Does the Pulsatile Preservation Machine Have Any Impact in the Discard Rate of Kidneys From Older Donors After Brain Death?

BACKGROUND: Donors after brain death (DBD) older than 60 years have become 46.8% of our current activity, with higher risk of renal discard rate (RDR). Assessment of kidney suitability requires complementary strategies: macroscopic evaluation, kidney biopsy score (KBS), and renal hemodynamic evaluation with the Pulsatile Perfusion Machine (PPM). METHODS: Descriptive, cross-sectional, comparative study of kidneys procured and RDR, comparing 3 time periods: 2000 to June 2004, when only KBS were used; July 2004 to 2008 (introduction of PPM and learning period); and 2009 to 2013 (experienced use of PPM). Transplantation criteria were KBS <3 and PPM renal resistance <0.4 mm Hg/mL/min and arterial renal flow >70 mL/min. RESULTS: Between 2000 and 2013, a 59.2% reduction in DBD kidneys was observed. However, older kidneys had an increase from 33.5% to 46.8%. The RDR had increased, comparing the first to the third period from 25.4% to 38.3%. However, the RDR was lower when kidneys were evaluated with PPM than those evaluated only with KBS and preserved in cold storage (CS) (21.4% versus 43.7%). There was a significant difference in cold ischemia time, because CS kidney was grafted before PPM. During the third period, more kidneys with KBS ≥4 were assigned to PPM. CONCLUSIONS: Notwithstanding the decrease in DBD-procured kidneys and the increase in older kidneys during last period, the use of PPM allowed low DR compared with CS. A bias in the results of PPM could be generated when kidneys with higher KBS were excluded from PPM. The use of KBS only to decide acceptance could preclude the use of an additional tool to evaluate suitability.

Seroprevalence of Toxoplasma gondii infection in domestic horses in Durango State, Mexico.

The seroprevalence of Toxoplasma gondii infection in horses in Mexico is unknown. Therefore, antibodies to T. gondii were assessed in 495 horses in Durango State, Mexico, using the modified agglutination test (MAT). Horses were from 18 farms in 3 municipalities in the valley region of Durango State. Antibodies to T. gondii were found in 30 (6.1%) of 495 horses, with MAT titers of 1:25 in 19, 1:50 in 6, and 1:100 in 5. Seropositive horses were found in 8 (44.4%) of 18 farms sampled in all 3 municipalities. Age, gender, and breed of horses did not influence significantly the seroprevalence of T. gondii infection. The seroprevalence in horses was higher in rural (7.8%) versus urban (0%) areas, and in larger herds (30-64 horses, 7.8%) versus smaller ones (3-28, 3.5%). The seroprevalence was higher in stall fed (16.5%) than in pastured horses (3.1%). Results indicate that infected horses represent a potential source of T. gondii infection for humans in Mexico. This is the first report of T. gondii infection in horses in Mexico.

Prevalence of Toxoplasma gondii infection in wild birds in Durango, Mexico.

There is a lack of information concerning the prevalence of Toxoplasma gondii infection in wild birds in Mexico. In the present study, serum samples and tissues from 653 birds from Durango State, Mexico, were evaluated for T. gondii infection. Antibodies to T. gondii (modified agglutination test, titer 1∶25 or higher) were found in 17 (2.6%) of the 653 birds, including 1 of 2 curve-billed thrashers (Toxostoma curvirostre), 2 (1 Anas platyrhynchos, 1 Anas diazi) of 4 ducks, 1 of 2 eagles (Aquila sp.), 5 (27.8%) of 18 great-tailed grackles (Quiscalus mexicanus), 7 (1.3%) of 521 rock pigeons (Columba livia), and 1 (14.3%) of 7 quail (Coturnix coturnix). The seroprevalence of T. gondii infection in birds captured in a park outside the city zoo (11.6%, 8/69) was significantly higher than that found in birds from other regions (1.5%, 9/584, OR  =  8.38; 95% CI: 2.82-24.77; P  =  0.0001). Brains and hearts of 23 birds (17 seropositive, 6 seronegative) were bioassayed in mice for the isolation of T. gondii . Viable T. gondii was isolated from 1 of 7 seropositive pigeons. The DNA obtained from the T. gondii isolate from the pigeon was genotyped using the PCR-RFLP typing using 11 markers (B1, SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico) and revealed an atypical genotype. This is the first report of T. gondii infection in great-tailed grackles, the Mexican duck, and curved-billed thrashers and the first survey of wild birds in Mexico.

Isolation of Toxoplasma gondii from animals in Durango, Mexico.

Little is known concerning the epidemiology of Toxoplasma gondii infection in people and animals in rural Mexico. Serum samples and tissues from 150 dogs (Canis familaris), 150 cats (Felis catus), 65 opossums (Didelphis virginianus), 249 rats (Rattus spp.), 127 mice (Mus musculus), and 69 squirrels (Spermophilus variegatus) from the Durango area were evaluated for T. gondii infection. Using a modified agglutination test and a serum dilution of 1:25, antibodies to this parasite were found in 68 (45.3%) of 150 dogs, 14 (9.3%) of 150 cats, 11 (16.6%) of 66 opossums, 2 (0.8%) of 249 rats, 4 (3.1%) of 127 mice, and 0 of 69 squirrels. Tissues (brain and heart) of dogs, cats, opossums, rats, mice, and squirrels were bioassayed in mice for the presence of T. gondii. Viable T. gondii was isolated in tissues from 3 of 28 seropositive dogs and 5 of 8 seropositive cats, but not from the other animals. The DNA obtained from the 3 T. gondii isolates from dogs, 6 isolates from 5 cats, and 4 isolates from free-range chickens from Mexico, previously isolated, were genotyped. The PCR-RFLP typing, which used 11 markers (B 1, SAGI, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico), identified 5 genotypes. One genotype (the 4 chicken isolates) belongs to the clonal Type III lineage, three genotypes were reported in previous reports, and 1 genotype is unique.