-
Eurotransplant csatlakozs:relis lehetsg? Dr. Langer
Rbertegyetemi docens, klinika igazgatSemmelweis Egyetem,
Transzplantcis s Sebszeti Klinika, Budapest
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Eurotransplant csatlakozs relis lehetsg?Dr. Langer Rbert
Semmelweis Egyetem Transzplantcis s Sebszeti Klinika
-
Balancing urgency and outcomeNet benefit-/Transplant
window-concept-> Increasing organ failure -> MortalityMed.
TherapyTransplantationbenefittoo earlytoo lateTransplantation
window
-
n= 5782VESETRANSZPLANTCI MAGYARORSZG
-
HLA antign mismatch Magyarorszgon
-
ET Organ allocation - renalAB/LDHRNLSLO
-
Kidney graft survival and HLA-ABDR mismatches Adult first
cadaver kidney-only transplantsPost-transplant time
(m)P=0.0001%83%71%
-
100%10073total0,4%4462,4 %244510,5 %1055430,2%3043326,6
%26792832121760PercentageNo. of transplantationsNo. of
mismatchesHLA-matching in kidney transplantationET 2000-2004,
non-ESP patients21,6 %8,3 %
-
Origin of donor organs transplantedEurotransplant: 01.01.2001
31.12.2005
Diagramm5
256127770
13481266465
46751327117
1562227171
130035231
own country
other ET country
outside ET
Tabelle1
HeartKidneyLiverLungPancreas
bad donor quality138917419437
no recipient9421147714
logistical problem6221156528
recipient problem21
other25822677
32114212540386
706511717131
HeartKidneyLiverLungPancreas
elective recipients3910215029
HU recipients3115212
Tabelle2
HeartKidneyLiverLungPancreas
not accepted32114212540386
transplanted706511717131
Tabelle2
not accepted
transplanted
Tabelle4
HeartKidneyLiverLungPancreas
own country256113481467515621300
other ET country27726641327227352
outside ET706511717131
Kidney
own country-other recipients9743
own country-ESP recipients1887
own country-HU recipients285
own country-AM recipients85
own country-000 HLA recipients1481
exchanged - other recipients1406
exchanged- HU recipients73
own country-elective recipients140841649281262exchanged-AM
recipients147
own country-HU recipients115351163438exchanged-000 HLA
recipients1038
exchanged - elective recipients130769142314
exchanged- HU recipients1475588538
Tabelle4
own country
other ET country
outside ET
Tabelle3
HeartKidneyLiverLungPancreas
bad donor quality138917419437
no recipient9421147714
logistical problem6221156528
recipient problem21
other25822677
Tabelle3
bad donor quality
no recipient
logistical problem
recipient problem
other
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International organ exchange in kidney transplantationImpact for
selected patient groupsEurotransplant 01.01.2002 -31.12.2006
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Chance of every new highly sensitized patient to receive a
suitable crossmatch negative organ within 12 months (real life
data)Offer[%]Standard allocationAM
-
Claas et al. Transplantation, 2004
-
n=427MJTRANSZPLANTCI MAGYARORSZG
-
Liver allocation rules ETNational prioritization - Mechanisms of
balancing
HUElectiveInternational HU Open obligations (based on previous
HU-Tx)Mechanism for balancing
National Transplantable/ElectiveMatchMELD (= urgency)Ischemic
time (regional factor)Waiting timeInternationalLabMELDIschemic time
(regional factor)Waiting timeOutside ET
- n=201 (16%)n=1053 (84%)Waiting time HU Liver-transplantFirst HU
Liver-Tx [n=1254]Pediatric (
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PANCREAS TRANSZPLANTCI MAGYARORSZG
-
P-PASS
Item1 point2 points3 pointsAge (years) (x2)
-
Reported Pancreata: P-PASS ET, Jan 1, 2002 Jun 30, 2005, N =
3310
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Pancreas graft survival curve*stratified by P-PASS
Eurotransplant, SPK transplantation, January 2002 - June 2005 [N =
174]
-
p = 0.02
post-transplant time (months)
*-Death censored
We used the first 48 returned questionairres combined with the
information present in ENIS to estimate a Kaplan-Meier survival
curve between 2 PASS-groups, which we see on this slide. All
transplantations took place in the study period, we censored the
graft survival by death and stratified the curve by PASS. We set
our cut-off point at 14 derived from the PAS-Score which was
mentioned before.On this slide we see the rates of pancreas
survival between the two groups, which were composed by setting the
PASS-cut-off-point at 14. All the cases mentioned here consists of
all transplanted pancreas combined with kidney post-listing. But
what we see is a difference between survival in the groups, however
the The p-value is only 0.2, the low number of significance can be
explained by the low power of the test, because we didnt include so
many cases yet. and therefore the value is not significant.
Correlation between PASS cut-off point en survival with first 48
returned questionairres
-
SZVTRANSZPLANTCI MAGYARORSZG
-
Average waiting time in HU-status until first heart
offerEurotransplant - 01.01.-31.07.2008
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ET Horvtorszglpcszetes csatlakozsEgy vig rszleges
csatlakozsSpecilis betegcsoportok (HU, AM, gyermekek)Zero-national
balanceMinden donort jelenteniET rszvtel: Organ Advisory
CommitteesTeljes csatlakozs egy v utn
-
HU mjprogram Vese: acceptable mismatch programSzenzitizlt
betegek listra tteleHU szv s HU veseElektv gyermekszv s
gyermekmjTeljes tagsgET Horvtorszg lpcszetes csatlakozs
-
sszefoglalsA kollaborci elnyei:Jobb allokciTransparens
betegorientlt allokci Zero mismatch 20%, high urgency
betegekTudomnyos alapon bizonytott allokcis elnyk Elvesztett donor
szervek minimalizlsaNemzetkzi tudomnyos egyttmkdsA rsztvevk szmra
elrhet adatbzisok
-
ORSZGOS VRELLT SZOLGLAT http://www.ovsz.hu Szervkoordincis Iroda
http://donacio.ovsz.hu %-14,7%-2%-5,4%
-
**********On this slide we see the PPASS-factors on the left.The
Eurotransplant Pancreas advisory committee has already composed a
prognostic score which means that they have already weighted each
individual factor based on literature review and medical expertise,
where the weight should reflect the likeliness of pancreas
unsuitability, so high PASS means not likely to be PA donor. Before
starting the investigation, we divided all pre-procurement factors
into ranges with cut-off points.
*Using the P-PASS, we gave all reported pancreata
retrospectively a score, according to the pre-procurement PASS. We
then looked if we could conclude anything about the allocation
algorithm. Red bars represent pancreata not accepted for
transplantation; Green bars represent pancreata that are ultimately
transplanted. And yes, what we see here, is a correlation between
PASS and transplantation. For example: the group of reported PASS
13, 60 % is finally used for transplantation. And pancreas donors
reported with a high PASS, a much lower rate is finally used for
transplantation, as we can see here. With help of a logistic
regression model, we calculated that pancreata with a P-PASS same
or higher than 17 were significantly negative associated with
pancreas acceptance, these donors were 3 times more likely to be
refused as a pancreas donor.
*In order to evaluate outcome after pancreas transplant, we
started a retrospective study of all transplanted pancreata in the
time-period 2002 2005. We sent questionairres to the Eurotransplant
pancreas transplantation centres and used them to estimate a
Kaplan-Meier survival curve of the 2 PASS-groups, which we see on
this slide. All transplantations took place in the study period, we
censored the graft survival by death and stratified the curve by
PASS. We set our cut-off point at 17 derived from the PAS-Score
which was mentioned before. Blue line pancreas transplantations of
donors with P-PASS lower than 17, red same or higher than 17.What
we see is a significant difference in graft survival in both
pancreas groups. ***