A pilot study of a system for harvesting kidneys from nonheartbeating donors where attempts of resuscitation after a witnessed outofhospital cardiac arrest have failed (uncontrolled NHBDs) resulted in 21 successful kidney transplants a 10% increase in the transplantation rate over 17 months. Researchers writing in BioMed Centrals open access journal Critical Care have shown that retrieval from uncontrolled NHBDs may provide a valuable source of organs and could help counter the shortage of kidney grafts in France.

Dr MarieReine Losser, from the Paris Diderot University (Paris7), worked with a team of French researchers to trial the retrieval protocol in the Hôpital SaintLouis (Assistance PubliqueHôpitaux de Paris). She said, “Patients dying from sudden out of hospital refractory cardiac arrests may be eligible kidney donors. In the system we describe, the emergency services referred such patients to our institution under continuous ventilation and CPR. After death was certified, the kidneys were preserved while approval for donation was sought from the patients next of kin”.

Between February 1st 2007 and June 30th 2008, 122 patients were referred to the hospital in this way, and 49 were found to be eligible for organ retrieval. The families of 15 of these patients refused consent for organ donation, in 12 cases in the absence of or contrary to the donors previously expressed wishes. From the remaining patients, 31 kidneys were transplanted and at least 27 of these transplants were ultimately successful.

According to Losser, the procedure raised ethical controversies in France, “The question emerged about a conflict of interest between patient care and potential organ procurement. In fact, in this cohort, resuscitation duration was always longer than recommended. There is, however, a clear need for better acceptance of organ donation within the population, something that could be achieved by sustained nationwide information campaigns”.

Notes
Kidney retrieval after sudden out of hospital refractory cardiac arrest a cohort of uncontrolled non heart beating donors. Fabienne Fieux, MarieReine Losser, Eric Bourgeois, Francine Bonnet, Olivier Marie, Francois Gaudez, Imad Abboud, JeanLuc Donay, France Roussin, Francois Mourey, Frederic Adnet and Laurent Jacob. Critical Care (in press). ccforum.com/

Source
Graeme Baldwin

Springer, one of the leading publishers in the fields of science, technology and medicine, has signed an agreement with The Endocrine Society to copublish a new journal, Hormones & Cancer, starting in January 2010. Hormonal cancers include two of the most deadly cancer subtypes, cancers of the breast and prostate. In addition to these cancers, Hormones & Cancer will include research articles covering other lesscommonly occurring cancer subtypes, such as thyroid, gynecologic and pituitary cancer. The journal will help to bridge the gap between those working in the two often disconnected fields of endocrinology and cancer research.

Hormones & Cancer will be a true translational journal, including basic scientific, epidemiological and clinical research papers. Because of the inherent multidisciplinary nature of the field, it is anticipated that the journals focus will be on all aspects of hormone action on cancer causation, progression, dependence, prevention, resistance and treatment. Translational studies, especially those utilizing novel cancer agents selectively designed to exert their action at hormone target tissues, will also be welcomed.

Springer and The Endocrine Society have worked together to create a highly respected, international editorial board that includes many of the leaders in this interdisciplinary field. The editorinchief will be Jonathan Li of the Department of Pharmacology, Toxicology, and Therapeutics at Kansas University School of Medicine in Kansas City, Kansas. Board members include V. Craig Jordan, the first to discover the breast cancer prevention properties of tamoxifen, and Kate Horwitz, Distinguished Professor of Endocrinology, Metabolism, and Diabetes at the University of Colorado Denver, and Past President of The Endocrine Society.

“The timing of this journals launch could not be better,” said Kate Horwitz. “The disciplines of endocrinology and oncology have been artificially segregated for years. This is evident in factors as disparate as the divisional structure of departments of medicine and the layout of granting agency review panels. Cancers of hormoneproducing organs, and of organs that are the targets of hormones, represent a large and diverse group. Hormones & Cancer will now link them.”

“We are pleased to add Hormones & Cancer to The Endocrine Societys family of journals. It will create a home for this important field of research, which is a focus of many of our members, and a concern for our practitioners and their patients,” commented Margaret Shupnik, Publications Core Committee Chair, The Endocrine Society.

Henk van der Rijst, Executive Vice President, Biomedical and Life Sciences at Springer, said “Working with a prestigious society to disseminate critical information more widely is one of our core activities. Springer looks forward to a long and collaborative partnership with The Endocrine Society.”

Hormones & Cancer will be published bimonthly both electronically and in print. The journal will include Cross Reference Linking, alert services, and Online First™, a feature by which articles are published online before they appear in print. The journal will be available on SpringerLink.com, the worlds most comprehensive collection of scientific, technological, and medical journals, books and reference works.

Founded in 1916, The Endocrine Society is the worlds oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. It is an international body, with 14,000 members from over 100 countries. The Endocrine Society publishes four worldrenowned journals and a monthly news magazine. It also holds scientific conferences, provides educational programs for physicians, issues clinical practice guidelines and promotes careers in endocrinology. The Society advocates for appropriate funding of scientific research in endocrinology and public policies that support the practice of clinical endocrinology.

Springer is a leading global scientific publisher of books and journals, delivering quality content through innovative information products and services. It publishes close to 500 academic and professional society journals. Springer is part of the publishing group Springer Science+Business Media. In the science, technology and medicine (STM) sector, the group publishes around 2,000 journals and more than 6,500 new books a year, as well as the largest STM eBook Collection worldwide. Springer has operations in about 20 countries in Europe, the USA, and Asia, and more than 5,000 employees.

Hormones & Cancer
ISSN 18688497 (print version), ISSN 18688500 (electronic version)

Source
Joan Robinson

Across the country, students are preparing to start or return to college. This is an exciting time, though for some its overwhelming and stressful. Depression, substance use and eating disorders are increasingly common mental health issues on college campuses.

According to a 2008 American College Health Association survey1, within the last 12 months, 30 percent of students reported feeling so depressed that it was difficult to function and 49 percent felt overwhelming anxiety. In addition, 10 percent of students also reported being diagnosed or treated for depression and more than six percent seriously considered suicide.

Major depression increases the likelihood of substance abuse, impairs functioning at school, and influences an individuals subsequent development in negative ways. Depression can also cooccur with other disorders, including physical illnesses and other mental disorders, such as anxiety and eating disorders.

College Students and Alcohol, a Sobering Look

College is also a time to enjoy the social atmosphere that thrives on campuses. Most students can balance the mix of academic and social activities, though pressure to participate in binge drinking, drinking large quantities of alcohol most nights during the week, and drinking to feel like a part of the crowd are common occurrences. Most students do not connect alcohol abuse with a potential mental health issue. If a student feels that alcohol has become a problem, it is important for him or her to seek care. Many colleges have excellent mental health resources associated with their student health services. Checking in with them as a part of the orientation process can be very helpful for many students and families.

Visit HealthyMinds.org for additional mental health information.

Follow the APA on Facebook at American Psychiatric Association and APA Healthy Minds. Healthy Lives. andfollow APAPsychiatric and APAHealthyMinds on Twitter.

1 American College Health Association. American College Health AssociationNational College Health AssessmentReference Group Executive Summary Fall 2008. Baltimore American College Health Association; 2008.

The most severely ill advanced renal cell cancer patients in England & Wales (numbering around 390 people) have been dealt a blow by the decision of the National Institute for Health and Clinical Excellence (NICE) to reject an appeal by Wyeth against NICEs earlier decision not to recommend Torisel (temsirolimus) for use by the NHS in England & Wales.

As the only treatment evaluated in NICEs recent Health Technology Appraisal of kidney cancer drugs to have demonstrated a significant extension to life in this severely ill group of patients1, the rejection of Torisel will be seen as further limiting the options available to patients fighting advanced kidney cancer.

“The rejection of this appeal and the failure to recommend Torisel the only treatment proven to extend life in these patients is a devastating blow to patients and their families” said Dr Vignesh Rajah, Medical Director, Wyeth. “It further accentuates the disparity in cancer care between the UK and other advanced countries, where Torisel and other innovative renal cell cancer drugs are routinely used. NICEs rejection also conflicts with professional treatment guidelines on renal cell cancer published earlier this year, recommending Torisel as first line treatment for poor prognosis patients2,3.”

Torisel is licensed to treat a very small group of advanced renal cell cancer patients with the poorest prognosis. Given the rarity of this severe form of renal cancer, it is termed an “ultraorphan” condition. NICE has previously acknowledged that appraising drugs for very rare conditions, such as this, “presents special difficulties”.4

Wyeth believes that NICE failed to fully take into account both the very small number of patients eligible for treatment with Torisel and their degree of clinical need. Consequently, Wyeth believes that this has resulted in a decision that discriminates against the most seriously ill renal cell cancer patients.

NICE has already taken an important step forward in recommending an innovative lifeextending treatment for some other groups of renal cancer patients. Nevertheless, the hardest hit patients those with advanced renal cell cancer with the poorest prognosis have been left without access to the only drug proven to extend their lives.

Wyeth appealed against the proposed Final Appraisal Determination with respect to the fact that NICE had failed to act fairly and in accordance with its published procedures and with regard to the fact that it had prepared a Final Appraisal Determination which was perverse in the light of evidence submitted.

Dr Rajah commented “Wyeth is very disappointed by the rejection of this appeal as we believe the Appraisal Committee failed to correctly apply the Institutes own guidance (known as the End of Life Supplementary Advice) for appraising lifeextending, endoflife treatments. This requires due consideration to be given to the impact of giving greater weight to the quality of life of patients in the later stage of terminal diseases in order to fully capture the treatment benefits of life extending drugs, such as Torisel.

He continued “In addition, we consider that the Appraisal Committee failed to adequately use its discretion in applying directions from the Secretary of State for Health that allow particular features of a condition and the patient population it affects to be taken into account when determining the cost effectiveness of a treatment.”

Following the rejection of its appeal, Wyeth is considering its position and the available options to secure patient access to Torisel.

About Torisel

Torisel (temsirolimus) is the first and only renal cell cancer therapy proven to extend overall survival in the treatment of advanced renal cell carcinoma (RCC) in patients with poor prognosis compared with interferonalpha.1 An openlabel, randomised, phase 3 study compared Torisel alone, a combination of Torisel plus interferonalpha, and interferonalpha alone as firstline therapy in 626 patients with advanced RCC who had at least three of six prognostic risk factors.1

In this study, Torisel alone significantly increased median overall survival by 49 % compared with interferonalpha alone (10.9 months for Torisel vs. 7.3 months for interferonalpha, P=0.0078).1Torisel was also associated with statistically significant improvement over interferonalpha in the secondary end point of progressionfree survival (PFS), when the disease does not get worse (3.8 months of PFS vs. 1.9 months of PFS, P

The most severely ill advanced renal cell cancer patients in England & Wales (numbering around 390 people) have been dealt a blow by the decision of the National Institute for Health and Clinical Excellence (NICE) to reject an appeal by Wyeth against NICEs earlier decision not to recommend Torisel (temsirolimus) for use by the NHS in England & Wales.

As the only treatment evaluated in NICEs recent Health Technology Appraisal of kidney cancer drugs to have demonstrated a significant extension to life in this severely ill group of patients1, the rejection of Torisel will be seen as further limiting the options available to patients fighting advanced kidney cancer.

“The rejection of this appeal and the failure to recommend Torisel the only treatment proven to extend life in these patients is a devastating blow to patients and their families” said Dr Vignesh Rajah, Medical Director, Wyeth. “It further accentuates the disparity in cancer care between the UK and other advanced countries, where Torisel and other innovative renal cell cancer drugs are routinely used. NICEs rejection also conflicts with professional treatment guidelines on renal cell cancer published earlier this year, recommending Torisel as first line treatment for poor prognosis patients2,3.”

Torisel is licensed to treat a very small group of advanced renal cell cancer patients with the poorest prognosis. Given the rarity of this severe form of renal cancer, it is termed an “ultraorphan” condition. NICE has previously acknowledged that appraising drugs for very rare conditions, such as this, “presents special difficulties”.4

Wyeth believes that NICE failed to fully take into account both the very small number of patients eligible for treatment with Torisel and their degree of clinical need. Consequently, Wyeth believes that this has resulted in a decision that discriminates against the most seriously ill renal cell cancer patients.

NICE has already taken an important step forward in recommending an innovative lifeextending treatment for some other groups of renal cancer patients. Nevertheless, the hardest hit patients those with advanced renal cell cancer with the poorest prognosis have been left without access to the only drug proven to extend their lives.

Wyeth appealed against the proposed Final Appraisal Determination with respect to the fact that NICE had failed to act fairly and in accordance with its published procedures and with regard to the fact that it had prepared a Final Appraisal Determination which was perverse in the light of evidence submitted.

Dr Rajah commented “Wyeth is very disappointed by the rejection of this appeal as we believe the Appraisal Committee failed to correctly apply the Institutes own guidance (known as the End of Life Supplementary Advice) for appraising lifeextending, endoflife treatments. This requires due consideration to be given to the impact of giving greater weight to the quality of life of patients in the later stage of terminal diseases in order to fully capture the treatment benefits of life extending drugs, such as Torisel.

He continued “In addition, we consider that the Appraisal Committee failed to adequately use its discretion in applying directions from the Secretary of State for Health that allow particular features of a condition and the patient population it affects to be taken into account when determining the cost effectiveness of a treatment.”

Following the rejection of its appeal, Wyeth is considering its position and the available options to secure patient access to Torisel.

About Torisel

Torisel (temsirolimus) is the first and only renal cell cancer therapy proven to extend overall survival in the treatment of advanced renal cell carcinoma (RCC) in patients with poor prognosis compared with interferonalpha.1 An openlabel, randomised, phase 3 study compared Torisel alone, a combination of Torisel plus interferonalpha, and interferonalpha alone as firstline therapy in 626 patients with advanced RCC who had at least three of six prognostic risk factors.1

In this study, Torisel alone significantly increased median overall survival by 49 % compared with interferonalpha alone (10.9 months for Torisel vs. 7.3 months for interferonalpha, P=0.0078).1Torisel was also associated with statistically significant improvement over interferonalpha in the secondary end point of progressionfree survival (PFS), when the disease does not get worse (3.8 months of PFS vs. 1.9 months of PFS, P

The Centers for Disease Control and Prevention is drafting a formal recommendation that all male infants born in the U.S. be circumcised as a way to reduce the spread of HIV/AIDS, the New York Times reports. Recent studies have shown that in African countries circumcision reduces a mans risk of infection by 50%; however, those studies focused on heterosexual men who are at a high risk of contracting HIV from female partners. The procedure does not seem to protect men who have sex with men the population at greatest risk of infection in the U.S. It is unclear whether male circumcision reduces the risk for women, experts say. “Theres mixed data on that,” according to Peter Kilmarx, chief of epidemiology for the division of HIV/AIDS prevention at CDC. He added, “If we have a partially successful intervention for men, it will ultimately lower the prevalence of HIV in the population, and ultimately lower the risk to women.”

The recommendation is expected to be released by the end of the year, but the issue already has generated controversy. Critics contend that the procedure subjects male infants to medically unnecessary surgery without their consent, while proponents argue that any measure that can reduce HIV infection rates should be taken under consideration. About 79% of adult men in the U.S. are circumcised. The Times reports that rates have fallen in recent years in part because the American Academy of Pediatrics does not endorse routine circumcision. AAPs policy states that circumcision is “not essential to the childs current wellbeing.” As a result, many state Medicaid programs do not cover the operation, the Times reports. However, AAP is revising its guidelines and is expected to replace the neutral tone with a policy stating that circumcision has health benefits even beyond HIV prevention, such as reducing urinary tract infections in infants, according to Michael Brady, an AAP consultant.

Kilmarx said, “We have a significant HIV epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic.” He added, “What weve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.” Still, according to Kilmarx and other public health officials, the benefits of such preventive measures would be muted in the U.S. compared with Africa because HIV is less prevalent here, spreads through different routes and because circumcision already is highly common (Rabin, New York Times, 8/24).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

The program created to provide Medicare recipients with prescription drug benefits exceeded expectations during its first two years, extending pharmacy coverage to most seniors while reducing their overall spending on drugs, according to a new RAND Corporation study.

Although Medicare Part D generated confusion when it was introduced in January 2006, the program has worked well for most seniors and is comparable to other nonMedicare drug plans that cover large groups of seniors, according to the report published in the August edition of the American Journal of Managed Care.

“In the beginning there was a lot of concern about Medicare Part D, but we found convincing evidence that it has exceeded expectations and generally has been successful,” said Geoffrey Joyce, the studys lead author and a senior economist at RAND, a nonprofit research organization. “Most seniors now have prescription drug coverage that allows them to buy drugs at a reasonable cost.”

Researchers estimate that during its first year in 2006, Medicare Part D resulted in a 16 percent drop in outofpocket spending among seniors for prescription medication and a 7 percent increase in the number of prescriptions filled. The savings appears to have been concentrated among the poor and disabled.

“It appears that Medicare Part D has been particularly successful in lowering costs for the poor and the disabled, which is an important finding since initially there was concern these groups would be particularly vulnerable under a privately administered benefit,” Joyce said.

Researchers from RAND Health used administrative records to examine seniors participation in the Medicare Part D program, including how the program has affected seniors access to medications, their use of prescription drugs and their financial risk. They also compared the 10 largest Part D plans in 2006 to seven nonMedicare drug plans often cited as examples of lowcost or generous pharmacy benefits.

After two years, about 90 percent of seniors have drug coverage at least as generous as the standard Part D benefit. Medicare recipients in most states could choose from more than 50 different Part D plans in 2008, a sign of competition among the private companies that provide the coverage.

The number of covered drugs in the 10 largest Medicare Part D plans compared favorably with the coverage provided by other prescription drug plans that insure seniors, such as those offered by Kaiser Permanente, the Veterans Administration and the California Public Employees Retirement System.

Among the 300 prescription drugs most often used by seniors, about half were covered under the lowest copayment tiers provided by the 10 largest Medicare Part D plans, according to the study. The number of drugs not covered varied from four to 41 among the largest Part D plans. In contrast, Kaiser Permanente and the Veterans Administration excluded 75 and 84 medications, respectively.

Although the program has exceeded initial expectations, researchers say problems remain with Medicare Part D.

A substantial number of predominantly lowincome seniors still need to be better educated that enrolling in the program is in their interest and given instruction about how to evaluate the many plans offered to choose the one that best meets their prescription drug needs.

In addition, the annual spending caps included in the plans leave too many seniors without pharmacy coverage for a portion of each year, according to researchers. Recent work suggests that 3 million seniors reached the so called “donut hole” or gap in Part D coverage during 2007, with about 20 percent of seniors stopping their medications after their coverage lapsed for the year.

Funding for the study was provided by the California HealthCare Foundation, the National Institute on Aging through its support of the RAND Roybal Center for Health Policy Simulation and the Bing Center for Health Economics. Other authors of the study are Dana Goldman and William B. Vogt of RAND, and Eric Sun and Anupam B. Jena of RAND and the University of Chicago.

Source
Warren Robak

People over the age of 60 are the most vulnerable to heat waves, with 82% to 92% more deaths than average occurring in this age group. Risks for heatrelated illness or injury such as heat stroke, heat exhaustion and heat cramps are also heightened in people with obesity, heart disease, diabetes and respiratory conditions as these decrease the bodys ability to adapt to temperature changes. A review in CMAJ (Canadian Medical Association Journal) describes the effect of heat on human physiology and factors that increase the risk of heat stress.

Physicians and their patients must be aware of the risk factors for older people and people with chronic disease in excessive heat conditions and counsel and manage accordingly.

Laboratorybased physiologic studies show that the ability to detect heat is reduced, and the physiological response to heat with adequate blood distribution and sweating to cool the body is slower, in otherwise healthy older individuals compared to younger people. Their ability to respond to thirst is also delayed and they take longer to recover from dehydration.

People of lower socioeconomic groups, lower levels of education and those who are socially isolated have a greater risk of mortality. Air conditioning is associated with a risk reduction of 80% and working fans with a 30% reduction. Housing may be a factor as lower income people often live in crowded or poorquality housing, with inadequate ventilation and cooling systems. Homeless people are at risk because of lack of shelter from extreme heat and often also by underlying physical or psychiatric issues.

However, there are gaps in knowledge that can serve as further areas for research.

“It will be essential to discern whether impairment in thermoregulatory capacity exists in terms of the wholebody response and not simply in terms of local heatloss responses (sweating and/or skin blood flow),” write Dr. Glen Kenny from the Faculty of Health Sciences at the University of Ottawa and coauthors. “New research should focus not only on filling these gaps in the sciencebased information but also on developing clinical guidelines for health professionals to facilitate the giving of advice to patients.”

The Medicines Company (NASDAQ MDCO) announced the withdrawal of the European marketing authorization application (MAA) for the 200mg 37 day daily dose therapy of oritavancin, its investigational antibiotic drug candidate for the treatment of complicated skin and skin structure infections (cSSSI) caused by gram positive pathogens.

The MAA was filed in Europe in June 2008, by Targanta Therapeutics Corp. (Targanta). The Medicines Company acquired Targanta in February 2009. During their review of the MAA this year, the European Medicines Agency (EMEA) expressed concerns similar to those raised by the Food & Drug Administration (FDA) in their complete response letter, issued December 2008, to Targantas new drug application for oritavancin. Feedback from both agencies indicated that another trial would be required before approval could be considered. The Medicines Company has formally notified the EMEA of its decision to withdraw its MAA for the 200mg daily dose of oritavancin.

The Medicines Company is in dialogue with the FDA regarding plans for a global Phase 3 program. The Company also intends to confer with the European regulators to ascertain their support for the program design. As stated previously, the Company anticipates the start of the program in 4Q 2009, with an expected enrollment period of 12 years.

About Oritavancin

Oritavancin is an investigational, semisynthetic lipoglycopeptide antibiotic with potent and rapid bactericidal (killing) activity against a broad spectrum of grampositive bacteria, including methicillinresistant staphylococcus aureus (MRSA). The Medicines Company is developing an IV formulation of oritavancin for the treatment of complicated skin and skin structure infections caused by grampositive bacteria. Future indications for the IV formulation may include anthrax, bacteremia, and surgical prophylaxis. In addition, The Medicines Company is developing an oral formulation of oritavancin for the treatment of Clostridium difficile.

Source

In most transplant centers, the kidneys of very young deceased donors are transplanted together into one patient. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), a single kidney from a very young deceased donor maintains the health of an adult with kidney failure.

Determining the minimum donor age or body weight for splitting kidneys for transplant is controversial. Transplanting both pediatric kidneys into an adult theoretically provides better kidney function, and surgeons do not usually divide kidneys when the donor is under five years of age. However, giving each of two patients in need one organ from the same donor could increase kidney transplants in the United States approximately 80,000 individuals are waiting for kidney transplants, and 4,000 die each year before receiving transplants. Rubin Zhang, MD (Tulane Abdominal Transplant Institute), and his colleagues compared the longterm health of adult patients after they were transplanted with either single pediatric kidneys from donors less than five years of age or single kidneys from donors more than five but less than 10 years of age.

The researchers study included all 79 adults who were transplanted at the Tulane Abdominal Transplant Institute with single pediatric kidneys from deceased donors aged 10 years or less between January 1996 and June 2007. Physicians transplanted a single pediatric kidney if it was healthy enough for splitting and the recipient consented. Half of the adults received single pediatric kidneys from donors less than five years of age. The other half received single kidneys from donors aged five to 10 years.

While more patients in the group that received a kidney from the youngest donors (73%) needed ureteral stents (tubes inserted to help drain urine from the kidney) than patients in the other group (38%), complications that required additional surgery were similar in the two groups. Patients in the two groups experienced similar rates of kidney rejection and delayed kidney function. In both groups, kidney function improved dramatically in the first year after transplant, and it continued to improve into the third year. Furthermore, patients in the two groups lived a similar length of time. The youngest donor in the study was a ninemonth old female; both of her donated kidneys remain healthy more than six years posttransplantation into two different recipients.

While other studies have reported more complications when single kidneys from very young donors are transplanted into adults, this study found that the practice is safe and effective. “Single pediatric kidney transplants from donors less than five years can be utilized with acceptable complications and good longterm outcomes” the authors concluded.

The authors report no financial disclosures. Study coauthors include Anil Paramesh, MD, Sandy Florman, MD, C. Lillian Yau, PhD, Saravanan Balamuthusamy, MD, N. Kevin Krane, MD, and Douglas Slakey, MD (Tuland Abdominal Transplant Institute).

The article, entitled “LongTerm Outcome of Adults Who Undergo Transplantation with Single Pediatric Kidneys How Young Is too Young?” appeared online at cjasn.asnjournals.org/ on August 20, 2009, doi 10.2215/CJN.04610908.

Source
Shari Leventhal