La importancia de la actuación médico-legal en la donación y trasplante de órganos y tejidos / The importance of medical-legal action in the donation and transplantation of organs and tissues

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Situación actual de la donación-trasplante de órganos y tejidos en Andalucía / Current situation of donation organ and tissue transplant in Andalusia

La situación actual de los programas de trasplantes de Andalucía constituye un fiel exponente del grado de modernidad, desarrollo y avance social experimentado en los últimos años. En efecto, debemos estar orgullosos de vivir en una comunidad que ocupa un lugar destacado en todo el mundo en donación-trasplante, a gran distancia de los países avanzados de nuestro entorno, incluidos los míticos EE.UU. La probabilidad de recibir un trasplante en nuestro sistema sanitario público en caso de necesitarlo es doble que en el resto de los países desarrollados. Se describe el trabajo desplegado en los últimos 25 años, que ha hecho que Andalucía pase de estar en el ‘furgón de cola’ a ocupar un consolidado lugar de liderazgo y ser referente de un país, España, que es el primero del mundo en donación y trasplantes de órganos de forma consecutiva en los últimos 23 años (AU)

The current situation of the Andalusian transplant programs is a valuable example of the degree of modernity, development and social progress made in recent years. Indeed, we must be proud of living in a region that leads worldwide the donor-transplantation rates, far better than other develop countries, including the mythical USA. In Andalucia, the chances of receiving an organ transplant is twice than in other developed countries. In this article we describe the organ transplant organisation in Andalucia over the last 25 years. Andalusia has become one of the most important regions in Spain, country which leads the organ donation transplant rates worldwide in the past 23 years (AU)

Associated characteristics and impact on survival of post renal-transplantation lymphoproliferative disease: case-control study from a regional registry.

BACKGROUND: Lymphoproliferative disease (LPD) after renal transplantation (RT) is an unusual complication but one that impacts greatly on survival. We examined possible predisposing factors and their effect on survival using data from the Andalusian Transplant Co-ordination Information System (SICATA) regional computerized database of patients on renal replacement therapy due to chronic kidney disease (CKD). METHODS: The study population comprised all RT undertaken at adult centers in Andalusia from January 1, 1990 to December 31, 2009 (N = 5577). We retrospectively analyzed cases at December 31, 2011 (N = 60). A control group comprised the 2 closest RT in time done at the same center and with equal or greater graft survival at the time of diagnosis of LPD in the associated case (N = 120). The basic variables were obtained from the general register (1990-2009) and widened from the specific register (2000-2009). Case-control comparison of survival was done with Kaplan-Meier from diagnosis to death or organ loss censored for death. Cox univariate and multivariate (LPD plus available covariables of demonstrated effect) analyses were done. RESULTS: We found no significant differences between cases and controls regarding the characteristics of the recipient or of the donor/organ, initial immunosuppression by intention to treat, or post-RT course. The impact on recipient survival 5 years after diagnosis was as follows: LPD, 35%; controls, 90% (P < .000). Cox univariate analysis showed the relative risk (RR) of death for LPD was 11.36 (95% confidence interval [CI], 6.2-20.9; P < .000) and the multivariate analysis showed relative risk (RR) = 13.87 (7.45-25.3; P < .000). The impact on death-censored graft survival 5 years after diagnosis was as follows: LPD, 65%; controls, 87% (P = .007). Cox univariate analysis was as follows: RR of failure for LPD, 2.70 (95% CI, 1.3-5.7; P = .009). CONCLUSIONS: We found no significant differences between LPD cases and contemporary controls regarding the basic characteristics of the recipient, donor/organ, initial immunosuppression, or initial graft evolution. There was an enormous impact on both patient and graft survival.

[The endourological treatment of distal ureteral fistulae in the kidney transplant. The exclusion or "dry" technic]. / Tratamiento endourológico de las fístulas de uréter distal en el trasplante renal. Técnica de exclusión o "seca".

The present study reports our experience in the endourological treatment of fistulas of the distal ureter in renal transplant patients. The temporary urinary exclusion or dry technique was effective in 8 of the 10 patients. We advocate the use of this simple and safe technique which achieves excellent results.