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Einstein (Säo Paulo) ; 20: eRB6181, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1364795


ABSTRACT Ischemia-reperfusion injury is a pathophysiological event occuring after abdominal organ transplantation, and has a significant influence on prognosis and survival of the graft. It is involved in delaying the primary function or non-functioning of the graft. The objective of this study was to provide information on heat shock protein mechanisms in ischemia-reperfusion injuries in abdominal organ transplantations, and to indicate the possible factors involved that may influence the graft outcome. Several classes of heat shock proteins are part of the ischemia and reperfusion process, both as inflammatory agonists and in protecting the process. Studies involving heat shock proteins enhance knowledge on ischemia-reperfusion injury mitigation processes and the mechanisms involved in the survival of abdominal grafts, and open space to support therapeutic future clinical studies, minimizing ischemia and reperfusion injuries in abdominal organ transplantations. Expression of heat shock proteins is associated with inflammatory manifestations and ischemia-reperfusion injuries in abdominal organ transplantations and may influence graft outcomes.

Organ Transplantation ; (6): 98-2022.
Article in Chinese | WPRIM | ID: wpr-907039


Objective To investigate the conversion rate, organ procurement rate and influencing factors of organ donation in a single center from Fujian province. Methods Baseline data of 182 potential organ donors of Fujian Medical University Union Hospital from November 2018 to June 2021 were retrospectively analyzed. The conversion rate of organ donation, baseline data of successful organ donors and the causes of failure of organ donors were identified. The organ procurement rate and the influencing factors of the number of organ donations were analyzed. Results Among 182 potential organ donors, 46 cases were successful organ donors with a conversion rate of 25.3%. In addition, 136 cases failed to donate organ. The main causes included disagreement from family members (58.1%), insufficient evaluation time (24.3%) and ineligible for donation criteria (17.6%). A total of 212 large organs and tissues were donated by 46 organ donors, including 88 kidneys, 42 livers, 15 lungs, 19 hearts and 48 corneas, with 4.6 large organs and tissues, and 3.6 large organs for each donor. Age, sex, native place, organ donation area and blood type were the influencing factors of the number of large organ donations. Organ donation area was the influencing factor of the number of tissue donations. Conclusions The conversion rate of organ donation is relatively low in a single center from Fujian province. Disagreement from family members is the main cause. Suitable potential organ donors should be selected for organ donation to improve the conversion rate and organ procurement rate of organ donation.

Organ Transplantation ; (6): 12-2022.
Article in Chinese | WPRIM | ID: wpr-907027


With the reform of organ donation and transplantation in China, the establishment of Organ Procurement Organization (OPO) will become more centralized and enlarged in scale, evolving into the united OPO development stage coordinated by multiple hospitals. How to enhance the operation management and scientific development planning of united OPO has become an urgent and novel issue facing the administrators at all levels. At present, certain constraint factors of united OPO still exist in the integrated management, cost control, service homogenization, cultural integration and discipline layout. To give full play to the large-scale benefits and expand the supply of high-quality organ donation services, the development principle of putting connotation construction first and the appropriate direction of public welfare should be upheld. Leading and driving the development of organ donation services of our province are the responsibility, and discipline construction and talent training serve as the core. The overall development plan should be determined in a scientific pattern and homogeneous management should be implemented according to local conditions, aiming to provide successful experience for establishing a provincial unified OPO.

Article in Chinese | WPRIM | ID: wpr-907026


Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.

Organ Transplantation ; (6): 169-2022.
Article in Chinese | WPRIM | ID: wpr-920846


In recent years, organoid technology has become one of the major technological breakthroughs in biomedical field. As miniature organs constructed by three-dimensional culture of tissue stem cells in vitro, organoids are highly consistent with the source tissues in terms of tissue structures, cell types and functions, which serve as an ideal model for biomedical basic research, drug research and development and clinical precision medicine, and show important potential value in regenerative medicine. Organ transplantation is one of the most effective approaches to treat organ failure. However, the source of donor organs is currently limited, which could not meet the patients' needs. Identifying suitable graft substitutes is the key to breaking through the predicament. Organoids could be derived from the autologous tissues of patients. Multiple studies have demonstrated that organoids possess potent transplantation and repairing capabilities and may effectively avert the risk of immune rejection and tumorigenicity, etc. In this article, the development process and main application directions of organoid technology were summarized, and the application prospect and challenges of organoids in organ transplantation were reviewed and predicted.

Organ Transplantation ; (6): 161-2022.
Article in Chinese | WPRIM | ID: wpr-920845


3D bioprinting is an advanced manufacturing technology that utilizes biomaterials and bioactive components to manufacture artificial tissues and organs. It has been widely applied in multiple medical fields and possesses outstanding advantages in organ reconstruction. In recent years, 3D bioprinted organs have made an array of groundbreaking achievements. Nevertheless, it is still in the exploratory stage of research and development and still has bottleneck problems, which can not be applied in organ transplantation in vivo. In this article, the application of 3D printing technology in medicine, characteristics of 3D bioprinting technology, research hotspots and difficulties in bionic structure, functional reconstruction and immune response of 3D bioprinted organs, and the latest research progress on 3D bioprinting technology were illustrated, and the application prospect of 3D bioprinting technology in the field of organ reconstruction was elucidated, aiming to provide novel ideas for the research and clinical application of organ reconstruction and artificial organ reconstruction, and promote the development of organ transplantation and individualized medicine.

Organ Transplantation ; (6): 144-2022.
Article in Chinese | WPRIM | ID: wpr-920844


Organ transplantation is the most effective treatment for end-stage organ failure, and voluntary donation after citizen's death is the only source of transplant organ in China. Clinically, transplant organ protection technique plays a critical role in improving the quality of transplant organs and the prognosis of recipients. On the basis of domestic and worldwide basic research and clinical practice of transplant organ protection and according to the Oxford evidence classification and GRADE system, the experts organized by Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, Branch of Transplantation Group of Surgery of Chinese Medical Association and China Liver Transplant Registry Scientific Committee had compiled and published the Chinese Expert Consensus on Organ Protection of Transplantation (2016 edition) for liver, kidney, pancreas, small intestine, heart, lung transplant organs. With the support of China Liver Transplant Registry, National Trauma Medical Center, National Quality Control Center for Human Donated Organ Procurement, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation and National Center for Healthcare Quality Management in Liver Transplant combined with recent domeatic and worldwide clinical practice and research progress for organ transplantation and organ protection, the Chinese Expert Consensus on Organ Protection of Transplantation (2022 edition) has been published recently. This consensus focuses on updating the technical progress and evidence-based medicine of organ procurement, preservation, transport, and quality evaluation in clinical practice. Additionally, the content of composite tissue transplantation mainly including limb transplantation has also been covered. The aim is to promote the the scientific and standardized clinical organ transplantation.

Radiol. bras ; 54(4): 270-276, July-Aug. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1287745


Abstract Pancreas transplantation is a well-established treatment for patients with complicated diabetes mellitus and advanced renal failure. The most common procedure is simultaneous pancreas-kidney transplantation, in which the pancreas graft is positioned in the right pelvic region and the kidney graft is positioned in the left iliac fossa. Various imaging methods are used for the post-transplantation evaluation of the graft parenchyma and vascular anatomy, as well as for the identification of possible complications. As the number of cases increases, it is fundamental that radiologists understand the surgical procedure and the postoperative anatomy, as well as to recognize the possible postoperative complications and their imaging aspects, with the aim of providing the best guidance in the postoperative management of transplant recipients.

Resumo O transplante de pâncreas representa uma terapia bem estabelecida no tratamento de pacientes com diabetes mellitus complicada com insuficiência renal em estágios avançados. A maior parte ocorre em associação ao transplante renal (transplante simultâneo de pâncreas e rim), no qual se posiciona o enxerto pancreático na região pélvica direita e o enxerto renal na fossa ilíaca esquerda. Diversos métodos de imagem são utilizados para avaliação parenquimatosa dos enxertos, bem como a anatomia vascular e as possíveis complicações. A compreensão do procedimento cirúrgico, das técnicas utilizadas e da anatomia pós-cirúrgica é fundamental à medida que o número de casos aumenta, assim como conhecer as possíveis complicações associadas e seus aspectos de imagem, com a finalidade de proporcionar o melhor direcionamento no manejo pós-operatório de receptores de transplantes.

Medicina (B.Aires) ; 81(3): 359-366, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346470


Resumen El síndrome de leucoencefalopatía posterior reversible (PRES) es un desorden neurológico agudo caracterizado por cefalea, alteración de la conciencia, convulsiones y alteraciones visuales, con imágenes de edema vasogénico reversible en regiones cerebrales posteriores. Nos propusimos describir una serie de casos de pacientes trasplantados que desarrollaron PRES, caracterizando su presentación, evolución clínica, imágenes y terapéutica. Se analizaron historias clínicas informatizadas desde enero 2009 hasta enero 2019. Se recabaron datos demográficos, antecedentes clínicos, motivos y días de internación, tiempos desde el trasplante a la presentación clínica y diagnóstico. Se evaluó la mejoría/resolución en estudios por imágenes y la supervivencia anual. Se identificaron 27 pacientes con PRES; 22 trasplantados de órgano sólido de 1647 totales (1.3%) y 5 de médula ósea de 617 totales (0.8%). La media de edad fue de 38.2 años (DS 19.5), 62.9% de sexo femenino, 59.2% (16) antes del año del trasplante. Las comorbilidades más frecuentes enfermedad renal (14; 51%) e hipertensión arterial (11; 40%). Se realizó tomografía axial computarizada (TAC) a 23 pacientes (85.1%), siendo patológica en 11 (47.8%), y resonancia magnética nuclear (RMN) a 25 (92.6%), mostrando patrón característico en 17 (62.9%), con mejoría/resolución antes del año en 20 (74%). El tratamiento fue sintomático, modificando la inmunosupresión. Se registraron 5 óbitos durante la internación y otros 3 antes del año, con una supervivencia anual del 70.3% (19). La población de trasplantados, en crecimiento en nuestro medio, es particularmente susceptible al PRES. Tanto su presentación en estudios por imágenes, como su comorbilidad, difieren de otras poblaciones.

Abstract Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by headache, encephalopathy, seizures and visual disturbances, with reversible vasogenic edema in posterior brain areas. The aim of this research was to describe a case series of transplanted patients who developed PRES, characterize their presentation, treatment, clinical and imaging evolution. Electronic medi cal records were analyzed from January 2009 to January 2019. Demographic data, clinical backgrounds, causes of admission, hospital length of stay and time from transplantation to PRES were collected. Image improvement/ resolution and annual survival were assessed. We identified 27 patients with PRES; 22 of 1647 total solid-organ transplant (1.3%) and 5 of 617 total bone marrow transplant (0.8%). The mean age at presentation was 38.2 years (SD 19.5), 62.9% female, 59.2% (16) before the year of transplantation. The most common comorbidities were kidney disease (14; 51%) and high blood pressure (11; 40%). Computed axial tomography (CT) was per formed in 23 patients (85.1%), with pathological findings in 11 (47.8%). Magnetic resonance imaging (MRI) of 25 (92.6%), showed a characteristic pattern in 17 (62.9%) with improvement/resolution before the year in 20 (74%). Treatment was symptomatic, modifying immunosuppression. Five deaths were recorded during hospital stay and another 3 before the year of admission, with an annual survival of 70.3% (19 patients). Organ transplant trend is growing in our region. These patients are particularly susceptible to PRES, with a different imaging presentation and comorbidities from other populations.

Humans , Male , Female , Posterior Leukoencephalopathy Syndrome/etiology , Posterior Leukoencephalopathy Syndrome/epidemiology , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Hypertension , Seizures , Magnetic Resonance Imaging , Follow-Up Studies
Rev. Assoc. Med. Bras. (1992) ; 67(4): 602-606, Apr. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1340642


SUMMARY OBJECTIVE: A survey among medical students in a Brazilian public university was performed to investigate the acceptance of organ donation in Brazil, particularly donation after circulatory death (DCD). METHODS: A questionnaire including 26 objectives and Likert scale questions was validated and sent to all medical students of our institution. The answers were analyzed considering the whole set of individuals as well as by dividing the medical students into two groups: less graduated students and more graduated students. RESULTS: From 1050 students, 103 spontaneous answers (9.8%) were retrieved after 3 weeks. A total of 89.3% agreed totally with deceased donor organ donation and 8.7% agreed partially. However, only 50.5% of the students agreed totally and 31.1% agreed partially to living donation. Students revealed that 82.6% know the concept of brain death. On the other hand, 71.8% of them declared not knowing the concept of planned withdrawal of life-sustaining therapy, mainly cardiorespiratory support. A total of 85.4% of students agreed totally with donation after brain death and 11.7% agreed partially. However, when questioned about donation in awaiting circulatory death after a planned withdrawal of life-sustaining therapy, only 18.4% agreed totally and 32% agreed partially. Both groups of less and more graduated students showed similar results. CONCLUSIONS: Our study found a clear lack of information and consequently in acceptance of DCD. Education in the field of end-of-life management may improve not only the acceptance of DCD donation but also the whole understanding of planned withdrawal of life-sustaining therapy.

Rev. bras. ter. intensiva ; 33(2): 290-297, abr.-jun. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1289077


RESUMO Objetivo: Analisar o impacto da resolução 2.173/2017 do Conselho Federal de Medicina nos resultados da Central Estadual de Transplantes de Santa Catarina. Métodos: Estudo observacional do tipo transversal, com dados de prontuário de todos os pacientes (1.605) com suspeita de morte encefálica notificados à Central Estadual de Transplantes de Santa Catarina e que iniciaram procedimentos para confirmação desse diagnóstico entre julho de 2016 e dezembro de 2017 e entre janeiro de 2018 e junho de 2019. A mediana do tempo de duração do protocolo em cada período foi considerada para a comparação entre os intervalos. Os dados coletados foram transformados em taxas (por milhão de população). As taxas médias dos períodos antes e depois da implantação do protocolo foram analisadas pelo teste t de Student, e as variáveis qualitativas foram analisadas pelo teste do qui-quadrado de Pearson. Resultados: O tempo médio de duração dos procedimentos de confirmação de morte encefálica apresentou redução de mais de 1 hora no segundo período em relação ao primeiro, com significância estatística (p = 0,001). As taxas de fígados captados e de pâncreas transplantados, o número de notificações por porte hospitalar e a taxa de parada cardiorrespiratória na macrorregião do Vale do Itajaí também apresentaram diferenças com significância estatística na comparação entre os dois períodos. Conclusão: No período após a nova resolução sobre morte encefálica, houve redução do tempo de duração do diagnóstico. Contudo, outros indicadores não sofreram alteração significativa, evidenciando a natureza multidimensional do processo de transplante de órgãos em Santa Catarina e a necessidade de mais estudos para a melhor compreensão e otimização do processo.

ABSTRACT Objective: To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina. Methods: This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student's t-test, and qualitative variables were analyzed by Pearson's chi-squared test. Results: The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods. Conclusion: In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.

Humans , Brain Death , Brazil/epidemiology , Cross-Sectional Studies
Rev. bras. enferm ; 74(supl.1): e20200610, 2021. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1288429


ABSTRACT Objectives: to map the care recommendations available in the literature capable of supporting health professionals' decision-making in the organ and tissue donation process before the COVID-19 pandemic. Methods: is a nine-step scoping review with searches performed in three databases and an electronic library (Science Direct). Results: 873 publications were retrieved, 15 selected for analysis. All were published in 2020, originating mainly on China, with predominance of original articles. The most frequent recommendations relate to testing to detect SARS-CoV-2 infection for deceased donors (52.6%) and clinical evaluation of potential donors and possible donors (31.6%). Final considerations: it is believed that the recommendations evidenced will support health professionals in the process of donation and organ transplantations to determine interventions for decision-making during the COVID-19 pandemic.

RESUMEN Objetivo: mapear las recomendaciones de atención disponibles en la literatura capaces de apoyar la toma de decisiones de los profesionales de la salud que trabajan en el proceso de donación de órganos y tejidos ante la pandemia de COVID-19. Métodos: es una revisión de alcance desarrollada en nueve etapas con búsquedas realizadas en tres bases de datos y una biblioteca electrónica (Science Direct). Resultados: se recuperaron 873 publicaciones, 15 seleccionadas para su análisis. Todos fueron publicados en 2020, originados principalmente en China, con predominio de artículos originales. Las recomendaciones más frecuentes están relacionadas con las pruebas para detectar la infección por SARS-CoV-2 en donantes fallecidos (52,6%) y la evaluación clínica del donante potencial y posible donante (31,6%). Consideraciones finales: se cree que las recomendaciones evidenciadas subsidiarán a los profesionales de la salud que trabajan en el proceso de donación y trasplante de órganos para determinar intervenciones para la toma de decisiones durante la pandemia de COVID-19.

RESUMO Objetivo: mapear as recomendações de cuidados disponíveis na literatura capazes de subsidiar a tomada de decisão de profissionais da saúde atuantes no processo de doação de órgãos e tecidos diante da pandemia de COVID-19. Métodos: trata-se de uma revisão de escopo desenvolvida em nove etapas com buscas realizadas em três bases de dados e uma biblioteca eletrônica (Science Direct). Resultados: foram recuperadas 873 publicações, 15 selecionadas para análise. Todas foram publicadas em 2020, tendo como origem principalmente a China, predominando artigos originais. As recomendações mais frequentes se relacionam com a realização de testes para detectar a infecção por SARS-CoV-2 para doadores falecidos (52,6%) e avaliação clínica do potencial doador e possível doador (31,6%). Considerações finais: acredita-se que as recomendações evidenciadas subsidiarão os profissionais de saúde atuantes no processo de doação e transplantes de órgãos a determinar intervenções para a tomada de decisão durante a pandemia de COVID-19.

Rev. Col. Bras. Cir ; 48: e20213042, 2021. tab
Article in English | LILACS | ID: biblio-1340670


ABSTRACT The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.

RESUMO A utilização intensa dos recursos para o combate da COVID-19 causa preocupação em toda comunidade de transplantes, pois além das limitações físicas, como leitos de UTI, a falta de protocolos homogêneos para tratamentos e as incertezas dos efeitos da imunossupressão na progressão do vírus, resultam em um impacto significativo nas cirurgias de transplantes. O objetivo do presente estudo é avaliar comparativamente o número de transplantes de órgãos sólidos realizados nos anos de 2019 e 2020, e o impacto da pandemia na doação e transplantes de órgãos no Brasil. Considerando os últimos 10 anos, é possível observar uma tendência de aumento no número de transplantes de órgãos sólidos, com queda expressiva no ano de 2020. O transplante pulmonar foi o mais atingido pela pandemia, sendo realizado apenas nos estados do Rio Grande do Sul e São Paulo. O transplante hepático foi o menos afetado, apresentando uma diminuição de apenas 10,8% nos três primeiros trimestres de 2020, quando comparados com 2019. Sobre os pacientes ativos em lista de espera, houve um aumento em 2020 para transplante de coração e rim. Portanto, estratégias devem ser desenvolvidas para que a estrutura necessária ao processo de transplantes de órgãos se mantenha ativa, reduzindo assim os impactos da pandemia sobre estes pacientes.

Humans , Tissue and Organ Procurement , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2
Einstein (Säo Paulo) ; 19: eRW5630, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286306


ABSTRACT Objective To learn about the scientific production on strategies adopted for hemodynamic maintenance of brain-dead patients. Methods Integrative review with articles published between 2007 and 2019, in Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), PubMed® and ScienceDirect. The descriptors " Hemodinâmica AND Morte Encefálica " and "Hemodynamics AND Brain Death" were used. Exclusion criteria were non-human research and gray literature. Results A total of 21 articles were listed. As strategies, the use of drugs - noradrenaline (n=8), vasopressin (n=7), dobutamine (n=6), hydrocortisone (n=4) and methylprednisolone (n=4); invasive (n=10) and noninvasive (n=13) cardiac monitoring; control of ventilatory parameters (n=12); and correction of fluid and electrolyte disturbances (n=17) were highlighted. Conclusion The main strategies found in this integrative review were regulation of blood pressure and temperature, use of catecholamines and corticosteroids, in addition to the need for an early diagnosis of brain death. However, the lack of clearer protocols on the subject is notorious, making management with the potential donor difficult.

RESUMO Objetivo Conhecer a produção científica sobre estratégias adotadas para a manutenção hemodinâmica de pacientes com morte encefálica. Métodos Revisão integrativa com artigos publicados entre 2007 e 2019, nas bases Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed®e ScienceDirect . Utilizaram-se os termos "Hemodinâmica AND Morte Encefálica" e "Hemodynamics AND Brain Death ." Os critérios de exclusão foram pesquisas não realizadas com seres humanos e literatura cinzenta. Resultados Listaram-se 21 artigos. Como estratégias, destacaram-se uso de medicamentos - noradrenalina (n=8), vasopressina (n=7), dobutamina (n=6), hidrocortisona (n=4) e metilprednisolona (n=4); monitorização cardíaca invasiva (n=10) e não invasiva (n=13); controle dos parâmetros ventilatórios (n=12); e correção de distúrbios hidroeletrolíticos (n=17). Conclusão As principais estratégias encontradas nesta revisão integrativa foram regulação da pressão arterial e temperatura, uso de catecolaminas e corticosteroides, além da necessidade de um diagnóstico precoce de morte encefálica. Entretanto, é notória a escassez de protocolos mais esclarecidos sobre a temática, dificultando o manejo com o potencial doador.

Humans , Brain Death , Hemodynamics , Brain , Caribbean Region
Rev. eletrônica enferm ; 23: 1-6, 2021.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1151449


Objetivou identificar os elementos facilitadores no processo de doação de órgãos e tecidos para transplante, na perspectiva dos profissionais das Comissões Hospitalares de Transplantes. Estudo descritivo, qualitativo, realizado com 20 profissionais que compõem as Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplante. A coleta de dados ocorreu por meio de entrevista semiestruturada, analisados por meio da técnica do Discurso do Sujeito Coletivo. Emergiram três ideias centrais que versaram sobre os profissionais atuantes na Terapia Intensiva e Emergência como membros da Comissão Hospitalar de Transplantes; Suporte da Central Estadual de Transplante; Coordenação da Comissão Hospitalar de Transplantes. Identificou-se como elementos facilitadores no processo de doação de órgãos e tecidos os profissionais das comissões do quadro funcional das respectivas unidades envolvidas no processo. É necessário um serviço organizado e articulado, de profissionais capacitados e de liderança resolutiva para garantir sucesso no processo de doação de órgãos e tecidos para transplantes.

This work has aimed to identify the facilitating elements in the organ and tissue donation process for transplantation from the perspective of professionals from Brazilian Hospital Transplantation Commissions. This is a descriptive, qualitative study conducted with twenty professionals who make up the In-Hospital Commissions for Organ and Tissue Donation for Transplantation. Data collection took place through semi-structured interviews analyzed using the Collective Subject Discourse technique. Three central ideas have emerged, which address the professionals working in Intensive Care and Emergency as members of the Hospital Transplantation Commission (CHT), the Support from the State Transplant Center (CET), and the Coordination of the Hospital Transplantation Commission. The facilitating elements of the organ and tissue donation process were the professionals of the commissions from the respective units involved in the process. An organized and articulated service, with trained professionals and resolute leadership, is necessary to ensure the success in the organ and tissue donation process for transplantation.

Tissue and Organ Procurement , Commission on Professional and Hospital Activities , Brain Death
Article in Chinese | WPRIM | ID: wpr-911675


Objective:To compare the results of three detection methods, single antigen-bead assay(SAB), Luminex screening assay(LMX), and ELISA assay for detecting HLA antibody, and compares the two screening methods, LMX and ELISA with SAB detection as a reference method to provide a reference for organ transplantation laboratories to choose a reasonable HLA antibody test strategy.Methods:A lot of 124 consecutive samples were tested using SAB, ELISA, and LMX methods at the same time, and analyze the differences of these results. SAB testing was used as a reference method to analyze the sensitivity and specificity of the two screening assays. Chi-square analysis was used to compare the two methods, and P<0.05 was considered statistically significant. Results:Both ELISA and LMX methods showed low sensitivity of 34.4% and 31.3% for HLA class I, and 29.7% and 51.3% for class Ⅱ. Otherwise, the specificity of the ELISA and LMX method was much higher. For class, I both was 98.9%, and for class Ⅱ were 100% and 91.9% respectively. Out of 124 samples, the number of SAB(+ )ELISA(-)LMX(-) results was 17, and SAB(-)ELISA(+ )LMX(+ ) results was zero indicating that there were considerably screening assays probably with missed detection. In the cases of SAB(+ )ELISA(-)LMX(-), the distribution of MFI value of SAB assay ranges from 750 to 7000.Conclusions:Because the sensitivity of the two screening methods is relatively low, there is a greater risk of missed antibody detection in the scheme of testing for specific antibodies after the screening test is positive. This should be paid attention to, especially for patients with a history of sensitization. For negative screening test results, SAB or other assays should be considered to check the result. It could provide more accurate results when SAB which is recognized as higher sensitivity and specificity is directly used as an initial test. At the same time, the MFI value of the SAB test can serve as an indicator to determine whether to add other assays to check the ASB result.

Article in Chinese | WPRIM | ID: wpr-911285


Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

Article in Chinese | WPRIM | ID: wpr-908455


Transplantation acquired food allergy (TAFA) is a rare complication of solid organ transplantation. The pathogenesis of TAFA has not been fully elucidated. There are two possible mechanisms for its occurrence: food allergy mediated by IgE delivery of the donor and food allergy caused by food intolerance after transplantation. At present, there is still insufficient understanding of this complication among transplant physicians. Through systematic review of relevant literature, the authors summarized the research progress of TAFA, which mainly included the pathogenesis, clinical characteristics, treatment and prognosis of TAFA. In order to provide reference for the diagnosis and treatment of TAFA.

Organ Transplantation ; (6): 767-2021.
Article in Chinese | WPRIM | ID: wpr-904563


Posttransplant lymphoproliferative disease (PTLD) is a series of heterogeneous lymphoproliferative diseases and a severe complication after solid organ transplantation in children. Over 70% of PTLD is associated with Epstein-Barr virus (EBV). EBV-related B-cell lymphoma is also the main malignant tumor after pediatric organ transplantation. EBV-related PTLD is still a challenge in pediatric solid organ transplantation, which is mainly caused by immune function damage induced by immune suppression after transplantation. However, the specific mechanism remains elusive. In recent years, biomarkers have been developed to guide the diagnosis and individualized treatment of EBV-related PTLD, which possesses excellent application prospect. In this article, research progresses on the incidence of EBV-related PTLD in solid organ transplantation and its biomarkers were reviewed, aiming to explore novel ideas for clinical diagnosis and treatment.

Organ Transplantation ; (6): 707-2021.
Article in Chinese | WPRIM | ID: wpr-904554


Objective To analyze the status of job satisfaction of human organ donation coordinators in Fujian province during the normalization period of novel coronavirus pneumonia (COVID-19) epidemic prevention and control and put forward corresponding suggestions. Methods The job satisfaction of human organ donation coordinators in Fujian province was investigated by online questionnaires. The correlation analysis of all dimensions of the overall job satisfaction of human organ donation coordinators was carried out, and the influencing factors of the overall job satisfaction were analyzed. Results The overall job satisfaction of human organ donation coordinators was (2.9±0.8), which was a relatively low score. The job promotion satisfaction was (4.7±1.3), (2.0±1.4) for the job pay and benefits satisfaction, and (2.0±1.3) for the job communication satisfaction. The job pay and benefits satisfaction was positively correlated with job communication satisfaction (r=0.653, P < 0.05). Multiple factors differed in job satisFfaction. The overall job satisfaction of human organ donation coordinators was associated with gender, nature of job, working years, average monthly income, age, educational background and nature of post. Conclusions The job satisfaction of human organ donation coordinators is relatively low in Fujian province during the normalization period of COVID-19 epidemic prevention and control. Flexible and diverse methods should be employed from the government and hospital levels to further improve security policies for human organ donation coordinators.