Finally, these biochemical markers can only be useful to patients if interpreted in the context of the clinical history and GSK126 cell line examination and a consideration of what management is appropriate for the specific patient, and if a cardiovascular therapy that is effective in this population is identified or developed. MAR is supported by an NHMRC Training
Fellowship (628902). Key messages regarding troponin testing in dialysis patients with acute cardiac symptoms: The pre-test probability of cardiovascular disease is high “
“Date written: June 2007 Final submission: October 2008 a. The best designed randomised controlled trial demonstrates no advantage of donor-specific transfusions (DSTs) in graft survival at 2 years or in the incidence of acute rejection. (Level II evidence) (Suggestions are based on Level III and IV evidence) The high risk BGJ398 solubility dmso of sensitisation does not justify the routine use of DSTs (Level III evidence) No recommendation. Maximising graft survival from living donors is a major goal in transplantation given the mismatch between the number of available donors and the ever-increasing number of recipients. Blood transfusion from living donors to the recipient prior to kidney transplantation
was introduced several decades ago with the aim of improving graft outcome. However, with reduced acute rejection rates associated with newer immunosuppressive agents and recombinant erythropoietin use, DST is rarely practised. Nevertheless, modulating the immune response
to the donor and inducing ‘pseudo-tolerance’ without having to rely heavily on immunosuppression continues to be a goal of transplantation medicine. When reviewing the evidence, it needs to be recognized that there may be fundamental differences between early reports of DST use and the DST of today; red blood cells are now washed and are essentially free of white blood cells – which may have been an important mediator of the observed effects. Furthermore, more recent literature suggests that the beneficial effect of tolerance develops only if the blood donor and recipient have one HLA haplotype or at least one HLA-B and one HLA-DR Adenosine antigen in common.1 Many of the studies reviewed below do not specify these details. The purpose of these guidelines is to review the evidence on DST in living kidney donation (LKD) and to provide recommendations on when and whether its use is warranted. Databases searched: MeSH terms and text words for kidney transplantation and living donor were combined with MeSH terms and text words for blood transfusion. The search was carried out in Medline (1966 – September Week 2, 2006). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of search: 26 September 2006.