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  • 31
    Jan
    2013
    5:40pm, EST

    Time to kidney transplant varies by race, insurance

    By Genevra Pittman, Reuters

    NEW YORK - Kidney disease patients who are black or lack private health insurance are less likely to get matched up with a donor organ before needing to go on dialysis, a new study suggests.

    Still, researchers said, as long as patients get a kidney transplant within a year or so of starting dialysis, any extra benefit of a pre-dialysis transplant may be low.

    "It's a possible benefit, but it's not entirely clear," said Dr. Morgan Grams, who led the new study at the Johns Hopkins University School of Medicine in Baltimore.

    She told Reuters Health the findings represent "just another disparity" for African American patients, in particular, who take longer to get on the waitlist for a donor kidney and are less likely to get one at all.

    "Studies over the last 10 to 15 years have consistently shown that minorities have poorer access to transplantation," said Dr. Douglas Scott Keith, head of the kidney transplant program at the University of Virginia Medical Center in Charlottesville.

    "This article basically shows that it's persisting, it hasn't gotten much better," Keith, who wasn't involved in the new study, told Reuters Health.

    Grams and her colleagues looked at about 122,000 first-time kidney recipients who received their organ from a deceased donor off a transplant list between 1995 and 2011.

    Nine percent of those patients had their kidney transplant before going on dialysis, and another 12 percent received a kidney within their first year on dialysis, the researchers reported Thursday in the Clinical Journal of the American Society of Nephrology.

    African Americans were 56 percent less likely to receive a kidney before dialysis than whites - possibly because there was a delay in getting them on the transplant list or fewer matching donors, researchers said.

    Typically, an available organ goes to the local patient who has been on the kidney transplant list the longest - but that person can be skipped if the organ is a direct match to the immune system of another patient high on the list.

    People in the study who had private insurance were also three times more likely to get an early kidney than others.

    Insurance is required for a transplant, so anyone with private insurance can get on the list early. Others aren't eligible for government-funded insurance until they're on dialysis.

    It's still unclear whether receiving a kidney very early on improves the long-term outlook for patients with renal disease.

    Pre-dialysis recipients and people who got their kidney within a year of starting dialysis were equally likely to survive for years after their transplant, the researchers found. Both did better than late-dialysis recipients.

    "I would certainly not advocate postponing dialysis in the hope of getting a transplant without getting dialyzed," said Dr. Titte Srinivas, the head of transplant nephrology at the Medical University of South Carolina in Charleston, who also wasn't part of the research team.

    For a patient who needs it, "A short duration of dialysis is not really detrimental to health."

    Srinivas told Reuters Health what's most important is for anyone diagnosed with renal failure to get on the kidney transplant list as quickly as possible.

    Health care reform could make that easier for some people, Grams noted, as more low-income patients will have access to insurance - and the transplant list.

    "People don't realize that insurance makes such a huge difference," she said.

    Keith said aside from the insurance issue, researchers are still grappling with how to distribute kidneys of all different qualities, from all different types of donors, to the people who need them most.

    "We should be trying to make the system as fair as possible, and to limit disparities as much as possible," he said. "The question is how to do it."

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  • 20
    Oct
    2012
    9:33pm, EDT

    Father of bone marrow transplant, E. Donnall Thomas, dies at 92

    Susie Fitzhugh / FHCRC

    E. Donnall Thomas

    By Steven Dubois, The Associated Press

    E. Donnall Thomas, a physician who pioneered the use of bone marrow transplants in leukemia patients and later won the 1990 Nobel Prize in medicine, has died in Seattle at age 92. 

    The Fred Hutchinson Cancer Research Center announced the death Saturday. A spokesman said the cause was heart disease.

    Thomas' work is among the greatest success stories in the treatment of cancer. Bone marrow transplantation and its sister therapy, blood stem cell transplantation, have improved the survival rates for some blood cancers to upward of 90 percent from almost zero.


    This year, about 60,000 transplants will be performed worldwide, according to the Hutchinson Center.

    "Imagine coming up with an idea, making it a reality and touching that many lives," said Dr. Fred Appelbaum, Thomas' friend and the director of the center's Clinical Research Division.

    Thomas took after his father and became a doctor after getting his medical degree from Harvard. In 1956, he performed the first human bone marrow transplant.

    Thomas, along with a small team of fellow researchers, including his wife, Dottie, pursued transplantations throughout the 1960s and 1970s despite skepticism from the medical establishment.

    They sought to cure blood cancers by destroying a patient's diseased bone marrow with near-lethal doses of radiation and chemotherapy and then rescuing the patient by transplanting healthy marrow. The aim was to establish a functioning and cancer-free blood and immune system.

    The procedure would go on to become the standard treatment for many sufferers of leukemia and lymphoma. 

    "He was brilliant, he was incredibly generous and he was quick to deflect praise from himself to the individuals around him," Appelbaum said.

    "At the same time, while he was quiet and modest, he was stubborn," he added. "He believed in what he was doing and he was going to make it happen. It's hard to imagine today how hard it was to make this reality because it was against the prevailing medical wisdom."

    Thomas joined the University of Washington faculty in 1963. In 1974, he became the first director of medical oncology at the Hutchinson Center. It is now one of the world's top cancer treatment and research institutions.

    Thomas also edited the first two editions of the bone marrow transplantations reference book, "Hematopoietic Cell Transplantation," which would become a bible for the field.

    "To the world, Don Thomas will forever be known as the father of bone marrow transplantation, but to his colleagues at Fred Hutch he will be remembered as a friend, colleague, mentor and pioneer," Larry Corey, president of the research center, said in a statement.

    Thomas is survived by his wife, two sons and a daughter. 

    © 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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  • 25
    Sep
    2012
    12:37pm, EDT

    Report: Ohio nurse didn't realize she took kidney

    By The Associated Press

    A nurse who accidentally disposed of a living donor's kidney during a transplant said she didn't realize it was in chilled, protective slush that she removed from an operating room, took down a hall to a dirty utility room and "flushed down a hopper," according to a report released by health officials on Monday.

    The nurse said she had been on a break when a surgeon told everyone the kidney had been put in the sterile, semi-frozen solution. That detail was in a review by the state for the federal Centers for Medicare and Medicaid Services (CMS) and obtained by The Associated Press through a records request. The transplant was Aug. 10 at the University of Toledo Medical Center.

    Hospital administrative staff members interviewed on Aug. 21 hadn't determined how the nurse took the 13-gallon bag of slush, meant to extend the kidney's viability, past several members of the medical staff without them noticing a problem, the report said.

    It said poor oversight and communication and insufficient policies were factors in the kidney's disposal, which prompted the voluntary, temporary suspension of the hospital's living-donor kidney transplant program and led to reviews by health officials and a consulting surgeon hired by the hospital.

    The hospital, in northwest Ohio about 135 miles north of Columbus, "failed to provide adequate supervision and communication resulting in a donor's kidney being carried out of the operating room, down a hall, into a dirty utility room, and flushed down a hopper," the report stated.

    The hospital has since enacted clearer policies to clarify communication between nurses who fill in for one another and to make sure nothing is removed from an operating room until the patient has been moved from it, the report said.

    The surveyors determined the hospital wasn't in compliance with CMS conditions of participation for transplant and surgical services. CMS will authorize a full review of the conditions of participation for the hospital, and, if it's found out of compliance, it could be terminated from the Medicare program, CMS spokeswoman Elizabeth Surgener said in an email.

    The hospital, which says it offers specialty care in areas including cardiology, cancer, surgery and kidney transplantation, also may submit a plan of correction.

    A spokesman said he had no comment to provide from the hospital Monday.

    The hospital hasn't said what happened to the intended kidney recipient, who was supposed to receive an organ donated by her brother. The intended recipient and her brother were released from the hospital, which didn't identify them and said it couldn't say whether she received a different kidney.

    Hospital officials apologized and hired a Texas surgeon to evaluate their transplant procedures but have not released the results of that evaluation.

    The medical center suspended two nurses after the incident; one was later fired, and the other resigned, the hospital said. A surgeon was stripped of his title as director of some surgical services, and a surgical services administrator put on paid leave has resumed work.

    The hospital also notified 975 patients and potential organ donors and recipients that they might need to make other arrangements for services typically provided through the program under review.

    © 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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