Alan B. Leichtman

Report of a National Conference on Donation after cardiac death.

A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end‐of‐life care.

The Report of a National Conference on the Wait List for Kidney Transplantation

In March, 2002, over 100 members of the transplant community assembled in Philadelphia for a meeting designed to address problems associated with the growing number of patients seeking kidney transplantation and added to the waiting list each year. The meeting included representatives of nine US organizations with interests in these issues. Participants divided into work groups addressing access to the waiting list, assigning priority on the list, list management, and identifying appropriate candidates for expanded criteria donor kidneys. Each work group outlined problems and potential remedies within each area. This report summarized the issues and recommendations regarding the waiting list for kidney transplantation addressed in the Philadelphia meeting.

Differential effect of gamma-irradiated and heat-treated lymphocytes on T cell activation, and interleukin-2 and interleukin-3 release in the human mixed lymphocyte reaction.

Heat-inactivated (45°C/1 hr) lymphocytes selectively activate suppressor T cells in the mixed lymphocyte reaction (MLR), while no significant proliferation and cytotoxic T lymphocyte activation can be detected. It is not well understood why hyperthermic treatment abolishes the stimulatory capacity of lymphocytes since HLA-DR molecules remain detectable immediately following heat exposure. In order to further characterize the requirements for Ts activation we studied the effects of hyperthermic treatment on cellular protein and DNA synthesis and cell surface protein expression in prolif-…

EFFECT OF DECEASED-DONOR AGE ON MEDIAN KIDNEY RECIPIENT AND GRAFT SURVIVAL: A TARGET FOR INTERVENTION: 1358

Introduction: Renal aging is associated with both new and upregulated expression of genes associated with proinflammatory, procoagulent and profibrotic pathways, and with endothelial and epithelial cell activation (Wiggins, et. al. JASN, 2010). Future strategies to enhance kidney transplant survival may specifically target the expression of these genes and gene products. To quantify the relationship between donor age and transplant outcomes, this abstract presents median patient and graft lifespans for a range of recipient and donor age combinations. Methods: Using data from the Scientific Registry of Transplant Recipients database the median expected recipient and graft lifespans for deceased donor transplants performed from 2005 through 2007 were calculated using Cox models (Wolfe et al, AJT 2008). Results: The figure shows the median graft survival for each donor and recipient age category. Within each recipient age group, median graft survival is highly dependent upon donor age. Conclusions: Graft lifespan depends much more on donor age than recipient’s age (especially among patients under 50 years of age). Previous theories seeking to explain the relationship between donor chronological age and transplant survival solely on the basis of preexisting donor disease (biopsy findings) and hyperfiltration are likely oversimplistic and fail to recognize renal senescence as an active and potentially interventionable process. Animal models of strategies to restrain or even reverse biological aging are under investigation. Future therapies targeting biological aging hold promise for improving renal allograft survival and increasing organ quality and supply.