(Press-News.org) Johns Hopkins scientists have created a free, Web-based tool to help patients decide whether it's best to accept an immediately available, but less-than-ideal deceased donor kidney for transplant, or wait for a healthier one in the future.
Historically, the researchers say, it has been difficult, if not impossible, to accurately quantify the risk of accepting a deceased-donor kidney that may have been infected by hepatitis C, as compared to waiting what could be months or years for a better organ. There is a 5 to 15 percent chance of dying every year on the waiting list. Often, organs that may have been at risk of infection are thrown away and never transplanted.
In a new study described online in the American Journal of Transplantation, the Johns Hopkins researchers showed there are some types of patients for whom survival benefit outweighs the risks of accepting a possibly infected organ. They then developed a Web-based mathematical model to help predict which patients they would be. The easy-to-use website can be found at http://www.transplantmodels.com/ird.
"Because the supply of the healthiest donor organs is too small, patients need to consider all organ offers or risk dying while waiting for an organ. But this is a very hard decision, and many people turn down transplant offers that, in reality, would provide them significant benefit. Often they would have done much better taking the organ at hand than waiting for the next available one," says study leader Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. "This is the most important decision of a transplant candidate's life, and we have developed a novel tool we believe can help patients make the best choice."
Before they are made available for transplant, kidneys and other organs from deceased donors are tested for infectious diseases such as HIV and hepatitis C. But even when the tests come back negative, there is still a chance that some kidneys could be infected, more commonly with hepatitis C, because of donor risks such as intravenous drug abuse, prostitution, imprisonment and other criteria established by the U.S. Centers for Disease Control and Prevention. Although the risk of transmission of hepatitis C is low for transplanted kidneys, more than 10 percent of deceased donors in 2011 met the CDC criteria for infectious risk.
To develop the model, Segev and his colleagues pooled data from dozens of published papers and national databases of hundreds of thousands of patients. When information was missing, they sought out expert opinion to fill in the holes. They considered how long patients had been on a waiting list, whether they had undergone previous transplants, their age and whether they had diabetes, among other factors. Finally, they developed a complex statistical model and computer program to take all the factors into account and present it in a user-friendly manner.
Segev says there are more than 102,000 people on the kidney transplant waiting list in the United States, and thousands will die before they get an organ. The average waiting time for a kidney is three to five years, but in some regions of the United States, it can be as long as 10 years.
Some kidney transplant patients are healthy enough to safely reject a risky organ and wait for a better one. But that is not always the case.
Segev gives as one example a 45-year-old male who has been waiting two years for a new kidney, and thinks he has three more years to wait. Should he take an at-risk kidney, the Web-based tool says he would have a 78 percent chance of being alive in five years, even accounting for the possibility of an undetected infection such as hepatitis C. If he turns it down, his five-year survival is estimated to be 60 percent. It would make sense, according to Segev, for this patient to take the kidney, because trying for a better kidney would actually result in much worse outcomes.
The story is different, he notes, for a 25-year-old male who has been on the waiting list for four years and likely has one more year to wait. If he takes the risky organ, he has an 84 percent chance of five-year survival. The chance of five-year survival is 83 percent if he waits for a better organ to come along.
"In this example, it's not worth taking the risk of an infectious disease because you'd do just as well with the next organ without any risk of disease," Segev says. "At the end of the day, this is a personal choice, and it's hard to know which organ is the right one for you. But we hope this makes the decision easier, by clearly illustrating what would be predicted to happen depending on the choice you make."
INFORMATION:
This research was supported by the National Institutes of Health's National Center for Research Resources (UL1 RR 025005), the NIH Roadmap for Medical Research and the National Institute of Diabetes and Digestive and Kidney Diseases (R21DK089456).
Other Johns Hopkins researchers involved in the study include Eric K.H. Chow, M.S.; Allan B. Massie, Ph.D.; Abimereki D. Muzaale, M.D., Ph.D.; Andrew L. Singer, M.D., Ph.D.; Lauren M. Kucirka, Sc.M.; Robert A. Montgomery, M.D., D.Phil.; and Harold P. Lehmann, M.D., Ph.D.
For more information:
http://www.transplantmodels.com/ird
Media Contact: Stephanie Desmon, 410-955-8665; sdesmon1@jhmi.edu
Helen Jones, 410-502-9422; hjones49@jhmi.edu
END
VIDEO:
New research has revealed that the use of Antimicrobial Copper surfaces in hospital rooms can reduce the number of healthcare-acquired infections by 58 percent as compared to patients treated in...
Click here for more information.
New York, NY (April 9, 2013)— New research has revealed that the use of Antimicrobial Copper surfaces in hospital rooms can reduce the number of healthcare-acquired infections (HAIs) by 58% as compared to patients treated in Intensive ...
Tumbling in the waves as they hit a rocky shore tells purple sea urchin larvae it's time to settle down and look for a spot to grow into an adult, researchers at the University of California, Davis, Bodega Marine Laboratory have found. The work is published April 8 in the journal Proceedings of the National Academy of Sciences.
"How these animals find their way to the right habitat is a fascinating problem," said Brian Gaylord, professor of evolution and ecology at UC Davis and a researcher at the Bodega Marine Lab. "The turbulence response allows them to tell that they're ...
Researchers at Moffitt Cancer Center and colleagues at the University of South Florida have found that when given together, a two-drug combination acts synergistically in test animals modeled with sarcoma tumors. They report that the drug combination of MK-1775 and gemcitabine resulted in a 70 percent decrease in the tumor volume when compared to receiving one drug or the other.
Their study was published in the March 8 online edition of PLOS ONE.
"Sarcomas are rare tumors affecting both children and adults, but sarcomas account for a greater number of pediatric cancers ...
The following highlights summarize research papers that have been recently published in Geophysical Research Letters (GRL), Space Weather (SW), Journal of Geophysical Research-Earth Surface (JGR-F), and Journal of Geophysical Research-Biogeosciences, (JGR-G).
In this release:
Characterizing the Moon's radiation environment
Three-dimensional mapping of airflow over dunes
Forest organic runoff breaks down faster than agricultural, urban runoff
Examining CO2¬ concentrations and flow dynamics in streams
Measuring the forces generated by erosive debris flows
Agulhas ...
ATLANTA – A potential new strategy to developing new drugs to control inflammation without serious side effects has been found by Georgia State University researchers and international colleagues.
Jian-Dong Li, director of Georgia State's Center for Inflammation, Immunity and Infection, and his team discovered that blocking a certain pathway involved in the biological process of inflammation will suppress it.
Inhibiting a molecule called phosphodiesterase 4B, or PDE4B, suppresses inflammation by affecting a key gene called CLYD, a gene that serves as a brake on inflammation.
The ...
MADISON – The age at which a child with autism is diagnosed is related to the particular suite of behavioral symptoms he or she exhibits, new research from the University of Wisconsin–Madison shows.
Certain diagnostic features, including poor nonverbal communication and repetitive behaviors, were associated with earlier identification of an autism spectrum disorder, according to a study in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Displaying more behavioral features was also associated with earlier diagnosis.
"Early ...
PROVIDENCE, R.I. – A study at Rhode Island Hospital has found that despite complications, patients co-infected with the pandemic 2009-2010 influenza A H1N1 (pH1N1) and a second respiratory virus were not associated with worse outcomes or admission to the hospital's intensive care unit. The study is published online in the journal PLOS ONE.
"There is scant data in the literature regarding the incidence and impact of simultaneous infection by two respiratory viruses, particularly in adults," said senior investigator Leonard Mermel, D.O., medical director of the department ...
Multiple genes contribute to risk for schizophrenia and appear to function in pathways related to transmission of signals in the brain and immunity, according to an international study led by Virginia Commonwealth University School of Pharmacy researchers.
By better understanding the molecular and biological mechanisms involved with schizophrenia, scientists hope to use this new genetic information to one day develop and design drugs that are more efficacious and have fewer side effects.
In a study published online in the April issue of JAMA Psychiatry, the JAMA Network ...
A Johns Hopkins Children's Center survey of 102 clinicians who treat teenage girls with pelvic inflammatory disease (PID) has found that official guidelines designed to inform decisions about hospitalization versus outpatient care leave some clinicians scratching their heads.
The study, conducted by a team of adolescent medicine specialists and published online in the journal Sexually Transmitted Diseases, presented the clinicians with a series of common clinical scenarios and discovered a great deal of uncertainty among some trying to choose between inpatient and outpatient ...
SALT LAKE CITY, April 10, 2013 – University of Utah researchers developed a high-speed camera system that spent the past two winters photographing snowflakes in 3-D as they fell – and they don't look much like those perfect-but-rare snowflakes often seen in photos.
"Until our device, there was no good instrument for automatically photographing the shapes and sizes of snowflakes in free-fall," says Tim Garrett, an associate professor of atmospheric sciences. "We are photographing these snowflakes completely untouched by any device, as they exist naturally in the air."
Snowflakes ...
