Factors that predict survival in patients with cirrhosis considered for liver transplantation.

OBJECTIVE: To identify prognostic factors for survival at 6 and 12 months in patients evaluated for liver transplantation using Child-Pugh (CP) classification and the Model for End-Stage Liver Disease (MELD) score. METHODS: We evaluated 144 patients with cirrhosis who were candidates for liver transplantation. We excluded patients with hepatocellular carcinoma, recent liver recipients, and patients who died because of factors unrelated to liver disease. The studied variables were age and sex; prothrombin time; platelet count; albumin, cholesterol, bilirubin, creatinine, and serum sodium concentrations; CP classification and MELD score; and the presence of ascites, encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and previous variceal bleeding. Data were processed using statistical software (SPSS version 13.0). RESULTS: Of the 144 patients, 27 (18.7%) did not survive because of complications of liver disease. Univariate analysis showed the most significant factors to be sex, prothrombin time, bilirubin and albumin levels; ascites, encephalopathy, CP classification, and MELD score. At Cox regression analysis, only CP classification proved to be a valid predictor of survival in our cohort. The lowest survival according to CP classification at 6 and 12 months corresponded to stage C and to MELD scores higher than 15. CONCLUSIONS: Child-Pugh classification is an independent prognostic factor for recipient survival. Stage C in the CP classification and a MELD score higher than 15 were strongly related to worse survival. Both scores must be taken into consideration for adequate evaluation of liver transplantation for candidates.

Knowledge of the Brain Death Concept Among the Population of Havana, Cuba.

BACKGROUND: One of the main reasons against organ donation is the fear of apparent death due to ignorance of the brain death concept. Our aim was to assess knowledge about and acceptance of the brain death concept among the population of Havana, Cuba. METHODS: The population screened, stratified by gender and age, included those >15 years old and living in Havana, Cuba. The appraisal tool utilized was a questionnaire on attitude toward organ donation ("PCID-DTO Ríos"). A random selection of individuals were surveyed according to the stratification. Cuba's census data were used. The participation was anonymized and self-administered. The verbal consent of participants was provided. RESULTS: There were 920 respondents: 31% (n = 282) knew the concept of brain death and accepted it; 57% (n = 529) did not; and 12% (n = 109) had a misperception, or did not accept brain death as a person's death. Those who knew and accepted the concept had a more favorable attitude toward their own organ donation after death (85% vs 61%; P < .001). The psychosocial factors related to the knowledge of brain death concept were: the gender (P = .002), to make up for speaking at a family level about the organ transplant (P < .001), the couple's opinion about the organ donation (P < .001) and the religion (P < .001). CONCLUSION: The brain death concept is not well understood in the population of Havana, Cuba.

A multicenter study on attitude toward organ donation in Spain and Latin America between the surgical units of 12 hospitals.

INTRODUCTION: Medical advances and improvements in surgical techniques have transformed transplantation into an ever safer therapeutic option. However, its main limitation is the shortage of available organs. Therefore, it is necessary to join forces to achieve optimal deceased donation and prevent the loss of potential donors. We sought to analyze the acceptance of deceased organ donation (OD) among hospital personnel in surgical units in hospitals in Spain and Latin America. METHOD: A random sample (n = 554) was taken was stratified according to surgical services and job category in 12 hospitals-4 in Spain (n = 294 participants), 5 in Mexico (n = 202), 2 in Cuba (n = 41), and 1 in Costa Rica (n = 17). Attitude was assessed using a questionnaire validated, which was completed anonymously and self-administered. The χ(2) test, Student t test, and a logistic regression analysis were used. RESULTS: Overall, 75% of respondents (n = 417) were in favor of deceased OD and 25% were against it (n = 137). Regarding the respondent's country, there was a favorable attitude among 88% of Cubans, 85% of Mexicans, 82% of Costa Ricans, and 67% of Spaniards (P < .001). The physicians were most in favor of OD with 87% supporting it (n = 149), followed by nurses (n = 182) and ancillary personnel (n = 28) both at 74%, and the health care assistants at 59% (n = 58; P < .001). The following factors affect attitude toward OD: young age (37 ± 10 years; P = .001), being a male (P = .018), having an unstable job situation (P = .009), a belief that one might need a future transplant (P = .036), having a favorable attitude toward living donation (P < .001), being in favor of donating a family member's organs (P < .001), having had a family discussion about OD (P < .001), and a partner's favorable attitude (P < .001). CONCLUSIONS: Attitude toward OD among surgeons in hospitals in Spain and Latin America was not as favorable as we might have expected.

[Monitorization of the jugular oxygen saturation and cerebral ischaemia in the neurocritical patient]. / Monitorización de la saturación yugular de oxígeno y la isquemia cerebral en el paciente neurocrítico.

INTRODUCTION: Catheterization of the jugular bulb is of great value in the study of cerebral metabolism, since it permits diagnosis of episodes of hypoxia and cerebral ischaemia. OBJECTIVES: To determine the frequency of the appearance of episodes of desaturation and cerebral ischaemia, whether these were simultaneous and their relation to the mortality in an intensive care unit (ICU). PATIENTS AND METHODS: We studied 21 neurocritical patients, recording the following data: age, sex, diagnosis and state at the time of discharge from the ICU (alive or dead). In the group of patients in whom the jugular bulb had been catheterised we also recorded: the side cannulated, complications, SyO2, cerebral lactate oxygen index and modified cerebral lactate oxygen. RESULTS: In 57% of the patients we catheterised the jugular bulb and in 50% of them at least one episode of desaturation was recorded, and cerebral ischaemia in 42%. Only one patient had simultaneous desaturation and cerebral ischaemia. Of the six patients in whom desaturation was detected, 5 died in the ICU (83.3%). The mortality of patients with ischaemia was only 40%. 40% of the patients with head injuries were monitored and 50% of the non monitored patients had head injuries. CONCLUSIONS: Episodes of desaturation are frequent in neurocritical patients and are associated with increased mortality. Recordings of lactate are not useful at present in the diagnosis of cerebral ischaemia.

[Predictive factors of neurological complications in the period immediately after liver transplant: experiences in the Centro de Investigaciones Médico Quirúrgicas in Cuba]. / Factores predictivos de las complicaciones neurológicas en el postrasplante hepático inmediato: experiencia en el Centro de Investigaciones Médico Quirúrgicas de Cuba.

INTRODUCTION: Liver transplant (LT) is today a first choice procedure in a group of hepatic diseases in their acute and chronic terminal stages. It is not, however, a technique that is completely free of complications and those of a neurological nature constitute between 8 47% of those reported. AIMS. The purpose of this study is to present the immediate neurological complications (NC) found in our patients, as well as to determine the predictive factors and their relation to the mortality rate. PATIENTS AND METHODS: From the medical records of 26 patients who received LT at the CIMEQ (July 1999 December 2001), we collected a group of variables related to the donor, the surgical procedure and the post operative period and associated them to the occurrence of NC while these patients were in the ICU. RESULTS: NC were found in 16 patients (61.5%), the most frequent being encephalopathy (30.8%), tremor (26.9%), and convulsions (19.2%). No relation was found between the presence of NC and prior hepatic encephalopathy, the use of a suboptimal donor, nor did it represent a significant increase in the mortality rate. There was a significant relation with LT to recipients rated as grade C on the Child Pugh classification system, the presence of intraoperative hypotension (p= 0.0164) and primary dysfunction of the liver graft (p= 0.041). CONCLUSIONS: NC represented a significant cause of morbidity in the period following a liver transplant in our series, although they had no significant repercussion on the mortality rate. Their presence is related to variables concerning the recipient, the surgical procedure itself and the immediate post operative period.

[Epidemiological characteristics of a group of multi organ donors used to transplant organs in Cuba]. / Características clinicoepidemiológicas de un grupo de donantes multiorgánicos utilizados para trasplante de órganos en Cuba.

INTRODUCTION: For current transplants, the organ donor is a basic factor. OBJECTIVES: To determine the demographic characteristics of the donors used in the Cuban liver transplant programme, the main causes of brain death, most widely used amines and serology pattern. To report the transplants carried out. PATIENTS AND METHODS: We reviewed the clinical histories of the actual donors processed between July 1999 and July 2000. RESULTS: During the period studied 13 actual donors were used: 9 men (69.2%) and 4 women (30.8%) distributed in the following age groups: 15 30 years: 3 cases (23%); 31 45 years : 4 cases (30.8%); 46 60 years: 5 cases (38.5%), and over 60 years: 1 case (7.7%). We did 42 transplants: 12 liver, including the first hepato renal in Cuba, 18 kidney, 10 cornea, and 1 heart. The causes of death were: head injury: 10 (76.9%), and hemorrhagic cerebral vascular accident: 3 (23.1%). Only 3 cases (23.1%) did not require the use of vasoactive amines. These were used in the other 10 (76.9%). The most commonly used were dopamine and epinephrine, in 6 cases each (46.1%). In the serological studies for immunoglobulin G for cytomegalovirus all 13 were positive, Epstein Barr virus 6 (46.1%), toxoplasma 12 (92.3%), herpes virus 1: 13, herpes virus 11: 13. CONCLUSIONS: The typical donor was a man aged 46 60 years with brain death due to head injury following a road traffic accident. A large proportion of donors required the use of amines to maintain hemodynamic stability. There was a large proportion of patients who were found on microbiological serology studies to test positive.

Ecografía clínica en enfermos críticos en países en desarrollo de Latinoamérica / Point-of-care ultrasound in critically ill patients in developing countries of Latin America

En los últimos años, la ecografía clínica ha revolucionado el cuidado de los enfermos críticos y puede considerarse hoy en día una herramienta de trabajo imprescindible para los profesionales. Si bien su uso atraviesa una etapa in crescendo en los países en desarrollo de Latinoamérica, aún es infrautilizada, por diversos motivos. Describimos en este artículo el estado actual de la ecografía en el enfermo crítico en varios países en vías de desarrollo de Latinoamérica, los problemas y barreras que atentan contra su implementación, y proponemos algunas estrategias para la diseminación del método.

In recent years, point-of-care ultrasound has revolutionized the care of critically ill patients, and currently, it is considered an essential work tool for practitioners. Although its use is growing in developing countries of Latin America, for many reasons it is still underutilized. In this article, we describe the current status of point-of-care ultrasound in critical care in several developing countries of Latin America and address the problems and barriers that prevent its implementation. Finally, we propose strategies that would help to expand the adoption of this tool.

Ancillary personnel in Spanish and Latin-American hospitals faced with living related kidney donation.

INTRODUCTION: Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. OBJECTIVE: To analyze the attitude toward living kidney donation (LKD) among ancillary personnel in Spanish and Latin-American hospitals and to analyze the variables that might influence such attitude. PATIENTS AND METHOD: from «International Collaborative Donor Project¼ a random sample was taken among ancillary personnel in Spain, Mexico and Cuba hospitals. Attitude towards LKD was evaluated using a validated, anonymously filled and self-administered survey. RESULTS: 951 professionals were surveyed (Spain: 277, Mexico: 632, Cuba: 42). 89% (n=850) are in favor of related kidney donation, lowering to 31% (n=289) in non-related donation. Of the rest, 8% (n=78) are not in favor and the 3% (n=23) are unsure. By country, Cubans (98%) and Mexicans (91%) are more in favour than Spanish (84%) (P=.001). The following variables are related to favourable attitude towards LKD: female sex (P=.017), university degree (P=.010), work in health services (P=.035), labour stability (P=.016), personal experience in donation and transplantation (P=.001), positive attitude toward cadaveric donation (P<.001), belief that he or she might need a transplant in the future (P<.001), positive attitude towards living liver donation (P<.001), a willingness to receive a donated living liver if needed (P<.001), having discussed the subject of organ donation and transplantation within the family (P<.001), partner's positive attitude towards the subject (P<.001), participation in voluntary type pro-social activities (P=.002) and not being concerned about possible mutilation after donation (P<.001) CONCLUSIONS: The attitude toward living related kidney donation is favourable among ancillary personnel in Spanish and Latin-Americans hospitals. Because living donation is a better source of organs than cadaveric ones, this favourable predisposition can be used as promoting agent of living donation in order to develop it in Spanish-speaking countries.

Multivariate analysis of the factors affecting attitude toward living liver donation among workers in surgical services in Spanish, Mexican, and Cuban hospitals.

INTRODUCTION: Current liver donation rates are insufficient to cover transplant needs. Therefore, it is essential to promote living liver donation (LLD) given the ever decreasing morbidity and mortality in the donor and the improving results in the recipient. LLD is becoming increasingly accepted. However, in the health care system, a percentage of the personnel are not in favor. OBJECTIVE: To analyze the attitude of personnel in surgical services in Spain and Latin-America hospitals toward LLD. MATERIALS AND METHODS: As part of the "International Collaborative Donor Project," a random sample was taken and stratified according to surgical service and job category in 10 hospitals; three in Spain, five in Mexico, and two in Cuba (n = 496). Attitude was evaluated using a validated survey that was completed anonymously and self-administered. RESULTS: Eighty-six percent (n = 425) of respondents were in favor of related living liver donation, and 30% (n = 147) were in favor if it were not related. According to country, 88% of the Mexican respondents were in favor of living liver donation, 85% of the Cubans, and 82% of the Spanish (P > .05). In the multivariate analysis of the variables with most weight affecting attitude toward LLD, the following significant associations were found: (1) a favourable attitude toward living kidney donation (odds ratio [OR] = 91; P < .001); (2) acceptance of a donated living liver if one were needed (OR = 11; P < .001); and (3) family discussion about donation and transplantation (OR = 2.581; P = .037). CONCLUSIONS: Attitude toward related living liver donation was very favorable among hospital personnel in Spanish and Latin American surgical services.

Spanish and Latin American nursing personnel and deceased organ donation: a study of attitude.

OBJECTIVE: To analyze the attitude of nursing personnel about organ donation and transplantation in hospitals in Spain and Latin America, and factors that affect this attitude. METHODS: Data were selected from 12 hospitals and 32 primary care centers participating in an international study (Proyecto Donante, Murcia) in 4 countries including Spain (n = 650), Mexico (n = 428), Cuba (n = 89), and Costa Rica (n = 27). The sample was random and stratified by type of service among nursing personnel (n = 1194). Attitude was evaluated using a psychosocial questionnaire. RESULTS: Of nursing personnel surveyed, 77% (n = 922) were in favor of organ donation. No differences were found according to whether they were directly involved in transplantation-related services (P < .05). Attitude in favor of organ donation varied between countries: 92% in Cuba, 85% in Costa Rica, 80% in Mexico, and 73% in Spain (P < .001) This attitude was also related to donation of a family member's organs (P < .001), having discussed organ donation and transplantation within the family (P < .001), the concept of brain death (P < .001), fear of body mutilation (P < .001), and manipulation of the body after death (P = .001). CONCLUSION: Attitude toward deceased organ donation among nurses varies between countries. There is a discrepancy between those in favor vs actual donation rates in countries and work centers. These fears may become worse when donation is seen as common in daily clinical practice.

Level of acceptance of a clinical solid organ xenotransplantation program among personnel in organ transplant-related services in Spanish, Mexican, and Cuban hospital centers.

INTRODUCTION: Xenotransplantation is far from becoming a clinical reality. However, in vital organs it could be used as a bridge until a human organ becomes available, in an emergency situation. We analyzed the attitude toward xenotransplantation among personnel in transplant-related services in several hospitals in Spain and Latin America. METHODS: A random sample stratified by type of service and job category (n = 738), in transplant-related services (procurement units, transplant units, and transplant patient follow-up units) was examined in eight hospital centers from three different countries: Spain (n = 349), Mexico (n = 269), and Cuba (n = 120). A self-administered validated questionnaire was completed anonymously. RESULTS: Based on the assumption that all the results of xenotransplantation were similar to those achieved with human donors, most respondents [66% (n = 484)] would be in favor. The employees from Cuban centers had the most favorable attitudes (72% in favor), followed by the Spanish (64%) and the Mexicans (61%; P = .013). However, the differences were mainly determined by job category: Physicians showed the most favorable attitudes and auxiliary staff the least (67% vs 40%; P = .010). Attitudes were significantly related to beliefs about different types of human donation [deceased (P < .001) and living (P < .001)], the possibility of needing a transplant for oneself (P < .001), and a favorable attitude toward donating the organs of a deceased family member (P = .004). CONCLUSIONS: Currently, a third of health care employees working in transplant-related services are not in favor of xenotransplantation. More information should be provided about the subject, especially in centers with preclinical xenotransplantation programs.

Attitudes toward living kidney donation in transplant hospitals: a Spanish, Mexican, and Cuban multicenter study.

INTRODUCTION: Living donor kidney (LKD) transplantation provides better results than deceased donor donation, involving minimum risk for the donor. However, LKD donation rates are low in most countries. We analyzed attitudes toward LKD in transplant hospitals in Spain, Mexico, and Cuba. MATERIALS AND METHODS: Data were obtained from five transplant hospitals through the International Collaborative Program "Proyecto Donante Vivo, Murcia" in three countries: Spain (n = 1168), Mexico (n = 903), and Cuba (n = 202). The random sample (2273 employees) was stratified according to job category. The instrument used to evaluate attitude was a validated questionnaire. Statistical analysis included Student t test, the chi(2) test, and multivariate analysis. RESULTS: Eighty eight percent (n = 2002) of Spanish, Mexican, and Cuban transplant hospital personnel were in favor of related LKD and 24% nonrelated LKD (n = 555). Attitudes were more favorable among centers in Cuba 97% (n = 195), followed by Mexico 88% (n = 793) and by Spain 87% (n = 1014; P < .001). According to job category, 91% (n = 617) of physicians were in favor, 88% (n = 543) of nurses, 85% (n = 198) of health care assistants, and 85% (n = 198) of auxiliary personnel. Attitudes were related to variables of: attitude toward deceased donation (P < .001), discussion about organ donation and transplantation (P < .001), concern about body mutilation after donation (P = .001), a possible need for a transplant in the future (P < .001), and attitude toward living liver donation (P < .001). CONCLUSIONS: Attitudes toward LKD in Hispanic/Latin Transplant Hospitals were favorable and could encourage an increase in LKD in the coming years assuming suitable sociopolitical and economic condition, as well as support from nephrologists.

Attitude toward living liver donation in transplant hospitals in Spain, Mexico and Cuba.

BACKGROUND: Transplantation hospitals have played a key role in developing deceased organ donation and transplantation (ODT). To reduce the number of deaths on the transplant waiting list, it is essential to encourage living liver donation (LLD). Involvement of personnel in these hospitals is crucial. PURPOSE: We analyzed the attitudes toward LLD among hospital personnel in Spain, Mexico, and Cuba. MATERIALS AND METHODS: Data were obtained from 5 transplant hospitals in Spain, Mexico, and Cuba. The sample was stratified according to job category and type of service (n=2273). A validated questionnaire about living donation was used as the instrument. RESULTS: Most respondents (82%) were in favor of related LLD. If the LLD was not related, acceptance fell to 21%. A total of 85% of physicians, 79% of nursing personnel, 74% of nursing assistants, and 83% of auxiliary staff were in favor (p<.001). A favorable attitude toward LLD was associated (P<.05) with age (37±10 y vs 39±10 y), a favorable attitude toward deceased donation, a belief that a possible transplant is needed, acceptance of LLD if necessary, a favorable attitude toward living kidney donation, family discussion about ODT, a partner's favorable attitude toward ODT, an intention to participate in prosocial activities, being a Catholic, and a belief that one's religion is in favor of ODT. CONCLUSIONS: Personnel from Spanish, Mexican, and Cuban transplantation hospitals have favorable attitudes toward LLD. This suggests that there may be an increase in LLD in the future, provided that there is the necessary sociopolitical and economic support.