Presence in the media of the topic "donation and transplantation of organs and tissues" during the 2005 to 2007 period in Venezuela as a strategy to improve its perception in Venezuelan society.

INTRODUCTION: Media are main allies to encourage donation and transplantation. We sought to quantify the presence in the media of the topic "Donation and transplantation (D/Tx)" during the period 2005 to 2007 and to determine the relationship between the volume of information issued by the media and indexes related to the topic. METHODS: We conducted a systematic recording of the news on the topic of D/Tx in print, radio, and television during 2005 to 2007. RESULTS: There was an increased presence in the media by 100% in 2005 and 2006, and by 200% in 2007. The presence in print media was greater than radio (249 +/- 31.5 vs 131 +/- 5.49; P = .05) or television (249 +/- 31.5 vs 92 +/- 7.12; P = .01). We observed a positive correlation between the total number of contacts versus the number of registered volunteer donors (R(2) = 0.9713) and number of contacts versus total number of transplants from cadaveric donors (CTX; R(2) = 0905). The index CTX per million population increased by 30% (2006 vs 2005) and 100% (2007 vs 2005). The percent of family refusals fell from 41% in 2005 to 34% in 2006 and to 31% in 2007. The rate of donors per million population grew steadily from 1.8 in 2005 to 2.3 in 2006, and to 3.6 in 2007. CONCLUSION: The sustained increase in D/Tx briefing as a strategy of Sistema de Procura de Organos y Tejidos has helped to foster a positive perception that is reflected in the increased rate of donation and transplantation in Venezuela.

Identification of variables that influence brain-dead donors' family groups regarding refusal.

OBJECTIVE: To identify the variables that influenced brain-dead donor family groups to refuse donation. METHODS: The Tissue and Organ Procurement System in Venezuela designed a tool to register some phases of a family interview performed by transplant coordinators. This tool analyzed three phases. The first phase of the interview allowed the coordinator to evaluate the communication quality with the family group during a brain-death notification. The second phase assessed how families understood this notification, and the third phase identified the family grief sequence. Among the 186 interviews during 2007 to procure tissues and organs for transplantation, 37.63% (n = 70) concluded as family refusals. A retrospective study sought to analyze these results. RESULTS: The average time between notification of brain death and the first approach to the family was 8.78 hours. Setting a place for interviews was done in 91.10% of cases. Previous knowledge about donation was seen in only 53.33% of cases. The main phase of family grief identified was denial (80%). The five reasons for family denial were: absolute denial, family disagreement, uncertainty about the destination of the donated organs and tissues, fear about deformation of the donor's body, and lack of acceptance of brain death. CONCLUSIONS: Brain-death notification produced a deep sadness among family groups. There was a lack of knowledge regarding donation of tissues and organs. It was impossible to quantify the time needed by families to understand and accept brain death and to identify the grief sequence in order to avoid family refusals.

[Latin-American Dialysis and Kidney Transplantation Registry: data on the treatment of end-stage renal disease in Latin America]. / Registro latino-americano di dialisi e trapianto: dati relativi al trattamento dell'insufficienza renale cronica terminale nell'America Latina.

Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.

Use of intrarenal needle manometry in acute renal dysfunction following renal transplantation.

Intrarenal manometry (IRM) using the Salaman fine-needle technique was routinely performed in 28 renal transplant patients in order to make the differential diagnosis of acute tubular necrosis, cyclosporin nephrotoxocity, and acute rejection. A total of 246 IRM determinations with simultaneous percutaneous renal biopsies were obtained in cases of acute renal failure following a renal transplant. Normal IRM values were 21.4 +/- 1.3 mm Hg. After collecting the clinical data, cyclosporin levels, ultrasound information, response to therapy, and renal biopsy results, we retrospectively obtained 49 IRM measurements in acute rejection, 9 in cyclosporin nephrotoxicity, and 26 in acute tubular necrosis. The values in acute rejection (41.3 +/- 9.5 mm Hg) were significantly different from the normally functioning kidneys, cyclosporin nephrotoxicity, or acute tubular necrosis. The values in cyclosporin nephrotoxicity were slightly elevated when compared to the normal or acute tubular necrosis determinations (p < 0.04) but were still significantly lower than the acute rejection. Our results suggest that IRM represents a useful technique in the approach to the acute renal dysfunction in renal transplant recipients.

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

BACKGROUND: The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. METHODS: This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. RESULTS: The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. CONCLUSION: In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

[Impact of the Hospital Coordinator Program on obtaining kidneys for renal transplantation]. / Impacto del Programa de Coordinadores Hospitalarios en la obtención de riñones para trasplante renal.

Limited organ supply is currently the major obstacle to the transplantation programs around the world. As an alternative to increase the organ donation rate, we undertook a preliminary transplant coordinator program study, during a 6 month period, in five public hospitals, as part of the National Transplant Program of the Centro Nacional de Diálisis y Trasplante. The primary objective of the Transplant Coordinator Program was donor detection and organ procurement, along with education of the community. Forty five predonors were detected, with an average age of 25.8 +/- 1.6 years, of these, 36 were men (80%). None of them was a voluntary donor. The most frequent diagnoses were cranial trauma in 57.8% and stroke in 22.2% Forty two percent (42.3%) of the predonors were detected in the emergency room, 33.3% in intensive care units and 24.4% in the surgery recovery room. The conversion rate of predonors to donors were 29%. The main causes for not conversion of predonors into donors were: family refusal 44%, sepsis 13%, cardiac arrest 13%, and reduced renal function 6%. In conclusion, the Transplant Coordinator Program allows to increase the predonor detection and gives good information for adequate management of donor and public educational campaign about the subject.

[Safety in the switching traditional cyclosporin to microemulsion cyclosporin in stable renal transplant patients: cooperative study]. / Seguridad en la conversión de ciclosporina tradicional a ciclosporina como microemulsión en trasplante renal estable: estudio cooperativo.

In an open clinical trial we assessed the tolerance and safety of the 1:1 conversion of traditional cyclosporine A (CyA) to a new cyclosporine formulation based on a microemulsion technology (CyN) in 18 patients with stable renal allografts. 56% patients were female. Median patient age was 40.9 +/- 3.2 years (range 18 to 65). Renal transplantation was performed in 24.1 +/- 4.6 months (range 6 to 67 months), prior to the beginning of the study, and 67% of the transplants were from cadaveric donor. The most frequent underlying renal disease was glomerulonephritis (44.4%). None of the patients entering the study were withdrawn prematurely. After 2 weeks of observation for graft function stability, the study was divided in two phases: I: during 4 weeks the patients received CyA traditional at fixed doses (Mean dose administered 3.056 +/- 0.25 mg/Kg/d) and II: during the consecutive 6 weeks with conversion to CyN, with doses adjustment as required (Mean dose 2.887 +/- 0.21 mg/Kg/d). Clinical events, adverse reactions and laboratory parameters were evaluated. Levels of 100-200 ng/ml measured by monoclonal specific fluorescence polarization immunoassay were considered appropriate. There were no significant changes in physical examination and laboratory parameters between phases. The incidence of adverse reactions reported in phase I was only gingival hypertrophy (5%) which persisted in phase II, qualified as probably related to the cyclosporine, and in phase II tremor in 17%, qualified as definitively related. Both drugs were well tolerated and there was no report of acute rejection during the study. We conclude that the tolerance and safety of the 1:1 conversion of CyA to CyN were confirmed by our results, and considering the improved pharmacokinetic properties of the second, the microemulsion presentation will be used preferentially as immunosuppressive drug in the treatment of stable kidney transplant patients.

[Need and demand of kidneys for transplantation in Venezuela]. / Necesidades y demanda de riñones para trasplante en Venezuela.

The number of cadaveric kidneys available for transplantation has become insufficient around the world. Despite concerted efforts, we have been unsuccessful in greatly improve the supply of organ donors, and consequently the number of end stage renal failure patients awaiting for kidney transplantation continues to increase. The primary objective of this paper is to quantify the need and supply of kidneys for transplant in Venezuela. An overview of the current level of kidney transplant activity in Venezuela is presented, observing that the activity with cadaveric donors had been predominant since 1983, although not to an optimal level. The annual activity in kidney transplant between 1989-1991 remained stable in 6 transplants/million people, but went sharply down to 4.6 in 1992. An estimate of the current need is around 10 donors/million people. This is in contrast with an effective donation rate of only 2.01 and 1.92 donors/million achieved in 1990 and 1991 respectively. The most frequent cause for no donation was the lack of familiar consent. Based on an analysis of the factors involved in the shortage of donor supply in Venezuela, we present some recommendations to increase the availability of cadaveric organ donors in the country. These measures include an improvement of education and legal regulation in the field of organ donation and transplantation, and following the Spanish model, the creation of a program of hospital transplant coordinators that can detect and evaluate potential organ donors as well as coordinate the logistical aspects of transplantation.

Effect of acidosis on PTH-dependent renal adenylate cyclase in phosphorus deprivation: role of G proteins.

These studies examine the regulation of adenylate cyclase in renal cortical membranes from phosphate-deprived and phosphate-deprived acidotic dogs. Enzyme stimulation by parathyroid hormone (PTH) was decreased in phosphate deprivation [Vmax 1,578 +/- 169 vs. 2,581 +/- 219 pmol adenosine 3',5'-cyclic monophosphate (cAMP).mg protein-1 x 30 min-1 in controls, P less than 0.01]. Metabolic acidosis further decreased PTH-stimulated activity. Membranes from phosphate-deprived dogs showed a decrease in Gs alpha-content by cholera toxin-dependent ADP-ribosylation (174 +/- 18 arbitrary units vs. 266.4 +/- 13.6 in controls, P less than 0.01). Metabolic acidosis further decreased Gs alpha-content, P less than 0.01. Gi content by pertussis-dependent ADP-ribosylation was also lower in phosphate-deprived and phosphate-deprived acidotic animals. Gs function was examined by its property to protect the catalytic unit from inactivation by N-ethylmaleimide when preincubated with GTP gamma S. In controls, protection of inactivation was 80% of the maximal activity, whereas in phosphate deprivation protection was less than 50%. In conclusion, metabolic acidosis enhances adenylate cyclase resistance to PTH in phosphate deprivation. These alterations are associated with a decrease in the content and function of Gs alpha, suggesting a role of Gs in the renal adaptation to phosphate depletion and acidosis.

Altered response of adenylate cyclase to parathyroid hormone during compensatory renal growth.

The loss of renal mass is associated with functional adaptations in the remaining nephrons to maintain homeostasis. Although parathyroid hormone (PTH) is important in the adaptations to phosphate, the mechanisms are not completely defined. In the present studies we examined the response of the adenylate cyclase system to PTH in renal cortical membranes of rat kidneys ten days after unilateral nephrectomy. The kidneys obtained at the time of the initial nephrectomy were used as controls. Unilateral nephrectomy resulted in contralateral compensatory renal growth, as demonstrated by a 24 +/- 4.7% (P less than 0.01) increase in weight in the remaining kidney. Glomerular filtration rate (GFR) after unilateral nephrectomy was 62% of the control, while basal fractional phosphate excretion was higher in rats with unilateral nephrectomy (7.7 +/- 2.1% vs. 2.9 +/- 0.8%, P less than 0.05). PTH infusion resulted in a similar increase of fractional phosphate excretion and urinary cAMP in both groups. In the absence of added guanine nucleotides, PTH-dependent adenylate cyclase activity in cortical membranes from kidneys with compensatory growth was decreased as compared to controls (Vmax 807.5 +/- 62.7 pmol cAMP/mg protein/30 min vs. 1,384.8 +/- 116.1, respectively, P less than 0.01). The apparent affinity for PTH stimulation of adenylate cyclase (Kact) was unchanged. Magnesium-dependent adenylate cyclase activity was also decreased in the membranes from kidneys with compensatory growth. However, the kinetics of adenylate cyclase for the substrates ATP-Mg or ATP-Mn were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of cadmium on canine renal cortical adenylate cyclase.

The present studies examine the effects of cadmium (Cd2+) on adenylate cyclase activity in basolateral renal cortical membranes from normal dogs. Cd2+, in the dose range of 1 to 200 microM caused a dose-dependent inhibition of adenylate cyclase activity due to competitive inhibition with respect to the allosteric activator Mg2+ (increase in the Kact for Mg2+ from 13.8 to 37.2 mM). In addition, increasing Cd2+ concentrations from 0 to 25 microM resulted in a purely competitive inhibition with respect to ATP. The Km for ATP increased from 61 to 128 microM. When Mn2+ at a concentration of 20 mM was substituted for Mg2+, Cd2+ maintained its inhibitory effect at concentrations lower than 25 microM. At higher concentrations it stimulated enzyme activity in a dose-dependent fashion. In the absence of other divalent cations Cd2+ was a potent stimulator of basal adenylate cyclase activity, far more potent than the physiological activator of the system Mg2+. Kact for Cd2+ was 1.0 mM (Kact for Mg2+ 20 mM), whereas the Vmax showed a fourfold increase compared with the Mg2+-stimulated membranes. However, under these conditions, synthetic bovine parathyroid hormone (1-34) or 5'-guanylylimidodiphosphate did not stimulate adenylate cyclase. It is concluded that Cd2+ behaves as a partial agonist in this system, due to its ability to form a new enzymatic substrate complex: Cd-ATP, which competes with the physiological substrate Mg-ATP at the catalytic site of the enzyme. In addition, Cd2+ in the absence of other divalent cation stimulates basal enzyme activity, presumably through interaction at an additional site, closely related to the allosteric metal regulatory site of this enzyme system.

Effect of metabolic acidosis on the PTH receptor-adenylate cyclase system of canine kidney.

The phosphaturic action of parathyroid hormone (PTH) is blunted during metabolic acidosis. Previous studies suggest that the activation of renal cortical adenylate cyclase by PTH is decreased under this condition. However, the mechanisms underlying the defect are not completely defined. The present studies were designed to examine the interaction of PTH with its receptor-adenylate cyclase system in basolateral cortical membranes from dogs with metabolic acidosis. Chronic metabolic acidosis was induced in seven normal dogs. Venous blood pH decreased to 7.21 +/- 0.01 and serum bicarbonate to 12.58 +/- 0.32 meq/liter. In seven control dogs blood pH was 7.38 +/- 0.002 and serum bicarbonate was 20.14 +/- 0.26 meq/liter. The kidneys were surgically removed and basolateral membranes were prepared by differential centrifugation and ultracentrifugation in discontinuous sucrose density gradients for studies of adenylate cyclase activity and hormone-receptor binding. Metabolic acidosis resulted in a significant decrease in PTH-dependent adenylate cyclase activity (Vmax 2,119 +/- 150 pmol cAMP X mg prot-1 .30 min-1 vs. 3,548 +/- 116 in the controls). The PTH concentration giving half-maximal activation of adenylate cyclase was unchanged. However, PTH-receptor binding showed similar affinity and binding capacity in both groups of membranes. Basal enzyme activity was also similar. In the presence of the GTP analogue 5'-guanylylimidodiphosphate, PTH-dependent adenylate cyclase activity remained markedly decreased in the acidotic dog membranes compared with the controls. The ability of NaF to stimulate enzyme activity was also depressed in the membrane of acidotic dogs. Enzyme activity in the presence of Mn2+ was similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of acute potassium load on reabsorption in Henle's loop in chronic renal failure in the rat.

To determine the effect of an acute load of potassium on potassium reabsorption by the loop of Henle in chronic renal failure, the right kidney was removed and branches of the left renal artery were ligated in 17 rats. One week later and after 2 days of a potassium-free diet, rats were studied before (period 1) and after (period 2) acute loads of potassium chloride (KCl group), equimolar sodium chloride (NaCl group) or no solute (time control). The KCl load increased urinary potassium excretion to a greater extent (from 5 to 50%, P less than 0.005) than in NaCl (14 to 27%) or time control (9 to 14%), and caused as great a diuresis and natriuresis as did NaCl. Fractional delivery of water, sodium, and potassium to the end-proximal tubule increased similarly in the NaCl and KCl groups and slightly less so in the time control group in period 2. The major finding was a striking increase in potassium delivery to the beginning of the distal tubule (from 17 to 37%) in period 2 which was substantially greater than in the combined control groups (13 to 19%, P less than 0.025) and was equivalent to three-quarters of urinary potassium excretion. This was the consequence of an increase in the filtered load of potassium, an increase in absolute delivery of potassium from the proximal tubule (P less than 0.005), and a decrease in fractional potassium reabsorption by the loop of Henle from 64 to 48%, versus 72 to 69% in the control groups (P less than 0.01). These results suggest that the proximal tubule and, in particular, Henle's loop play a role in excreting an acute potassium load in chronic renal failure.