June 1, 2001
Development of the new database software for use by individual transplant centers is progressing on schedule. We are currently performing extensive field tests and we anticipate that the software will be available for delivery by the end of August. To recapitulate: the package will include a data bank system for transplant data that can be installed on your local PC. The system will contain functions for CTS transplant registration as well as follow up documentation. In addition, research variables that are of particular interest at a given center can be added and analyzed. The main advantage of the system is that all data are maintained and can be accessed locally. The data can be exported for preparation of center statistics using Excel, etc. Actuarial graft and patient survival analyses can be performed via the CTS internet function. The system is flexible in that you may choose either to enter your CTS data at your local PC or, alternatively, continue sending forms to CTS but request periodic data downloads for local statistical use.
We realize that some centers already have access to a well-funtioning computerized transplant database. The new CTS development is meant for those who do not have such access. Use of the new software package is entirely voluntary and free of charge.
If you would like to take advantage of this computer development, we will prepare an initial program and data set specifically for your center. We will download all data previously reported by you to CTS, so that your package will contain afully functional database. Since this preparation involves spending considerable time and effort on the part of our computer staff, we would be grateful if you would first consider the likelihood that the new software will be useful at your center. If the answer is yes, please send us your request for the software package on the enclosed form. In order not to cause confusion due to multiple requests from the same center, we are sending only one request form per center to the person who receives the regular CTS computer printout. Please discuss your potential requirements with your colleagues and forward your request if you would like to receive your center-specific data package. Thank you for your cooperation.
Please be reminded that the next date for shipment of material for the DNA project is
As in the past, please be sure to indicate that the material is intended for an international research study in organ transplantation, is not dangerous, and has no commercial value. Send us the shipping details (flight number, AWB number) by fax or e-mail so that we can track down packages in the case that they go astray. Thank you for your support of this project!
We recently noticed a marked rise of interest in the Steroid Withdrawal Project , possibly as a result of the data presented in the December 2000 CTS newsletter. A new analysis update shows that graft outcome in steroid-free patients continues to be excellent and there is still no evidence (after 5 years of follow up) that patients who must be returned to steroid treatment because of rejection suffer from deleterious longterm consequences. The advantage of steroid withdrawal becomes increasingly convincing. We would therefore like to encourage you to enroll all eligible patients in this project. Please let us know if you require additional information.
The majority of organs used for transplantation are obtained from cadaveric donors. Cause of donor death , in addition to length of ischemia, has been discussed as an important variable that may influence transplant outcome. For this newsletter we performed an analysis of the CTS data on donor cause of death.
Figure 1 shows kidney graft survival rates in relation to the cause of donor death. It appears that death from drowning is associated with a lower success rate. Separate examination of donor age, however, showed that death from drowning was particularly common among very young donors.
Figure 1
When donors younger than 5 were excluded from the analysis, the 1-year graft survival rate was no longer influenced by cause of death (Figure 2).
Figure 2
For subsequent analysis steps, we concentrated on the two most common causes of donor death: traumatic and cerebrovascular (CVA) . In agreement with previous reports, kidneys obtained after traumatic death had a significantly better 5-year survival rate (Figure 3).
Figure 3
However, donors dying from CVA were strikingly older than donors dying from traumatic causes (Figure 4)..
Figure 4
When the analysis was stratified for donor age , there was little difference in transplant outcome between the two groups, regardless of age bracket. What did change was the numerical distribution : where 45% of 25-50 year-old donors had died from traumatic causes, this fraction decreased to approximately 25% for donors in the older age groups. Clearly, donor age was much more influential than cause of death (Figures 5-6)..
Figure 5
Figure 6
Similar relationships were found in an analysis of heart and liver transplants . Whereas the overall comparisons showed superior graft outcome with organs derived from traumatic-death donors (Figures 7-8), the influence of donor age was predominant and the cause of death lost its importance when the analysis was age-stratified (Figures 9-10). Altogether, these results are in good agreement with the reports on analyses of donor age in CTS newsletters 2:1986, 1:1988, 5:1991, and 1:1992 (see CTS website under "Publications")..
Figure 7
Figure 8
Figure 9
Figure 10
Thanks are due to all staff members who have contributed with the documentation of malignant tumors in transplant recipients. Most centers have now returned the confirmation questionnaires and we will soon embark on an analysis of cancer data, the results of which will be shown in one of the forthcoming newsletters. Please consider specific questioning concerning the occurrence of tumors whenever you obtain follow up information on a patient. Completion of the yearly confirmation questionnaire will then not require much additional effort. The analysis of posttransplant malignancies is a very important part of the CTS study and your continued support will be highly appreciated.
Thank you for your cooperation.
Sincerely yours,