Short- and long-term outcomes of every graft recovered during a multi-organ procurement procedure including the intestine.

BACKGROUND: The development of intestinal transplant (Tx) programs introduces thymoglobulin donor treatment as well as an almost complete warm dissection of the abdominal organs to allocate them to different recipients. Our aim is to assess the reproducibility and feasibility of the surgical technique of multi-organ procurement with the use of thymoglobulin donor pre-treatment and report the short- and long-term outcomes of every graft harvested as part of multi-organ procurement (MTOp), including the intestine. METHODS: Data were collected of all organs harvested from MTOp, including the intestines allocated to our center from March 2006 to July 2011. Data from 92 recipients and 116 organs procured from 29 MTOp were analyzed. Twelve hearts, 2 lungs, and 1 cardio-pulmonary block were transplanted; primary graft dysfunction developed in 4 of the 12 hearts and in the cardio-pulmonary block. RESULTS: The survival rate was 75% and 100% for hearts and lungs, respectively. Nineteen livers, 9 kidney-pancreas, 19 kidneys, and 29 intestines were transplanted. Delayed graft function (DGF) of the pancreas developed in 3 of 9 kidney-pancreas, and the other 3 exhibited DGF of the kidney; 4 of 19 Tx kidneys had DGF. The survival was 84%, 78%, 95%, and 65.5% for livers, kidney-pancreas, kidneys, and intestines, respectively. CONCLUSIONS: Organs procured during MTOp including the intestine can be safely used, increasing organ availability and transplant applicability without compromising allocation, quality, and long-term results of the non-intestinal-procured organs.

Factors associated with patient and graft survival using kidneys from cadaveric donors in transplant patients under 18 years of age in Argentina.

BACKGROUND: Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with end-stage renal disease (ESRD) has dramatically declined. Kidney transplantation has become the primary method to treat ESRD in the pediatric population. MATERIALS AND METHODS: Information was obtained from SINTRA (National Information System of Orrgan Procurement and transplantation in Argentina) for the period 1998-2009. We used the Kaplan-Meier curve, survival was measured at 30 days, 1, 5, and 10 years. The Cox regression variables taken for patient and graft survival were gender and age of both donor and recipient, ischemia time (> or <24 hr), etiology of chronic renal failure, time on dialysis (> or <3 years) of the recipient, cause of donor's death (stroke, head trauma, anoxia, other causes of coma, tumor and others). We coded the value of mismatch. For each HLA, it was 0 when they shared the 2. Adding the 3 types of antigens, the possible mismatch values ranged between 0 and 6. However, all had values between 5 and 6. We used SPSS statistical software Medcalc 17. RESULTS: We analyzed 345 (54%) men and 290 (46%) women. The average age was 12.5 + 3.9 years. The median follow-up time was 4 years (maximum 13 years). Patient survival rates at 30 days were 99.4%, at 1 year 96.8%, at 5 years 91.1%, and at 10 years 82.5%. Cox regression for patient survival: being a female and receiving HR 1.88 (95% CI 1.09-3.25) P = .023 or donor HR 1.86 (95% CI 1.06-3.25) P = .030. Tumor HR 17.19 (95% CI 4.48-65.98) P = <.0001. For recipient's age compared with <12 years >12 years HR 1.99 (95% CI 1.11-3.65) P = <.024. Graft survival rate at 30 days was 97.2%, at 1 year was 91.9%, at 5 years was 79.3% and at 10 years was 61.8%. Compared with donor's age <18 years: 45-59 years HR 2.52 (95% CI 1.42-4.47) P = .002. Glomerulonephritis HR 1.71 (95% CI 1.10-2.77) P = .018. Tumor as the cause of donor's death HR 4.39 (95% CI 1.28-2.28) P = .012. Time on dialysis > 3 years HR 1.59 (95% CI 1.11-2.28) P = .012. CONCLUSIONS: Being a female, receiving a kidney from a woman and tumor as the cause of donor's death and age >12 years were associated with worse patient survival. Donor's age between 45 and 59, glomerulonephritis as the etiology of renal failure, tumor as the cause of death and time on dialysis >3 years were associated with lower graft survival.

Analysis of mortality while on waiting list for kidney transplant in adults in Argentina 2005-2009.

INTRODUCTION: Comparison of survival after renal transplant patients on the waiting list is an important factor to evaluate this therapy. OBJECTIVE: To measure the magnitude of deceased donor kidney transplant on patient survival compared to patients on dialysis and on waiting lists in over 18 years in Argentina. MATERIAL AND METHODS: The information was obtained from SINTRA for the period January 2003 to December 2009. The follow-up period ended in December 2010. Survival was considered as the time from the entrance to the waiting list until death, the end of the study (June 2009), or last follow-up available, whichever came first. The Kaplan-Meir method was used. The survival rate was recorded at 30 days, 1, 5 and 10 years. Log-rank was used to compare the curves and their statistical significance. The Cox regression model was used to consider the variables for both patient and graft survival, such as gender and age, time on dialysis, etiology of end-stage renal disease (ESRD), and presence of comorbidities. The MedCalc and SPSS 17 statistical packages were used. RESULTS: We analyzed 1682 patients transplanted average age 48.14 + 13.48 years and 3647 patients on waiting lists average age 47.88 + 14.32 years. For patients transplanted 30-day survival was 99.8% at 1 year 96.2% and 5 years of 79.9%. For patients on the waiting list survival at 30 days was 99.7% at 1 year and 5 years 94.6% 66.6%. Chi-square was 42.77, P = <.0001. HR 0.64 (95% CI 0.56 to 0.73). Cox regression for patients on waiting lists HR 1.40 (95% CI 1.20-1.63) P = <.0001. The time dependent Cox regression showed for patients transplanted at 30 days, <1 year >1 year showed HR 4.18 (95% CI 2.88-6.06) P = <.0001, HR 0.40 (95% CI 0.27 to 0.61) P = <.0001 and HR 0.19 (95% CI 1.12-0.29) P = <.0001, respectively. CONCLUSIONS: Survival, both at baseline and in the long term, is better in transplant patients as compared to patients on waiting list. In Cox time-dependant regression the risk of death during the first 30 days is 4 times higher in transplant patients. This reverses and at 1 year, transplant patients are 60% less likely to die, and after one year this probability is 81% lower (P =<.0001).

Factors associated with patient and graft survival using kidneys from cadaveric donors in transplanted patients over 18 years of age in Argentina.

BACKGROUND: With improvements in short-term kidney graft and patient survival, focus has shifted to understand patient and graft features that affect long-term survival. MATERIALS AND METHODS: This retrospective analysis from January 1998 to December 2009 employed Kaplan-Meier analysis to evaluate survival ratios at 30 days as well as 1, 5, and 10 years. A multivariable Cox regression model considered variables of donor and recipient, gender and age, cold ischemia time (CIT), chronic renal failure etiology, time on dialysis (TD) and cause of donor death. The mismatch (MM) value was coded according to the number of antigens shared by both the donor and the recipient for HLA-A, B, and DR. The MM values ranged between 0 and 6. Two groups were analyzed according the number of shared antigens: 0 to 3 versus 4 to 6. RESULTS: Among 3030 (55.85%) males and 2395 (44.15%) females, the overall mean age was 46.9 ± 13.9 years. Median follow-up was 4 years (max 13 years). Patient survival rate (SR) was 97.5% at 30 days, 87.5% at 1 year, 74.5% at 5 years, and 59.2% at 10 years. Using Cox analysis, patient SR was affected by: diabetic nephropathy (DN) hazard ratio (HR) 1.55 (95% confidence interval [CI 95%] 1.21-1.97) P = .0005; head trauma (HT) cause of donor death HR 0.83 (0.73-0.95) P = .0005 and donor age (DA) compared by 18 to 44 years: 45 to 59 years HR 1.44 (CI95% 1.00-1.30) P = .043, >60 years HR 1.41 (CI95% 1.17-1.70) P = .0004. In addition relevant factors were recipient age (RA) compared by 18 to 44 years: 45 to 59 HR 1.99 (CI95% 1.74-2.27) P < .0001, >60 years HR 3.24 (CI95% 2.79-3.75) P < .0001 and DT >7 years HR 1.33 (CI95% 1.19-1.48) P = .0001. MM HLA 0 to 3 level HR 0.78 (CI95% 0.69-0.88) P < .0001. Graft SR was 95% at 30 days, 81.6% at 1 year, 64.7% at 5 years, and 47.3% at 10 years. The relevant factors were: DN HR 1.26 (CI95% 1.01-1.57) P = .04; HT HR 0.82 (0.74-0.91) P = .0004; DA compared by 18 to 44 years: 45-59 years HR 1.19 (CI95% 1.07-1.32) P = .002, >60 years HR 1.53 (CI95% 1.30-1.80) P < .0001; RA compared by 18 to 44 years: 45-59 HR 1.33 (CI95% 1.19-1.47) P < .0001, >60 years HR 1.84 (CI95% 1.63-2.09) P < .0001; DT > 7 years HR 1.22 (CI95% 1.11-1.35) P = .0001; CIT >24 hours HR 1.13 (CI95% 1.03-1.23) P = .009 and MM HLA 0 to 3 HR 0.82 (CI95% 0.74-0.91) P = .0002. CONCLUSION: HT as the cause of donor death and MM between 0 and 3 were associated with better patient and graft SR, DN, TD over 7 years, DA and RA over 45 were associated with lower patient SR. CIT > 24 hours, DN, TD over 7 years, as well as donor and recipient ages over 45 yr were associated with a lower graft SR.

Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

BACKGROUND: In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL). METHODS: Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL. RESULTS: The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001). CONCLUSIONS: After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

Is fibrin glue useful in preventing dialysate leakage in children on CAPD? Preliminary results of a prospective randomized study.

Children on continuous ambulatory peritoneal dialysis (CAPD) have a higher incidence of dialysate leakage than patients receiving cycler dialysis. To date, fibrin glue has been used to treat dialysate leakage but not as a method of prevention. Therefore, we conducted a prospective study in which 20 catheters were implanted in 19 children, with each catheter randomly assigned to either the treatment group (1 mL of fibrin glue added to peritoneal cuff suture) or the control group. There was no difference in mean patient age, elapsed time between catheter implantation and first catheter usage, and albumin concentration between the two groups. Dialysate leakage was detected in 4 patients in the control group, 3 of whom underwent early initiation of dialysis, but none of the patients in the treatment group (including 4 with early dialysis) had a similar problem. In summary, these preliminary data suggest that fibrin glue may be of benefit when applied at the time of catheter implantation. Further experience is necessary before this method can be routinely recommended.