Midterm Results of Renal Transplantation From Controlled Cardiac Death Donors Are Similar to Those From Brain Death Donors.

BACKGROUND: The systematic use of grafts from controlled donors after cardiac death (cDCD) started in our country in 2012 and expanded with the strategic support of National Transplant Organization. We present our experience in kidney transplantation with organs from cDCD donors with a mean follow-up of 3 years. METHODS: Observational prospective study of all transplants performed in our center in 2012-2013 followed to 2016. The immunosuppression protocols were triple therapy for low-risk recipients from a standard brain death donor (DBD), adding basiliximab or thymoglobulin induction for extended-criteria donor or high-risk recipient, respectively, and thymoglobulin induction plus triple therapy for all cDCD recipients. RESULTS: A total of 42 donors were included (84 grafts in total, but 1 discarded due to multiple cysts); 25 DBD and 17 cDCD without differences in age or sex. The graft use rate was 98.9% for cDCD; 55 grafts were implanted in our hospital (26 DBD and 29 cDCD), and the remaining 28 grafts were transferred to other centers. There were no differences in primary failure (3.4% cDCD vs 7.4% DBD), but the cDCD organs had a higher incidence of delayed graft function (51.7% vs 25.9%). Despite that, graft and patient survivals, as well as glomerular filtration rate (66.3 vs 59.6 mL/min) were similar in both groups. Only 1 patient died at home with a functioning graft in the cDCD group. CONCLUSIONS: Despite a higher rate of delayed graft function with cDCD, the midterm outcomes are at least similar to those with DBD. The cDCD programs should be promoted to increase the chances of a transplant in our patients.

Kidney transplantation with organs from donors after circulatory death type 3: a prospective multicentric Spanish study (GEODAS 3).

To increase the number of kidney donors, new strategies are needed such as living donor programs, expanded criteria donors, or donors after circulatory death (DCD) kidney transplantation programs. The GEODAS group has started an observational, prospective, multicenter clinical study, collecting data from all DCD type-3 kidney transplantations performed in seven Spanish hospitals from January 2012 to January 2014. The preliminary results have shown a delayed graft function of 40.4% and graft survival of 93.7% with a nadir creatinine of 1.3 mg/dL. From all 33 potential donors included in the study, 32 were effective and 63 kidney grafts were transplanted with a utilization rate of 98.5%. Creatinine evolution (median [range]) was in the first month: 2.1 [0.6-5.6]; third month: 1.6 [0.8, 4.2]; first year: 1.6 [0.9-2.2]. These results are similar to kidney transplantation from donors after brain death as shown in the literature, especially in the graft and recipient survival rates. In addition, the controlled programs are easier and less expensive than uncontrolled DCD programs with a higher rate of graft use.

Contestación a la carta “ Trastornos de personalidad en prisión. Una cuestión compleja” / Answer to letter “ Personality disorders in prison”

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Demoras en el diagnóstico y tratamiento del cáncer de mama / Delay in diagnosis and treatment of the cancer of breast

El diagnóstico y tratamiento del cáncer de mama es una fase temprana mejora las perspectivas para una supervivencia a largo plazo. Por lo tanto, los tiempos de demora relacionados constituyen factores pronósticos de primer orden. Se realizó un estudio descriptivo sobre el tiempo que tardan las mujeres que son remitidas desde la Diputaicón General de Aragón (DGA), mediante el programa de screening de Cáncer de Mama, en ser visitadas en el Hospital Clínico Universitario “Lozano Blesa” (HCU) de Zaragoza. También se estudiaron las demoras entre el momento del diagnóstico y la confirmación anatomopatológica y el momento del inicio del tratamiento. Para ello se diseñó un análisis de las tendencias de las principales demoras entre los años 2002 y 2006. Se observa una tendencia descendente en casi todos los tiempos de espera, excepto en dos: el tiempo que se tarda en remitir a las mujeres desde el programa de screening de la DGA y ser visitadas en la Unidad de Mama del HCU y la demora entre la realización de la biopsia y el diagnóstico anatomopatológico

The diagnosis and treatment of the cancer of breast in an early phase improbé the perspective for a survival in the long term. Therefore, the related times of delay constitute factors prognoses of first order. A descriptive study was made on the time that takes the women who are sent from the General Delegation of Aragón (DGA), by means of the program of screening of Cancer of Breast, in being visited in the Clinical Hospital University “Lozano Blesa” (HCU) of Zaragoza. Also the delays between the moment of the diagnosis and the pathological confirmation and the moment of the beginning of the treatment studied. For it an analysis of the tendencies of the main delays between years 2002 and 2006 was designed. A descendent tendency in almost all the times of delay is observed, except in two: the time that takes in sending to the women from the program os screening of the DGA and being visited in the Unit of Breast of the HCU and the delay between the accomplishment of the biopsy and the pathological diagnosis

[From the myth of narcissus to personality disorders in aragonese prisons: an introductory profile of personality disorders amongst people deprived of their liberty]. / Del mito de Narciso a los trastornos de la personalidad en las cárceles aragonesas: Una aproximación al perfil de estos desórdenes en las personas privadas de libertad.

Personality Disorders are important pathologies in the prison context and awareness of their existence is necessary for several reasons: the high prevelance of PDs amongst inmates, their high level of comorbidity with other mental and addictive disorders, and for the link between PD and impulsive behaviour and possible violence. A study was carried out in prisons in the province of Zaragoza (Spain). The sample consisted of 236 inmates, 25% of whom were women. The abbreviated "International Personality Disorder Examination" (IPDE) questionnaire proved to be a useful defining tool for this pathology.

Del mito de Narciso a los trastornos de la personalidad en las cárceles aragonesas: una aproximación al perfil de estos desórdenes en las personas privadas de libertad / From the myth of narcissus to personality disorders in aragonese prisons: an introductory profile of personality disorders amongst people deprived of their liberty

Los Trastornos de la Personalidad tienen que considerarse como una patología a tener en cuenta en el medio penitenciario por varios motivos: su elevada prevalencia, su gran comorbilidad con otros trastornos mentales y adictivos y con la notable relación que tienen con las conductas impulsivas y el riesgo de comportamientos violentos. Se planteó realizar un estudio de prevalencia de estos desórdenes en las prisiones de la provincia de Zaragoza. La muestra era de 236 internos, de los cuales una cuarta parte eran mujeres. El cuestionario abreviado del “Examen Internacional de Trastornos de la Personalidad” (IPDE) se mostró como una herramienta útil de cribado de esta patología

Personality Disorders are important pathologies in the prison context and awareness of their existence is necessary for several reasons: the high prevelance of PDs amongst inmates, their high level of comorbidity with other mental and addictive disorders, and for the link between PD and impulsive behaviour and possible violence. A study was carried out in prisons in the province of Zaragoza (Spain). The sample consisted of 236 inmates, 25% of whom were women. The abbreviated “International Personality Disorder Examination” (IPDE) questionnaire proved to be a useful defining tool for this pathology