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Using older donors can increase number of pancreas transplants, reports university of Pittsburgh Surgeons Surgeons achieved their best results with older, “marginal” donors

Piittsburgh, Jan 27 - Transplanting pancreases from “marginal” donors - those who are clinically unstable or over the age of 45 - can significantly expand the pool of donated organs, which are currently in scarce supply, and double the number of pancreases transplanted into diabetic patients, a team from the University of Pittsburgh Medical Center (UPMC) reports today in the journal Transplantation. In fact, those organs did just as well, if not batter, than organs from ideal donors, the results of the study show. The chronic shortage of organs has forced UPMC surgeons into the practice of accepting organs from marginal donors. But the shortage is compounded by problems with the national distribution system, namely that organ procurement organizations (OPOs) do not always obtain family consent for pancreas donation, and that donated pancreases are often discarded or are not shared outside the OPO's local area or region. “Utilization of pancreas grafts varies from 0 percent to more than 70 percent among different procurement regions”, wrote the authors. “With demand for organs far exceeding the supply of optimal donors, we have instituted an aggressive policy that does not exclude organs based on age or hemodynamic status”, says Robert J. Corry, M.D., professor of surgery and director of pancreas transplantation at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute, who notes that the region surrounding Pittsburgh has the highest numbers of older and senior adults in the United States. In their study, UPMC surgeons followed 137 patients transplanted between July 1994 and March 1998 with organs procured by the center's own surgeons. With a mean follow-up of nearly two years, the overall graft survival rate was 83 percent. But in a subset of patients who received organs from donors over the age of 45, the survival was 86 percent. Thirteen of these patients' donors were between 50 and 62 years of age, and 92 percent maintained functioning grafts. Another subset consisting of 51 patients who received organs from clinically unstable donors had a graft survival of 86 percent. “There was no significant difference found in graft survival between recipients of pancreatic grafts from marginal and nonmarginal donors”, say the authors. Furthermore, patients with marginal grafts did not have higher rates of complications, and although by certain clinical measures grafts were slower to function in patients whose organs were from less stable patients, the long-term graft survival and function were not adversely affected. The surgeons reported that the best assessment of the suitablility of an organ is visual inspection for calcification, fat and evidence of fibrosis. All of the 137 patients in the study were diabetic with major complications of their disease. The majority, 117, received simultaneous kidney and pancreas transplants. Eight patients underwent solitary pancreas transplantation, and were kidney recipients who had a second operation to transplant the pancreas. According to the study, the patients who did the best with marginal donors were those receiving simultaneous kidney-pancreas transplants and those receiving solitary pancreases. Pancreas transplantation reverses or arrest many of the major complications of diabetes. It significantly improves quality of life, and some researchers argue it to be a lifesaving procedure. Diabetes affects 16 million Americans. According to the United Network for Organ Sharing (UNOS), more than 2,200 patients are awaiting kidney-pancreas or pancreas transplants in the Unites States. (More than 40,000 are awaiting kidneys). In 1997, there were 5,475 cadaveric donors, but only 1,316 pancreases were removed from these donors. According to UNOS, which oversees the nation's procurement and transplant network under federal contract,nearly 11 percent of recovered pancreases are discarded at the local OPO level, the highest rate for all the organ types. In addition to Dr. Corry, other authors include Sandip Kapur, M. D.; C. Andrew Bonham, M.D.; S. Forrest Dodson, M.D., and Igor Dvorchilk, Ph D. Their results were presented at the 24th Annual Meeting of the American Society of Transpant Surgeons in Chicago Iast May. Today's journal also contained another papar from the University of Pittsburgh that examined the favorable results obtained using the anti-rejection drug tacrolimus, on Prograf, for patients who receive kidney and kidney-pancreas transplants. For more information about UPMC Health System, please access http://www.upmc.edu

Cocaine and tobacco use increase risk of miscarriage, find university of Pittsburgh researchers Pittsburgh, feb 3 -

Tobacco smoking and cocaine use independently contribute to spontaneous abortion (miscarriage), according to results of a landmark study led by Roberta B. Ness, M.D., M.P.H., at the University of Pittsburgh Graduate School of Public Health (GSPH). Result are reported in the February 4 issue of The New England Journal of Medicine. “This is the first study show that cocaine use is linked with subsequent risk of miscarriage and that cocaine use is associated with miscarriage independent of tobacco use”, said Dr. Ness, associate professor of epidemiology, director of the Cancer Epidemiology Program of the University of Pittsburgh Cancer Institute and director of the Epidemiology of Women's Health Program at the GSPH. “This research emphasizes that virtually any exposure to illecit drugs is dangerous for a pregnant woman and her fetus”, said Alan I. Leshner, M.D., director of the National Institute on Drug abuse (NIDA), National Institute of Health, which provided partial funding for the study. “With addiction, an individual's compulsion to use drugs may well be greater than her ability to protect her health and pregnancy. The need for adequate treatment for these women is critical”. The rates of substance use were high in the study group of 970 inner-city, pregnant women of lower socioeconomic status. The report is based on 400 of those women who had miscarriages (cases) and 570 who carried their pregnancies past 22 weeks (controls). Almost 30 percent had evidence of cocaine use in the previous few months, and over one-third currently smoked. Both current smoking and cocaine use significantly increased the risk of miscarriage. In fact, the study reports that 24 percent of the risk for miscarriage in study women could be related to cocaine and tobacco use. “Cocaine has been previously associated with low birthweight,” said Dr. Ness. “Our findings suggest that it and tobacco can interfere with pregnancy, and that they act early in gestation”. According to the study report, cocaine was measured at baseline by self-report and urine and by hair analysis. Tobacco use was measured by self-report and urine cotinine, a major metabolite of nicotine. Hair analysis for cocaine was chosen because it serves as an indicator of long-time use. Hair samples were washed thoroughly before measurement to reduce the incidence of false positives due to external contamination. “Tobacco use is, perhaps, the greatest environmental contributor to neonatal health problems”, said Dr. Ness. “Young women are also the fastest growing population to take up smoking. For both these reasons, it is vitally important that we tackle the problem of tobacco use during pregnancy. Ongoing research is evaluating the effectiveness of smoking cessation programs during pregnancy. Evaluation and implementation of such programs should be a priority. “The use of cocaine,” she continued, “probably varies substantially over different populations. In one national survey, five percent of women of childbearing age reported cocaine use in the past month. Marital status id associated with reduced use, and young age is associated with increased use. The rates in our study are particularly high, probably because they reflect inner-city, indigent, young, unmarried women”. Dr. Ness specializes in reproductive and women's health. She has additional research interests in obesity, cardiovascular disease and pelvic inflammatory disease. Celebrating its 50th year, the GSPH is world-renowned for contributions that have influenced public health practices and medical care for millions of people. For more information about the GSPH access http://www.pitt.edu/( gsphhome/. This research is supported by grants from the National Institute on Drug Abuse and the Agency on Health Care Policy Research. Using older donors can increase number of pancreas transplants, reports university of Pittsburgh Surgeons Surgeons achieved their best results with older, “marginal” donors

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