[The effect of gender on the results of related kidney transplantation].

AIM: To define the effect of donor and recipient gender on the results of kidney transplantation from living related donor. MATERIAL AND METHODS: Group of 271 patients who underwent kidney transplantation from living related donor was analyzed. There were 115 women and 156 men. Age varied from 1 to 63 years (mean 21.30±12.32). There were 127 children aged 1-18 years (mean 11.28±4.63) and 144 adults aged 19-63 years (mean 29.81±11.24). Donors included 162 women and 109 men. Overall survival was calculated using Kaplan-Mayer. Mortality and incidence of transplants failure were determined using Fisher's exact test. RESULTS: All patients were divided into 2 groups depending on recipients' gender and then into 4 subgroups depending on gender of donors and recipients. Comparative statistical analysis showed that transplants survival was higher in women vs. men (T=2.7, p=0.007). Survival of patients was similar in both groups. Moreover it was the best in subgroup of recipients-women with kidneys from donors-men. Difference was statistically significant (T=2.16, p=0.03). There was no significant difference in all other cases. CONCLUSION: The results of kidney transplantation are better in recipients-women than in men.

Safety and Effectiveness of Marginal Donor in Living Kidney Transplantation.

BACKGROUND: We evaluated the safety and feasibility of living kidney transplantation from marginal donors. PATIENTS AND METHODS: Between June 2006 and March 2015, we performed 61 living related renal transplantations at two renal transplantation centers. Marginal donors were defined as those who were older than 70 years or who had hypertension, reduced renal function, body mass index greater than 30 kg/m(2), or mildly impaired glucose tolerance. We retrospectively compared renal function and graft survival between marginal and standard living donor kidney transplantations. To evaluate renal function, creatinine clearance (CCr) was preoperatively used for donors, and estimated glomerular filtration rate (eGFR) was postoperatively used for donors and recipients. RESULTS: Among 61 donors, 14 (23%) met the marginal criteria, the major reason being hypertension (91%). The mean age tended to be higher in the marginal group. Preoperative eGFR was significantly lower in the marginal group, whereas postoperative renal function decline ratio at two years was not significantly different between the groups (67% vs 67%, P = .960). Five-year graft survival rates were not significantly different between the two groups. However, recipient eGFR 1 year after kidney transplantation was lower in the marginal group than in the standard group (44 ± 8 vs 55 ± 9 in eGFR, P = .003). CONCLUSIONS: No significant differences were observed between the groups regarding donor renal function. Careful marginal donor selection can be safe and feasible for donors and recipients of living kidney transplantation; however, it may have a negative impact on recipient renal function.

Donante vivo. Legislación / Living donor. Legislation

Introducción: Trasplantes realizados de órganos procedentes de donante vivo pueden serlo de un riñón y parciales de hígado, intestino e incluso pulmón. Si bien varían fundamentalmente en el riesgo que supone para el donante y los resultados en la supervivencia del injerto, la implicación legal es la misma. Así, me centraré en el protocolo con mayor experiencia, menor riesgo para el donante y mejores resultados: la donación renal de vivo. El trasplante renal ha demostrado ser el mejor tratamiento de la insuficiencia renal crónica en cuanto a supervivencia, calidad de vida, menores complicaciones y mejor relación coste-beneficio frente a la diálisis. Situación actual del donante vivo: El trasplante renal procedente de donante vivo se realiza en 14 de las 17 comunidades autónomas del territorio nacional. Destacan, en el año 2013, Cataluña (165 trasplantes), Andalucía (60 trasplantes), Madrid (40 trasplantes) y País Vasco (38 trasplantes), y la evolución del plan nacional de trasplante cruzado, con un incremento muy significativo en el número de trasplantes, desde su comienzo en el año 2009 con dos trasplantes renales hasta 41 trasplantes renales procedentes de donante vivo cruzado en el año 2013. Legislación: El trasplante renal de donante vivo estaba regulado en España por la Ley de trasplantes 30/1979. Esta ley regulaba la donación en vida de un órgano si es compatible con la vida y la función del órgano o parte de él es compensada por el organismo. Especifica además que el destino del órgano será su trasplante a una persona determinada. Luego siguió el Real Decreto 2070/1999, la Ley de Autonomía del Paciente 41/2002 y finalmente el Real Decreto 1723/2012 de 28 de diciembre. En Europa, la Directiva 2010/45/UE del Parlamente Europeo y del Consejo Europeo de 7 de julio de 2010 (AU)

Introduction: Organ transplants from living donors may be a partial kidney and liver, intestine and even lung. If they vary mainly in the risk to the donor and results in graft survival, the legal implication is the same. So I will focus for this chapter in the protocol with more experience, the less risk to the donor and better results: the living kidney donation. Kidney transplantation has proven to be the best treatment of chronic renal failure in terms of survival, quality of life, fewer complications and better cost-benefit ratio compared to dialysis. Current status of the living donor: Kidney transplant from a living donor is performed in 14 of the 17 regions of the country. Highlighted in the year 2013 Catalonia (165 transplantations), Andalusia (60 transplants), Madrid (40 transplants) and the Basque Country (38 transplants). The evolution of cross-national transplantation plan, with a significant increase in the number of transplants, since its inception in 2009 with two kidney transplants, 41 kidney transplants from living donors crossed in 2013. Legislation: The living donor kidney transplantation was regulated in Spain by Law 30/1979 transplant. This law regulated living donation of an organ if it is compatible with the life and function of the body or part of it offset by the body. Further specifies that the fate of organ transplantation to be a certain person. Then he followed the Royal Decree 2070/1999, Law 41/2002 of Patient Autonomy and finally Royal Decree 1723/2012, 28 December. At the European level, Directive 2010/45/EU of the European Parliament and right of the European Council of July 7, 2010 (AU)

Recovery pattern of non-protein respiratory quotient and non-esterified fatty acids after liver resection.

OBJECTIVE: Perioperative nutritional care is important to maintain preoperative and postoperative nutritional status. However, few reports have investigated energy metabolism after hepatectomy. The aim of this study was to determine differences in energy metabolism, blood biochemistry, and nutritional status before and after liver resection in patients with hepatocellular carcinoma (HCC) and healthy living donors for liver transplantation. METHODS: Eighteen hospitalized patients with HCC group and 13 living donors for liver transplantation (donor group) were enrolled in this study. The donor group was divided into two groups on the basis of age; Y-donor group (age < 40 y, n = 7), and O-donor group (age ≥ 40 y, n = 6). Energy metabolism was measured by indirect calorimetry at preoperative day and postoperative day (POD) 7 and 14, and blood biochemistry was also examined. RESULTS: Recovery of non-protein respiratory quotient (npRQ) and blood biochemical data such as total bilirubin, aspartate aminotransferase and alanine aminotransferase levels were observed in Y-donor group on POD 14. However, although biochemical data improved in the HCC and O-donor group, npRQ remained unchanged on POD 14. CONCLUSIONS: Improvement of npRQ took longer than blood biochemical data in patients with HCC and older donors. Because the recovery of npRQ is associated with donor age, careful nutritional management may be required for a longer time depending on the pathophysiological condition of each patient after hepatectomy.

Long-term outcomes of renal transplants from spousal and living-related and other living-unrelated donors: a single center experience.

BACKGROUND: Deceased donor organ shortage has made living donors (LD) major source for renal transplantation (RTx) in India. Spouses represent an important source of allograft. We carried out a retrospective study of spousal RTx vs. other LDRTx to compare long-term results. METHODS: This retrospective single-center study was undertaken to evaluate demographic, patient survival, graft survival, function vis-à-vis serum creatinine (SCr) and rejection episodes in 1523 living donor renal allograft recipients from 1998 to 2009. It included spouse donors (n=337) (group 1), living related donors (LRD) (n=969) (group 2), and living unrelated donors (LUD) (n=217) (group 3). RESULTS: Mean recipient age (years +/- SD)) was 41.48 +/- 8.87, 30.49 +/- 10.61, and 37.13 +/- 13.25, respectively for the three groups who were followed for 4.47 +/- 3.03, 4.47 +/- 3.0 and 5.15 +/- 3.28 years respectively. Female donors were 92.6%, 66.4%, and 41%, mean HLA match was 1.15 +/- 0.93, 3 +/- 1.05 and 1.30 +/- 1.08 respectively. One, 5 and 12 year graft survivals among group 1 were 91.39%, 75.49%, and 73.13%; 90.98%, 74.10% and 64.57% in group 2 and 94.92%, 82.86% and 70.31% in group 3. Patient survival for 1, 5 and 12 years were 89.31%, 72.55% and 66.58% in group 1, 93.57%, 82.25% and 72.23% in group 2, and 92.62%, 79.76% and 66.79% in group 3. Acute rejections were noted in 16.6%, 15.8% and 17% respectively. CONCLUSIONS: In circumstances of organ shortage andunavailability of well developed ABO incompatible transplants, spousal donation is viable option.

Ventajas e inconvenientes de las diferentes técnicas quirúrgicas en el trasplante 'dominó' / No disponible

No disponible

New classification of ELPAT for living organ donation.

In the literature, varying terminology for living organ donation can be found. However, there seems to be a need for a new classification to avoid confusion. Therefore, we assessed existing terminology in the light of current living organ donation practices and suggest a more straightforward classification. We propose to concentrate on the degree of specificity with which donors identify intended recipients and to subsequently verify whether the donation to these recipients occurs directly or indirectly. According to this approach, one could distinguish between "specified" and "unspecified" donation. Within specified donation, a distinction can be made between "direct" and "indirect" donation.

Estimation of standard liver volume in Chinese adult living donors.

AIM: To determine a formula predicting the standard liver volume based on body surface area (BSA) or body weight in Chinese adults. MATERIALS AND METHODS: A total of 115 consecutive right-lobe living donors not including the middle hepatic vein underwent right hemi-hepatectomy. No organs were used from prisoners, and no subjects were prisoners. Donor anthropometric data including age, gender, body weight, and body height were recorded prospectively. The weights and volumes of the right lobe liver grafts were measured at the back table. Liver weights and volumes were calculated from the right lobe graft weight and volume obtained at the back table, divided by the proportion of the right lobe on computed tomography. By simple linear regression analysis and stepwise multiple linear regression analysis, we correlated calculated liver volume and body height, body weight, or body surface area. RESULTS: The subjects had a mean age of 35.97 +/- 9.6 years, and a female-to-male ratio of 60:55. The mean volume of the right lobe was 727.47 +/- 136.17 mL, occupying 55.59% +/- 6.70% of the whole liver by computed tomography. The volume of the right lobe was 581.73 +/- 96.137 mL, and the estimated liver volume was 1053.08 +/- 167.56 mL. Females of the same body weight showed a slightly lower liver weight. By simple linear regression analysis and stepwise multiple linear regression analysis, a formula was derived based on body weight. All formulae except the Hong Kong formula overestimated liver volume compared to this formula. CONCLUSIONS: The formula of standard liver volume, SLV (mL) = 11.508 x body weight (kg) + 334.024, may be applied to estimate liver volumes in Chinese adults.

Body mass index evaluating donor hepatic steatosis in living donor liver transplantation.

INTRODUCTION: Evaluation of graft hepatic steatosis is important for the safety of the donor and the recipient in living donor liver transplantation. It is necessary to establish a noninvasive evaluation method to avoid performing a liver biopsy for donor safety. The aim of this study was to identify independent factors that correlated with hepatic steatosis to create a noninvasive method to evaluate hepatic steatosis. METHODS: We retrospectively collected data from 105 living donors. No prisoners were used to obtain the grafts, all of which underwent postoperative histological evaluation for hepatic steatosis. Preoperative clinical and biochemical variables were examined with univariate analyses, and filtered variables further examined with ordinal regression analysis. RESULTS: Eighty (76.2%) donors showed no hepatic steatosis, 15 (14.3%), mild steatosis, and 10 (9.5%), moderate steatosis. In ordinal stepwise regression analysis, body mass index (BMI; P = .000) was the only independent factor that correlated with the grade of hepatic steatosis. Preoperative biochemical parameters were not significantly correlated with hepatic steatosis. A regression model based on BMI was created to evaluate hepatic steatosis grade. Furthermore, individuals with a BMI > 27.5 were most likely to show moderate steatosis, and those with BMI < 23 likely to display no or mild steatosis. CONCLUSION: BMI can help to identify the grade of hepatic steatosis among living donors. BMI is also useful to select living donors for a preoperative liver biopsy before liver transplantation.

Comparison of long-term outcomes between spousal transplants and other living unrelated donor transplants: single-center experience.

BACKGROUND/AIMS: The greater use of living unrelated donors (LUDs) as kidney donors is a worldwide trend in the current era of organ shortage, and spouses are an important source of LUDs. This study was to compare the long-term outcomes of spousal donor grafts with other LUD grafts. METHODS: Among 445 LUD grafts, 77 were spouses and 368 were other LUDs. The clinical characteristics and long-term survival rates for spousal transplants were compared with those for other LUD transplants, and risk factors affecting graft survival were assessed. RESULTS: Spousal donors had a significantly higher average number of human leukocyte antigen (HLA) mismatches (4.2 vs. 3.4, p < 0.001) and were older (41 vs. 33 years, p < 0.001) than LUDs. The 10-year survival rates for spousal donor grafts were 60.6%, similar to those for LUD grafts (58.5%, p = 0.61). The 10-year biopsy-proven acute rejection-free survival rates (85.5 vs. 89.6%, p = 0.45) and patient survival rates were also similar (84.3 vs. 79.6%, p = 0.35). The degree of HLA mismatching, the spousal donor type or donor age did not affect the graft survival. CONCLUSION: Renal transplants from spousal donors show similar long-term outcomes to those from better HLA-matched and younger LUDs.

Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

The aim of the study was to identify procedures of maximum importance for acceptance or rejection of kidney donation from a living donor as well as making the process more cost-effective. We identified all potential living related donors who were examined during the period between January 2002 and December 2006 at our department. The cost in euro (euro) for the programme was estimated using the Danish diagnosis-related group-system (DRG). The donor work-up programme was described. One hundred and thirty-three potential donors were identified; 66 male- and 67 female subjects, median age of 52 years (range 22-69). Sixty-four participants were rejected as donors. Abdominal CT-scan with angiography and urography ruled out 22 of the above 64 potential organ donors; thus, 48% of the volunteers for living kidney donation were unsuited for donation. Abdominal CT-scan with angiography and urography was the procedure identifying most subjects who were unsuited for kidney donation. A rearrangement of the present donor work-up programme could potentially reduce the costs from euro6911 to euro5292 per donor--saving 23% of the costs. By changing the sequence of examinations, it might be possible to cut down on time spent and number of tests needed for approving or rejecting subjects for living kidney donation.

Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited.

BACKGROUND AND OBJECTIVES: Living donor liver transplantations (LDLT) donor candidates are being assessed with MRCP (magnetic resonance cholangiopancreatography) to identify their suitability for standard surgical techniques. Variations of the bile duct anatomy play an important role in donor selection and in the selection of the resection technique. If bile duct anatomy is misrecognized, complications may occur. Anatomic variations are classified according to the origin of the right posterior hepatic duct (RPHD). According to the so called Huang classification, type A1 is the most, and type A5 is the least frequent variation. These frequencies were initially validated on Chinese population. Later studies revealed significant variability in frequency for the so called trifurcation, the variation in which a common junction of RHPD, right anterior hepatic duct (RAHD) and left hepatic duct (LHD) (A2) exists. In this study we aimed to determine the bile duct anatomy variations for the Anatolian Caucasians. METHODS: One hundred and thirty-four healthy subjects were investigated under 1.5 T MRI, with breath-hold (expiration) heavily T2-weighted turbo spin echo (TSE) static fluid imaging (TR/TE=8,000/800). The sequence has permitted three to five oblique coronal thick sections (40 mm) around a common axis. Sequences were repeated until anatomically interpretable images were obtained. Diagnostic images could not be obtained in 22 subjects. Radiologists who were fully experienced in LDLT assessment investigated these images, and classified them for the surgical variations of the bile duct anatomy. RESULTS: One hundred and twelve subjects (58 men, 54 women) who were classified were between 14 and 81 years of age (mean: 39.3; SD 14.1). According to Huang classification, 61 of them (55%) were classified as type A1 (normal right and left hepatic duct junction), 16 (14%) as type A2 (common junction of RAHD, RHPD and LHD), 24 (21%) as type A3 (aberrant drainage of RPHD to left main duct), and 11 (10%) as type A4 (aberrant drainage of RPHD to main hepatic duct). When subjects, in whom the distance (d) between RPHD insertion and the right and left hepatic duct junction is less than 1 cm, are classified as type A2, the type A1 prevalence decreases to 28%. For the entire population that distance was between 3 and 25 mm (mean: 9.8, SD: 4.8). Accordingly, the frequency of type A1 anatomy was 8-29% lower than the respective frequency in Chinese population. CONCLUSION: From the surgical perspective, close proximity (d<1 cm) of RPHD to right and left hepatic duct junction is considered as type A2 variation. According to that concept, type A1, usually accepted as the dominant anatomic variation, is encountered only in 28% of the Anatolian Caucasians. We have proposed a modified surgical classification in which Huang type 2 was subdivided into types K2a (close proximity) and K2b (trifurcating). The predominance of K2 types in the population of the study may necessitate the use of bench ductoplasty in many liver grafts.

Living-unrelated donor renal transplantation: an alternative to living-related donor transplantation?

INTRODUCTION: An increasing number of living-unrelated, kidney donor transplants are being performed in our unit. We present a comparison of living-unrelated (LURD) and living-related donor (LRD) renal transplant outcomes and analyse influencing factors. PATIENTS AND METHODS: We retrospectively analysed the outcome of all living-donor renal transplants performed at our centre from 1993 to 2004. The parameters studied included patient and graft survival, functioning status of grafts (determined by estimated GFR) at last follow-up and any rejection episodes. Multivariate analysis was performed for recipient and donor age, ethnicity, HLA matching and re-transplants. RESULTS: A total of 322 live donor kidney transplants (LRD, n = 261; LURD, n = 61) were carried out over this period. Mean recipient age was 28 +/- 16 years in the LRD group and 48 +/- 12 years in LURD, while mean age of the donors was 43 +/- 11 years and 48 +/- 10 years, respectively. Caucasians constituted 80% of all the living donors. Amongst LRD, parents were the commonest (58%) donors followed by siblings (35%). In LURD, 80% were spouses. A total of 33 grafts failed, 30 in LRD (11%) and 3 in LURD (5%). Thirteen patients died, 11 (4.2%) in LRD (7 with functioning graft) and 2 (3.3%) in LURD (1 with functioning graft). Acute rejections occurred in 41% recipients in LRD and 35% in LURD (P = 0.37). Estimated GFR was lower in LURD than in LRD (49 +/- 14 versus 59 +/- 29 ml/min/1.73 m(2); P = 0.032). One- and 3-year patient survival for LRD and LURD was 98.7% and 96.3% and 97.7% and 95%, respectively (P = 0.75). One- and 3-year graft survival was equivalent at 94.8% and 92.3% for LRD, and 98.4% and 93.7% for LURD, respectively (P = 0.18). CONCLUSIONS: Outcome of LRD and LURD is comparable in terms of patient and graft survival, acute rejection rate and estimated GFR despite differences in demographics, HLA matching and re-transplants of recipients.

Donor factors influencing graft outcomes in live donor kidney transplantation.

Living donor renal allograft survival is superior to that achieved from deceased donors, although graft outcome is suboptimal in some of these patients. In an effort to identify the subset of patients at high risk for poor outcomes we studied donor risk factors in 248 living kidney donor-recipient pairs. Unadjusted donor (125)I-iothalamate GFR (iGFR), donor age more than 45 years, donor total cholesterol level less than 200 mg/dL, and donor systolic blood pressure (SBP) less than 120 mm Hg were correlated with allograft estimated glomerular filtration rate (eGFR), and incidence of acute rejection (AR), delayed graft function and/or graft loss at 2 years posttransplantation. Donor iGFR less than 110 mL/min (slope=-7.40, P<0.01), donors more than 45 years (slope=-8.76, P<0.01), donor total cholesterol levels more than 200 mg/dL (slope=-10.03, P<0.01), and SBP more than 120 mm Hg (slope=-5.60, P=0.03) were associated with lower eGFR. By multivariable linear regression analysis these variables remained independently associated with lower eGFR, and poorer outcomes. The increasing number of donor factors (age, iGFR, cholesterol, and blood pressure) was directly associated with worse posttransplant eGFR (P<0.01). In conclusion, our data suggest that routine assessment of living donor parameters could supplement the consideration of recipient characteristics in predicting posttransplant risk of graft injury/dysfunction.

Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation.

Kidney transplantation from living donors is important to reduce organ shortage. Reliable pre-operative estimation of post-donation renal function is essential. We evaluated the predictive potential of pre-donation glomerular filtration rate (GFR) (iothalamate) and renal reserve capacity for post-donation GFR in kidney donors. GFR was measured in 125 consecutive donors (age 49 +/- 11 years; 36% male) 119 +/- 99 days before baseline GFR (GFRb) and 57 +/- 16 days after donation (GFRpost). Reserve capacity was assessed as GFR during stimulation by low-dose dopamine (GFRdopa), amino acids (GFRAA) and both (GFRmax). GFRb was 112 +/- 18, GFRdopa 124 +/- 22, GFRAA 127 +/- 19 and GFRmax 138 +/- 22 mL/min. After donation, GFR remained 64 +/- 7%. GFRpost was predicted by GFRb(R2 = 0.54), GFRdopa(R2 = 0.35), GFRAA(R2 = 0.56), GFRmax(R2 = 0.55)and age (R2 = -0.22; p < 0.001 for all). Linear regression provided the equation GFRpost = 20.01 + (0.46*GFRb). Multivariate analysis predicted GFRpost by GFRb, age and GFRmax(R2 = 0.61, p < 0.001). Post-donation renal function impairment (GFR < or = 60 mL/min/1.73 m2) occurred in 31 donors. On logistic regression, GFRb, body mass index (BMI) and age were independent predictors for renal function impairment, without added value of reserve capacity. GFR allows a relatively reliable prediction of post-donation GFR, improving by taking age and stimulated GFR into account. Long-term studies are needed to further assess the prognostic value of pre-donation characteristics and to prospectively identify subjects with higher risk for renal function loss.

Anatomia das veias hepáticas em doadores e receptores de transplante hepático intervivos / Hepatic veins anatomy of donors and recipients of living related liver transplantation

Anomalias das veias hepáticas são comuns e podem aumentar as complicações do transplante hepático intervivos. Objetivo - avaliar a anatomia das veias hepáticas nos doadores e receptores do transplante hepático intervivos realizados no Hospital de Clínicas da Universida Federal do Paraná e do Hospital Nossa Senhora das Graças de Curitiba / Anomalies of the hepatic veins are common and may increase complications after living related liver transplantation. Aim - to describe the anatomy of the hepatic artery of donors and recipients of living related liver transplantation...

Extended indications in living-donor liver transplantation: bile duct cancer.

The advantages of living donor liver transplantation are an individually available graft and a tremendously reduced waiting time until transplantation. One consequence is that many centers have extended the pretransplant selection criteria, especially for potential recipients suffering from hepatocellular carcinoma. In contrast, reports on living donor liver transplantation for cholangiocarcinoma are restricted to few case reports. We have analyzed our experience with seven patients suffering from cholangiocarcinoma (Klatskin tumors, n=5; intrahepatic cholangiocarcinoma, n=2). During a median follow-up of 20 months (range 2-46 months), all patients are alive except for one posttransplant death. Four patients suffering from Klatskin tumors are alive without recurrence; both patients suffering from intrahepatic cholangiocarcinoma are alive with bone and peritoneal metastases. Living donor liver transplantation may be beneficial in selected patients suffering from Klatskin tumors, whereas caution should prevail when considering intrahepatic cholangiocarcinoma.

Influence of HLA compatibility on success with living-related pediatric liver transplantation.

It is not clear how HLA compatibility influences acute rejection and postoperative complications in cadaveric liver transplantation. Even less is known about this factor in pediatric living-related liver transplantation (LRLT). This research assessed HLA compatibility relative to rejection rates and complications in pediatric LRLT. The study retrospectively investigated data from 14 pediatric LRLTs in which the donor and recipient HLA genotypes were determined preoperatively. Three recipients (21.4%) developed biliary complications (two biliary leakage, one bile duct stenosis). Three others (21.4%) developed vascular complications (two hepatic artery thrombosis, one hepatic artery stenosis). Eight recipients (57.1%) were diagnosed with acute rejection. The incidence of acute rejection was not correlated with the number of HLA mismatches (P > .05), or with the number of HLA class I mismatches (P > .05); however, it was negatively correlated with number of HLA class II mismatches (P = .02). Arterial and biliary complications were not correlated with any of these categories of HLA compatibility. In conclusion, the data from this small group of patients provided no evidence that closeness of donor-recipient HLA matching influences outcome in pediatric LRLT.

Mil trasplantes hepáticos en el Hospital Clínic i Provincial de Barcelona / One thousand liver transplants in Hospital Clinic i Provincial de Barcelona (Spain)

Objetivo. El objetivo de este trabajo fue estudiar una serie de 1.000 trasplantes hepáticos (TH) y evaluar los cambios experimentados en el tiempo de los donantes y receptores utilizados, así como los resultados obtenidos. Material y método. Con el fin de evaluar las diferencias entre el inicio y la actualidad, se compararon los primeros 100 trasplantes (entre junio 1988 y junio de 1990) con los últimos 200 trasplantes (entre enero de 2001 y junio de 2003). Resultados. Destaca el aumento en la edad de los donantes (23 ± 10 frente a 45 ± 19), el cambio en la etiología de la muerte cerebral (traumatismo craneoencefálico: el 78 frente al 23,5%; accidente cerebrovascular: el 17 frente al 52,5%) y el mayor porcentaje de donantes procedentes de programas alternativos a la donación estándar de cadáver en el segundo período (donante vivo: 12,5%). Asimismo, el inicio de la técnica de Piggy-back y la realización de la anastomosis biliar sin tutorización. La supervivencia actuarial del paciente al año fue superior en el segundo período con respecto al primero (el 84 frente al 91,3%).El porcentaje de retrasplante total de toda la serie fue del 9,5%. La supervivencia actuarial del retrasplante fue a 1, 5 y 10 años del 67,7, 51,3 y 39,4%, respectivamente. Conclusión. La falta de donantes y el aumento de la lista de espera han hecho que aceptemos donantes de peor calidad, receptores en situaciones más críticas y que iniciemos programas alternativos e innovadores. Pese a ello, no se han alterado los buenos resultados alcanzados, debido a una mejoría del manejo del paciente antes, durante y después del trasplante (AU)

The aim of this study was to evaluate a consecutive series of 1000 liver transplants performed in our institution and to evaluate changes over time in donors and recipients, as well as results. Material and method. To clearly evaluate the differences between the initial transplantation period and the present period, the first 100 consecutive liver transplantations performed (June 1988-June 1990) and the last 200 consecutive liver transplantations performed (January 2001-June 2003) were compared. Results. Donor age increased (23±10 vs. 45±19), the etiology of brain death changed (severe head injury: 78% vs. 23.5%; stroke: 17% vs. 52.5%) and the percentage of donors from alternative methods to cadaveric donors increased (living donors: 12.5%) in the second period. Regarding recipients, the piggy-back technique and biliary anastomosis without T-tube were introduced in the second period. Actuarial 1-year survival was higher in the second period than in the first (84% vs. 91.3%). The need for retrasplantation in the entire series was 9.5%, with actuarial survival at 1, 5 and 10 years of 67.7%, 51.3% and 39.4%, respectively. Conclusion. Because of the lack of donors and the greater number of patients on the waiting list, poorer quality donors and more critical recipients have been accepted and alternative and innovative programs have been started. Nevertheless, due to improvement in patient management before, during and after transplantation, the previous good results have been maintained (AU)