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J De Meester

Publications and source records attributed to J De Meester.

29 records · Page 2Linked to original sources
PubMed1998

The impact of special programs for kidney transplantation of highly sensitized patients in Eurotransplant.

Highly immunized patients will continue to accumulate on the waiting list of many registries unless special allocation programs are introduced. In Eurotransplant such patients can benefit from 2 programs, the Acceptable Mismatch (AM) and the Highly Immunized Tray (HIT) programs. Kidney exchange is mandatory in these programs. In addition, highly immunized patients who do not participate in these programs profit from additional points in the allocation procedure (ET-HI). In the past 18 months the 3 programs have run in parallel. Here, we show that the AM and HIT programs are highly effective with respect to increasing the patient's chance of finding a crossmatch negative donor in an adequate time course. Furthermore, the transplantation results of AM and HIT are at least comparable to those of the ET-HI. The main gain at present seems to be the significantly shorter waiting time in the AM and HIT programs.

Europe↗
PubMed1998

Trends in organ donation.

Renal and extrarenal transplant data were collected for seven geographical regions for the period 1989-1996. In Western Europe and North America the number of kidney donors increased by 926 and 2743, respectively. The total number of transplants also increased in both regions by 3756 and 6936, respectively. Renal transplants accounted for approximately 60% of the total number of transplants and, although the number of renal transplants did not alter in Western Europe, the number rose by 3055 in North America. Outside of these regions the number of extrarenal transplants was 3-18% of the total. The number of living kidney donors in North America increased each year and was higher than the number recruited in Western Europe (3389 vs 943 in 1996). With the exception of Eastern Europe, where virtually no renal transplants were carried out using organs from living donors, the number of living kidney donors rose in other regions: for example, in Latin America, the proportion of living kidney donors rose from 29% in 1970-88 to 51% in 1995, and, in Asia, 90% of kidneys were donated by living donors. As the quality of cadaveric donor organs is often sub-optimal, the use of living donors is likely to increase in both Western Europe and North America, but is unlikely to become the most important source of organs in these regions.

Humans↗
PubMed1997

Changing patterns in organ donation in Eurotransplant, 1990-1994.

Organ transplantation has become the treatment of choice for patients with end-stage organ failure and has led to progressive increases in the size of waiting lists over the past decade. Unfortunately, from 1990 to 1994, the number of organ donors remained stable while the number of organs transplanted from these donors increased by only 10%. In view of the severity of the current organ shortage, elderly individuals are increasingly being accepted as organ donors. The graft survival rate with kidneys from donors older than 55 years is 5% lower than that with kidneys from younger donors at 1 years and 9% lower at 3 years post-transplantation. Graft survival is also significantly lower with organs from donors who die from cerebrovascular accidents than it is with organs from donors whose cause of death is cerebral trauma. The number of patients waiting for a nonrenal donor organ has increased rapidly in the past 5 years, and an increasing number of donor kidneys are now being provided by multiorgan donors. The favorable graft survival rate with multiorgan donor kidneys, which is significantly better than that obtained with single organ donor kidneys, confirms their suitability for renal transplantation.

Adult↗
PubMed1996

The outcome of kidney grafts from multiorgan donors and kidney only donors.

From 1988 to 1994, 15356 renal cadaveric transplantations have been performed within the Eurotransplant area (Austria, Belgium, Germany, Luxembourg and The Netherlands); 8746 kidneys were obtained from multiorgan donors and 6610 from kidney only donors. To evaluate the impact of the procurement policy, multiorgan donor (MOD) versus kidney only donor (KOD), on renal graft survival, an observational study has been performed. Multivariate analysis using Cox's proportional hazards model served to quantify the role of the procurement policy on renal graft survival after adjustment for other prognostic factors. The kidneys obtained from MODs had a significantly better graft survival at 1, 3, and 5 years after transplantation than the kidneys obtained from KODs (85%, 75%, and 58% versus 78%, 68%, and 46% (P=0.0001). In the Cox model, patients transplanted with a KOD kidney had a 1.28 times higher risk of losing their graft than patients transplanted with a MOD kidney. This benefit in graft survival for MOD kidneys could not be explained by the fact that the MODs were younger and male, and that UW was used as preservation solution. A plausible explanation is that MODs, on average, because of the nonrenal transplants, are better supervised. We expect that optimal donor management will contribute to a better outcome of all renal grafts.

Adenosine↗
PubMed1996

Six newly identified HLA-DRB alleles: DRB1*1121, *1419, *1420, *1421, DRB3*0203 and DRB5*0103.

Seven samples with irregular PCR-SSO hybridization patterns, observed during routine HLA-DRB typing, were studied in more detail. Group-specific amplification, followed by hybridization with relevant SSOs strengthened the suggestion that these samples contained new DRB alleles. DRB exon 2 segments were amplified, cloned and sequenced and revealed: DRB1*1121 [MUL] is similar to DRB1*1102 in which codon 85 changed from GTT(V) into GTC(A); DRB1*1419 [AKKAL] is similar to DRB1*1402 with codon 71 changed from AGG(R) into AAG(K); DRB1*1420 [OND-52971] is a DRB1*1406 with codon 37 changed from AAC(N) into TTC(F); DRB1*1421 [TGI] is similar to DRB1*1417 with codon 71 changed from AGG(R) into AAG(K); DRB3*0203 [POS] is similar to DRB3*0202 in which codons 37-38 are changed from TAC GCG(YA) into TCC GTC(SV); DRB5*0103 was found in two unrelated individuals of Oriental origin [IND-24 and IND-59] and is similar to DRB5*0102 in which codon 71 AGG(R) changed into ACG(T). This particular sequence variation at position 71 has not yet been described. The new DRB sequences were confirmed using the sequencing based typing technique. Low resolution PCR-SSP typing failed to amplify two of the DRB1*14 variants, whereas high resolution PCR-SSP resulted in aberrant patterns. Class II alloantisera identify the codon 71 changes in DRB1*1419 and *1421 with respect to the MC1 ('DR1+DR4') epitope.

Alleles↗
PubMed1996

The relative impact of presumed-consent legislation on thoracic organ donation in the Eurotransplant area.

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg. in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

Europe↗
PubMed1996

Long-term results of solid organ transplantation. Report from the Eurotransplant International Foundation.

Graft survival of cadaveric kidney-only, liver-only and heart-only transplants, performed in the Eurotransplant area between 1987-1990, was analysed, up to 5 years after transplantation. 1. HLA-A,-B,-DR mismatches had a statistically significant adverse influence on renal graft survival. 2. Kidney retransplantation was not found to be associated with a higher risk of graft loss, in contrast to liver and heart retransplantation. 3. The use of non-ideal donors (aged under 16 or over 55, non-head trauma donors) in renal transplantation should be re-evaluated, while elderly donors as well as elderly recipients jeopardized liver and heart transplant success rates. 4. A learning phase in liver and heart transplantation was evident from 1987-1990. 5. Time-effect studies can be used to adopt individual monitoring schemes. A persistent risk of graft loss in renal transplantation was observed for transplants from older donors and transplants in older recipients; these grafts constituted a very vulnerable group. For liver and heart retransplants it was noted that once patients had survived the first postoperative month, their relative risk of graft failure was no longer significantly different from patients with a first transplant. A well-considered long-term monitoring scheme for heart allograft recipients who are over age 55 is justified, as these patients had a higher risk of failure compared with younger patients. The same would be advantageous for liver transplants that are performed because of underlying liver malignancies.

Adolescent↗
PubMed1994

Factors and complications affecting catheter and technique survival with permanent single-lumen dialysis catheters.

This long-term study on the outcome of permanent silicone single-lumen dialysis catheters consisted of 43 surgically inserted catheters in 33 patients. All catheters were attached to a pressure-pressure single-cannula dialysis system. Technique and catheter survival were 80 and 59% at 1 year, and 63 and 50% at the 3rd year respectively. These parameters were not different in older patients (> or = 70 years, n = 12). Factors corresponding to a less successful outcome were placement in the left jugular vein (3-month actuarial survival of 44%) and absence of distal side holes (1-year actuarial survival of 44%). Insertion in both subclavian veins was not different to the classical right jugular vein. Infectious complications (incidence of 0.72 per 1000 catheter days) often caused simultaneous catheter and technique failure (14 versus 15%), whereas inadequate flow (incidence of 2 per 1000 catheter days) caused catheter rather than technique failure (30 versus 12%). The incidence of both complications declined significantly with time after insertion during the follow-up period. The first 3 months after insertion were more predisposed to the occurrence of inadequate flow than catheter-related infections. The general performance of these permanent single-lumen catheter devices justifies their long-term application in haemodialysis, even as a first choice of vascular access, especially in the elderly. Insertion in the left jugular vein and use of catheters without side holes should be avoided, providing a better catheter survival.

Adult↗