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Leah B Edwards

Publications and source records attributed to Leah B Edwards.

28 records · Page 2Linked to original sources
PubMed2003

Geographic differences in access to transplantation in the United States.

BACKGROUND: The Etablissement français des Greffes reports regional variability in access to organ transplantation in France. Some variability seems to be inevitable for reasons discussed in the French article. We provide comparative data on a similar phenomenon in the United States, including some historical perspectives and recent attempts to minimize geographic variability especially for patients in urgent need of liver transplants. METHODS: To assess regional variability in access to heart, liver, and kidney transplants, a competing risks method was used. Outcomes were examined for primary transplant candidates added to the waiting list during 3-year periods. Results were stratified by region of listing. RESULTS: Four months after listing, the transplant rate for all U.S. kidney transplant candidates was 10.9%. Regionally the 4-month transplant rate ranged from 4.2% to 18.5% for highly sensitized patients and from 5.4% to 19.6% for nonsensitized patients. For liver candidates, the overall national transplant rate 4 months after listing was 22%, but the overall regional rate varied from 11.8% to 36.5%. The overall transplant rate for heart candidates 4 months after listing was 43.9%, whereas regional 30-day transplant rates for the most urgent heart candidates (status 1A) ranged from 25.1% to 47.1%. Four-month transplant rates for less urgent heart candidates ranged from 24.9% to 40.7%. CONCLUSION: Similar to the French experience, pretransplantation waiting times in the 11 U.S. regions vary considerably. Computer-simulated modeling shows that redrawing organ distribution boundaries could reduce but not eliminate geographic variability. It may be too early to tell whether the recently implemented Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease liver allocation system will decrease regional variability in access to transplant as compared with the previous system.

Geography↗
PubMed2003

Mechanical Circulatory Support device database of the International Society for Heart and Lung Transplantation: first annual report--2003.

Over the last 2 decades, mechanical circulatory support devices have been developed with the goal of supporting patients with advanced heart failure as a bridge to cardiac transplantation, a bridge to recovery, and an alternative to transplantation (also called chronic or destination therapy). The current generation of devices provides a differentiated spectrum of circulatory support. The major limitations of mechanical circulatory support devices are infection, coagulopathies and device dysfunction. The Scientific Council on Mechanical Circulatory Support of the International Society for Heart and Lung Transplantation has established an international database to generate critical data to advance knowledge about the effectiveness of mechanical circulatory support device therapy for one of the most difficult and costly contemporary medical problems, the malignant syndrome of advanced heart failure.

Adolescent↗
PubMed2002

Thoracic organ transplantation in the US.

Based on data reported to the United Network for Organ Sharing through December 2001: 1. The number of heart transplant procedures performed in the United States increased slightly (< 1%) during each of the last 2 complete years from 2,187 transplants during 1999 to 2,197 transplants during 2000, followed by an additional increase in 2001 to 2,202 transplants. A more substantial increase was seen in the number of lung transplants performed: from 890 transplants in 1999 to 956 in 2000 (+7%) and an additional increase to 1,053 transplants in 2001 (+10%). Fewer than 30 heart-lung transplants were performed in 2001. Living-donor lung transplants comprised 2-3% of lung transplants performed between 1995-2001. 2. Pediatric recipients were more frequently on life support in the ICU; more likely to have an ischemia time of at least 4 hours; more often gender mismatched; and more often ABO-compatible rather than ABO-identical with the donor than adult recipients for all thoracic organ types. 3. The most common indication for transplant since 1996 in adult heart recipients was coronary artery disease (50%), followed closely by cardiomyopathy (42%). Among pediatric heart recipients, the 2 most common indications: cardiomyopathy (46%) and congenital heart disease (43%) accounted for approximately 90% of the transplants. The indications for lung transplants were more disparate. In adult lung recipients, the 4 most common diagnoses (COPD - 42%, IPF - 17%, CF - 15% and A1A - 9%) encompassed more than 80% of the transplants. More than half of the pediatric lung transplants were performed in recipients with CF. The 3 most frequently cited indications for adult heart-lung transplant recipients (Eisenmenger's Syndrome, other congenital heart diagnoses and PPH) accounted for greater than 75% of the transplants. 4. Approximately 30-35% of adult heart transplants since 1999 have been performed in patients who were Status 1A. For pediatric transplant recipients, Status 1A comprised 60-70% of the transplants. 5. The one-year survival rate for transplants performed during the first three-quarters of 2001 was 85% for both adult and pediatric heart transplant recipients and 77% for both adult and pediatric recipients of lung transplants. For adult heart-lung transplants performed during 2000, the one-year survival rate was 69%. 6. The long-term patient survival rates were: 39% for adult heart recipients and 50% for pediatric heart recipients at 12 years; 18% at 11 years for adult lung recipients and 31% at 9 years for pediatric lung recipients; and 24% at 11 years for adult heart-lung recipients and 21% at 8 years for pediatric heart-lung recipients. 7. Drug-treated rejection and drug-treated infection were reported to occur before discharge in approximately 20-40% of transplant recipients, with the exception of pediatric lung and heart-lung recipients, with rates varying by organ and age group. Drug-treated infections were reported before discharge in more than 60% of pediatric lung recipients and approximately half of pediatric heart-lung recipients. 8. Approximately 60% of adult heart recipients and 70% of pediatric heart recipients were hospitalized at least once during the first 3 years following their transplant.

Adolescent↗