Live donor renal transplantation is cost effective and associated with increase in QALYs. Therefore, preemptive live kidney transplantation should be promoted from a fiscal as well as medical point of view.

The aim of this study was to test plasma lipoprotein Lp(a) and other lipkj and lipoprotein levels for association with the Incidence of myocardial Infarction. Total plasma cholesterol, trlglycerides, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and Lp(a) were measured In 1486 men at the age of 18 years. In addition, the Broca Index (a measure of relative body weight) and other data were recorded. The sample was divided Into probands whose mothers or fathers suffered a myocardial Infarction (case group, n=52) and Into probands whose parents had no myocardial Infarction (control group, n = 1434). In the case group, 32% had Lp(a) plasma concentrations greater than 25 mg/dl, but only 13.4% of the control group had this level of concentration, a highly significant difference (p<0.01). In addition, there was a statistically significant difference In the ratio of LDL cholesterol/HDL cholesterol (p<0.05) and the Broca Index (p<0.01) between cases and controls. The parents of the case group were significantly older than the parents of the control group; however, when a control group was matched for parents' age, the result* were similar. These data suggest that parents of male children with Lp(a) plasma concentrations greater than 25 mg/dl have a 2.5-fold higher Incidence of myocardial Infarction. Considering the familial aggregation of elevated Lp(a) levels, we conclude that increased levels of this lipoprotein may be a significant risk factor for myocardial infarction. (Arteriosclerosis 8:398-401, July/August 1988) A ccording to current concepts, increased plasma concentrations of atherogenic lipoproteins play an important role in the development of atherosclerosis leading to premature myocardial infarction (Ml) and stroke. This has been shown in many case-control studies.1 ' 23 The results from prospective studies are scarce and, in most instances, they include only the measurements of lipids and lipoprotein lipids, 4 ' 5 despite the fact that individual lipoprotein levels seem to be of greater predictive value in the assessment of atherosclerosis risk.36 -8 One particular fraction, which is important in that respect, is Lp(a), a lipoprotein that is inherited as a quantitative genetic trait (reviewed by Kostner 10 ). Albers et al. 11 demonstrated that plasma Lp(a) levels were not correlated with apolipoprotein B levels. We have shown in previous reports 12 that I-P(a) is synthesized independently of other cholesterol ester-rich apo B-containing lipoproteins. Furthermore, the rate of Lp(a) synthesis is the determinant of plasma Lp(a) concentration, 13 which may vary considerably among individuals and may range from <1 to >150 mg/dl. Lp(a) catabolism, on the other hand, proceeds via routes that resemble those of LDL. Parts of this study were submitted for presentation at the 60th Scientific Sessions of the American Heart Association.Address for reprints: Dr. Gerald Hoefler, Kennedy Institute for Handicapped Children, 707 North Broadway, Baltimore, MD 21205.Received November 3...

The efficacy of statins for the prevention of cardiovascular events is well established in the general population but remains unknown in renal transplant recipients. In this study, the association of statin use with patient and graft survival was investigated in a cohort of 2041 first-time recipients of renal allografts between 1990 and 2003. Multivariable Cox regression demonstrated that statin use was independently associated with lower mortality rates. Twelve-year survival rates were 73% for statin users and 64% for nonusers (P ϭ 0.055). The adjusted hazard ratio for all-cause mortality associated with statin use was 0.64 (95% confidence interval 0.48 to 0.86). Graft survival rates during the same time period were 76% for statin users and 70% for nonusers (P ϭ 0.055). The adjusted hazard ratio for graft survival associated with statin use was 0.76 (95% confidence interval 0.55 to 1.04). Results from marginal structural models were virtually identical. In summary, statin use was associated with prolonged patient survival, but no difference in graft survival was detected. Although these results are encouraging, a definitive causal relationship can be determined only from randomized clinical trials.

Based on the evidence of observational studies, the summary of the current data suggests that radiofrequency ablation with the HALO system could be a promising method associated with a low complication rate, low risk of stricture formations, and a minor probability of buried glands. To evaluate the potential benefit at a higher level of evidence, randomized controlled trials (RCTs) involving a direct comparison with other more established endoscopic methods such as photodynamic therapy are necessary.

Measurement of flow volume could be used as a screen, in order to filter out reconstructions, which must be further clarified with an angiogram. A further prospective evaluation of the value of volume flow is needed before any conclusive recommendations can be drawn.