The effect of race on access and outcome in transplantation

Article Abstract:

A report is presented from the American Society of Transplant Physicians' Patient Care and Education Committee concerning racial inequality in organ transplantation. The specific focus is on kidney transplantation, since little data exist concerning racial aspects of transplantation of other organs. Blacks in the US have a fourfold higher risk for end-stage renal disease (irreversible kidney failure), as well as a higher prevalence. Other minority groups also appear at elevated risk, but data are scarce. Nonwhites make up a smaller proportion than whites of the patient population receiving dialysis (filtering the blood to remove waste products); a greater proportion of blacks have end-stage renal disease (28) than received a transplanted kidney in 1985 (21). Only 12 percent of recipients of a kidney from a living donor were black. It is clear that proportionally fewer blacks than whites receive kidney transplants. The reasons for this inequality include racial differences in blood group and other antigens (compatibility is important for preventing graft rejection); fewer minority organ donors (related to the first problem); insufficient medical insurance coverage (Medicaid does not completely cover the costs of kidney transplantation); poorer survival of the graft in black patients (even in medical centers with ''excellent'' results, long-term outcomes are poorer for blacks); and cultural and educational barriers between blacks and health care personnel. Little is known about kidney survival in other minority groups besides blacks, and very little about racial aspects of transplantation of other organs. Slightly more than 8 percent of 1,429 liver transplant recipients at one medical center during an eight-year period were black, a disproportionately low figure, since blacks have higher mortality from liver disease than whites, and make up more than 12 percent of the US population. Recommendations of the Committee are aimed at redressing the causes of these inequalities. While additional data are needed, change can begin immediately, particularly in the area of encouraging more organ donation by minority group members. Health care workers should strengthen their roles as advocates for these gravely ill, often poorly educated, patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Reports, Demographic aspects, Minorities, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, American Society of Transplant Physicians

---

Hyperlipidemia in the nephrotic syndrome

Article Abstract:

Nephrotic syndrome is a condition that results from various diseases that injure the glomeruli, tiny coils of capillaries in the kidneys. One common feature of the condition is hyperlipidemia, elevated levels of blood lipids, including cholesterol, triglycerides, and phospholipids. In particular, the increased serum level of low density lipoproteins (LDL), which has been associated with heart disease, has been observed. An article in the August 30, 1990 issue of The New England Journal of Medicine reported the use of radioactively labelled lipoproteins to examine the biosynthetic and catabolic (break-down) processes of lipid molecules that led to the hyperlipidemia in these patients. This and similar studies are very sensitive to the mathematic models that are used to interpret them, as well as to other methodological conditions, such that there remain concerns about the ability to compare results among studies in this area. While there have been conflicting reports concerning the ability of these patients to catabolize LDL molecules (reduced catabolism could lead to accumulations of LDL), most have reported increased synthesis of LDL. This finding can at least partially explain the accumulation of LDL in the blood; however, other biochemical mechanisms may be involved. For example, other related molecules, such as very low density lipoprotein (VLDL) may be metabolically converted into LDL and may aggravate the condition of hyperlipidemia. When a state of hyperlipidemia is expected to remain elevated, there is the possibility that it could precipitate cardiovascular problems, as well as new kidney complications. Physicians should consider therapeutic means of lowering this value by diet and medication in such cases. The underlying mechanisms that relate proteinuria (abnormally high levels of protein in the urine) to an associated finding of hyperlipidemia also remain unexplained. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, editorial

---

Abnormalities of lipoprotein metabolism in patients with the nephrotic syndrome

Article Abstract:

Nephrotic syndrome is a condition that results from various diseases that injure the glomeruli, tiny coils of capillaries in the kidneys. Characteristic features of nephrotic syndrome include spillage of protein into the urine, low levels of the blood protein albumin, and water retention (edema). One additional feature of the condition is hyperlipidemia, elevated levels of the blood lipids cholesterol, triglycerides, and phospholipids. It remains unclear whether the hyperlipidemia of nephrotic syndrome can lead to increased risk of heart attack. The reason for this condition in these patients remains unclear, but patients with nephrotic syndrome frequently have various abnormalities in their metabolism of lipoproteins. A study was performed of 57 patients with nephrotic syndrome who were otherwise free from complications or illness. The serum levels of various lipids and associated molecules were measured, and various ratios calculated. These patients, as expected, were found to have elevated blood levels of cholesterol, triglycerides, and phospholipids. The pattern of specific lipoproteins and their metabolism in these patients suggests that the difficulty involves an increased production of these molecules coupled with a normal metabolic utilization (catabolism). Therapies designed to inhibit the synthesis of low-density lipoproteins may be useful in alleviating the hyperlipidemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Similar abstracts:

• Abstracts: The use of anencephalic neonates as organ donors. Reexamining Organ Transplantation. The use of anencephalic infants as organ sources: a critique
• Abstracts: The effect of preexisting conditions on mortality in trauma patients. National inventory of hospital trauma centers
• Abstracts: The basis for a successful practice is 'PR,' patient relations. Dynamic growth through proper patient relations
• Abstracts: Prevalence of overweight and obesity in US Hispanic populations. Consequences for maternal nutrition of reproductive stress across consecutive pregnancies
• Abstracts: The federal regulation of prescription drug advertising and promotion. Introducing MEDWatch: A new approach to reporting medication and device adverse effects and product problems

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.