Search

The number of older patients is increasing on the transplant waiting list. Donation after circulatory death (DCD) kidney transplantation has increased, but there remains hesitancy in use of older DCD organs. The aim of this study was to evaluate outcomes of directing older DCD donor kidneys into older recipients. Methods Patients 60 years or older who received transplants from DCD donors 60 years or older, between February 2010 and January 2014, were identified from a prospectively maintained database. Results Over a 4-year period, 88 patients 60 years or older received DCD kidney transplants from donors 60 years or older. Of these 44 (55%) were 60 to 69 years old and 40 (45%) were 70 years or older. Median follow up was 63 months. Patient survival was 95% and 79% at 1 and 5 years, respectively, with a survival in those 70 years and older (69%) compared with those aged 60 to 69 (88%) years (P = .01). Censored for death graft survival was 94% and 80% at 1 and 5 years, respectively. Median estimated glomerular filtration rate at 12 months and 36 months was 36 mL/min (range, 11–70 mL/min) and 39.5 mL/min (range, 11–77 mL/min), respectively. Conclusions Older DCD kidneys, when transplanted into older recipients, result in good patient and graft survival and an acceptable graft function, especially considering their age. This represents a good use of this organ resource.

We aimed to analyse the efficacy of the Thymoglobulin dose used for induction in controlled DCD kidneys, and its initial impact on blood cell and CD3 count, as predictors of efficacy.140 DCD patients who received ATG induction, were analysed. Intended dose was 1.25 mg/kg/day over 5 days, rounded to nearest 25 mg and not exceeding 125 mg/dose. Outcomes included the total dose in relation with rejection, DGF, graft survival, eGFR. The cell count response to ATG was assessed as predictors of outcome.Graft survival, was 96.2%, 92.4%, 85% at 1, 3 and 5 years. Rejection was 7% at 1 year and associated with eGFR at 3 (p = 0.003) and 5 years. ATG dose was not predictive of rejection but was associated with the day5 leucocyte and lymphocyte count (p 0.001) and negatively with DGF (p = 0.05). In 31 patients day3 CD3 count was available and it was associated with rejection (p = 0.002), less DGF (p = 0.09), and 3 years eGFR (p = 0.01).Thymoglobulin provides excellent results in DCD kidneys that do not significantly differ with small dose variations. In higher doses it reduces DGF. Lymphocytes and CD3 count, may be useful surrogate markers of efficacy and outcome.

A prospective transplant patient’s work-up is a long and complex process. On the day of transplant, this information needs to be easily accessible and documented in one place. In an evolving environment, healthcare management is becoming a more individual process. Typical issues that became evident at morbidity and mortality meetings were that individual pre-operative concerns were not always highlighted at the time of admission. The published directorate protocol was not being fully initiated. Important discussions regarding donor risk to the patient were being written on pieces of paper, which could be easily lost. Our aim was to produce a document where the admitting doctor could input all of the up-to-date essential information into a single resource. The document included a full clerking of current state of health, background, past medical history, current medications and a pre-operative examination. Any concerns or management plans discussed by the transplant multi-disciplinary team (MDT) at the time of activation onto the transplant waiting list were given a place to be documented. Potential individual complications from the donor’s history were given a clear, defined place in the notes. A checklist was placed so that the department’s protocol was followed in its entirety. The proforma is currently in use on the Cardiff Transplant Unit. Leading the team by implementing a centralised document has enabled effective communication of key information to all relevant members of the team. This has helped to ensure that patient safety is optimised. The main message we would like to convey is the fact that a comprehensive admission proforma can aid in effective handover and communication, along with continuity of care and clarity of information. The proforma has streamlined the admission process, making the overall experience for the patients much more organised and straightforward, factors which are vital in an understandably anxiety-provoking time of their lives.

Introduction Socioeconomic deprivation is an important factor in determining poor health and is associated with a higher prevalence of many chronic diseases including diabetes and renal failure, and often poorer outcomes for patients with such conditions. The influence of deprivation on outcomes following vascular access surgery has not previously been reported. Methods The Welsh Index of Multiple Deprivation was used to assess the influence of socioeconomic deprivation on outcomes following 507 consecutive first upper limb arteriovenous (AV) fistulas from a single institution in the United Kingdom, performed between 2011 and 2014. The primary outcome measures were early failure and maturation into a working fistula. Results Four hundred and five (80%) patients had a patent AV fistula at the 2-week follow-up clinic. Three hundred and fifty-nine (71%) patients developed a functionally mature AV fistula as determined by clinical assessment and a Doppler scan. There were no differences in either early failure rates ( p = 0.95) or maturation rates ( p = 0.77) between the least and most deprived groups of patients. Conclusions In conclusion, this study has shown that socioeconomic deprivation does not influence outcomes following vascular access surgery.

Introduction Ankle sprains are among the most common of bone and joint injuries. Historically, distal tibiofibular syndesmotic injuries have been treated using syndesmotic metal screws to prevent diastasis. However, the use of screws meant that physiological micro-movement between the tibia and fibula was lost which often results in loosening and breaking of the screws. Tightrope fixation was a new technique that has been developed to overcome these complications and allowed some degree of flexibility similar to that offered by natural ligaments. The aim of our study was to evaluate such injuries. Materials and methods We conducted a retrospective study reviewing all clinical records of cases of patients with injuries of the distal tibofibular syndesmosis treated with the ankle tightrope (Arthrex Inc) in our institution between January 2008 and January 2011. Results A total of 42 patients were reviewed. We encountered five cases with complications (12%). Of those: three required removals due to prominent knot, one soft-tissue irritation and one with uncomplicated wound infection. Conclusion Our study, one of the largest so far evaluating complications of tightrope fixation, demonstrates that one in eight patients treated with tightrope will experience complication. How to cite this article Al-azzani WAK, Sabah T, Paringe V, O'Doherty D. Evaluation of Ankle Tightrope Syndesmosis fixation. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):1-4.