product alone explained 66% of the international variation in transplantation rates. Compared with high-income countries, kidney transplantation was 76% less likely to be performed in low-income and 58% less likely in middle-income countries. Overall five-year graft survival in Europe was 88% and showed little variation across countries. Thus, despite large disparities transplantation access across Europe, graft failure rates were relatively similar. Hence, graft survival in low-risk transplant recipients from lower-income countries seems as good as graft survival among all (low, medium, and high risk) graft recipients from high-income countries.

International audience; Background.We aimed to describe the immunosuppressive regimens and graft rejection rates in living-related HLA-identical (LR HLAid) renal transplantation.Methods.We performed a retrospective multicenter analysis of the French national database for LR HLAid renal transplantations performed between 2002 and 2012. Univariate and multivariate analysis were performed to determine risk factors for graft rejection in LR HLAid recipients.Results.A total of 27 218 renal transplantations were performed, of whom 163 had a LR HLAid donor. About immunosuppressive treatment

The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P, SCOPUS: ar.j, info:eu-repo/semantics/published

PURPOSE OF REVIEW Donor hysterectomy for live donor uterus transplantation was from the start performed by laparotomy, but minimal invasive surgery has entered the scene. In particular robotic-assisted laparoscopy is used since robotics is advantageous in the complex donor hysterectomy surgery in narrow space. This review covers the development and benefits of robotics and the published robotic donor hysterectomy experiences. RECENT FINDINGS Robotic donor hysterectomy publications are scarce with eight cases in Sweden, five in USA, and one each in China and Spain. Robotics have been performed for either the entire donor hysterectomy or with conversion to laparotomy for the last steps of the surgical procedure. The total operative times are in line with open surgery, although a decrease is expected in the future. The estimated blood loss and hospital stays are less than at open surgery. The complication panorama includes hydronephrosis, ureteric fistula and pressure alopecia. Live births with healthy babies have been reported. SUMMARY In uterus transplantation, robotic live donor hysterectomy has proven to be feasible, safe and associated with successful live births. The robotic donor hysterectomy is a low-volume procedure and an international registry to gather collective information is crucial for further evaluation and development.

Background: Environmental factors are associated with acquiring multiple sclerosis (MS) particularly in adolescence. Objective: To test for association between MS and exposure to passive smoking at the age of 10–19. Methods: A total of 919 patients from the Danish MS Registry and Biobank and 3419 healthy blood donors who had not smoked before the age of 19 were targeted. We analyzed separately for each sex and for those never-smokers (cohort 1) and active smokers above the age of 19 (cohort 2). All participants completed standardized questionnaires about smoking and lifestyle. We matched cases and controls in the ratio of 1:2 by propensity scores discarding unmatchable individuals and used logistic regression adjusted for all covariates and interactions. Results: After matching, we included 110/213 male cases/controls and 232/377 female case/controls in cohort 1. In cohort 2, the numbers were 160/320 and 417/760, respectively. Among women in cohort 1, the odds ratio (OR) for MS by passive smoking at the age of 10–19 was 1.432 ( p = 0.037) but in men it was 1.232 ( p = 0.39). Among men in cohort 2, OR was 1.593 ( p = 0.022) but among women it was only 1.102 ( p = 0.44). Conclusion: Among never smokers, female MS cases were more often than female controls reported with passive smoking between the age of 10 and 19, and among smokers above the age of 19, male MS patients were more often than male controls reported with passive smoking.

Background and Aims: The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. The aim of this study was to evaluate the post-hepatectomy effect of using N-Acetylcysteine (NAC) infusion in living donors undergoing donor hepatectomy. Methods: In a prospective randomised non-blinded study, 50 healthy donors were enrolled; following hepatectomy patients were randomised into 2 groups: Group NC receiving NAC 150 mg/kg diluted in 100 ml glucose 5% over 40 minutes, followed by NAC 12.5 mg/kg in 500 ml glucose 5% over 4 hours. This was followed by NAC 6.25 mg/kg for 2 post-operative days, Group C (Control group) received ringer acetate infusion at same rate for 2 days. The primary outcome was serum lactate levels. Secondary outcomes were liver function tests, serum creatinine and urine output on intensive care unit (ICU) admission (0 hr.), after 24 hours and 48 hours, length of ICU stay. Results: Our study revealed significant reduction in serum lactate in Group NC at 0, 24 and 48 hours compared to C group (P = 0.017, 0.002, 0.014). INR values showed significant reduction after 48 hours in Group NC compared to Group C (P = 0.049). Total Bilirubin, ALT, and Creatinine, urine output and ICU stay showed no statistical difference between the 2 groups. Conclusion: The NAC protocol is a safe, cost-effective tool for improvement of post hepatectomy liver function and early stabilisation of the metabolic profile.

We report the use of two corneal grafts derived from a donor, with a history of early stage keratoconus, for lamellar and penetrating keratoplasty. The first graft was used to perform Descemet stripping automated endothelial keratoplasty (DSAEK) in a patient with endothelial dysfunction and advanced pseudoexfoliative glaucoma. The second graft was used for an emergency penetrating keratoplasty in a patient with corneal perforation secondary to uncontrolled herpes keratitis. In the first case, 1 year postoperatively, the graft was clear and attached with no signs of rejection or failure. In the second case, the perforation did not relapse after keratoplasty and the globe retained its structural integrity during the 1-year follow-up.

We present four cases of fingertip amputation treated with local flap where the avulsed fingertip skin could be effectively utilized for these donor sites. The avulsed finger skin may be utilized even when replantation is not possible. This approach may serve as a new treatment option after fingertip amputation.

Acyl-coenzyme A: cholesterol acyltransferase 1 (ACAT1) is an enzyme that converts cholesterol to cholesteryl esters. A recent in vivo study reported that inhibiting ACAT1 enzyme activity upregulates the membrane cholesterol levels of T cells, enhancing their cytotoxic function. In the present study, we investigated whether the presence of the ACAT1 single nucleotide polymorphism rs11545566 in transplant donors affected the risk of graft-versus-host disease (GVHD) in 116 adult patients who underwent bone marrow transplantation from human leukocyte antigen-identical sibling donors, and who received GVHD prophylaxis with short-term methotrexate and cyclosporine. The frequencies of the AA, AG, and GG genotypes in the donors were 31%, 45%, and 24%, respectively. The cumulative incidences of grade II–IV acute GVHD on day 100 in patients whose donors had AA vs. non-AA genotypes were 6% and 18%, respectively, and those of extensive chronic GVHD at 2 years were 7% and 32%, respectively. Multivariate analyses demonstrated that donor rs11545566 non-AA genotypes showed a trend toward a higher incidence of grade II–IV acute GVHD (P = 0.079), and were significantly associated with a higher incidence of extensive chronic GVHD (P = 0.021). These results suggest that donor ACAT1 rs11545566 genotype may be predictive of GVHD., ファイル公開：2021/01/01

Platelet transfusion is used to prevent bleeding in patients with thrombocytopenia or platelet dysfunction. Purpose of investigating demographic characteristics of eligible volunteers as platelet donors and of demonstrating the association of platelet counts with blood groups as well as other factors. We used data of individuals who referred to a blood center in our hospital. Age, body weight, body mass index (BMI), and gender were determined, and than hemogram values such as leukocyte, hemoglobin, hematocrit, and platelet and ABO blood types of those individuals were identified. A statistically significant difference determined for height, body weight, and BMI in both genders. Although BMI was lower in the group of platelet count ≤ 250, it was higher in a group of platelet count > 250. Furthermore, platelet count was more moderate in blood group O Rh-positive but, no significant difference was group O Rh-negative. Platelet count was higher in other Rh-positive blood groups than Rh negatives. BMI is vital in apheresis donors, and individuals with higher BMI values may prefer in case of double dose or more apheresis need. The determination of platelet counts in Rh positives is more elevated than Rh negatives.

Introduction:The aim of this study was to retrospectively evaluate the brain death (BD) cases in our pediatric intensive care unit (PICU) within a period of two years.Methods:The patients with a diagnosis of BD between January 2016 and October 2017 were analyzed retrospectively. Demographic characteristics, diagnoses, BD detection time, additional tests, family’s consent to organ donation and donation rate, hospitalization day and routine laboratory data on the diagnosis day and insulin-desmopressin-vasopressor/inotropic infusions were recorded.Results:Twelve patients were diagnosed with BD. The mean age was 6.18±1.3 years. The most frequent diagnosis was post-traumatic BD (73%) in our PICU. Apnea testing was performed in all cases and radiological imaging methods were used in 36% (n=4) to support the diagnosis. The donation rate was 27% (n=3). Nine patients (82%) received vasopressor for hypotension, 5 (46%) received insulin for hyperglycemia, and 3 (27%) had desmopressin therapy for diabetes insipidus. Tests were performed in 82% of patients (n=9) for the diagnosis of BD in the first week of hospitalization. When the laboratory data and infusion status were compared on the day of hospitalization and on the day of diagnosis, similar results were found except for potassium and platelet count.Conclusion:When clinical evaluation is not sufficient in the diagnosis of BD, examination findings should be supported by laboratory tests. In the process for determining BD, a very rigorous general care and monitoring should be done. We believe that laboratory parameters should be closely monitored in cases diagnosed with BD.

Background: Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT). ----- Case summary: A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination. ----- Conclusion: The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.

Background The donor’s mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient. Methods All patients who underwent HTx between 1996 and 2017 were categorized according to donor’s BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD). Results The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42–0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51–0.85, p = 0.022). Conclusion Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.

Fecal microbiota transplantation (FMТ) is a robust and effective method for treating of the recurrent Clostridium difficile infection (CDI). The main pathogenetic mechanisms, explaining FMT efficacy in the treatment of CDI, have been elucidated. The review is focused on the analysis of provisions of the practical guidelines on FMT conduction in clinical practice with the detalization of donors’ selection, recipients’ preparation, and methods of FMT management. Nowadays, the range of FMT applications is rapidly extending and covers not only gastrointestinal pathologies, but also extra-gastrointestinal diseases. The donors’ selection with the use of questionnaire, interview, blood tests, and stool examinations should be strictly performed before FMT to reduce and prevent occurrence of any adverse events. Step-by-step and thorough preparation of the feces and recipients along with the adequate choice of the delivery methods based on the individual clinical situations are the key points of the FMT process. Currently, the CDI treatment is based on the immediate antibiotics’ cancellation, as these medications may provoke CDI recurrence. Either vancomycin or fidaxomicin is recommended rather than metronidazole for an initial episode of CDI. The vancomycin dose is 125 mg orally 4 times per day or fidaxomicin 200 mg twice a day for 10 days. The recommended metronidazole dose is 500 mg orally 3 times a day for 10 days. FMT is recommended for patients with multiple recurrences of CDI who have failed appropriate antibiotic treatments. The data of evidence-based medicine confirm that FMT is a generally safe therapeutic method with low number of side effects., Трансплантация фекальной микробиоты (ТФМ) является надежным и эффективным методом лечения рекуррентной инфекции Clostridium difficile. Освещены несколько основных патогенетических механизмов, объясняющих эффективность ТФМ в лечении инфекции C. difficile. Основной акцент сделан на анализе положений практических руководств по проведению ТФМ в клинической практике с детализацией требований, предъявляемых к отбору доноров, подготовке реципиентов и способам введения ТФМ. В настоящее время спектр показаний к проведению ТФМ активно расширяется и охватывает не только патологию желудочно-кишечного тракта, но и внекишечные заболевания. Отбор доноров с использованием специального опросника, собеседования и выполнением анализов крови и кала в обязательном порядке следует проводить перед ТФМ с целью уменьшения риска и предотвращения любых нежелательных явлений. Пошаговая тщательная подготовка фекалий и реципиентов наряду с адекватным выбором способа доставки являются ключевыми моментами в проведении ТФМ. Ныне терапия инфекции C. difficile базируется на незамедлительной отмене антибиотика, вызвавшего заболевание, так как он может спровоцировать рецидив заболевания. Для лечения первоначального эпизода инфекции C. difficile рекомендуют назначать ванкомицин или фидаксомицин, а не метронидазол. Доза ванкомицина составляет 125 мг перорально 4 раза в сутки, фидаксомицина — 200 мг 2 раза в сутки на протяжении 10 дней. Рекомендованная доза метронидазола — 500 мг перорально 3 раза в сутки на протяжении 10 дней. ТФМ рекомендована пациентам с множественными рецидивами инфекции C. difficile, не ответившими на адекватную антибиотикотерапию. Данные доказательной медицины подтверждают, что ТФМ является относительно безопасным терапевтическим методом лечения с небольшим количеством побочных действий., Трансплантація фекальної мікробіоти (ТФМ) є надійним та ефективним методом лікування рекурентної інфекції Clostridium difficile. Висвітлено кілька основних патогенетичних механізмів, які пояснюють ефективність ТФМ при лікуванні інфекції C. difficile. Основний акцент в огляді зроблено на аналізі положень практичних настанов з проведення ТФМ у клінічній практиці з деталізацією вимог, які пред’являють до відбору донорів, підготовки реципієнтів, способів введення ТФМ. Нині спектр показань до проведення ТФМ активно розширюється та охоплює не лише патологію шлунково-кишкового тракту, а і позакишкові захворювання. Відбір донорів з використанням спеціального опитувальника, співбесіди і виконання аналізів крові та калу обов’язково слід проводити перед ТФМ з метою зменшення ризику і запобігання будь-яким небажаним явищам. Покрокова ретельна підготовка фекалій та реципієнтів поряд з адекватним вибором способу доставки є ключовими моментами у проведенні ТФМ. Нині терапія інфекції C. difficile ґрунтується на негайній відміні антибіотика, який спричинив захворювання, тому що він може спровокувати рецидив захворювання. Для лікування первинного епізоду інфекції C. difficile рекомендують призначити ванкоміцин або фідаксоміцин, а не метронідазол. Доза ванкоміцину становить 125 мг перорально 4 рази на добу, фідаксоміцину — 200 мг двічі на добу протягом 10 днів. Рекомендована доза метронідазолу становить 500 мг перорально тричі на добу протягом 10 днів. ТФМ рекомендована пацієнтам з множинними рецидивами інфекції C. difficile, які не відповіли на адекватну антибіотикотерапію. Дані доказової медицини підтверджують, що ТФМ є відносно безпечним терапевтичним методом лікування з невеликою кількістю побічних дій

Background Human milk is the best nutrition for all infants. When this is not available, the use of donor human milk through human milk banks (HMBs), is recommended. The aim of the study is to explore Italian women's knowledge and attitude towards human milk donation and HMB. Methods A web-based self-administered 20-item questionnaire was developed based on the literature review and distributed via the social networking site Facebook. Results 3290 women completed the survey. Of those 76.57% knew about the opportunity to donate human milk and 72.37% were aware of the existence of HMBs, most of them breastfed for more than 6 months. Altruism towards other mothers and having an abundant milk supply, were found to be the most important facilitators that should lead women to donate their own milk. The most important barrier was lack of information (91.25%). A high rate of women who breastfed longer than 6 months expressed issues related to collection and transportation; concerns regarding the time needed to express was reported mainly by women currently breastfeeding. Conclusions This is the first Italian study to investigate this topic. Advertising to inform the general public should be used to increase awareness, short sessions within the school programme might sensitize women from a very young age. Healthcare professionals should strive to divulgate appropriate information.

INTRODUCTION Blood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to emerging infections. We describe the use of blood donor specimens to track the 'first-wave' of the COVID-19 pandemic in Ireland. METHODOLOGY A random selection of donor samples received by the Irish Blood Transfusion Service (IBTS) between February and September 2020 (n = 8,509) were screened by multiple commercial SARs-CoV-2 antibody assays. The antibody detection rate was adjusted to the population to determine the SARS-CoV-2 seroprevalence in Ireland. RESULTS SARS-CoV-2 antibody detection rose significantly during the first peak of COVID-19 infection, increasing from 0.3% in March, to 2.9% in April (p

Hydrogen sulfide (H2S) has been recognized as the third gasotransmitter, following nitric oxide and carbon monoxide, and it exerts important biological effects in the body. Growing evidence has shown that H2S is involved in many physiological processes in the body. In recent years, much research has been carried out on the role of H2S in bone metabolism. Bone metabolic diseases have been linked to abnormal endogenous H2S functions and metabolism. It has been found that H2S plays an important role in the regulation of bone diseases such as osteoporosis and osteoarthritis. Regulation of H2S on bone metabolism has many interacting signaling pathways at the molecular level, which play an important role in bone formation and absorption. H2S releasing agents (donors) have achieved significant effects in the treatment of metabolic bone diseases such as osteoporosis and osteoarthritis. In addition, H2S donors and related drugs have been widely used as research tools in basic biomedical research and may be explored as potential therapeutic agents in the future. Donors are used to study the mechanism and function of H2S as they release H2S through different mechanisms. Although H2S releasers have biological activity, their function can be inconsistent. Additionally, donors have different H2S release capabilities, which could lead to different effects. Side effects may form with the formation of H2S; however, it is unclear whether these side effects affect the biological effects of H2S. Therefore, it is necessary to study H2S donors in detail. In this review, we summarize the current information about H2S donors related to bone metabolism diseases and discuss some mechanisms and biological applications.

At present, there is unclear evidence on the need for a negative SARS‐CoV‐2 RT‐PCR for donors with a history of COVID‐19 prior to transplantation 1,2. We report two cases of heart and liver recipients from a donor with previous documented COVID‐19 and positive RT‐PCR at time of transplantation.

Background Patients with adult congenital heart disease (ACHD) experience long waitlist times for heart transplantation (HTx) while a large proportion of donor hearts are refused. The goal of this study was to inform optimal donor selection for patients with ACHD listed for HTx by examining the impact of donor characteristics on post‐HTx outcomes. Methods and Results Using the Scientific Registry of Transplant Recipients, we conducted a retrospective analysis of patients aged ≥18 years listed for HTx in the United States between 2000 and 2016. We compared waitlist times between patients with ACHD and patients with noncongenital heart disease and constructed multivariate hazard models to identify donor characteristics associated with increased waitlist time. We then compared post‐HTx survival between patients with ACHD and patients with noncongenital heart disease and constructed multivariate hazard models to identify donor characteristics associated with mortality. There were very few differences in donor characteristics between HTx recipients with ACHD and those with noncongenital heart disease. Status 1A–listed patients with ACHD experienced longer waitlist times compared with patients with noncongenital heart disease. Increased wait times were associated with some donor characteristics. Post‐HTx outcomes varied over time, with patients with ACHD having inferior early mortality (0 to 30 days), similar intermediate mortality (31 days to 4 years), and superior late mortality (>4 years). We identified no donor characteristics associated with mortality to justify the observed differences in donor selection or waitlist time. Conclusions HTx candidates with ACHD wait longer for transplant but do not require unique donor selection criteria. HTx teams should consider liberalizing donor criteria and focusing only on evidence‐based selection to improve waitlist outcomes and reduce the recipient–donor disparity.

Background: Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease with abdominal pain, mucus, pus and blood in the stool as the main clinical manifestations. The pathogenesis of UC is still not completely clear, and multiple factors, such as genetic susceptibility, immune response, intestinal microecological changes and environmental factors, together lead to the onset of UC. In recent years, the role of intestinal microbiota disturbances on the pathogenesis of UC has received widespread attention. Therefore, fecal microbiota transplantation (FMT), which changes the intestinal microecological environment of UC patients by transplantation of normal fecal bacteria, has attracted increasing attention from researchers. However, there are no guidelines to recommend fresh FMT or frozen FMT in the treatment of UC, and there are few studies on this. Therefore, the purpose of this study was to explore the effects of fresh and frozen FMT methods on the treatment of experimental UC models in rats.Results: Compared with the model control group, all FMT groups achieved better efficacy, mainly manifested as weight gain by the rats, improvements in fecal characteristics and blood stools, reduced inflammatory factors and normal bacterial microbiota. The efficacy of the frozen FMT group was better than that of the fresh FMT group in terms of behavior and colon length.Conclusion: FMT method supplements the gut microbiota with beneficial bacteria, such as short-chain fatty acid-producing bacteria. These bacteria can regulate intestinal function, protect the mucosal barrier and reduce harmful bacteria, thus mitigating the damage to the intestinal barrier and the associated inflammatory response, resulting in UC remission. FMT is a feasible method for treating UC, with frozen FMT having a superior therapeutic effect than that of fresh FMT.

ObjectiveOne of the main problems of lung transplantation is the shortage of organs as well as reduced survival rates. In the absence of an international standardized model for lung donor-recipient allocation, we set out to develop such a model based on the characteristics of past experiences with lung donors and recipients with the aim of improving the outcomes of the entire transplantation process.MethodsThis was a retrospective analysis of 404 lung transplants carried out at the Reina Sofía University Hospital (Córdoba, Spain) over 23 years. We analyzed various clinical variables obtained via our experience of clinical practice in the donation and transplantation process. These were used to create various classification models, including classical statistical methods and also incorporating newer machine-learning approaches.ResultsThe proposed model represents a powerful tool for donor-recipient matching, which in this current work, exceeded the capacity of classical statistical methods. The variables that predicted an increase in the probability of survival were: higher pre-transplant and post-transplant functional vital capacity (FVC), lower pre-transplant carbon dioxide (PCO2) pressure, lower donor mechanical ventilation, and shorter ischemia time. The variables that negatively influenced transplant survival were low forced expiratory volume in the first second (FEV1) pre-transplant, lower arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, bilobar transplant, elderly recipient and donor, donor-recipient graft disproportion requiring a surgical reduction (Tailor), type of combined transplant, need for cardiopulmonary bypass during the surgery, death of the donor due to head trauma, hospitalization status before surgery, and female and male recipient donor sex.ConclusionsThese results show the difficulty of the problem which required the introduction of other variables into the analysis. The combination of classical statistical methods and machine learning can support decision-making about the compatibility between donors and recipients. This helps to facilitate reliable prediction and to optimize the grafts for transplantation, thereby improving the transplanted patient survival rate.

Summary OBJECTIVE: This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon’s learning curve on these parameters. METHODS: This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21–72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. RESULTS: Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p

Toxoplasma gondiiis the organism that is responsible for toxoplasmosis disease.Toxoplasma gondii: is a crucial obligate intracellular parasite of humans and animals worldwide and infects nearly one-third of humanity; the disease can be severe and can lead to abortion or neonate’s death. In addition, an immunocompromised individual may develop several syndromes such as encephalitis, chorioretinitis, congenital infection and neonatal mortality. In this study, our objective is to determine the prevalence ofToxoplasma gondiiantibodies through blood transfusion. Therefore, our study was conducted from 1 May 2010 to 31 of May 2010 among Libyan donors. We tested 164 blood donors from different ages forToxoplasma gondiiantibodies in Tripoli, a capital city of Libya. The results showed that 33.5% of blood donors had positive IgG antibodies. Therefore, this study suggest blood screening with high-performance techniques forToxoplasma gondiibefore blood transfusion should be routinely done to avoid severe complications.&nbsp

Background Delayed graft function (DGF) is the most common early postoperative complication of renal transplantation. The occurrence of DGF can lead to both early and late devastating consequences on the allograft’s survival. The risk of developing this complication can increase with certain factors that are related to both the donor and the recipient. In the present study, we aimed to detect the incidence rate of DGF among patients attending a tertiary care hospital in Riyadh, Saudi Arabia, and to investigate potential predictors of DGF. Materials and methods This retrospective chart review was conducted at King Abdulaziz Medical City (KAMC), a tertiary care hospital in Riyadh, Saudi Arabia. The inclusion criteria were all patients, 18 years or older, who had renal transplantation from January 1, 2016, to March 31, 2020. Patients who had a second renal transplant, or renal transplantation in a different hospital and were followed up at KAMC were excluded. Patients’ medical records were accessed using the BESTCare electronic system to obtain the patients’ demographic data. A Chi-square test was used to test for the association between a predictor and a delay in graft function. Results A total of 344 patients were enrolled in the present study, approximately half of whom were males (56.6%, n=189). Around one-half (49.4%) were aged between 40 and 64 years. The most common cause of renal failure was hypertension, which was found in 117 (35%) patients, followed by diabetes mellitus (DM) in 94 (28.1%) patients. Most organ donors 258 (77.2%) were alive. A total of 23 (6.9%) participants developed DGF. Mycophenolate mofetil (MMF) was found to be significantly associated with DGF (P < 0.001). Those who took MMF (5.9%) had a significantly lower rate of DGF compared to those who did not (36.4%). A significantly higher rate of DGF was seen in patients whose transplants were taken from deceased donors (15.5%) compared to living donor transplants (3.9%). Gender, age, body mass index (BMI), recipient blood type, donor blood type, and cause of renal failure were not associated with DGF. Conclusions Only 6.9% of the study’s participants exhibited DGF. The observed rate was lower than the ones detected in the literature. Those who took MMF had a significantly lower rate of DGF compared to those who did not. Transplants of deceased donors (15.5%) showed a significantly higher rate of DGF. Larger multicenter studies are required to further investigate DGF in a region with a high prevalence of organ failure and a higher need for transplantations, such as Saudi Arabia.

IntroductionChronic lung allograft dysfunction (CLAD) represents the major impediment to long term survival following lung transplantation. Donor and recipient telomere length have been shown to associate with lung transplant outcomes, including CLAD. In this study we aimed to measure the telomere lengths of bronchial and bronchiolar airway cells in lung allografts early after transplantation and to investigate associations with CLAD and all-cause mortality.MethodsThis prospective, longitudinal study was performed at The Prince Charles Hospital, Australia. Airway cells were collected via bronchial and bronchiolar airway brushings at post-transplant bronchoscopies. The relative telomere length in airway cells was determined by quantitative PCR based on the T/S ratio. All patients were censored for CLAD and all-cause mortality in August 2020.ResultsIn total 231 bronchoscopies incorporating transbronchial brush and bronchial brush were performed in 120 patients. At the time of censoring, 43% and 35% of patients, respectively, had developed CLAD and had died. Airway bronchiolar and bronchial telomere lengths were strongly correlated (r=0.78, pConclusionsIn this cohort, airway telomere length was associated with donor age and smoking history but was not associated with the future development of CLAD or all-cause mortality.

Introduction As many as 50% of U.S. transplant centers do not accept kidney donor candidates with hypertension, citing the link between hypertension, kidney disease, and cardiovascular disease (CVD). Methods We ascertained mortality, CVD, proteinuria, estimated glomerular filtration rate (eGFR) trajectory, reduced eGFR, and end-stage kidney disease (ESKD) in 904 hypertensive donors (blood pressure [BP] ≥140/90 mm Hg or receiving treatment) versus 7817 donors with BP, Graphical abstract

Objective: It is estimated that twin-to-twin transfusion syndrome (TTTS) occurs in 10–15% of monochorionic twin pregnancies. One of the fetuses takes on the role of donor and the other of recipient. The treatment administered involves serial amnioreduction and laser photocoagulation of the communicating blood vessels. After TTTS, children may have deficiencies in psychomotor functioning, in particular in cognitive functions, expressive language, and motor skills. Few scientific reports indicate that twins after TTTS do not demonstrate significant differences in tests which measure intellectual functioning. Methods: The cognitive functioning of twins in the late childhood period was compared using the following tools: an analysis of their medical history, an interview with their parents, and neuropsychological tests allowing the evaluation of their whole profile of cognitive functions. Case Study: Cognitive functioning in the late childhood period was analyzed in a pair of 11-year-old male twins (juvenile athletes), a donor and a recipient, who had developed TTTS syndrome in the prenatal period. Results: Comparison of the cognitive functioning profile of the donor and recipient revealed that children with a history of TTTS develop normally in terms of cognitive and motor functioning in late childhood. A comparative analysis of the donor and recipient was more favorable for the recipient, who had a higher level of general intelligence, visual–motor memory, and semantic fluency. Conclusions: The fact that both the donor and the recipient chose to pursue athletics suggests that gross motor skills are their strongest suit. Playing sports as a method of rehabilitation of cognitive function of children born prematurely after TTTS could contribute to the improvement of cognitive functioning.

Background and objectiveSaving blood products is an important public health issue especially in developing countries with limited financial resources. We aimed to suggest a new hypothetical model to make a change in the current blood transfusion policy in the newborn intensive care unit (NICU) to reduce wastage of blood supplies as well as the risk of exposure to multiple donors.MethodsIn this cross-sectional study, all transfused neonates (n = 70) who were admitted to NICU of Nemazee Hospital, a tertiary referral hospital in Southern Iran, were evaluated between March and June 2019. Based on the information of neonates’ transfusion during this study period and determined transfusion indices, a specific pediatric pack was suggested and the related total costs per transfusion, as well as the donor-exposure rate of the hypothetical and the current transfusion method, were compared.ResultsConsidering the mean number of transfusions per neonate: 4 and mean volume of transfused packed red cells: 20 ml per transfusion, the cost-analysis of pediatric and the adult pack was presented. Arithmetically, we proved a higher total cost per transfusion for using adult pack comparing to pediatric pack. Additionally, using a pediatric pack set leads to a 24% reduction in RBCs wastage per transfusion and a 68.13% reduction in donor-exposure rate.ConclusionsThe assignment of a dedicated pediatric pack for neonates will be able to improve the cost-effectiveness by a substantial reduction in donor-exposure rate and blood wastage. This finding should be taken into consideration to generate economic growth and make improvements in child health status.

Organ transplantation is the process of moving an organ from one body to another or from a donor site to another location on the person's own body. It is often the only treatment for end stage organ failure, such as liver and heart failure. In such crucial procedures, Human Leukocyte Antigen (HLA) plays an insignificant role in matching donors with the organ needing a patient. It is a complex process that can be done at different levels of detail. The aim of the study is to review the HLA typing & its influence on organ transplantation. The objective of this study is to understand HLA typing, to explore the methods used in HLA typing and to determine the role of HLA typing in organ transplantation. Many organ transplant patients or guardians fail to recognize the importance of undergoing factors such as HLA typing before accepting a donor which leads to a misunderstanding of the Doctor in-charge. This may even further damage a good doctor-patient relationship. Thus, it will be advantageous bringing an awareness to such a group of people.

Summary The Heart Donor Score (HDS) predicts donor organ discard for medical reasons and survival after heart transplantation (HTX) in the Eurotransplant allocation system. Our aim was to adapt the HDS for application in the United Network for Organ Sharing (UNOS) registry. To adjust for differences between the Eurotransplant and UNOS registries, the “adapted HDS” was created (aHDS) by exclusion of the covariates “valve function,” “left‐ventricular hypertrophy,” and exclusion of “drug abuse” from the variable “compromised history.” Two datasets were analyzed to evaluate associations of the aHDS with donor organ discard (n = 70 948) and survival (n = 19 279). The aHDS was significantly associated with donor organ discard [odds ratio 2.72, 95% confidence interval (CI) 2.68–2.76, P

A new coronavirus SARS‐CoV‐2 emerged at the start of 2020 with rapid worldwide spread. It is the causative agent of Coronavirus Disease 2019 (COVID‐19). The resulting pandemic has been challenging for centres undertaking autologous and allogeneic haematopoietic stem cell transplants (HSCT). One of the main risks in HSCT is infection susceptibility, including viral infections, which are often more severe and life‐threatening.1\ud \ud \ud In response to the COVID‐19 pandemic, the National Institute for Health and Care Excellence (NICE) published the first version of the COVID‐19 rapid guideline for HSCT (NG164) on 1 April 20202; this was updated on 29 July 2020 in response to the changing context of the pandemic. The British Society of Blood and Marrow Transplantation and Cellular Therapy (BSBMTCT) and the European Society for Blood and Marrow Transplantation (EBMT) also developed detailed guidance to support transplant centres.3-5\ud \ud \ud This paper describes the development and update processes for NICE NG164, detailing the rationale behind the recommendations, implementation and the impact of COVID‐19 on HSCT activity in the UK compared with 2019, based on registrations in the BSBMTCT registry. The full NICE guidance can be obtained from: https://www.nice.org.uk/guidance/ng164.

The HLA-DPB1 locus has been demonstrated to have a significant role on patients' outcome after allogeneic HSCT, and the so-called T-cell epitope (TCE) algorithm has been incorporated in international guidelines for the selection of unrelated donors. The purpose of the present study is to measure, through a national survey conducted on behalf of the Associazione Italiana di Immunogenetica e Biologia dei Trapianti (AIBT), the extent of awareness and use of HLA-DPB1 TCE-based algorithms during the donor search. 89% of the HLA laboratories answered to a short questionnaire and the results showed a progressive increase of the laboratories typing DPB1 in patients and their potential donors during the search (from 44% to 79% during the 2010-2019 period) as well as the application of a TCE-based algorithm for the donor choice whenever possible (from 24% to 65% during the same period). The DP-permissiveness status is detailed in the official HLA typing report by 12%, 32% and 50% of laboratories in 2010, 2015 and 2019, respectively. The present data indicate an encouraging raise in the awareness of the HLA-DPB1 role in unrelated donor selection; noteworthy, mentioning the TCE-based permissiveness status in the HLA typing report of each potential unrelated donor represents a notable mean to raise awareness among transplant physicians and to support them in their task of choosing the best donor. Nonetheless, despite the compelling evidence of the predictive ability of TCE-based algorithms, further efforts are still needed to extend its application to all transplant centers in Italy.

Kidney donor with Down syndrom.

OBJECTIVES A heart transplant (Htx) remains the gold standard treatment for patients with advanced heart failure. Considering the limited availability of organs, donor risk scores might improve organ selection and allocation. The objective of the study was to compare United Network for Organ Sharing, RADIAL and Eurotransplant scoring models in calculating post-Htx outcomes in an Italian Htx population. METHODS Between January 2000 and December 2017, a total of 461 adult patients underwent Htxs. United Network for Organ Sharing, RADIAL and Eurotransplant scores were calculated. Clinical features and donor risk scores were tested to identify preoperative, intraoperative and postoperative risk variables and eventually validate the scores on our population. RESULTS Early graft failure was detected in 16.1% (74/461). Post-Htx extracorporeal life support was used in 11.1% (51/461). Of the donor-related factors, the use of noradrenaline (P = 0.015) negatively influenced early outcomes, whereas an ischaemic time >240 min (P = 0.037) influenced early graft failure occurrence. The Eurotransplant donor score did not impact outcomes; the RADIAL score significantly influenced both early and late mortality; and the United Network for Organ Sharing score influenced only late mortality. On the multivariable analysis, after adjustment of scores per cohort, noradrenaline infusion was the main independent predictor of in-hospital mortality for the donors, whereas age of the recipient [odds ratio (OR) 1.003, 1.003–1.081; P = 0.032] and use of preoperative extracorporeal membrane oxygenation (OR 3.320, 1.124–9.805; P = 0.030) were the main independent predictors for the recipients. CONCLUSIONS None of the validated donor scoring systems fully behave as reliable predictors of transplant outcomes. According to our ‘local only’ graft selection, specific donor and recipient risk variables should be monitored in order to predict early and late outcomes satisfactorily.

BACKGROUND N-acetylcysteine infusions have been widely used to reduce ischemia/reperfusion damage to the liver; however, convincing evidence of their benefits is lacking. OBJECTIVE To perform the largest randomized controlled trial to compare the impact of N-acetylcysteine infusion during liver procurement on liver transplant outcomes. METHODS Single center, randomized trial with patients recruited from La Fe University Hospital, Spain, from February 2012 to January 2016. A total of 214 grafts were transplanted and randomized to the N-acetylcysteine group (n = 113) or to the standard protocol without N-acetylcysteine (n = 101). The primary endpoint was allograft dysfunction (Olthoff criteria). Secondary outcomes included metabolomic biomarkers of oxidative stress levels, interactions between cold ischemia time and alanine aminotransferase level and graft and patient survival (ID no. NCT01866644). RESULTS The incidence of primary dysfunction was 34% (31% in the N-acetylcysteine group and 37.4% in the control group [P = 0.38]). N-acetylcysteine administration reduced the alanine aminotransferase level when cold ischemia time was longer than 6 h (P = 0.0125). Oxidative metabolites (glutathione/oxidized glutathione and ophthalmic acid) were similar in both groups (P > 0.05). Graft and patient survival rates at 12 mo and 3 y were similar between groups (P = 0.54 and P = 0.69, respectively). CONCLUSIONS N-acetylcysteine administration during liver procurement does not improve early allograft dysfunction according to the Olthoff classification. However, when cold ischemia time is longer than 6 h, N-acetylcysteine improves postoperative ALT levels.

Background We aimed to examine whether combined donor/recipient variants in the leptin receptor (LEPR) and adiponectin (ADIPOQ) genes may affect outcomes in renal transplantation. Methods A total of 233 donors and their corresponding 307 recipients were genotyped for LEPR rs1805094, rs1137100 and rs1137101, and ADIPOQ rs1501299 and rs224176. Combined donor/recipient genetic scores were created to investigate associations with delayed graft function (DGF), graft loss and estimated glomerular filtration rate (eGFR). Results Recipients whose donors carried variant alleles of LEPR rs1137100 and rs1137101 had lower risk of DGF [OR = 0.48 (0.24–0.97), p = 0.040] and [OR = 0.47 (0.23–0.95), p = 0.035], respectively. In addition, rs1137101 also showed an inverse association with lower incidence of graft loss [OR = 0.44 (0.31–0.97), p = 0.040]. The analysis of genetic scores of donor/recipients showed that again rs1137101 was inversely associated with both outcomes: OR = 0.46 (0.23–0.92), p = 0.029 and OR = 0.45 (0.11–0.81), p = 0.009, respectively. With regard to graft function, the T-allele of ADIPOQ rs1501299 in the donor was related to higher eGFR values (75.26 ± 29.01 vs. 67.34 ± 25.39 ml/min for wild-type grafts, p = 0.012). Higher combined genetic scores in this same polymorphism were also associated with better function (78.33 ± 31.87 vs. 68.25 ± 24.32 ml/min, p = 0.018). Finally, eGFR values were similar between paired kidneys but they were different when comparing grafts with or without the rs1501299 T-variant (77.87 ± 26.50 vs. 69.27 ± 26.73 ml/min, p = 0.016). Conclusions Our study has shown for the first time to our knowledge that variants in LEPR and ADIPOQ genes of the donors and/or their combination with those in the recipients may affect the outcome of renal transplantation.