Changes and mediators of survival disparity among Black liver transplant recipients in the United States

A landmark 2002 study identified Black liver transplant (LT) recipients as having lower post-LT survival compared to other races. While persistent disparities exist, changes over time and mediating factors are understudied. Capturing LT recipients between 2002 and 2018 in UNOS, we used logistic regression and Cox proportional-hazard models to calculate differences in post-LT mortality among races. We examined interactions between transplant year and race. A mediation analysis assessed biologic and environmental factors potentially associated with race differences in post-LT survival. The cohort included 46,997 LT recipients (3898 Black;36,560 White;6539 Hispanic). In most years, Black (vs. White) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics. In multivariable analysis, Blacks (vs. Whites) had higher (aHR = 1.15, 95% CI 1.07–1.24), whereas Hispanics had lower (aHR = 0.78, 95% CI 0.72–0.83) risk of mortality. Differences in post-LT mortality among Blacks (vs. Whites) narrowed between 2002 and 2009, were similar between 2010 and 2013, and may have worsened between 2014 and 2018. Race differences were larger for mortality beyond 1-year post-LT (vs. within 1-year), and among non-HCV (vs. HCV). Alcohol-associated liver disease (ALD) was the strongest mediator (13.9%, 95% CI 8.7–32.7%) of the Black–White disparity in 2010–2018. Our analyses suggest disparities may worsen with longer follow-up, as HCV recedes with elimination efforts, and with further increases in ALD.

     

Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

Background

Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.

‘To donate or not to donate? that is the question!’: an organ and body donation comic

Abstract

Conversations surrounding end of life and death can be difficult or taboo for some, meaning that matters of organ and body donation are not widely discussed. To Donate or Not to Donate? That is the Question! is a comic developed to raise awareness and challenge common misconceptions about donation by encouraging the publics to engage in informed discussions about the different options available. This case study proposes graphic medicine as an alternative method of presenting donation information to a public audience, and illustrates how the comic medium can communicate body donation information in an accessible and engaging way.     

Retrospective comparison between non-treponemal and treponemal tests for screening of blood donors for syphilis and their correlation with donor history in a tertiary care teaching hospital

Background and objectivesTreponemal tests provide advantage of better detection during early, late and latent stages of syphilis with equal or higher sensitivity & specificity in comparison to non-treponemal tests. The objective of the present study was to analyse the level of concordance between treponemal and non-treponemal tests for donor screening and to correlate them with donor history.Materials and methodsRetrospective analysis of syphilis screening by treponemal (Chemiluminescence & TPHA) and non-treponemal tests (RPR) was done and donor history for high-risk behaviour and factors associated with false positivity were collected from post-donation counselling and collected data was coded and analysed.ResultsAmongst the 12,000 donors screened, reactivity rate by RPR, TPHA and Chemiluminescence was 0.45%, 0.8% and 1.17% respectively. There was discordance of 62% and 32% for reactive results by RPR and TPHA respectively when compared with Chemiluminescence. History of high-risk behaviour was present in ∼ 50% and 15% of donors with discordant results by RPR and TPHA respectively. Of 34 donors who were reactive only by Chemiluminescence and were followed up, 15% had history of high-risk behaviour and 56% had factors associated with false reactivity.ConclusionTreponemal tests showed high syphilis reactivity amongst blood donors as compared to non-treponemal tests most likely due to their ability to detect early, late and latent syphilis cases. This may confer added transfusion safety in centres dependent on replacement donors without NAT testing by identifying donors with high-risk history with negligible increase in discard rate due to false reactivity.     

关于规范器官获取组织流程的思考

近年来,中国的器官移植事业发展较快,但由于缺乏系统规范的管理体系,衍生出了一系列社会、伦理、法律等方面的问题。通过分析我国器官捐献与获取现状以及所存在的问题,提示应采取及时发现潜在案例、判定生命状态、规范报批捐献手续、维护脏器功能、获取捐献器官、安抚供者家属、分配捐献器官等一系列措施来完善器官获取组织流程,以推进我国器官移植事业的健康长久发展。     

A retrospective analysis comparing set up errors from standard versus customised headrests for head and neck radiotherapy

IntroductionIn response to advice from The National Institute for Health and Care Excellence ⁽¹⁾ to reduce hospital visits during COVID-19, standard headrests were introduced for head and neck radiotherapy within Northern Centre for Cancer Care (NCCC). The standard headrest requires one mould room appointment compared to 3 appointments with customised headrests.MethodsTwo groups of 10 patients treated between December 2019 and June 2020 were retrospectively analysed by 1 observer. Groups were stratified according to age, sex and tumour site. One group had customised headrest and the other had standard headrest. Five hundred and forty seven cone beam computed tomography images were reviewed. A 6 Degree of Freedom match was performed then chin, shoulder and spine position were assessed using dosimetrist drawn structures. Structures out of the tolerance were recorded. A chi-squared test was used for statistical analysis.ResultsThe out of tolerance chin position count recorded was 21 for customised headrest and 36 for standard headrest, p-value 0.046. The shoulder position count was 13 for customised headrest and 77 for standard headrest p-value <0.001. The spine position count was 3 for CHR and 21 for standard headrest, p-value <0.001. This means the headrests compared are not equivalent in terms of set up reproducibility. Overall the standard headrest group had 10 set-up re-scans and no set up re-scans were recorded in the customised headrest group.ConclusionFewer hospital visits with SHR reduce patient exposure to COVID-19. However, CHR provided a more reliable level of immobilisation in this study.Implications for practiceThe radiotherapy service will be reviewed in line with these findings.     

正常儿童垂体MIR测量研究

目的测量正常儿童垂体体积及各径线的值,为各种导致垂体结构改变疾病的临床诊断和科学研究提供基础数据。方法对99例自愿者儿童依次采用MRI三维快速扰相梯度回波T1(3DT1WI FSPGR)序列进行扫描,垂体的体积及各方向径线测量使用MIP和Reformat处理软件的图像。相同性别不同年龄组的比较采用方差分析,不同性别相同组别的比较采用独立样本t检验分析,垂体分型数据采用卡方分析。结果垂体体积在相同性别不同年龄组间存在显著性差异(P<0.05);不同性别相同年龄组间分型有显著性差异(P<0.05)。结论采用高分辨率MRI获得正常人儿童不同年龄段的垂体体积及多方向径线数据,为进一步研究垂体相关疾病提供了基础性数据。     

肇庆市2008-2011年无偿献血情况分析

目的：分析肇庆市近4 年的无偿献血情况,为本站进一步做好采供血工作,保障临床用血需要提供科学依据.方法：收集肇庆市2008-2011 年的血液采集量和不同性别、年龄无偿献血者的献血情况等资料,对相关数据进行统计、分析.结果：AB 型采血量最少,O 型采血量最多,A 型与B 型采血量大致相等,AB：A：B：O 比例约为1：5：5：8 ;按性别统计,男性献血者（68.5%） 明显多于女性献血者（31.5%）,男女比例为2：1 ;按年龄统计,随着年龄的增长,参与献血的人数呈减少趋势,18-25 岁的献血者比例最多（ 占39.4%）,46-55 岁的献血者最少（ 占6.8%） ;2009 年-2011 年一次献血300 ml 和400 ml 的献血者人数与2008 年比较均明显增加.结论：针对不同人群采取不同策略,加强无偿献血知识的宣传,做好无偿献血者的动员、招募工作,按需采集血液,合理储存血液,临床用血量的需要会得到进一步的保障.     

甲醛染毒对雄性大鼠脏器及血清微量元素的影响

目的探讨甲醛染毒对雄性大鼠脏器及血清微量元素的影响.方法选用体重(110～130)g Wistar大鼠40只,随机分为4组, 染毒浓度分别为,高浓度组:(119.6±15.4) mg/m3、中浓度组:(25.2±4.6) mg/m3、低浓度组:(4.8±1.3) mg/m3和对照组;室内空气,采用静式吸入法,每天染毒1h,连续染毒9w后处死,测定大鼠各脏器的脏器系数、甲醛浓度、及大鼠血清中Fe,Cu,Zn的含量.结果高剂量组雄性大鼠肺、肾和肝脏中甲醛浓度明显高于对照组,各染毒组雄性大鼠体重明显低于对照组(P<0.05),高剂量组雄性大鼠各脏器的脏器系数与对照组比较均有显著性差异(P<0.05),雄性大鼠血清中锌含量明显降低、铜含量显著升高(P<0.05).结论长期高剂量吸入甲醛可影响雄性大鼠的生长及其血清Cu、Zn水平,并可损伤雄性大鼠的肝、肺、肾、心、脑、睾丸.