Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function (DGF) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5‐year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4‐20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34‐0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed (OR 0.48, 95%CI 0.28‐0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure (OR 0.93, 95%CI 0.87‐0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF, our study failed to demonstrate a graft survival advantage (hazard ratio [HR] 0.83, 95%CI 0.54‐1.27), whereas dopamine treatment was associated with improved long‐term outcome (HR 0.95, 95%CI 0.91‐0.99 per hour).     

The first case of ischemia‐free organ transplantation in humans: A proof of concept

Ischemia and reperfusion injury (IRI) is an inevitable event in conventional organ transplant procedure and is associated with significant mortality and morbidity post‐transplantation. We hypothesize that IRI is avoidable if the blood supply for the organ is not stopped, thus resulting in optimal transplant outcomes. Here we described the first case of a novel procedure called ischemia‐free organ transplantation (IFOT) for patients with end‐stage liver disease. The liver graft with severe macrovesicular steatosis was donated from a 25‐year‐old man. The recipient was a 51‐year‐old man with decompensated liver cirrhosis and hepatocellular carcinoma. The graft was procured, preserved, and implanted under continuous normothermic machine perfusion. The recipient did not suffer post‐reperfusion syndrome or vasoplegia after revascularization of the allograft. The liver function test and histological study revealed minimal hepatocyte, biliary epithelium and vascular endothelium injury during preservation and post‐transplantation. The inflammatory cytokine levels were much lower in IFOT than those in conventional procedure. Key pathways involved in IRI were not activated after allograft revascularization. No rejection, or vascular or biliary complications occurred. The patient was discharged on day 18 post‐transplantation. This marks the first case of IFOT in humans, offering opportunities to optimize transplant outcomes and maximize donor organ utilization.     

Analysis of public discourse on heart transplantation in Japan using social network service data

The clarification of public concerns regarding heart transplantation is important for improving low organ donation rates in Japan. In the present study, we used the Twitter data of 4986 tweets (between August 2015 and January 2016) and 1429 tweets (between April 2016 and May 2016) to analyze public discourse on heart transplantation in Japan and identify the reasons for low organ donation rates. We manually categorized all tweets relevant to heart transplantation into nine categories and counted the number of tweets in each category per month. During the study period, the most popular category of tweets was related to the media, followed by money (tweets questioning or even criticizing the high price of fundraising goals to go overseas for heart transplantations), while some tweets were misconceptions. We also conducted a sentiment analysis, which revealed that the most popular negative tweets were related to money, while the most positive tweets were related to reports on the favorable outcomes of recipients. Our results suggest that listening to concerns, providing correct information (particularly for some misconceptions), and emphasizing the outcomes of recipients will facilitate an increase in the number of people contemplating heart transplantation and organ donation.     

Program‐specific transplant rate ratios: Association with allocation priority at listing and posttransplant outcomes

The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program‐specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. We evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low‐priority candidates. Despite a strong association with unadjusted TRRs, we found no candidate‐level association between the components of allocation priority and adjusted TRRs. We found a strong program‐level association between median laboratory Model for End‐stage Liver Disease (MELD) score at listing and program‐specific adjusted TRRs (r = .37; P < .001). The program‐level association was likely confounded by regional differences in donor supply/demand and listing practices. In kidney transplantation, higher program‐specific adjusted TRRs were weakly associated with better adjusted posttransplant outcomes (r = ?.14; P = .035) and lower adjusted waitlist mortality rate ratios (r = ?.15; P = .022), but these associations were absent in liver, lung, and heart transplantation. Program‐specific adjusted TRRs were unlikely to be improved by listing candidates with high allocation priority and can provide useful information for transplant candidates and programs.     

Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system

The impact of a new national kidney allocation system (KAS) on access to the national deceased‐donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end‐stage renal disease (ESRD) patients is unknown. We examined waitlisting pre‐ and post‐KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005‐2015) using multivariable time‐dependent Cox and interrupted time‐series models. The adjusted waitlisting rate among incident patients was 9% lower post‐KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90‐0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre‐KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80‐0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85‐0.90). In adjusted time‐series analyses of prevalent patients, waitlisting rates declined by 3.45/10 000 per month post‐KAS (P < .001), resulting in ≈146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post‐KAS (P < .001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post‐KAS; however, disparity remains.     

Books,bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first “clinical discipline.” By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.