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  • 1
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 19 ( 2022-09-27), p. 5698-
    Kurzfassung: Kidney allografts are subjected to ischemia reperfusion injury during the process of transplantation. Hypothermic machine perfusion (HMP) of deceased donor kidneys from organ procurement until transplantation is associated with a superior outcome when compared to static cold storage (SCS). Nevertheless, cold ischemia time (CIT) remains an independent risk factor for delayed graft function (DGF) in HMP-preserved kidney allografts as well. We performed a retrospective single-center study including all adult recipients who underwent deceased donor kidney-only transplantation at our center between January 2019 and December 2020. Beside the clinicopathological donor and recipient data, flow and resistance data during HMP were assessed. Short- and long-term kidney allograft outcome after end-ischemic HMP and SCS were analyzed and compared. Organ preservation consisted of either SCS (n = 88) or HMP (n = 45). There were no differences in recipient demographics and donor details between groups. CIT was significantly longer in the HMP group (16.5 [8.5–28.5] vs. 11.3 [5.4–24.1] , p 〈 0.0001). The incidence of DGF as well as serum creatinine at discharge and at 1 year post transplant were comparable between groups. Duration of SCS prior to HMP was comparable among grafts with and without DGF. Flow rate and organ resistance at the start of HMP were significantly worse in DGF-kidney grafts (arterial flow 22.50 [18.00–48.00] vs. 51.83 [25.50–92.67] ml/min, p = 0.0256; organ resistance 123.33 [57.67–165.50] vs. 51.33 [28.17–111.50] mmHg/mL/min, p = 0.0050). Recipients with DGF had significantly worse creatinine levels at discharge (2.54 [1.08–7.64] vs. 1.67 [0.90–6.56] , p 〈 0.0001) and at 1 year post transplant (1.80 [1.09–7.95] vs. 1.59 [0.87–7.40] , p = 0.0105). In conclusion, baseline HMP parameters could be applied as a predictive tool for initial graft function, which in turn determines long-term outcome.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2022
    ZDB Id: 2662592-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    Springer Science and Business Media LLC ; 2023
    In:  Notfall + Rettungsmedizin Vol. 26, No. 6 ( 2023-09), p. 401-406
    In: Notfall + Rettungsmedizin, Springer Science and Business Media LLC, Vol. 26, No. 6 ( 2023-09), p. 401-406
    Kurzfassung: A portion of hospital admissions derive from unscheduled inpatients admitted through the emergency department (ED). Preparation for admission is routinely based on the decision by the physician in charge. The resulting time for the receiving ward to prepare for the admission is sometimes not sufficient and delays may occur. Aim The goal of this work is to demonstrate the benefits of using artificial neural networks (ANN) by illustrating its application within the context of predicting the probability that a patient in the ED will be admitted to the hospital. The question arises whether routinely collected patient data that are available in most EDs can already contribute to reducing the delay in the admission process. Materials and methods On the basis of limited and routinely collected data from a hospital information system, an ANN has been developed for an ED to predict whether admission to an inpatient ward is necessary. The ANN is implemented using the open source software R. Results Using routinely collected data, the ANN has an accuracy of 76.64%. The sensitivity, i.e., the share of correctly predicted admissions is 66.93%, which is lower than the specificity of 82.13% (share of correctly predicted discharges from ED). Discussion The results show that an ANN can make a valuable contribution to improve process management regarding admissions from the ED even if only routinely collected data are used. It is expected that additional variables, such as a patient’s age, will increase the accuracy of the prediction.
    Materialart: Online-Ressource
    ISSN: 1434-6222 , 1436-0578
    Sprache: Deutsch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2023
    ZDB Id: 1478809-3
    Standort Signatur Einschränkungen Verfügbarkeit
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