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Development of a transplant center management information system
Abstracts
#149 10.1
#150 10.1
119 DEVELOPMENT OF A TRANSPLANT CENTER MANAGEMENT INFORMATION SYSTEM. S Lana_reder, M. Kurtz, T. Bennett and P. Garvin,Department of Surgery, St. Louis University School of Medicine, St. Louis, MO 63110 Because of a lack o! an existing comprehensive database compatible with Apple Macintosh, we have developed a transplant management information system (TMIS) that is powerful yet flexible and easy to use. Our development goals were as follows: 1) to comply with the reporting requirements of various transplant registries, 2) to assemble reports for an increasing number of government agencies and insurance carriers, 3) to obtain updates of our operative experience at regular intervals, 4) to facilitate clinical investigation, 5) to provide the transplant team with immediate access to the HLA laboratory. TMIS operates in a network environment using Apple Macintosh computers, AppleShare network software and 4th Dimension database management software. TMIS is divided into five major areas: 1) patient demographical information, 2) transplant candidate and registration information, 3) detailed surgery and followup information, 4) donor information, and 5) HLA laboratory information. All five areas are linked by a common key field, therefore making access to various files transparent to the end user. Key features of the database include automation of all required reports, operative histories, transplant waiting lists, survival data analysis, UNOS point system calculations, automatic downloading of clinical laboratory information into patient tlowsheets and ease of exporting data to other software packages. The HLA module includes on line test requisitioning and result reporting, complete patient sensitization histories (which includes antibody profiles, crossmatch history and transfusion history), sera and cell registries, immediate update of 2 x 2 table analysis of sera and typing trays, graphical output of Class I and Class II antibody profiles, billing, inventory and quality control. All functions are conveniently accessed from a button panel located on screen or from custom menus. Data is entered remotely or from a workstation located next to tray reading stations. All network management responsibilities, data entry, internal and external report generation, and search and query functions are managed by one individual. The system has been an invaluable resource in the development and management of our transplant program.
ERYTHROPOIETIN. A POTENTIAL IMMUNOMODULATOR? PM Kimball K Gerolami, L De Los Santos, and RH Kerman, Department of Surgery, University of Texas Medical School, Houston, Texas. Recombinant erythropoietin (rEPO) may eliminate the need for obligatory blood transfusions in chronic disorders such as End Stage Renal Disease as well as avoid patient pre-sensitization to foreign antigens. The systemic effects of rEPO on the immune system have not been described. We report rEPO exerts an immunosuppressive effect on T as well as B cell activation that is cell cycle dependent and mediated by macrophages, rEPO was added to normal PBL's cultured with or without PHA or PWM and proliferation measured by uptake of 3H-thymidine. rEPO (200 to 0.i U/ml) reduced proliferation in PHA, PWM-stimulated or unstimulated cells by 25%, 13%, or 35%, respectively (n=4). Addition of i00, I0, 1 or 0.i U/ml rEPO at the onset of culture (Go) reduced PHAstimulated proliferation by 17%, 17%, 25% or 14% and PWM-driven proliferation by 15%, 14%, 10% or 14%, respectively (n=8). Addition of rEPO 24 hrs after the onset of mitogen stimulation (GI) did not affect proliferation. However, rEPO (i00, i0, 1 or 0.i U/ml) pretreatment of resting PBL's for 24 hrs reduced T-cell proliferation by 62%, 63%, 61% or 36% and B-cell proliferation by 26%, 16%, 13% or 13%. rEPO's impact on interleukin 1 production was measured in PBL's stimulated with PHA for 24-48 hrs. After 24 hrs incubation, cells (106) treated with 0, 50 or i00 U/ml rEPO produced 75, 19 or 1 pg ILl. By 48 hrs, the ILl content of rEPO treated cells was neglible. In summary, rEPO exerts an immunosuppressive effect on T as well as B lymphocyte activation that is mediated, in part, by ILl inhibition. This effect is more prominent, when rEPO-treatment preceeds antigen induction.
#149 10.1
#150 10.1
119 DEVELOPMENT OF A TRANSPLANT CENTER MANAGEMENT INFORMATION SYSTEM. S Lana_reder, M. Kurtz, T. Bennett and P. Garvin,Department of Surgery, St. Louis University School of Medicine, St. Louis, MO 63110 Because of a lack o! an existing comprehensive database compatible with Apple Macintosh, we have developed a transplant management information system (TMIS) that is powerful yet flexible and easy to use. Our development goals were as follows: 1) to comply with the reporting requirements of various transplant registries, 2) to assemble reports for an increasing number of government agencies and insurance carriers, 3) to obtain updates of our operative experience at regular intervals, 4) to facilitate clinical investigation, 5) to provide the transplant team with immediate access to the HLA laboratory. TMIS operates in a network environment using Apple Macintosh computers, AppleShare network software and 4th Dimension database management software. TMIS is divided into five major areas: 1) patient demographical information, 2) transplant candidate and registration information, 3) detailed surgery and followup information, 4) donor information, and 5) HLA laboratory information. All five areas are linked by a common key field, therefore making access to various files transparent to the end user. Key features of the database include automation of all required reports, operative histories, transplant waiting lists, survival data analysis, UNOS point system calculations, automatic downloading of clinical laboratory information into patient tlowsheets and ease of exporting data to other software packages. The HLA module includes on line test requisitioning and result reporting, complete patient sensitization histories (which includes antibody profiles, crossmatch history and transfusion history), sera and cell registries, immediate update of 2 x 2 table analysis of sera and typing trays, graphical output of Class I and Class II antibody profiles, billing, inventory and quality control. All functions are conveniently accessed from a button panel located on screen or from custom menus. Data is entered remotely or from a workstation located next to tray reading stations. All network management responsibilities, data entry, internal and external report generation, and search and query functions are managed by one individual. The system has been an invaluable resource in the development and management of our transplant program.
ERYTHROPOIETIN. A POTENTIAL IMMUNOMODULATOR? PM Kimball K Gerolami, L De Los Santos, and RH Kerman, Department of Surgery, University of Texas Medical School, Houston, Texas. Recombinant erythropoietin (rEPO) may eliminate the need for obligatory blood transfusions in chronic disorders such as End Stage Renal Disease as well as avoid patient pre-sensitization to foreign antigens. The systemic effects of rEPO on the immune system have not been described. We report rEPO exerts an immunosuppressive effect on T as well as B cell activation that is cell cycle dependent and mediated by macrophages, rEPO was added to normal PBL's cultured with or without PHA or PWM and proliferation measured by uptake of 3H-thymidine. rEPO (200 to 0.i U/ml) reduced proliferation in PHA, PWM-stimulated or unstimulated cells by 25%, 13%, or 35%, respectively (n=4). Addition of i00, I0, 1 or 0.i U/ml rEPO at the onset of culture (Go) reduced PHAstimulated proliferation by 17%, 17%, 25% or 14% and PWM-driven proliferation by 15%, 14%, 10% or 14%, respectively (n=8). Addition of rEPO 24 hrs after the onset of mitogen stimulation (GI) did not affect proliferation. However, rEPO (i00, i0, 1 or 0.i U/ml) pretreatment of resting PBL's for 24 hrs reduced T-cell proliferation by 62%, 63%, 61% or 36% and B-cell proliferation by 26%, 16%, 13% or 13%. rEPO's impact on interleukin 1 production was measured in PBL's stimulated with PHA for 24-48 hrs. After 24 hrs incubation, cells (106) treated with 0, 50 or i00 U/ml rEPO produced 75, 19 or 1 pg ILl. By 48 hrs, the ILl content of rEPO treated cells was neglible. In summary, rEPO exerts an immunosuppressive effect on T as well as B lymphocyte activation that is mediated, in part, by ILl inhibition. This effect is more prominent, when rEPO-treatment preceeds antigen induction.