Optimal donation of kidney transplants after controlled circulatory death

Controlled donation after circulatory death (cDCD) is used for “extended criteria” donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12–1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20–2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31–2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.     

Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept

Belatacept may increase cytomegalovirus (CMV) disease risk after conversion from CNI-based therapy. We analyzed CMV disease characteristics after belatacept conversion. Propensity score matching was used to compare CMV disease incidence in belatacept- and CNI-treated kidney transplant recipients (KTRs). CMV disease characteristics and risk factors under belatacept were analyzed. In total, 223 KTRs (median age [IQR] 59.2 years [45.4–68.5]) were converted to belatacept (median of 11.5 months [2.5–37.0] post-transplantation); 40/223 (17.9%) developed CMV disease. Independent risk factors included increased age (p = .0164), D+/R− CMV serostatus (p = .0220), and low eGFR at conversion (p = .0355). Among 181 belatacept-treated patients matched to 181 controls, 32/181 (17.7%) experienced CMV disease (vs. 5/181 controls [2.8%]). CMV disease cumulative incidences were 6.33 and 0.91/100 person-years (p-y) in belatacept and control groups, respectively. CMV disease risk was particularly high in elderly patients (converted >70 years) and those with eGFR <30 ml/min; cumulative incidences were 18.4 and 5.2/100 p-y, respectively. CMV diseases under belatacept were atypical, with late-onset disease (24/40 patients [60%]), high CMV seropositivity (27/40, 67%), increased severe and tissue-invasive disease rates (gastrointestinal involvement in 32/40 [80%]) and life-threatening diseases (4/40 [10%]). These findings should stimulate further research to secure the use of belatacept as a valuable rescue therapy in KTRs.     

Translation,cultural adaptation and construct validity of the German version of the Adult Social Care Outcomes Toolkit for informal Carers (German ASCOT-Carer)

Quality of Life Research - The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal...     

Colorectal cancer screening practices among cancer survivors five years after diagnosis

Background

Colorectal cancer (CRC) has a high incidence worldwide, especially in high-income countries. In France, a national CRC screening program targeting residents aged 50–74 years has been in place since 2009. Little is known about CRC screening practices in cancer survivors, even though some have an increased risk of developing a second cancer in the colorectum. This study aims to identify the barriers to CRC screening among cancer survivors.

Methods

This cross-sectional study based on the French national VICAN survey included individuals diagnosed in 2010 with a cancer in 1 of 11 locations other than the colorectum and interviewed 5 years after diagnosis about various health-related issues. Binary logistic regression was used to identify the factors associated with lack of up-to-date CRC screening in cancer survivors without cancer progression.

Results

Of the 2935 cancer survivors included in the study, 35.3% reported undergoing a screening test in the previous 2 years. The rate of up-to-date CRC screening rose to 49.3% in survivors aged 51–75 years. Among these, lack of CRC screening in the recommended time frame was associated with obesity, current smoking, non-use of complementary medicine, perceived financial difficulties, and poor access to general practitioners.

Conclusions

Barriers to CRC screening can be personal and/or institutional.

     

Viscoelastic properties of human arteries methodology and preliminary results

In order to study the biomechanical properties of the arterial wall and to compare arteries with different histologic structures, we designed a device that allows testing of arterial segments under near-physiologic conditions. A hydrodynamic generator simulates systolo-diastolic pressures in an open loop. An intraarterial pressure sensor and a sonomicrometer connected to two piezoelectric crystals placed in diametric opposition on the arterial wall allow computer calculation of compliance, stiffness, midwall radial arterial stress, Young modulus, and incremental modulus for a given arterial segment at a given pressure setting. Seven healthy common carotid artery (CCA) segments and seven healthy (superficial) femoral artery (FA) segments were studied immediately after removal from brain-dead donors between the ages of 18 and 35 years. Histologic examination was performed to determine the density of elastic fibers in the arterial wall. Hysteresis was observed in all segments regardless of pressure settings. Compliance was greater and modulus values and stiffness were lower in CCA than in FA. No evidence of structural change was noted after testing in the circulation loop. These preliminary results open the way to a wide variety of applications for our hydrodynamic circulation loop. Experiments will be undertaken to compare the mechanical properties of arteries before and after cryopreservation.

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Propriétés visco-élastiques des artères humaines. Méthodologie et résultats préliminaires

Résumé Dans le but d'étudier les propriétés mécaniques de la paroi artérielle et de pouvoir établir des comparaisons entre des segments artériels de structure histologique différente, nous avons mis au point un banc d'essai hydrodynamique permettant de tester des segments artériels dans des conditions voisines de la réalité physiologique. Un générateur hydrodynamique permettait d'obtenir dans un circuit ouvert un régime de pressions de type systolo-diastolique. Un capteur de pression intra-artériel, ainsi qu'un sonomicromètre relié à des cristaux piézo-électriques placés de façon diamétralement opposée sur la paroi artérielle, permettaient de calculer, pour un régime de pressions donné et grâce à l'acquisition de données dans un système informatique, la compliance, la rigidité, la contrainte trans-pariétale, le module de Young, le module incrémentiel d'un segment artériel. Nous avons étudié sept artères carotides communes (CC), et sept artères fémorales (superficielles) (F) fraîchement prélevées chez des sujets sains âgés de 18 à 35 ans. Des corrélations avec la richesse en fibres élastiques de la paroi artérielle ont été établies. Nous avons mis en évidence un phénomène d'hystérésis pour chaque artère testée quel que soit le niveau de pression considéré. La compliance des artères CC a été plus importante, les modules et la rigidité ont été moins importants et ce de façon significative par rapport aux artères F. Aucune altération histologique n'a été mise en évidence après passage des segments artériels au banc d'essai. Ces résultas préliminaires nous permettent d'envisager de nombreuses applications à ce travail dont l'une d'entre elles sera la mesure comparative des propriétés mécaniques des artères avant et après cryopréservation.

     

Differential diagnosis of lesser metatarsalgia

Pain in the lesser metatarsophalangeal area of the foot remains a diagnostic challenge. This pathology often is attributed to neuromas. These painful lesions, although predisposed to this area, are not nearly as common as they are thought to be. The "systems approach" to diagnosis can be extremely helpful in establishing an accurate cause and subsequent proper diagnosis of lesser metatarsophalangeal joint pain.     

Vaccine-induced binding and neutralizing antibodies against Omicron 6 months after a homologous BNT162b2 booster

Evidence about the long-term persistence of the booster-mediated immunity against Omicron is mandatory for pandemic management and deployment of vaccination strategies. A total of 155 healthcare professionals (104 COVID-19 naive and 51 with a history of SARS-CoV-2 infection) received a homologous BNT162b2 booster. Binding antibodies against the spike protein and neutralizing antibodies against Omicron were measured at several time points before and up to 6 months after the booster. Geometric mean titers of measured antibodies were correlated to vaccine efficacy (VE) against symptomatic disease. Compared to the highest response, a significant 10.2- and 11.5-fold decrease in neutralizing titers was observed after 6 months in participants with and without history of SARS-CoV-2 infection. A corresponding 2.5- and 2.9-fold decrease in binding antibodies was observed. The estimated T_1/2 of neutralizing antibodies in participants with and without history of SARS-CoV-2 infection was 42 (95% confidence interval [CI]: 25–137) and 36 days (95% CI: 25–65). Estimated T_1/2 were longer for binding antibodies: 168 (95% CI: 116–303) and 139 days (95% CI: 113–180), respectively. Both binding and neutralizing antibodies were strongly correlated to VE (r = 0.83 and 0.89). However, binding and neutralizing antibodies were modestly correlated, and a high proportion of subjects (36.7%) with high binding antibody titers (i.e., >8434 BAU/ml) did not have neutralizing activity. A considerable decay of the humoral response was observed 6 months after the booster, and was strongly correlated with VE. Our study also shows that commercial assays available in clinical laboratories might require adaptation to better predict neutralization in the Omicron era.