First global forum on education on organ donation and transplantation for schools.

The Transplantation Society, in collaboration with the Canadian Society of Transplantation, organized a forum on education on ODT for schools. The forum included participants from around the world, school boards, and representatives from different religions. Participants presented on their countries' experience in the area of education on ODT. Working groups discussed about technologies for education, principles for sharing of resources globally, and relationships between education, and health authorities and non-governmental organizations. The forum concluded with a discussion about how to best help existing programs and those wishing to start educational programs on ODT.

Pharmacologic approaches for volume excess in acute kidney injury (AKI).

Volume management is an integral component of the care of patients with acute kidney injury (AKI). Considerable controversy exists regarding the use of pharmacological agents for volume management. Although overt fluid overload is often seen in AKI and may prompt attention for the use of diuretics, often these agents are used in the absence of fluid retention. Over the last decade several new agents have become available for volume removal. We reviewed the literature on this topic and addressed four key questions for the appropriate utilization of these agents. These include the drug targets and mechanism of action of available agents; clinical goals and criteria for timing of intervention; adaptation of therapy for specific clinical settings and measures required for monitoring effectiveness and patient safety. This report details our current knowledge in this area, provides evidence-based clinical practice recommendations where appropriate, and formulates a research agenda to address unanswered questions.

Influence of socioeconomic and ethical factors on people's behaviour regarding the use of cadaveric organs.

An organ donation is based on feelings of human solidarity and altruism. This approach, however, has not improved the organ shortage problem. The following suggestions might help to dismantle the persistent barrier linked to organ donation. (1) Society should be aware that during our lifetime we might be as much potential organ recipients as organ donors. (2) Educational campaigns should integrate the notion that cadaver organs are an irreplaceable source of health for every member of society. (3) Communication campaigns should illustrate that in allowing the use of our organs after death, we are, in fact, sharing a chance to prolong health for everybody, including perhaps ourselves. Furthermore, people need to acknowledge that using body parts is acceptable, and part of a tacit agreement between all members of society. Making a live organ donation to which the donor is emotionally related is a pressure-free decision. On the contrary, the donation of cadaver organs is influenced by negative factors. Conversely, self-interest and resistance to offering the body of a loved one to a stranger may make donation much more difficult if the current message is not modified. In an international survey of 242 transplantation professionals, with a 57% response rate, 70% to 83% agreed with this proposal. An international public survey has recently been finished, showing some results about the public's knowledge about religious opinions concerning transplantation, suggesting that religious institutions should assume a leadership role to give information about their positions. On the other hand, partial results concerning public attitudes regarding economic support to organ donation indicate that final data may be of interest. The creation of a Task Force with representatives from the World Health Organization, UNESCO, churches, and leaders of the global transplantation community may be key to joint efforts as a means to modify negative attitudes, to develop a new philosophy, and to deliver a new message to society.

Cyclosporine plasma levels six hours after oral administration. A useful tool for monitoring therapy.

Clinical evolution and cyclosporine (CsA) monitoring of 65 transplanted patients (55 kidneys, and 10 kidneys and pancreases) treated with CsA were analyzed retrospectively (45 patients) and prospectively (34 patients). Our results showed the following: (1) nephrotoxicity is not uncommon even with low trough plasma levels of CsA; (2) the T6 value of a CsA pharmacokinetic plasma curve (6 hr after oral drug administration) is a valid expression of a full pharmacokinetic study; (3) when T6 was used prospectively as a monitoring tool and dose adjustments made disregarding concomitant serum creatinine levels, the latter decreased when CsA dose adjustments were made to correct toxic (greater than 350 ng/ml) or subtherapeutic (less than 100 ng/ml) T6, P less than 0.01. At present, serum creatinine for all our patients is 180.2 +/- 8 mumol/L, and no patient has needed to be switched to conventional treatment. The validity of trough plasma levels in patients under CsA oral administration once or twice a day seems questionable, and T6 proved to be more useful. Thus nephrotoxicity and CsA undertreatment may be avoided. This new monitoring tool (T6) will allow the utilization of lower doses of CsA and thus contribute to improved long-term graft function.

Histologic features of chronic allograft nephropathy revealed by protocol biopsies in kidney transplant recipients.

BACKGROUND: The aim of the present study was to describe the histologic features disclosed by protocol kidney transplant biopsies in patients who experienced neither acute rejection nor acute renal failure during the 2 years after transplantation. METHODS: We studied 10 recipients of HLA-identical kidneys from living-related donors and 31 recipients of cadaveric kidneys. They were selected because, during the 2 years after transplantation, they did not experience clinical acute or chronic rejection, their renal function was normal and stable, and they underwent a protocol kidney biopsy at 3 months and at 2 years after transplantation. RESULTS: Histologic chronic allograft nephropathy was present in 25% of patients at 3 months and in 50% at 2 years, but was absent in the recipients of HLA-identical kidneys. Histologic worsening was associated with increased donor age, the presence of asymptomatic grade I acute rejection at 3 months, and an increased cyclosporine trough level. CONCLUSIONS: Protocol biopsies contribute important information that could be used to improve the prophylaxis of chronic allograft nephropathy.

Is serum creatinine a reliable expression of an adequate cyclosporine immunosuppression?

In 13 renal transplant patients with an excellent graft function, but concomitant abnormal T6 CsA plasma levels (CsA plasma level, 6 hours after oral administration of the drug), dose adjustments of CsA were performed until a normal T6 was achieved. A significant decrease of serum creatinine values was obtained after dose modification. Prophylactic monitoring of CsA immunosuppression by T6 could be a means of avoiding nephrotoxicity or undertreatment in patients with acceptable serum creatinine levels and unsuspected drug related renal dysfunction.