RESUMEN
As the limited supply of human donor organs remains the greatest barrier to renal transplantation, porcine renal xenografts have the potential to reduce the organ shortage. Recent attempts at using genetically engineered porcine renal xenografts have met with technical and functional problems. It is theorized that if transplantation of the en bloc kidneys had been performed: (1) the double nephron mass would provide normal renal function, (2) the procedure would be easier and safer by using the larger and thicker donor aorta and vena cava instead of the smaller and thinner-wall renal vessels, and (3) the operative procedure would be less time consuming because there are only 2 anastomoses to perform instead of a minimum of 4. The literature review on the use of en bloc renal xenografts is performed, as well as the application on the long-term use of small pediatric kidneys in humans.
Asunto(s)
Trasplante de Riñón , Trasplante Heterólogo , Animales , Humanos , Trasplante de Riñón/historia , Trasplante de Riñón/métodos , Trasplante Heterólogo/historia , Porcinos , XenoinjertosRESUMEN
The cornerstone events of kidney and liver transplant history in Turkey are summarized herein. In 1975, we performed the first pediatric living-related renal transplant in Turkey. We followed this in 1978 with the first deceased donor kidney transplant, using an organ supplied by Eurotransplant. In 1979 the law on harvesting, storage, grafting, and transplant of organs and tissues was enacted; the first local deceased donor kidney transplant was performed by our team in 1979. In 1988, another ground-breaking event in Turkey, the Middle East, and North Africa was successfully achieved: the first successful deceased-donor liver transplant, and in 1990, the first pediatric living-related segmental liver transplant in Turkey, the region and Europe was performed by our team. One month later, an adult-to-adult living-related liver transplant (left lobe) in the World was successfully performed. On May 16, 1992, we performed the first combined liver-kidney transplant from a living-related donor, which was the first operation of its kind in the World. Between November 1975 and January 2022, we have performed 3288 kidney (380 pediatric) at the Hacettepe University Hospitals and later on at Baskent University; since 1988, 701 (334 pediatric) liver transplants have been performed. In over 40 years of kidney and liver transplants history in Turkey, 46876 kidney (2502 pediatric patients) and 18203 liver (2612 pediatric patients) transplants have been performed nationwide. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplant activities, especially for deceased donor organ procurement. Transplant activities are accelerating daily throughout the country, but deceased donors are still far below the desired rates.
Asunto(s)
Trasplante de Riñón , Trasplante de Hígado , Obtención de Tejidos y Órganos , Adulto , Niño , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Trasplante de Riñón/historia , Trasplante de Hígado/historia , Donadores Vivos , Resultado del Tratamiento , TurquíaRESUMEN
OBJECTIVES: Gujarat, Tamil Nadu, Telangana, Maharashtra, Kerala, Chandigarh, and Karnataka are states in India with active programs for deceased donor kidney transplant. We report our experience of 2 decades of deceased donor kidney transplant at the Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India. MATERIALS AND METHODS: This single-center retrospective study comprised data from 831 deceased donor kidney transplant recipients between January 1, 1997 and December 31, 2018. Mean recipient age was 38 ± 14 years; 564 were male, and 267 were female. Mean donor age was 45.3 ± 17.13 years; 565 were men, and 266 were women. RESULTS: Between January 1, 1997 and March 15, 2020, 5838 kidney transplants were completed, including 4895 living donor kidney transplants, 943 deceased donor kidney transplants, and 440 kidney paired donation transplants. Over the mean follow-up time of 8 ± 5.4 years, patient survival rate was 70% (n = 581) and death-censored graft survival rate was 84% (n = 698). Delayed graft function was shown in 210 patients (25%) and biopsy-proven acute rejection rate in 180 patients (21%). Our experience of favorable outcomes with deceased donor kidney transplants has expanded the donor pool in many ways, including transplant from expanded criteria donors to younger recipients; transplant from older donors to older recipients; donation after cardiac death; successful intercity organ procurement; dual-kidney transplant; en bloc transplant from a pediatric deceased donor; and transplant from brain death deceased donors who died from neurotoxic snakebite, recurrent primary brain tumor, bacterial meningitis, or head injury, or with disseminated intravascular coagulation and deranged renal functions. The pathway to increase organ donation was investigated. CONCLUSIONS: Deceased donor kidney transplant can achieve acceptable graft function with patient/graft survival, which may encourage the use of this approach to increase the number of available organs.
Asunto(s)
Trasplante de Riñón , Donantes de Tejidos/provisión & distribución , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Supervivencia de Injerto , Historia del Siglo XXI , Humanos , India , Lactante , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/historia , Trasplante de Riñón/mortalidad , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Donantes de Tejidos/historia , Resultado del Tratamiento , Adulto JovenRESUMEN
This paper uses the history of kidney transplantation in South Africa as a lens through which to write a racialized, micro history that illustrates the politics of medical discoveries and medical research at one of South Africa's most prestigious medical research universities, the University of the Witwatersrand (Wits) in Johannesburg. Between 1966 and the 1980s, the Wits team became the most advanced and prolific kidney transplant unit in the country. Yet the racist, oppressive Apartheid system fundamentally shaped these developments. Transplantation, as this paper shows, became an elite medical procedure, performed by a select group of white doctors on mostly white patients. For these doctors, transplantation showed their medical prowess and displayed the technical advancements they were able to make in research and clinical practice as they strove to position South Africa as a significant international player in medical research, despite academic boycotts and increasing sanctions. Transplantation became a symbol of white supremacy in a country where the black majority were excluded from anything but the most basic health care.
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Centros Médicos Académicos/historia , Apartheid/historia , Ética Médica/historia , Trasplante de Riñón/historia , Racismo/historia , Investigación Biomédica/ética , Investigación Biomédica/historia , Población Negra , Trasplante de Corazón/ética , Trasplante de Corazón/historia , Historia del Siglo XX , Humanos , Terapia de Inmunosupresión/historia , Trasplante de Riñón/ética , Sudáfrica , Población BlancaAsunto(s)
Hospitales Especializados/estadística & datos numéricos , Fallo Renal Crónico/cirugía , Trasplante de Riñón/estadística & datos numéricos , Obtención de Tejidos y Órganos/organización & administración , Egipto/epidemiología , Historia del Siglo XX , Historia del Siglo XXI , Hospitales Especializados/historia , Hospitales Especializados/organización & administración , Humanos , Fallo Renal Crónico/mortalidad , Trasplante de Riñón/historia , Trasplante de Riñón/métodos , Donadores Vivos , Nefrología/historia , Nefrología/organización & administración , Nefrología/estadística & datos numéricos , Obtención de Tejidos y Órganos/historia , Obtención de Tejidos y Órganos/estadística & datos numéricos , Resultado del Tratamiento , Urología/historia , Urología/organización & administración , Urología/estadística & datos numéricosRESUMEN
Organ transplantation is one of the most important medical achievements of the 20th century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.
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Trasplante de Riñón , Croacia/epidemiología , Europa (Continente) , Femenino , Historia del Siglo XX , Humanos , Riñón , Trasplante de Riñón/historia , Eslovenia/epidemiologíaRESUMEN
Fabry disease is classified as a rare X-linked disease caused by a complete or partial defect of enzyme alpha-galactosidase, due to GLA gene mutations. This disorder leads to intracellular globotriaosylceramide (Gb3) deposition associated with increased Gb3 plasma levels. Most of the symptoms of the disease, involving kidneys, heart and nervous system, result from this progressive Gb3 deposition. The incidence is estimated in 1/50,000 to 1/117,000 in males. Fabry nephropathy begins with microalbuminuria and/or proteinuria, which, in the classic form, appear from childhood. Thus, a progressive decline of renal function can start at a young age, and evolve to kidney failure, requiring dialysis or renal transplantation. Enzyme replacement therapy (ERT), available since 2001 for Fabry disease, has been increasingly introduced into the clinical practice, with overall positive short-term and long-term effects in terms of ventricular hypertrophy and renal function. Kidney transplantation represents a relevant therapeutic option for Fabry nephropathy management, for patients reaching end-stage renal disease, but little is known about long-term outcomes, overall patient survival or the possible role of ERT after transplant. The purpose of this review is to analyze the literature on every aspect related to kidney transplantation in patients with Fabry nephropathy: from the analysis of transplant outcomes, to the likelihood of disease recurrence, up to the effects of ERT and its possible interference with immunosuppression.
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Enfermedad de Fabry/complicaciones , Trasplante de Riñón/historia , Trasplante de Riñón/normas , Adulto , Enfermedad de Fabry/historia , Enfermedad de Fabry/mortalidad , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Trasplante de Riñón/efectos adversos , MasculinoRESUMEN
BACKGROUND: From 1968 until 1997, transplantation-related activities were not properly regulated and were informally practiced. During 20 years, many legal and political changes influenced it. OBJECTIVE: To provide a historical overview of the 20 years with a descriptive data analysis of a 20-year data set. METHODOLOGY: We investigated information from Brazilian Transplantation Reports between 1997 and 2017. In this way, we classified all data into 5 Brazilian macro regions: Center-West, Northeast, North, Southeast, and South. In total, we included 27 states (including Capital District) and limited study to the heart, liver, and kidney. RESULTS: We analyzed 2835 data entries and associated population information from the Brazilian Institute of Geography and Statistics. We observed 2 distinct groups, one uniquely formed by the North region, with figures significantly lower than the remaining regions. After 2003, Southeast, South, and Northeast regions indicated a growing movement, whereas Center-West indicated certain stability in 50 and ranging between 50 and 100 cases (yearly basis) after 2011. Recently (2016 and 2017), the South region indicates another crescendo movement suggesting another detachment from the other regions, but it is something not clearly observed and, if true, should be figured in new reports of Brazilian Association of Organ Transplantation. CONCLUSION: This study identified and observed the time-spatial progress of organ transplantation in Brazil. In conclusion, after analysis of this 20-year data consolidation related to organ transplantation in Brazil, we observed a public investment in implementing quality evaluation and safety to provide figures that deliver visibility to the numbers reported in this article.
Asunto(s)
Trasplante de Corazón/tendencias , Trasplante de Riñón/tendencias , Trasplante de Hígado/tendencias , Adulto , Brasil/epidemiología , Niño , Recolección de Datos , Bases de Datos Factuales , Geografía , Trasplante de Corazón/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Trasplante de Riñón/historia , Trasplante de Hígado/historia , Factores de Tiempo , Obtención de Tejidos y Órganos/tendenciasRESUMEN
Pocas acciones en medicina son tan gratificantes como el trasplante exitoso de un órgano de una persona a otra. El rápido desarrollo de esta terapia para enfermedades terminales depende del coraje de los receptores, la generosidad de los donantes, del extraordinario esfuerzo de cirujanos, coordinadores y demás profesionales de la salud. Esta forma de tratamiento es inseparable del acto humano de donación. En efecto, el trasplante presupone una previa, explícita, libre y consciente decisión por parte del donante. Es la decisión de ofrecer sin recompensa, una parte del propio cuerpo para dar salud y bienestar a otra persona. El futuro de este sistema terapéutico realmente espectacular, será posible gracias a la donación de órganos y tejidos. El concepto de generosidad en la donación, sin ninguna clase de compensación, se ha impuesto en nuestra civilización occidental. El objetivo y compromiso del Instituto Nacional de Donación y Trasplante de Órganos Tejidos y Células (INDOT), entidad adscrita al Ministerio de Salud Pública y el Hospital José Carrasco Arteaga (IESS) con la sociedad ecuatoriana, es lograr el consentimiento efectivo de las personas a la donación de órganos y tejidos, disminuir la morbilidad de los pacientes que requieren este tratamiento, mejorar la calidad de vida y gestionar con transparencia el proceso. Hoy en día los trasplantes se han convertido en una práctica médica muy extendida con múltiples beneficios para los pacientes que de otra forma, no tendrían una segunda oportunidad. Cuando hay un trasplante no existen palabras de agradecimiento ante el gesto desinteresado y bondadoso que esto supone. Por tanto el objetivo de este editorial es destacar una actividad que salva vidas, brindando un homenaje a los que hacen posibles este milagro.