Comparison of the reliability and validity of four contemporary risk stratification schemes to predict thromboembolism in non-anticoagulated patients with atrial fibrillation.

BACKGROUND: The risk of thromboembolic (TE) complications in atrial fibrillation (AF) patients is not homogeneous. Risk schemes can help target anticoagulant therapy for patients at highest risk of TE complications. OBJECTIVES: To test the predictive ability of 4 risk schemes: The Framingham, the 8th ACCP, the ACC/AHA/ESC 2006, and the CHA2DS2-VASc. METHODS: 186 patients with non-valvular AF and off anticoagulant therapy were included. All subjects who experienced a stroke, transient ischemic attack, or peripheral embolism were identified. Each schema was divided into low, intermediate, and high-risk categories. Discrimination was assessed via the c-statistic. RESULTS: We identified 10 TE events that occurred during 668 person-years off anticoagulation therapy. All risk schemes had fair discriminating ability (c-statistic ranged from 0.59 [for CHA2DS2-VASc] to 0.73 [for Framingham]). The proportion of patients assigned to individual risk categories varied widely across schemes. CHA2DS2-VASc categorized the fewest patients into low and intermediate-risk categories, whereas the Framingham schema assigned the highest patients into low-risk strata. There were no TE events in the low and intermediate-risk categories using CHA2DS2-VASc, whereas the most schemes assigned patients into intermediate-risk category had a event rate ranging from 2.5 (ACC/AHA/ESC and 8th ACCP schemes) to 6% (Framingham). The negative predictive value of TE events was of 100% for the no high-risk patients using CHA2DS2-VASc. CONCLUSIONS: Compared to ACC/AHA/ESC, 8th ACCP, and Framingham, CHA2DS2-VASc risk stratification schema may be better in discriminating between patients at a low and intermediate risk of TE complications.

Características clínicas y pronóstico de pacientes con enfermedad cerebrovascular crónica (estudio ICBAR) / Clinical features and prognosis of patients with chronic cerebrovascular disease (ICBAR study)

Introducción. Los pacientes con enfermedad cerebrovascular (ECV) son un grupo de muy alto riesgo cardiovascular, ademásde por su propia patología vascular, probablemente por un inadecuado control de factores de riesgo y por la presencia de comorbilidades.Pacientes y métodos. Estudio multicéntrico, con participación de 34 médicos de atención primaria y registro de característicasde 473 pacientes con historia de episodio de ECV que precisó hospitalización. Tras seguimiento clínico de la cohorte, se analizaron reingresos hospitalarios, mortalidad y causas. Resultados. La edad media de los pacientes (el 52% varones) fue de 75 ± 10 años, y los factores de riesgo más prevalentesfueron hipertensión arterial (79%), dislipidemia (66%), obesidad (43%) y diabetes (29%). El 68% de los pacientes tenía diagnóstico de ictus y el 32%, de ataque isquémico transitorio. El tiempo medio transcurrido desde el primer episodio de ECV fue de 6,6 ± 5,5 años. Presentaban situación de dependencia el 29% y sólo un tercio mostraron buen control tensionaly lipídico. Durante un seguimiento de 8,2 ± 2,3 meses, el 7,2% de los pacientes sufrió algún episodio cardiovascular (muerte u hospitalización), del que resultaron determinantes independientes la insuficiencia cardíaca previa (hazard ratio, HR = 2,74; intervalo de confianza del 95%, IC 95% = 1,3-5,9), la miocardiopatía (HR = 3,32; IC 95% = 1,4-8,2), laanemia (HR = 3,09; IC 95% = 1,6-6,2), la insuficiencia renal (HR = 2,4; IC 95% = 1,0-5,6), la situación de dependencia (HR = 2,57; IC 95% = 1,3-5,7) y los ingresos cardiovasculares en el último año (HR = 3,05; IC 95% = 1,5-5,6).Conclusiones. Los pacientes con ECV seguidos en el ámbito de atención primaria presentan una prevalencia elevada y un escaso grado de control de hipertensión arterial. Su pronóstico está condicionado por comorbilidades cardiovasculares ysecuelas de su patología cerebrovascular (AU)

Introduction. Patients with cerebrovascular disease (CVD) are a group with a very high cardiovascular risk, in addition tothat arising from their own vascular pathology, probably due to an inadequate control of risk factors and owing to the presence of comorbidities. Patients and methods. This research consisted in a multi-centre study involving the collaboration of 34 primary carephysicians and recording of the features of 473 patients with a previous history of a CVD event that required hospitalisation.After a clinical follow-up of the cohort, hospital readmissions, mortality and causes were analysed.Results. The mean age of patients (52% males) was 75 ± 10 years and the most prevalent risk factors were arterial hypertension (79%), dyslipidaemia (66%), obesity (43%) and diabetes (29%). Sixty-eight per cent of patients had been diagnosed with stroke and 32% with transient ischaemic attack. The mean amount of time elapsed since the first CVDevent was 6.6 ± 5.5 years. Twenty-nine per cent of patients had a situation of dependence and only one third showed good blood pressure and lipid control. During a follow-up lasting 8.2 ± 2.3 months, 7.2% of patients suffered some kind of cardiovascular event (death or hospitalisation), which independent determinants were found to be previous heart failure (hazard ratio, HR = 2.74; 95% confidence interval, CI 95% = 1.3-5.9); cardiomyopathy (HR = 3.32; CI 95% = 1.4-8.2); anaemia (HR = 3.09; CI 95% = 1.6-6.2); renal failure (HR = 2.4; CI 95% = 1.0-5.6); the situation of dependence (HR = 2.57; CI 95% =1.3-5.7) and cardiovascular admissions over the past year (HR = 3.05; CI 95% = 1.5-5.6).Conclusions. Patients with CVD followed up in the area of primary care present a high prevalence of arterial hypertension and little is done to control it. Their prognosis is conditioned by cardiovascular comorbidities and sequelae of their cerebrovascular disease (AU)

[Renal function in heart failure patients. Prognostic influence and therapeutic implications]. / Función renal en pacientes con insuficiencia cardíaca. Influencia pronóstica e implicaciones terapéuticas.

A close relationship has been described between renal function and cardiovascular risk; renal dysfunction promotes cardiovascular disease and the different vascular diseases increase the risk of renal failure. Pathogenetic mechanisms common to both processes could justify this parallelism. These relationships are must closer in heart failure. We have carried out a recent literature review in which we describe the epidemiological and clinical situation of renal failure in patients with heart failure, as well as the diagnostic, therapeutic and prognostic implications. There is an increased prevalence of renal failure in patients with heart failure (with depressed ejection fraction as well as normal). This is accompanied by a greater clinical and diagnostic complexity, independently increases the risk of death and complications during follow up. It also has therapeutic implications, since in this group of patients the drugs that block the renin-angiotensin-aldosterone system have a particular prognostic benefit although strict clinical control must be followed. Renal failure in patients with heart failure is highly prevalent and has extremely significant clinical and therapeutic implications.

Función renal en pacientes con insuficiencia cardíaca. Influencia pronóstica e implicaciones terapéuticas / Renal function in heart failure patients. Prognostic influence and therapeutic implications

Se ha descrito una estrecha relación entre la función renal y el riesgo cardiovascular; la disfunción renal promueve enfermedad cardiovascular y las distintas enfermedades vasculares incrementan el riesgo de insuficiencia renal. Mecanismos patogenéticos comunes a ambos procesos podrían justificar dicho paralelismo. La insuficiencia cardíaca es una situación en la que son más estrechas estas relaciones. Hemos llevado a cabo una revisión de la literatura médica reciente en la que se describe la situación epidemiológica y clínica de la insuficiencia renal en pacientes con insuficiencia cardíaca, así como de las implicaciones diagnósticas terapéuticas y pronósticas. Existe una elevada prevalencia de insuficiencia renal en pacientes con insuficiencia cardíaca (tanto con fracción de eyección deprimida como normal), se acompaña de una mayor complejidad clínica y diagnóstica, empeora de forma independiente el riesgo de muerte y complicaciones durante el seguimiento y presenta implicaciones terapéuticas ya que en este grupo de pacientes los fármacos que bloquean el sistema renina- angiotensina-aldosterona ejercen un especial beneficio pronóstico aunque deben emplearse con un estricto control clínico. La insuficiencia renal en pacientes con insuficiencia cardíaca es muy prevalente y presenta implicaciones clínica y terapéuticas de la máxima relevancia (AU)

A close relationship has been described between renal function and cardiovascular risk; renal dysfunction promotes cardiovascular disease and the different vascular diseases increase the risk of renal failure. Pathogenetic mechanisms common to both processes could justify this parallelism. These relationships are must closer in heart failure. We have carried out a recent literature review in which we describe the epidemiological and clinical situation of renal failure in patients with heart failure, as well as the diagnostic, therapeutic and prognostic implications. There is an increased prevalence of renal failure in patients with heart failure (with depressed ejection fraction as well as normal). This is accompanied by a greater clinical and diagnostic complexity, independently increases the risk of death and complications during follow up. It also has therapeutic implications, since in this group of patients the drugs that block the renin-angiotensin-aldosterone system have a particular prognostic benefit although strict clinical control must be followed. Renal failure in patients with heart failure is highly prevalent and has extremely significant clinical and therapeutic implications (AU)

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]. / Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autnoma de Galicia.

BACKGROUND: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000. METHODS: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model. RESULTS: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). CONCLUSIONS: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in the northwest of spain: analysis of the activity in the region of Galicia

Introducción: España encabeza la actividad trasplantadora internacional y Galiciase sitúa en un nivel semejante; sin embargo, la ausencia de registros oficialesimpide tener conocimiento de los resultados en esta Comunidad Autónoma.Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinarsus resultados en cuanto a supervivencia y factores de riesgo.Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizadosen Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos ypacientes en función de distintas variables relacionadas con receptor y donante.Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan-Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales deCox.Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver,siendo la supervivencia del injerto del 80% y 67% después de uno y cincoaños; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidasde injerto se producen en los primeros doce meses, siendo la causa más frecuentela trombosis vascular (44%). Los factores de riesgo independientes para la pérdidadel injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalode confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05-2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre enrelación a los menores de 40); injerto generado en hospital no trasplantador (RR= 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante(RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte(38%), seguidas de patologías cardiovasculares (30%) y tumores (11%).Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales,es de 50 por millón de población y la supervivencia del paciente es comparablea la de cualquier registro internacional; sin embargo, la supervivencia delinjerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamentemejorable

Background: Spain is the world leader in organ transplant rates, and the nationalaverage is maintained in the northwestern Spanish region of Galicia. However,there is no official registry recording transplantation results in this region. In thispaper we report a study of patient and graft survival and risk factors among kidneytransplant patients in Galicia between january 1996 and december 2000.Methods: Patients receiving kidney transplants in Galicia in the above periodwere monitored up to the end of 2001, deaths and graft losses were recordedand analysed by actuarial and Kaplan-Meier methods, and possible risk factors fordeath and graft loss were evaluated using Cox’s proportional hazards model.Results: In the study period, 672 kidneys were transplanted, all from deceaseddonors. Graft and patient survival rates were respectively 80% and 94% after1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred withinthe first year and the most common cause was vascular thrombosis (44%).Independent risk factors for graft loss were donor asystole (relative risk [RR] =3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR= 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation(RR = 1.56, CI: 1.03-2.37). The main causes of death were infections(38%), followed by cardiovascular pathologies (30%) and tumours (11%).Conclusions: The kidney transplant rate varies excessively within Galicia; the globalrate is 50 per million inhabitants per year. Patient survival is similar to thoserecorded in national registers, but graft survival is deficient, apparently due to ahigh incidence of vascular thrombosis

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in northwestern Spain

Introducción: España encabeza la actividad trasplantadora internacional y Galicia se sitúa en un nivel semejante; sin embargo, la ausencia de registros oficiales impide tener conocimiento de los resultados en esta Comunidad Autónoma. Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinar sus resultados en cuanto a supervivencia y factores de riesgo. Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizados en Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos y pacientes en función de distintas variables relacionadas con receptor y donante. Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan- Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales de Cox. Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver, siendo la supervivencia del injerto del 80% y 67% después de uno y cinco años; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidas de injerto se producen en los primeros doce meses, siendo la causa más frecuente la trombosis vascular (44%). Los factores de riesgo independientes para la pérdida del injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalo de confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05- 2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre en relación a los menores de 40); injerto generado en hospital no trasplantador (RR = 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante (RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte (38%), seguidas de patologías cardiovasculares (30%) y tumores (11%). Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales, es de 50 por millón de población y la supervivencia del paciente es comparable a la de cualquier registro internacional; sin embargo, la supervivencia del injerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamente mejorable

Background: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between january 1996 and december 2000. Methods: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox’s proportional hazards model. Results: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05- 2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under- 40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). Conclusions: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis

Factores de riesgo para la desestimación de riñones en Galicia. ¿Es posible incrementar su utilización? / Risk factors for refusing kidneys in galicia. ¿is it possible to increase its use?

Los cambios demográficos, junto con el incremento de la demanda de órganos yde la experiencia de los equipos trasplantadores, conlleva una constante modificaciónde las características de los donantes y, en consecuencia, de la proporción deórganos utilizados y desestimados.Pretendemos analizar la utilización y desestimación de riñones generados en Galicia,para lo cual hicimos un seguimiento de los donantes renales generados entre1996 y 2000, estudiando las causas de no extracción y desestimación de riñones yanalizando la influencia que sobre ellas ejercen las características de los donantes.Para evaluar factores de riesgo de no utilización de los injertos se elaboraron modelosde regresión logística múltiple, estimando odds ratios con intervalos de confianzaal 95%.Se extrajeron 836 riñones de 433 donantes, de los que se implantaron 697. El17% de los órganos extraídos, porcentaje que en los dos últimos años se aproximóal 25%, se desestimaron, bien por resultados de las biopsias (27%), patologías previasdel donante (22%), problemas anatómicos (16%), isquemia prolongada(12%) o ausencia de receptor (14%).La edad media de los injertos desechados fue significativamente mayor que la delos implantados, de modo que superar los 45 años representó un factor de riesgo independientepara la desestimación de riñones (OR = 1,76 y p = 0,05, para edadesentre 45 y 59 años; OR = 6,1 y p = 0,000, para mayores de 60 años), al igual que lofueron los antecedentes de hipertensión arterial (OR = 1,59 y p = 0,044), los niveleselevados de creatinina sérica (OR = 1,83 y p = 0,005) y la presencia de anticuerposfrente al virus de la hepatitis C (OR = 5,65 y p = 0,001) y para el antígeno del corede la hepatitis B (OR = 2,91 y p = 0,017).En definitiva, los donantes añosos y con patología asociada permiten incrementarel número de injertos, aunque conllevan un incremento de los desestimados, que alcanzancasi el 20% de los generados; sin embargo, más de la mitad de los mismosse desecharon por causas potencialmente evitables, por lo que podrían haber sidovalorados para implantar en receptores límites

Introduction. Demographic changes along with an increase in the demand oforgans and an increase in the expertise of transplantation teams, lead to a constantmodification of donors’ characteristics and, accordingly, of the supply of theorgans used and refused.Objective. Analyze the use and refusal of kidneys generated in Galicia.Subjects and method. A follow-up of kidney donors was carried out between1996 and 2000, studying the reasons for non extraction and refusal of kidneysand analyzing the influence that donors’ characteristics have on them. In order toevaluate the risk factors of not using grafts, multiple logistic regression patternswere made, assessing odds ratios with confidence intervals at 95%.Results. 836 kidneys were recovered from 433 donors, and 697 were implantedout of them. 17% of the organs extracted, a percentage approaching 25% inthe two latest years, were discarded, due to the biopsy findings (27%), donor’sprevious conditions (22%), anatomical disorders (16%), prolonged cold ischemia(12%) or recipient not located or unsuitable (14%).The average age of refused grafts was significantly higher than that of implantedones, in such a way that having more than 45 years old was an independentrisk for refusing kidneys (OR = 1.76 and p = 0.05, for 45-59 years old; OR = 6.1and p = 0.000, for older than 60 years old). The same happened with history ofhypertension (OR = 1.59 and p = 0.044), high serum creatinine level (OR = 1.83and p = 0.005) and positive serology for HCV (OR = 5.65 and p = 0.001) andanti-HBc (OR = 2.91 and p = 0.017).Conclusions. Elderly donors and donors with concomitant diseases enable us toincrease the number of grafts, although they also lead to an increase in refusals,which nearly amounts to 20% of the ones generated. However, more than thehalf were refusede due to pontentially avoidable reasons and therefore these couldhave been valued for transplantation to limit recipients

[Risk factors for refusing kidneys in Galicia. Is it possible to increase its use?]. / Factores de riesgo para la desestimación de riñones en Galicia. Es posible incrementar su utilización?

INTRODUCTION: Demographic changes along with an increase in the demand of organs and an increase in the expertise of transplantation teams, lead to a constant modification of donors' characteristics and, accordingly, of the supply of the organs used and refused. OBJECTIVE: Analyze the use and refusal of kidneys generated in Galicia. Subjects and method. A follow-up of kidney donors was carried out between 1996 and 2000, studying the reasons for non extraction and refusal of kidneys and analyzing the influence that donors' characteristics have on them. In order to evaluate the risk factors of not using grafts, multiple logistic regression patterns were made, assessing odds ratios with confidence intervals at 95%. RESULTS: 836 kidneys were recovered from 433 donors, and 697 were implanted out of them. 17% of the organs extracted, a percentage approaching 25% in the two latest years, were discarded, due to the biopsy findings (27%), donor's previous conditions (22%), anatomical disorders (16%), prolonged cold ischemia (12%) or recipient not located or unsuitable (14%). The average age of refused grafts was significantly higher than that of implanted ones, in such a way that having more than 45 years old was an independent risk for refusing kidneys (OR = 1.76 and p = 0.05, for 45-59 years old; OR = 6.1 and p = 0.000, for older than 60 years old). The same happened with history of hypertension (OR = 1.59 and p = 0.044), high serum creatinine level (OR = 1.83 and p = 0.005) and positive serology for HCV (OR = 5.65 and p = 0.001) and anti-HBc (OR = 2.91 and p = 0.017). CONCLUSIONS: Elderly donors and donors with concomitant diseases enable us to increase the number of grafts, although they also lead to an increase in refusals, which nearly amounts to 20% of the ones generated. However, more than the half were refused due to pontentially avoidable reasons and therefore these could have been valued for transplantation to limit recipients.

Organ donation process: quinquennial analysis in a Spanish autonomous region.

BACKGROUND: At present, transplantation of organs represents a therapeutic alternative, but the candidates for this treatment suffer from the scarcity of donors. We analyzed the process of the donation of organs in Galicia, an autonomous region in the northwest of Spain. METHODS: We summed all the potential donors in Galicia between January 1996 and December 2000 to analyze the reasons for nonconversion, the characteristics of the actual donors, and the use of the generated organs. RESULTS: We found 779 potential donors of whom 443 (56%) became actual donors (annual rate 31.6 pmp), although an important interterritorial variability was observed. The main reason for not obtaining potential donors was family refusal (32%), with denial during life being given as the reason in 45% of these families. We observed a progressive aging of the donors (39% older than 60 years in 2000), who had a mean age of 46 +/- 18 years. There also was an increased percentage of deaths due to vascular causes (mean 53%), while traumatic deaths (mean 40%) showed an inverse tendency. Donation because of asystole represented 5%. Among all the retrievals, 90% were multiorgan, generating 1437 organs including 1227 that were transplanted, yielding 3.3 possible organs from each donor including 2.8 organs that were transplanted. Among donors younger than 45 years, the numbers increased to 3.7 and 3.4, respectively, and for donors older than 60 years, the numbers were 2.7 and 1.9, respectively. CONCLUSIONS: Despite the increase in donors and organs, family refusal did not decrease, as this was the main reason for potential donor loss. Therefore it is necessary to create a regional program to promote donation.

Analysis of survival after liver transplantation in Galicia, Spain.

BACKGROUND: Transplantation is the treatment of choice for many patients with end-stage liver disease. We evaluated the results of liver transplantation in Galicia, an autonomous community in Northwest Spain. METHODS: We analyzed 452 patients and 490 grafts from 1996 to 2000 for causes of loss with respect to recipient and donor variables using the actuarial method, Kaplan-Meier curves, log-rank test, and Cox proportional risks model. RESULTS: The overall graft survival was 77% and 64% at 1 and 5 years, respectively; while that of the patients was 83% and 69%. The risk factors for graft loss were donation in heart failure (HR = 4.91, CI:2.51-9.61); donor age (HR = 1.70, CI:1.01-2.85 between 40 and 60 years; HR = 2.37, CI:1.37-4.10 in those over 60 years, as compared to patients under 40); urgent transplant (HR = 3.95, CI:2.07-7.54); and transplant due to acute liver failure (HR = 3.53, CI:1.72-7.25) as compared to alcoholic cirrhosis. For patient death the risk factors were age of recipient over 60 years, compared to those under 40 (HR = 2.42, CI:1.11-5.28); foreign place of origin (HR = 2.02, CI:1.14-3.59); transplant due to viral cirrhosis (HR = 1.76, CI:1.03-3.02) and transplant due to acute liver failure (HR = 4.62, CI:2.12-10.06), as compared to alcoholic cirrhosis; urgent transplant (HR = 2.65, CI:1.48-4.72), and age of donor over 60 years, as compared to those under 40 (HR = 2.65, CI:1.48-4.72). Infections were the principal cause of death (45%), mostly in the first month (72%); while after the first year, 74% were due to recurrence of the primary disease and de novo malignancy. CONCLUSIONS: Graft and patient survivals were comparable to international registries. The donor characteristics had a greater influence on graft survival than on patient survival.

La prevalencia de la insuficiencia renal crónica en Galicia / No disponible

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[Dyslipemia in physicians. The need for a plan of primary prevention of atherosclerosis in our country]. / Dislipemia en médicos. Necesidad de un plan de prevención primaria de ateroesclerosis en nuestro medio.

A comparative study of the total cholesterol (TC) and its fractions was carried out in 3 groups of males. The first group consisted of (C) 53 healthy males (18 between 30-39 years old, 17 between 40-49 and 18 between 50-65); the second group (M) was of 57 male doctors (19 between 30-39 years old, 21 between 40-49, and 17 between 50-65); third group (E) was of 94 males with myocardial infarction (22 between 30-39 years old, 32 between 40-49, and 40 between 50-65). TC was significantly lower (p less than 0.02 and p less than 0.001) in both the lower ages ranges in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower (p less than 0.001) in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower HDL-C (p less than 0.01) and to group M in the lowest age range (p less than 0.005). LDL-C was significantly higher (p less than 0.001) in Group M compared to C in the higher age range. VLDL-C was higher (p less than 0.05) in Group E compared to C in both the higher age ranges (p less than 0.05) as well as to the middle age range of Group M (p less than 0.05). The indexes TC/HDL-C and LDL-C/HDL-C were significantly higher in Group E compared to Groups C and M in all age ranges. These indexes were significantly higher (p less than 0.01 and p less than 0.05) in Group M compared to group C in all age ranges.(ABSTRACT TRUNCATED AT 250 WORDS)