Deceased organ donor factors influencing pancreatic graft transplantation and survival
| العنوان: | Deceased organ donor factors influencing pancreatic graft transplantation and survival |
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| المؤلفون: | Michael P. Hutchens, Tahnee Groat, Claus U. Niemann, Elizabeth A. Swanson, Mitchell B. Sally, Margaret Katherine Ellis, Darren Malinoski, Madhukar S. Patel |
| المصدر: | Clin Transplant |
| بيانات النشر: | Wiley, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, Organ procurement organization, Brain Death, medicine.medical_specialty, Tissue and Organ Procurement, medicine.medical_treatment, 030230 surgery, Pancreas transplantation, Article, Donor Selection, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, medicine, Humans, Prospective Studies, Intensive care medicine, Transplantation, Type 1 diabetes, business.industry, Insulin, Middle Aged, Prognosis, medicine.disease, Tissue Donors, Survival Rate, medicine.anatomical_structure, Female, 030211 gastroenterology & hepatology, Pancreas Transplantation, Solid organ, Pancreas, business, Follow-Up Studies |
| الوصف: | Pancreatic transplantation has become a standard of care for complicated type 1 diabetes therapy. In the United States in 2015, there were approximately 1000 patients awaiting pancreas transplant, with the percentage of active listings at 65%, the highest in decades.1 Solid organ pancreata can be transplanted individually, after a kidney transplant (pancreas-after-kidney [PAK]), or with a simultaneous pancreas-kidney (SPK) transplant. As diabetes is cited as a major, in- creasing public health burden,2 pancreas transplant has been recommended by the American Diabetes Association and other national guidelines as an accepted treatment, particularly when coupled with end-stage renal disease.3 Benefits to pancreas transplantation, SPK, and PAK are well described, having both improvements in mortality when compared to those on the waiting list4 and better overall glycemic control, reducing number of hypoglycemic episodes compared to those on insulin regimens.5 In addition, pancreas transplantation has been shown to delay secondary complications of diabetes, such as cardiovascular disease6 and nervous system complications.7 Despite these demonstrated advantages for pancreatic transplantation, only approximately 10% of available organs are recovered from donors after brain death (DBD). Additionally, there has been an overall decline in pancreatic transplantation over the past decade.8 In pancreatic transplantation, inconsistent donor management and organ acceptance practices are pervasive. Potentially contributing to this lack of consistency in donor management is the fact that the current risk-adjustment models used to predict both organ procurement organization (OPO) donor pancreas utilization and transplant center graft survival models lack detailed donor critical care data. In an effort to increase standardization and data collection, several OPOs have collaborated to develop a checklist of critical care endpoints to guide the bedside care of potential organ donors. These endpoints are also known as donor management goals (DMGs), and they represent normal hemodynamic, respiratory, renal, acid-base, and endocrine parameters for an organ donor. Multiple studies have shown improvements in both organ utilization rates9–13 and recipient graft outcomes14–16 when these goals are met. The link between optimal management of the potential organ donor after brain death (DBD) and pancreatic graft utilization and function has not yet been explored in the literature, and we sought to further elucidate this relationship using a deceased organ donor database containing demographic and critical care data at 4 time points during donor management. Given anecdotal reports of insulin requirements being used as criteria for pancreatic acceptance or denial, we also sought to determine the relationship between insulin dose and pancreatic usage and function. |
| تدمد: | 1399-0012 0902-0063 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1e750e53a55a22d3518043f280ae1c1bTest https://doi.org/10.1111/ctr.13571Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1e750e53a55a22d3518043f280ae1c1b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 13990012 09020063 |
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