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New Insights Into the Alleged Kidney Donor Profile Index Labeling Effect on Kidney Utilization
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D. E. Stewart V. C. Garcia M. I. Aeder D. K. Klassen 《American journal of transplantation》2017,17(10):2696-2704
The Kidney Donor Profile Index (KDPI) became a driving factor in deceased donor kidney allocation on December 4, 2014, with the implementation of the kidney allocation system (KAS). On April 20, 2016, the annual recalibration of the Kidney Donor Risk Index into KDPI was incorrectly programmed in DonorNet, resulting in erroneously high KDPI values, by between 1 and 21 percentage points (e.g. actual KDPI of 70% was displayed as 86%). The error was corrected on May 19, 2016, <24 h after being recognized. During this 30‐day period, the distribution of recipients largely resembled pre‐KAS patterns. The observed discard rate of 22.9% was higher than the post‐KAS average of 19.6% (odds ratio [OR]: 1.22) but far lower than the projected rate of 31.4% (OR: 1.96) based on the usual discard rate by KDPI relationship, suggesting clinicians and patients did not rely heavily on this single number (KDPI) in kidney‐utilization decisions. Still, risk‐adjusted analyses suggest the elevated discard rate was most likely attributable to the erroneously high KDPIs, not a shift in donor characteristics or random chance. The rise in discard rate was sharply higher for kidneys with inflated KDPI that crossed the 85% policy threshold (OR: 1.46; p = 0.049) versus those that did not (OR: 1.06; p = 0.631). 相似文献
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PROviding Better ACcess To ORgans: A comprehensive overview of organ‐access initiatives from the ASTS PROACTOR Task Force
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M. J. Hobeika C. M. Miller T. L. Pruett K. A. Gifford J. E. Locke A. M. Cameron M. J. Englesbe C. S. Kuhr J. F. Magliocca K. R. McCune K. L. Mekeel S. J. Pelletier A. L. Singer D. L. Segev 《American journal of transplantation》2017,17(10):2546-2558
The American Society of Transplant Surgeons (ASTS) PROviding better Access To Organs (PROACTOR) Task Force was created to inform ongoing ASTS organ access efforts. Task force members were charged with comprehensively cataloguing current organ access activities and organizing them according to stakeholder type. This white paper summarizes the task force findings and makes recommendations for future ASTS organ access initiatives. 相似文献
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Catherine F. Borders Yoshikazu Suzuki Jared Lasky Christian Schaufler Djamila Mallem James Lee Kevin Carney Scarlett L. Bellamy Christian A. Bermudez A. Russell Localio Jason D. Christie Joshua M. Diamond Edward Cantu 《The Journal of thoracic and cardiovascular surgery》2017,153(5):1197-1203.e2
Objective
Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant.Methods
Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay.Results
Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion.Conclusions
Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant. 相似文献55.
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背景 我国分级诊疗制度将社区卫生服务中心划分为一级医疗机构,其诊疗能力和服务水平的提升有助于满足人民不断增长的医疗服务需求。目的 缩短社区卫生服务中心疾病筛查工作的患者等待时间,提高服务效率及患者满意度。方法 将社区卫生服务中心的疾病筛查工作视作一个排队系统,提出基于共享模式的联合筛查方案,并与其余方案进行比较。结果 应用排队模型比较社区服务中心在4种优化方案下的患者等待时间,得到在不同控制因素下的优化方案。在不投入成本的前提下,3个社区卫生服务中心联合工作,可通过共享医师缩短患者等待时间。结论 排队理论可辅助基层医疗管理者在实践中依据不同的控制因素,优化服务系统。同时,医疗服务共享可提升社区卫生服务中心的服务效率与患者满意度,合理规划医疗资源,增强基层医疗系统的综合实力。 相似文献
58.
Defne A. Magnetta Justin Godown Shawn West Matthew Zinn Kirsten Rose‐Felker Susan Miller Brian Feingold 《American journal of transplantation》2019,19(12):3276-3283
US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on “high‐dose” inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2‐ to 3‐fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5‐fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision. 相似文献
59.
David Goldberg Ivo C. Ditah Kia Saeian Mona Lalehzari Andrew Aronsohn Emmanuel C. Gorospe Michael Charlton 《Gastroenterology》2017,152(5):1090-1099.e1
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