TY  - JOUR
A1  - Assfalg, Volker
A1  - Selig, Katharina
A1  - Tolksdorf, Johanna
A1  - van Meel, Marieke
A1  - de Vries, Erwin
A1  - Ramsoebhag, Anne‐Marie
A1  - Rahmel, Axel
A1  - Renders, Lutz
A1  - Novotny, Alexander
A1  - Matevossian, Edouard
A1  - Schneeberger, Stefan
A1  - Rosenkranz, Alexander R.
A1  - Berlakovich, Gabriela
A1  - Ysebaert, Dirk
A1  - Knops, Noël
A1  - Kuypers, Dirk
A1  - Weekers, Laurent
A1  - Muehlfeld, Anja
A1  - Rump, Lars‐Christian
A1  - Hauser, Ingeborg
A1  - Pisarski, Przemyslaw
A1  - Weimer, Rolf
A1  - Fornara, Paolo
A1  - Fischer, Lutz
A1  - Kliem, Volker
A1  - Sester, Urban
A1  - Stippel, Dirk
A1  - Arns, Wolfgang
A1  - Hau, Hans‐Michael
A1  - Nitschke, Martin
A1  - Hoyer, Joachim
A1  - Thorban, Stefan
A1  - Weinmann‐Menke, Julia
A1  - Heller, Katharina
A1  - Banas, Bernhard
A1  - Schwenger, Vedat
A1  - Nadalin, Silvio
A1  - Lopau, Kai
A1  - Hüser, Norbert
A1  - Heemann, Uwe
T1  - Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis
JF  - Transplant International
N2  - In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re‐transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15‐year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re‐DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and ≥4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re‐DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re‐DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for ≥4th DDRT.
KW  - allocation
KW  - child
KW  - fourth
KW  - graft
KW  - kidney
KW  - loss
KW  - repeated
KW  - re‐transplantation
KW  - survival
KW  - third
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214161
VL  - 33
IS  - 6
SP  - 617
EP  - 631
ER  - 
TY  - JOUR
A1  - Gabriel, Katharina M. A.
A1  - Jírů-Hillmann, Steffi
A1  - Kraft, Peter
A1  - Selig, Udo
A1  - Rücker, Victoria
A1  - Mühler, Johannes
A1  - Dötter, Klaus
A1  - Keidel, Matthias
A1  - Soda, Hassan
A1  - Rascher, Alexandra
A1  - Schneider, Rolf
A1  - Pfau, Mathias
A1  - Hoffmann, Roy
A1  - Stenzel, Joachim
A1  - Benghebrid, Mohamed
A1  - Goebel, Tobias
A1  - Doerck, Sebastian
A1  - Kramer, Daniela
A1  - Haeusler, Karl Georg
A1  - Volkmann, Jens
A1  - Heuschmann, Peter U.
A1  - Fluri, Felix
T1  - Two years' experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)
JF  - BMC Neurology
N2  - Background 
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. 

Methods 
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. 

Results 
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. 

Conclusion 
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
KW  - pilot project
KW  - care tempis
KW  - ischemic stroke
KW  - thrombolysis
KW  - areas
KW  - time
KW  - hospitals
KW  - mortality
KW  - outcomes
KW  - quality
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229214
VL  - 20
ER  -