[Important contribution to tissue donation and transplantation by departments of forensic medicine (DFM) in Sweden 2011-16]. / Rättsmedicins viktiga bidrag till vävnadsdonation och transplantations­verksamheten.

The number of organ donors in Sweden is not enough to cover the need of tissues for transplant purposes. Other sources have to be defined. Young and healthy potential donors can be identified within DFM. Without precise written agreements and a well-educated and trained organization those donations will not be realized. With the purpose to evaluate national efforts to establish close cooperation between tissue establishments and DFM, two surveys were conducted at two time periods, 2011-13 and 2014-16. A total of 2118 pieces of tissue were retrieved within 6 years, 1799 for transplant purposes and 319 for research or education. Most common tissues were heart valves and cornea but also skin and ear bones were collected. 23% of all retrieved tissue from deceased donors in Sweden came from DFM. In the first period 19 % of all transplanted tissue came from DFM and in the latter period it had increased to 26%. Education and national courses for employees in DFM as well as logistic and economical support from national authorities are important factors for building a stable organization and for sustainable progress.

Clinical Outcome and Safety Profile of Patients Underwent Hair Transplantation Surgery by Follicular Unit Extraction.

INTRODUCTION: Hair transplant surgery is a minimally invasive surgery, where hair follicle is transplanted from donor area of patient's own body to the desired area. METHODS: Patient with hair transplant surgery from a clinic were followed up for one year. The patients were asked for their complications within 2 days, 7 days, one month, 2 to 6 months and one year for assessment of results, side effects. At the end of one-year, subjective evaluation was done with patient's satisfaction to growth as- poor growth, satisfactory and good growth. RESULTS: Out of 152 patients, maximum patients 74 (48.6%) were in age group 21-30, followed by 61 (40.01%) in age group 31-40, mean age was 31.79, youngest being 21 years and oldest being 70 years of age. Among the complications, swelling of forehead was in more than two- thirds of the patients 106 (69.74%), followed by temporary hair fall noted in 65 (42.76%) of patients. Clients' remarks noted at the end on one-year revealed 86.18% as excellent results, 11.84% as satisfactory and 1.97% as poor results. CONCLUSIONS: Hair transplant sugary by FUE is a relatively safe surgery with optimum results and minimum complications, which can be useful to patients with androgenetic alopecia.

Analysis of the order-implantation relationship for musculoskeletal tissue transplantation. / Análisis de la relación solicitud-implante de injerto para trasplante osteomuscular.

OBJECTIVE: To analyze orders requested from a musculoskeletal tissue bank and to evaluate the percentage of tissue implantation. MATERIAL AND METHODS: Two hundred and sixty-five orders for musculoskeletal tissue were analyzed over the course of a year. EXCLUSIONS: 5 duplications and 5 orders for which there was no availability to cover the need. We analyzed the number of surgeries in which the graft was finally used. RESULTS: Of a total of 255 orders, the graft was used in 178 (70%), and the graft was not used in 77 (30%). Of the 178 used, there was a partial refund in 23 (10%). Of the 77 orders not used, surgery was performed in 32 (13%) without the use of bank tissue, while surgery was discontinued in the remaining 45 (17%). DISCUSSION: A non-utilization rate of 30% was identified, of which 17% was from surgery that was not performed and 13% from surgery that was performed, but the tissue was returned to the tissue bank, because it was not required. In a further 10% there was partial return of the tissue. Based on this analysis, we consider that it is important to have direct confirmation of the surgery to avoid sending tissue for discontinued surgeries, since in addition to the economic impact, the bank must ensure adequate temperature maintenance during transportation and storage in the transplantation centre, to avoid discarding said tissue if it is returned.

Surgical sponge associated with platelets rich plasma in skin mesh grafts and layer in rabbits (Oryctolagus cuniculus) / Esponja cirúrgica associada com plasma rico em plaquetas em enxertos cutâneos em malha e camada em coelhos (Oryctolagus cuniculus)

The aim of this study was to evaluate of the efficacy of PRP employment associated with surgical sponges to improve the integration of the graft in the recipient bed. It was held at the Veterinary Hospital UNESP, Campus of Jaboticabal - SP, a study of 64 rabbits, divided into eight groups with eight animals. The groups were divided in control with saline solution 0,9%, control with PRP both without the sponge, surgical sponge with PRP, surgical sponge without PRP, and were used mesh and layer grafts in the respective groups. The data were submitted to statistical analysis (paired t-test, Kruskal-Wallis test, with subsequent use of the multiple comparison tests of Dunn, analysis of variance (F) test, Tukey test, P< 0.05). Edema and exudate with 3 and 3 and 7 days (P= 0,03 e P= 0,0049); coloring on the 14th day (P= 0,0001); cosmetic appearance on the 7th and 14th day (P= 0,0026 and P= 0,0001); mononuclear cells (P= 0,01) and polymorphonuclear (P= 0,01); fibroblast proliferation (P= 0,01); collagenous (P= 0,05); hemorrhage (P-007); necrosis and re-epithelialization (P= 0,2928 and P= 0,1). We concluded that the use of Platelet Rich Plasma Gel on skin grafts associated with a sponge as a compressive dressing promote the skin graft survival without a previous granulation tissue.(AU)

O objetivo deste estudo foi avaliar a eficácia do PRP associado com esponjas cirúrgicas na integração do enxerto ao leito receptor. Realizou-se, no Hospital Veterinário da Unesp, Jaboticabal, SP, um estudo com 64 coelhos, separados em oito grupos, com oito animais. Os grupos foram: Gprpc (PRP, sem esponja cirúrgica, enxerto camada), Gprpce (PRP, esponja cirúrgica, enxerto camada), Gcc (solução fisiológica 0,9%, sem esponja cirúrgica, enxerto camada), Gcce (solução fisiológica 0,9%, esponjas cirúrgicas, enxerto camada), Gprpm (PRP, sem esponja cirúrgica, enxerto malha), Gprpme (PRP, esponja cirúrgica, enxerto malha), Gcm (solução fisiológica 0,9%, sem esponja cirúrgica, enxerto malha) e Gcce (solução fisiológica 0,9%, esponjas cirúrgicas, malha). Os dados foram analisados pelo teste t emparelhado, Kruskal-Wallis, análise de variância, e teste de Tukey (P<0,05). Edema e exsudato presente com três e sete dias (P=0,03 e P=0,0049); coloração cianótica no 14º dia (P=0,0001); aspecto cosmético bom no sétimo e no 14º dia (P=0,00026 e P=0,0001); presença de células mononucleares (P=0,01) e polimorfonucleares (P=0,01); proliferação de fibroblastos discreta (P=0,01); colagenização intensa (P=0,05); hemorragia discreta (P=0,007); ausência de diferença significativa em necrose e reepitelização (P=0,2928 e P=0,1). Conclui-se que o emprego do PRP gel em enxertos cutâneos associando esponjas cirúrgicas como curativo compressivo favorece sua integração ao leito receptor sem a presença prévia de tecido de granulação.(AU)

Current organ allocation disadvantages kidney alone recipients over combined organ recipients.

BACKGROUND: The United Network for Organ Sharing began including the Kidney Donor Profile Index (KDPI) March 26, 2012 and began a new allocation scheme December 1, 2014. METHODS: Kidney donors from our organ procurement organization from March 2012 to December 2014 were reviewed. The KDPIs of all 919 kidney only transplants were compared with all 102 kidney/extrarenal transplants. RESULTS: The average KDPI for kidney alone allografts was 47 (range 1 to 100) (standard deviation = 25.83) vs 27 for kidney/extrarenal kidneys (range 1 to 82) (standard deviation = 20.16) (P < .001, t test). Multivariate analysis including in- vs out-of-state recipient, donor body mass index, and donation after cardiac death vs brain-dead donor showed significantly lower KDPI for kidney/extrarenal transplants. CONCLUSIONS: Kidney/extrarenal organs have decreased graft survival compared with kidneys transplanted alone. In this sample, 21% of lower KDPI kidneys were allocated as kidney/extrarenal organs. This disadvantages those waiting for a kidney alone. Attention to the outcomes of kidneys transplanted with extrarenal organs is needed.

The immunological barriers to xenotransplantation.

The availability of cells, tissues and organs from a non-human species such as the pig could, at least in theory, meet the demand of organs necessary for clinical transplantation. At this stage, the important goal of getting over the first year of survival has been reported for both cellular and solid organ xenotransplantation in relevant preclinical primate models. In addition, xenotransplantation is already in the clinic as shown by the broad use of animal-derived medical devices, such as bioprosthetic heart valves and biological materials used for surgical tissue repair. At this stage, however, prior to starting a wide-scale clinical application of xenotransplantation of viable cells and organs, the important obstacle represented by the humoral immune response will need to be overcome. Likewise, the barriers posed by the activation of the innate immune system and coagulative pathway will have to be controlled. As far as xenogeneic nonviable xenografts, increasing evidence suggests that considerable immune reactions, mediated by both innate and adaptive immunity, take place and influence the long-term outcome of xenogeneic materials in patients, possibly precluding the use of bioprosthetic heart valves in young individuals. In this context, the present article provides an overview of current knowledge on the immune processes following xenotransplantation and on the possible therapeutic interventions to overcome the immunological drawbacks involved in xenotransplantation.

[Report on notifications according to section 8d of the German Transplantation Act (TPG) for the years 2009-2011]. / Bericht zur Meldung nach § 8d Transplantationsgesetz (TPG) für die Jahre 2009 bis 2011.

In Germany, the Tissue Act came into effect on 1 August 2007. Since then, every tissue establishment is legally obligated to keep a record of its activities according to section 8d subsection 3 of the Transplantation Act (TPG). An annual report must be submitted to the Paul Ehrlich Institute once a year up to 1 March of the subsequent year. The report should include the types and quantities of tissues procured, conditioned, processed, stored, distributed or otherwise disposed of, imported, and exported. The report should be made on a TPG-based notification form published on the Internet by the Paul Ehrlich Institute. The present report according to section 8d subsection 3 of the TPG is based on data of the reporting years 2009-2011. Six years after implementation of the TPG's reporting obligation for tissue establishments, the number of tissue establishments known by the Paul Ehrlich Institute has increased from 349 in 2007 to 949 in 2011. In the course of continuous optimization of the notification forms, including tissue-specific glossaries, the reported data of most of the tissues and tissue preparations have become more conclusive.

[Report on notifications according to Section 8d of the German Transplantation Act (TPG) for the year 2008]. / Bericht zur Meldung nach § 8d Transplantationsgesetz (TPG) für das Jahr 2008.

In Germany, the tissue law came into effect on 1 August 2007. The law implemented the requirements of EC directives on quality and safety of human tissues and cells in the German Transplantation Act ("Transplantationsgesetz," TPG) and in the German Medicinal Products Act. Accordingly, tissue establishments are obligated to keep a record of their activities and to submit an annual report to the Paul-Ehrlich-Institut (PEI). The report shall include the types and quantities of tissues procured, conditioned, processed, stored, and distributed, or otherwise disposed of, imported and exported. For this purpose, the PEI published TPG-based notification forms in the Bundesanzeiger and in the Internet. The data provided by tissue establishments have been anonymized and compiled in a general report. The analysis revealed inconclusive data, which can be due to a number of different causes. To achieve better consistency of data provided in the future, the explanations for completing the notification forms will be amended. Thus far, compiled data are not appropriate to draw conclusions on the availability of tissues and tissue preparations in Germany, but the data can serve as reference points.

[The 2009 performance report of the German cornea banks]. / Leistungsbericht der Deutschen Hornhautbanken 2009.

BACKGROUND: In Germany, human tissue for corneal and amniotic transplantation is supplied by 27 cornea banks. METHODS: The Section for Tissue Transplantation and Biotechnology of the German Ophthalmological Society records the cornea banks' activities by means of an annual questionnaire. RESULTS: In 2009, a total of 4,818 corneal grafts were processed by 21 responding cornea banks, and 57% were deemed suitable for transplantation. This ratio is slightly higher than the European average. In addition, German cornea banks released 1,257 amniotic grafts in 2009. DISCUSSION: German cornea banks are currently facing new regulatory issues due to updated legislation regarding tissue transplantation. Recent updates in European law have limited the cutoff time for postmortem blood sampling to 24 h, and this regulation may lead to a significant reduction in potential donors.

A survey on cellular and engineered tissue therapies in europe in 2008.

Cellular therapy is an evolving investigational treatment modality in regenerative medicine, but little published information is available on its current use. Starting from the established European group for Blood and Marrow Transplantation activity survey on hematopoietic stem cell transplantation, a joint committee of four major scientific organizations made a coordinated attempt to collect detailed information in Europe for the year 2008. Thirty-three teams from 16 countries reported data on 656 patients to a "novel cellular therapy" survey, which were combined to additional 384 records reported to the standard European group for Blood and Marrow Transplantation survey. Indications were cardiovascular (29%; 100% autologous), musculoskeletal (18%; 97% autologous), neurological (9%; 39% autologous), epithelial/parenchymal (9%; 18% autologous), autoimmune diseases (12%; 77% autologous), or graft-versus-host disease (23%; 13% autologous). Reported cell types were hematopoietic stem cells (39%), mesenchymal stromal cells (47%), chondrocytes (5%), keratinocytes (7%), myoblasts (2%), and others (1%). In 51% of the grafts, cells were delivered after expansion; in 4% of the cases, cells were transduced. Cells were delivered intravenously (31%), intraorgan (45%), on a membrane or gel (14%), or using three-dimensional scaffolds (10%). This data collection platform is expected to capture and foresee trends for novel cellular therapies in Europe, and warrants further consolidation and extension.

Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 1837 Louisiana State University Health Sciences Center median, radial, and ulnar nerve lesions.

OBJECTIVE: Data from three Louisiana State University Health Sciences Center (LSUHSC) publications were summarized for median, radial, and ulnar nerve injuries. METHODS: Lesion types, repair techniques, and outcomes were compared for 1837 upper-extremity nerve lesions. RESULTS: Sharp laceration injury repair outcomes at various levels for median and radial nerves were equally good (91% each) and better than those for the ulnar nerve (73%). Secondary suture and graft repair outcomes were better for the median nerve (78% and 68%, respectively) than for the radial nerve (69% and 67%, respectively) and ulnar nerve (69% and 56%, respectively). In-continuity lesions with positive nerve action potentials during intraoperative testing underwent neurolysis with good results for the median (97%), radial (98%), and ulnar nerves (94%). For radial, median, and ulnar nerve in-continuity lesions with negative intraoperative nerve action potentials, good results occurred after suture repair in 88%, 86%, and 75% and after graft repair in 86%, 75% and 56%, respectively. CONCLUSION: Good outcomes after median and radial nerve repairs are attributable to the following factors: the median nerve's innervation of proximal, large finger, and thumb flexors; and the radial nerve's similar innervation of proximal muscles that do not perform delicate movements. This is contrary to the ulnar nerve's major nerve supply to the distal fine intrinsic hand muscles, which require more extensive innervation. The radial nerve also has a motor fiber predominance, reducing cross-motor/sensory reinnervation, and radial nerve-innervated muscles perform similar functions, decreasing the chance of innervation of muscles with opposite functions.

Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions.

OBJECTIVE: With the use of data from 3 Louisiana State University Health Sciences Center (LSUHSC) publications, various parameters for buttock/thigh-level sciatic nerve and tibial and common peroneal divisions/nerve injuries were summarized, and outcomes were compared. METHODS: Data from 806 buttock/thigh-level sciatic nerve and tibial and common peroneal division/nerve injury repairs were summarized. Lesion types, repair techniques, and outcomes were compared. RESULTS: Acute lacerations undergoing suture repair were best for the thigh-then-buttock-level tibial (93%/73%) and then same-level common peroneal divisions (69%/30%); at the knee level, tibial outcomes (100%) were better than those for the common peroneal nerve (CPN) (84%). Secondary graft repairs for lacerations had good outcomes for the thigh-then-buttock-level tibial (80%/62%), followed by common peroneal divisions at the same levels (45%/24%). The knee/leg-level tibial nerve (94%) did better than the CPN (40%) here. In-continuity lesions with positive intraoperative nerve action potentials underwent neurolysis with better results for the thigh-then-buttock-level tibial division (95%/86%) than for same-level CPN (78%/69%). The knee/leg-level tibial nerve did better than the CPN (95%/93%). CONCLUSION: Better recovery of buttock- and thigh-level tibial division/nerve occurs because: 1) the CPN is lateral and thus vulnerable to a more severe injury; 2) the tibial nerve is more elastic at impact owing to its singular-fixation site (the CPN has a dual fixation); 3) the tibial nerve has a better blood supply and regeneration; 4) the tibial nerve has a higher force-absorbing fascicle/connective tissue count than the CPN; and 5) the tibial nerve-innervated gastrocnemius soleus requires less reinnervation for functional contraction than deep peroneal branches, which innervate long, thin extensor muscles at multiple sites and require coordinated nerve input for effective contraction.

Iatrogenic sciatic nerve injuries at buttock and thigh levels: the Louisiana State University experience review.

OBJECTIVE: To provide an overview of iatrogenic sciatic nerve injuries at the buttock and thigh levels, and to analyze results of the treatment provided at Louisiana State University Health Sciences Center-New Orleans. METHODS: The data from 196 patients were reviewed retrospectively. All patients had iatrogenic sciatic nerve injuries at the buttock and thigh levels and were evaluated and treated at the Louisiana State University Health Sciences Center between the years 1968 and 1999. One hundred sixty-four of these patients had injuries caused by injections at the buttock level, 15 sustained sciatic nerve injuries after a total hip arthroplasty, and 17 had iatrogenic damage at the thigh level. RESULTS: Patients with severe motor deficits underwent neurolysis if they had positive nerve action potentials, and end-to-end anastomosis or grafting if the nerve action potentials were negative. Operations were performed on 64 patients with injection injuries at the buttock level, on 15 with iatrogenic damage at the thigh level, and on 15 with deficits after total hip arthroplasty. Results were analyzed by the procedure performed and by the outcome in both the peroneal and tibial divisions. CONCLUSION: Patients with mild or no motor deficits and those with pain that was manageable did not undergo surgery and were treated conservatively. For patients with significant motor deficits and those with pain that was not responsive to pharmacological management, physical and occupational therapy required surgical intervention. Patients who had positive nerve action potentials required neurolysis only and had the best recovery, whereas those with negative nerve action potentials required more extensive intervention entailing reanastomosis or grafting and had worse outcome. In general, the outcome was better for the tibial than for the peroneal divisions, regardless of the type of intervention.

Global observatory and database on donation and transplantation: world overview on transplantation activities.

INTRODUCTION: The Global Database on Donation and Transplantation is one of the main areas of the Global Observatory on Donation and Transplantation (GODT), which is the information platform designed to implement some of the requirements of the World Health Assembly Resolution WHA57.18. OBJECTIVES OF THE GLOBAL DATABASE: The objectives are to collect, analyze, and disseminate information on legislative and organizational frameworks and annual aggregated data on donation and transplantation activities of the World Health Organization (WHO) Member States. Another objective is to establish the transplantation network with the national health authorities. The database should provide a working tool that helps to exchange information and be a reference for professionals involved, promoting international cooperation through the website. METHODS: The data collection for the Global Database is done through a specific questionnaire, including questions on legislation, organizational systems, and updated data on organs, tissues and cells donation, and transplantation from each country. For the statistical analysis of activity data, descriptive statistics have been used. RESULTS: The Global Database has organizational and legislative pieces of information of 94 countries. In 2007 activity data of 97 countries have been analyzed. Reported to the database were 21,489 deceased donors. Currently around 100,000 solid organ transplantations are performed per year worldwide: 68,250 kidney, 19,850 liver, 5179 heart, 3245 lung, and 2797 pancreas transplantations. CONCLUSIONS: This kind of tool is necessary to improve knowledge about the donation and transplantation activities over the world. Close collaboration with countries is crucial to obtain reliable data.

Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008.

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.

Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53 percent to 88 percent. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.

Science of composite tissue allotransplantation.

The science of composite tissue allotransplantation (CTA) is rooted in progressive thinking by surgeons, fueled by innovative solutions, and aided by understanding the immunology of tolerance and rejection. These three factors have allowed CTA to progress from science fiction to science fact. Research using preclinical animal models has allowed an understanding of the antigenicity of complex tissue transplants and mechanisms to promote graft acceptance. As a result, translation to the clinic has shown that CTA is a viable treatment option well on the way of becoming a standard of care for those who have lost extremities and suffered large tissue defects. The field of CTA has been progressing exponentially over the past decade. Transplantation of hands, larynx, vascularized knee, trachea, face, and abdominal wall has been performed. Several important observations have emerged from translation to the clinic. Although it was predicted that rejection would pose a major limitation, this has not proven true. In fact, steroid-sparing protocols for immunosuppression that have been successfully used in renal transplantation are sufficient to prevent rejection of limbs. Although skin is highly antigenic when transplanted alone in animal models, when part of a CTA, it has not proven to be. Chronic rejection has not been conclusively demonstrated in hand transplant recipients and is difficult to induce in rodent models of CTA. This review focuses on the science of CTA, provides a snapshot of where we are in the clinic, and discusses prospects for the future to make the procedures even more widely available.