Journal articles in November focused on the economy of HLA matching in kidney transplantation and on the survival of children with cystic fibrosis who have lung transplants.
On November 4 in The New England Journal of Medicine (1999;341:1440-1446), Mark A. Schnitzler, PhD, of Washington University School of Medicine and colleagues said that better-matched cadaveric kidneys could lead to substantial savings in health care costs. Addressing the ongoing issue of whether organs should first be allocated on a local or national basis, the authors found that "because of the detrimental effects of the longer cold-ischemia time that is likely in a national allocation scheme, the economic benefits resulting from greater HLA matching are most readily available at the local level. Ignoring this fact may make an already imperfect system worse."
Paul Aurora of the Great Ormond Street Hospital for Children, London, and colleagues reported on November 6 in The Lancet that correctly timed lung transplantation will prolong life for most children with cystic fibrosis (1999;354:1591-1593). "Unless survival without transplantation improves dramatically, transplantation should remain a therapeutic option for cystic fibrosis patients with end-stage lung disease," they said. The authors studied 124 children with cystic fibrosis who were accepted for lung transplantation. Of the 47 patients who received transplants during the study period, 35 (74%) were alive a year after transplantation, and 12 patients were still alive five years after transplantation.
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