Impact of donor-recipient gender and race mismatching on patient survival in patients with end-stage liver diseases undergoing liver transplantation

Background. End-stage liver disease (ESLD) is an irreversible condition that leads to the imminent complete failure of the liver. Orthotopic liver transplantation (OLT) has been well accepted as the best curative option for patients with ESLD. Despite the progress in liver transplantation, the major limitation nowadays is the discrepancy between donor supply and organ demand. In an effort to alleviate this situation, mismatched donor and recipient gender or race livers are being used. However, the simultaneous impact of donor and recipient gender and race mismatching on patient survival after OLT remains unclear and relatively challenging to surgeons. ^ Objective. To examine the impact of donor and recipient gender and race mismatching on patient survival after OLT using the United Network for Organ Sharing (UNOS) database. ^ Methods. A total of 40,644 recipients who underwent OLT between 2002 and 2011 were included. Kaplan-Meier survival curves and the log-rank tests were used to compare the survival rates among different donor-recipient gender and race combinations. Univariate Cox regression analysis was used to assess the association of donor-recipient gender and race mismatching with patient survival after OLT. Multivariable Cox regression analysis was used to model the simultaneous impact of donor-recipient gender and race mismatching on patient survival after OLT adjusting for a list of other risk factors. Multivariable Cox regression analysis stratifying on recipient hepatitis C virus (HCV) status was also conducted to identify the variables that were differentially associated with patient survival in HCV + and HCV − recipients. ^ Results. In the univariate analysis, compared to male donors to male recipients, female donors to male recipients had a higher risk of patient mortality (HR, 1.122; 95% CI, 1.065–1.183), while in the multivariable analysis, male donors to female recipients experienced an increased mortality rates (adjusted HR, 1.114; 95% CI, 1.048–1.184). Compared to white donors to white recipients, Hispanic donors to black recipients had a higher risk of patient mortality (HR, 1.527; 95% CI, 1.293–1.804) in the univariate analysis, and similar result (adjusted HR, 1.553; 95% CI, 1.314–1.836) was noted in multivariable analysis. After the stratification on recipient HCV status in the multivariable analysis, HCV + mismatched recipients appeared to be at greater risk of mortality than HCV − mismatched recipients. Female donors to female HCV − recipients (adjusted HR, 0.843; 95% CI, 0.769–0.923), and Hispanic HCV + recipients receiving livers from black donors (adjusted HR, 0.758; 95% CI, 0.598–0.960) had a protective effect on patient survival after OLT. ^ Conclusion. Donor-recipient gender and race mismatching adversely affect patient survival after OLT, both independently and after the adjustment for other risk factors. Female recipient HCV status is an important effect modifier in the association between donor-recipient gender combination and patient survival.^

Sulfur speciation and isotopic composition in waters and sediments from river and seawater mixing zones

Studies of sulfur behavior in the water column and in sediments in river and seawater mixing zone were conducted in three areas of the Black and Azov Seas. These investigations showed constancy of sulfate concentrations versus chlorinity. Sulfur isotope composition in sulfates of surface, bottom, and pore waters depended on sulfate contents and salinity. The dependence was complicated by partial sulfate depletion in pore water due to bacterial sulfate reduction and also by alteration of isotope composition. Surface sediments in mixing zones are characterized by intensive sulfate reduction, great variability of content and isotopic composition of reduced sulfur, and a low mean isotopic fractionation factor of sulfur.

14C sedimentation rates and benthic mixing of equatorial Pacific sediments

Carbon-14 determinations on box cores of calcareous ooze from the western and eastern equatorial Pacific suggest that patterns of mixed-layer ages, sedimentation rates, and mixed-layer thicknesses are controlled by gradients of carbonate dissolution and fertility, and by small-scale redeposition processes. Mixed-layer ages range from 3000 to 7000 years, with a mode between 4000 and 5000 years. Sedimentation rates range from 0.8 to 2.4 cm/1000 years. Mixed-layer depths, calculated according to the box model of mixing, range from 7 cm to 16 cm. Observed thicknesses are about one-fourth smaller than calculated ones.

Tidal-induced mixing and diapycnal nutrient fluxes in the Mauritanian upwelling region

The Mauritanian coastal area is one of the most biologically productive upwelling regions in the world ocean. Shipboard observations carried out during maximum upwelling season and short-term moored observations are used to investigate diapycnal mixing processes and to quantify diapycnal fluxes of nutrients. The observations indicate strong tide-topography interactions that are favored by near-critical angles occurring on large parts of the continental slope. Moored velocity observations reveal the existence of highly nonlinear internal waves and bores and levels of internal wave spectra are strongly elevated near the buoyancy frequency. Dissipation rates of turbulent kinetic energy at the slope and shelf determined from microstructure measurements in the upper 200 m averages to ? = 5 × 10-8 W kg-1. Particularly elevated dissipation rates were found at the continental slope close to the shelf break, being enhanced by a factor of 100 to 1000 compared to dissipation rates farther offshore. Vertically integrated dissipation rates per unit volume are strongest at the upper continental slope reaching values of up to 30 mW m-2. A comparison of fine-scale parameterizations of turbulent dissipation rates for shelf regions and the open ocean to the measured dissipation rates indicates deficiencies in reproducing the observations. Diapycnal nitrate fluxes above the continental slope at the base of the mixed layer yielding a mean value of 12 × 10-2 µmol m-2 s-1 are amongst the largest published to date. However, they seem to only represent a minor contribution (10% to 25%) to the net community production in the upwelling region.