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Linda C. Cendales - One of the best experts on this subject based on the ideXlab platform.
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vascularized composite allotransplantation in the united states a retrospective analysis of the Organ Procurement and transplantation network data after 5 years of the final rule
American Journal of Transplantation, 2021Co-Authors: Holly C Lewis, Linda C. CendalesAbstract:On July 3, 2014, the Organ Procurement and Transplantation Network (OPTN) began overseeing vascularized composite allotransplantation/allografts (VCA) in the United States. For the past 6 years, centers performing VCAs have been requested to submit data into a biometric repository, in parallel with systems used by solid Organ transplant centers. Currently, 62 VCAs are reported in the entire OPTN database, with 36 of these transplants reported as performed after VCA was added to the OPTN Final Rule. Of these 36 recipients, 16 received uterus transplants, most of which (11) occurred from living donors. Ten patients received hand transplants and 6 received face transplants. Two patients received abdominal wall transplants, 1 patient received a scalp transplant, and 1 patient received a penile transplant. The present manuscript represents the query of a nationalized database for VCA type, immunosuppression treatment, and clinical outcomes for VCAs. This manuscript provides a report of the current VCA data reported to the OPTN after the Final Rule.
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hand transplantation in the united states a review of the Organ Procurement and transplantation network united network for Organ sharing database
American Journal of Transplantation, 2020Co-Authors: Rachel E Hein, David S Ruch, Christopher S Klifto, Fraser J Leversedge, Suhail K Mithani, Tyler S Pidgeon, Marc J Richard, Linda C. CendalesAbstract:Hand transplantation is the most common application of vascularized composite allotransplantation (VCA). Since July 3, 2014, VCAs were added to the definition of Organs covered by federal regulation (the Organ Procurement and Transplantation Network (OPTN) Final Rule) and legislation (the National Organ Transplant Act). As such, VCA is subject to requirements including data submission. We performed an analysis of recipients reported to the OPTN to have received hand transplantation between 1999 and 2018. Forty-three patients were identified as having been listed for upper extremity transplantation in the United States. Of these, 22 received transplantation prior to July 3, 2014 and 10 from then to December 31, 2018. Of patients transplanted after 2014, posttransplant functional scores included a decrease in Disabilities of the Arm, Shoulder and Hand questionnaire in 3 of 10 patients, Carroll test scores ranging from 9 to 60 of 99, and monofilament testing with protective sensation achieved in 4 of 6 patients. Complications included rejection in nine recipients with Banff scores from II-IV. One patient experienced graft failure 5 days after transplantation. Of the remaining patients, two were reported as receiving monotherapy and seven receiving dual or triple immunosuppression therapy. The inclusion of VCA in the OPTN Final Rule standardized parameters for safe implementation and data collection.
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vascularized composite allotransplantation in the united states a descriptive analysis of the Organ Procurement and transplantation network data
American Journal of Transplantation, 2019Co-Authors: Wida S Cherikh, David K. Klassen, Linda C. Cendales, Christopher L Wholley, J L Wainright, Vijay S Gorantla, Sue V Mcdiarmid, L S LevinAbstract:On July 3, 2014, the Organ Procurement and Transplantation Network/United Network for Organ Sharing was charged with the oversight of vascularized composite allograft (VCA) Procurement and transplantation in the United States. As of December 31, 2017, 61 VCA programs at 27 centers were approved in the United States. Fifty candidates have been added to the waiting list at 15 centers. Twenty-eight VCA transplants have been performed at 14 programs (10 upper limb, 10 uterus, 5 craniofacial, 1 scalp, 1 abdominal wall, and 1 penile). Twenty-two VCAs were procured from 21 deceased donors, resulting in 109 non-VCA Organs transplanted (15 hearts, 3 intestine, 40 kidney, 20 livers, 24 lungs, and 7 pancreata). Six uterus transplants were performed from living donors. Fourteen candidates were still waiting at 9 centers on December 31, 2017. Two of the 10 uterus recipients had live births and 3 still had viable grafts. Seventeen of 18 nonuterus recipients had functioning grafts. At present, VCA is an emerging field with a small number of patients transplanted. Data on posttransplant survival and functional outcomes continue to be collected to further the understanding of this complex and evolving field. Further systematic data are important for policy refinement and assurance of patient safety.
Robert M. Merion - One of the best experts on this subject based on the ideXlab platform.
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improving Organ Procurement travel practices in the united states proceedings from the michigan donor travel forum
American Journal of Transplantation, 2010Co-Authors: Michael J Englesbe, Raymond J Lynch, John P Roberts, Shimul A Shah, J A Cutler, R Africano, M Seely, R Hasz, M L Sweeney, Robert M. MerionAbstract:There are significant risks and inefficiencies associated with Organ Procurement travel. In an effort to identify, quantify, and define opportunities to mitigate these risks and inefficiencies, 25 experts from the transplantation, transportation and insurance fields were convened. The forum concluded that: on Procurement travel practices are inadequate, there is wide variation in the quality of aero-medical transportation, current travel practices for Organ Procurement are inefficient and there is a lack of standards for Organ Procurement travel liability coverage. The forum concluded that the transplant community should require that air-craft vendors adhere to industry quality standards compatible with the degree of risk in their mission profiles. Within this context, a purchasing collaborative within the transplant community may offer opportunities for improved service and safety with lower costs. In addition, changes in travel practices should be considered with broader sharing of Procurement duties across centers. Finally, best practice standards should be instituted for life insurance for transplant personnel and liability insurance for providers. Overall, the aims of these proposals are to raise Procurement travel standards and in doing so, to improve the transplantation as a whole.
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the riskiest job in medicine transplant surgeons and Organ Procurement travel
American Journal of Transplantation, 2009Co-Authors: Michael J Englesbe, Robert M. MerionAbstract:Transplant surgeons are exposed to workplace risk due to the urgent nature of travel related to Organ Procurement. A retrospective cohort study was completed using data from the Scientific Registry of Transplant Recipients and the National Transportation Safety Board. A web-based survey was administered to members of the American Society of Transplant Surgeons. The survey response rate was 38% (281/747). Involvement in ≥1 Procurement-related travel accident was reported by 15% of respondents; surgeons reported 61 accidents and 11 fatalities. Air travel was used in 26% of Procurements and was involved in 56% of accidents. The risk of fatality while traveling on an Organ Procurement flight was estimated to be 1000 times higher than scheduled commercial flight. Involvement in a ‘near miss accident’ was reported by 80.8%. Only 16% of respondents reported feeling ‘very safe’ while traveling. Procurement of Organs by the geographically closest transplant center would have reduced the need for air travel (>100 nautical miles) for lung, heart, liver and pancreas Procurement by 35%, 43%, 31% and 49%, respectively (p < 0.0001). These reductions were observed in each Organ Procurement and Transplantation Network region. Though these data have important limitations, they suggest that Organ Procurement travel is associated with significant risk. Improvements in Organ Procurement travel are needed.
Suphamai Bunnapradist - One of the best experts on this subject based on the ideXlab platform.
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risk factors for new onset diabetes mellitus in adult liver transplant recipients an analysis of the Organ Procurement and transplant network united network for Organ sharing database
Transplantation, 2010Co-Authors: Hung Tien Kuo, Marcelo Santos Sampaio, Pavani Reddy, Paul Martin, Suphamai BunnapradistAbstract:OBJECTIVE.: To analyze the risk factors for new-onset diabetes mellitus (NODM) in liver transplant recipients using the Organ Procurement and Transplant Network/United Network for Organ Sharing database. METHODS.: Among 20,172 primary liver recipients (age > or =18 years) transplanted between July 2004 and December 2008 in Organ Procurement and Transplant Network/United Network for Organ Sharing databases, 15,463 recipients without pretransplant diabetes were identified. Risk factors for NODM were examined using multivariate Cox regression analysis. RESULTS.: NODM was reported in 26.4% of recipients (median follow-up, 685 days). Independent predictors of NODM development included recipient age (> or = 50 vs. or = 25 vs. or = 60 vs. <60 year, HR=1.152), diabetic donor (HR=1.151), tacrolimus (tacrolimus vs. cyclosporine, HR=1.236), and steroid at discharge (HR=1.594). Living donor transplant (HR=0.628) and induction therapy (HR=0.816) were associated with a decreased risk of NODM. CONCLUSION.: The incidence of NODM was 26.4% in liver recipients with a median follow-up time of 685 days. Identified risk factors for NODM in liver transplantation were similar to that in kidney transplantation. Some of the identified factors are potentially modifiable, including obesity and the choice of immunosuppressive regimens.
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donor biopsy and kidney transplant outcomes an analysis using the Organ Procurement and transplantation network united network for Organ sharing optn unos database
Transplantation, 2007Co-Authors: Meera Bajwa, Yong W Cho, Phuongthu T Pham, Tariq Shah, Gabriel M Danovitch, Alan H Wilkinson, Suphamai BunnapradistAbstract:Background. Although the degree of glomerulosclerosis on pretransplant donor biopsy is one criterion used in the decision to accept a deceased donor kidney, its relationship with graft survival remains controversial. This study compared graft survival with the degree of glomerulosclerosis found on donor biopsy. We also examined the agreement in degree of glomerulosclerosis between paired kidneys. Methods. Biopsy results from 12,129 adult deceased donor transplants between January 1,2000 and December 31,2005 were identified in the Organ Procurement and Transplantation Network/United Network for Organ Sharing data, as of September 11, 2006. Of these, 2696 donors had both kidneys biopsied and subsequently transplanted. Results. Among the groups with greater than 5% glomerulosclerosis, there was no statistically significant difference in graft survival rates (log-rank, P=0.44). The overall graft survival rates of the 0-5% group were significantly superior to those of the >5% groups (1-, 3-, and 5-year rates: 85.9%, 72.4%, and 59.0% for 0-5% group vs. 81.6%, 68.1%, and 53.6% for >5% group, log-rankP 5% glomerulosclerosis in the left kidney). Conclusion. Donor kidneys with less than 6% glomerulosclerosis were associated with better graft outcomes and intrapair agreement in the degree of glomerulosclerosis. Among kidneys with greater than 5% glomerulosclerosis, the degree of glomerulosclerosis did not help predict graft outcomes. Sampling error may contribute to the lack of outcome differences seen among these kidneys, given the low intrapair agreement.
Michael J Englesbe - One of the best experts on this subject based on the ideXlab platform.
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improving Organ Procurement travel practices in the united states proceedings from the michigan donor travel forum
American Journal of Transplantation, 2010Co-Authors: Michael J Englesbe, Raymond J Lynch, John P Roberts, Shimul A Shah, J A Cutler, R Africano, M Seely, R Hasz, M L Sweeney, Robert M. MerionAbstract:There are significant risks and inefficiencies associated with Organ Procurement travel. In an effort to identify, quantify, and define opportunities to mitigate these risks and inefficiencies, 25 experts from the transplantation, transportation and insurance fields were convened. The forum concluded that: on Procurement travel practices are inadequate, there is wide variation in the quality of aero-medical transportation, current travel practices for Organ Procurement are inefficient and there is a lack of standards for Organ Procurement travel liability coverage. The forum concluded that the transplant community should require that air-craft vendors adhere to industry quality standards compatible with the degree of risk in their mission profiles. Within this context, a purchasing collaborative within the transplant community may offer opportunities for improved service and safety with lower costs. In addition, changes in travel practices should be considered with broader sharing of Procurement duties across centers. Finally, best practice standards should be instituted for life insurance for transplant personnel and liability insurance for providers. Overall, the aims of these proposals are to raise Procurement travel standards and in doing so, to improve the transplantation as a whole.
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the riskiest job in medicine transplant surgeons and Organ Procurement travel
American Journal of Transplantation, 2009Co-Authors: Michael J Englesbe, Robert M. MerionAbstract:Transplant surgeons are exposed to workplace risk due to the urgent nature of travel related to Organ Procurement. A retrospective cohort study was completed using data from the Scientific Registry of Transplant Recipients and the National Transportation Safety Board. A web-based survey was administered to members of the American Society of Transplant Surgeons. The survey response rate was 38% (281/747). Involvement in ≥1 Procurement-related travel accident was reported by 15% of respondents; surgeons reported 61 accidents and 11 fatalities. Air travel was used in 26% of Procurements and was involved in 56% of accidents. The risk of fatality while traveling on an Organ Procurement flight was estimated to be 1000 times higher than scheduled commercial flight. Involvement in a ‘near miss accident’ was reported by 80.8%. Only 16% of respondents reported feeling ‘very safe’ while traveling. Procurement of Organs by the geographically closest transplant center would have reduced the need for air travel (>100 nautical miles) for lung, heart, liver and pancreas Procurement by 35%, 43%, 31% and 49%, respectively (p < 0.0001). These reductions were observed in each Organ Procurement and Transplantation Network region. Though these data have important limitations, they suggest that Organ Procurement travel is associated with significant risk. Improvements in Organ Procurement travel are needed.
Dorry L. Segev - One of the best experts on this subject based on the ideXlab platform.
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restructuring the Organ Procurement and transplantation network contract to achieve policy coherence and infrastructure excellence
American Journal of Transplantation, 2019Co-Authors: Sommer E. Gentry, Dorry L. SegevAbstract:The Organ Procurement and Transplantation Network (OPTN) went up for competitive bid again this year, yet this contract has been held by only 1 entity since its inception. The OPTN's scope has grown steadily, and it now embraces several disparate missions: to operate the computing and coordination infrastructure that maintains waitlists and makes Organ offers in priority order, to regulate transplant centers and Organ Procurement Organizations, to follow and protect living donors, and to decide Organ allocation policy in concert with the many voices of the transplant community. The contracting process and performance work statement continue to discourage both innovative approaches to the OPTN and competitive bids outside of United Network for Organ Sharing (UNOS), with evaluation criteria that either disqualify or strongly disadvantage new applicants. The performance work statement also emphasizes bureaucratic tasks while obligating the OPTN contractor to the specific committee structure that has impeded decision-making and tended to preserve the status quo in controversial matters. Finally, the UNOS computing infrastructure is antiquated and requires months to years to implement small changes. Restructuring the OPTN contract to separate the information technology requirements from the policy/regulatory responsibilities might allow more nimble and effective specialty contractors to offer their capabilities in service of the national transplant enterprise.
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Liver sharing and Organ Procurement Organization performance
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation S, 2015Co-Authors: Sommer E. Gentry, Eric K.h. Chow, Allan B. Massie, Xun Luo, David Zaun, Jon J. Snyder, Ajay K. Israni, Bert L Kasiske, Dorry L. SegevAbstract:Whether the liver allocation system shifts Organs from better performing Organ Procurement Organizations (OPOs) to poorer performing OPOs has been debated for many years. Models of OPO performance from the Scientific Registry of Transplant Recipients make it possible to study this question in a data-driven manner. We investigated whether each OPO's net liver import was correlated with 2 performance metrics [observed to expected (O:E) liver yield and liver donor conversion ratio] as well as 2 alternative explanations [eligible deaths and incident listings above a Model for End-Stage Liver Disease (MELD) score of 15]. We found no evidence to support the hypothesis that the allocation system transfers livers from better performing OPOs to centers with poorer performing OPOs. Also, having fewer eligible deaths was not associated with a net import. However, having more incident listings was strongly correlated with the net import, both before and after Share 35. Most importantly, the magnitude of the variation in OPO performance was much lower than the variation in demand: although the poorest performing OPOs differed from the best ones by less than 2-fold in the O:E liver yield, incident listings above a MELD score of 15 varied nearly 14-fold. Although it is imperative that all OPOs achieve the best possible results, the flow of livers is not explained by OPO performance metrics, and instead, it appears to be strongly related to differences in demand. Liver Transpl 21:293–299, 2015. © 2015 AASLD.