Influence of donor capnometry on renal graft evolution in uncontrolled donation after circulatory death.

AIM: To analyse the association between donor capnometry data and the short-term evolution of kidney grafts in cases of uncontrolled donation after circulatory death (uDCD). METHOD: We used an ambispective observational study design, conducted in the Community of Madrid between January and December 2019, inclusive. Patients who suffered out-of-hospital cardiac arrest (CA) with no response to advanced cardiopulmonary resuscitation (CPR) were selected as potential donors. Donor capnometry levels were measured at the start, midpoint and transfer to hospital then compared with indicators of renal graft evolution. RESULTS: The initial selection included 34 possible donors, of which 12 (35.2%) were viable donors from whom 22 (32.3%) kidneys were recovered. There was a correlation between the highest capnometry values and less need for post-transplant dialysis (≥24 mmHg, p < 0.017), fewer dialysis sessions and fewer days to recover correct renal function (Rho -0.47, p < 0.044). There was a significant inverse correlation between the capnometry values at transfer and 1-month post-transplant creatinine levels (Rho -0.62, p < 0.033). There were no significant differences between the capnometry values at transfer and primary nonfunction (PNF) or warm ischaemia time. One-year patient survival was 100% for patient receiving organ donation, while graft survival was 95%. CONCLUSIONS: Capnometry levels at transfer are a useful predictor of the short-term function and viability of kidney transplants from uncontrolled donations after circulatory death.

Long-term plasmapheresis therapy in the management of focal segmental glomerulosclerosis recurrence after kidney transplantation.

The recurrence of primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation (KT) appears in 30 % of the recipients. Sometimes it can cause the loss of the allograft. Although many treatments for this condition have been reported, 20 %-40 % of the affected patients are refractory or presents frequents relapses. In this paper we describe the evolution of three recipients treated with long-term plasmapheresis therapy after a recurrence of FSGS with a bad or incomplete response to other treatments. Although our findings require confirmation, long-term plasmapheresis could be a therapeutic option for this condition.

[Factors affecting the survival of transplants from donors after prehospital cardiac death]. / Factores que influyen en la evolución de los injertos de donantes tras muerte cardiaca extrahospitalaria.

OBJECTIVES: To evaluate factors that influence the survival of transplanted organs from donors after prehospital cardiac death. MATERIAL AND METHODS: Retrospective observational study of data collected from hospital emergency service records. Information included prehospital cardiac deaths evaluated as donors as well as patients who received transplants. RESULTS: Two hundred cases from 2008 through 2011 were studied. Sixty-nine potential donors (34.5%) were rejected. Three hundred organs were extracted from the remaining 131 donor cases, to yield a mean (SD) of 2.32 (0.83) transplanted organs/donor or 1.52 (1.29) organs/potential donor. One hundred fifty-two potential donors (76%) were treated with mechanical cardiopumps during transport. We detected no significant differences between cases transported with manual chest compressions and cases treated with cardiopumps regarding age (40.1 vs 43.5 years, P=.06), responder arrival times (13 min 54 s vs 12 min 54 s, P=.45), or transport times (1 h 27 min vs 1 h 32 min). However, case transported with manual chest compressions yielded significantly more kidneys (mean, 1.96/potential donor) than those transported with cardiopump compressions (mean, 1.38/potential donor) (P=.008). Eleven of the 229 kidneys harvested (4%) were not transplanted. The median (interquartile range) serum creatinine concentrations after kidney transplants at 6 and 12 months, respectively, were 1.37 (1.10-1.58) mg/dL and 1.43 (1.11-1.80) mg/dL. CONCLUSION: Our findings suggest that the use of a cardiopump reduces donor recruitment. Long-term creatinine levels are similar after transplantation of kidneys from donors transported with a cardiopump or with manual compressions.

OBJETIVO: Valorar los factores extrahospitalarios que pueden influir en la viabilidad de los injertos en los receptores. METODO: Estudio observacional retrospectivo que recoge datos de los registros del sistema de emergencias (pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar) y del hospital (pacientes trasplantados) de aquellos pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar. RESULTADOS: Se recogen 200 casos entre los años 2008 y 2011, de los que 69 (34,5%) no fueron donantes. De los 131 donantes utilizados se extrajeron 300 órganos [media de 2,32 (DE 0,83) órganos/donante utilizado y 1,52 (DE 1,29) órganos/donante potencial]. De los 200 pacientes, 152 fueron trasladados bajo cardiocompresión mecánica (76%). No hay diferencia significativa en edad (40,1 frente a 43,5 años, p = 0,06) y tiempo de llegada (13' 54' ' frente a 12' 54' ' , p = 0,45) y tiempo de trasferencia (1 h y 27' frente a 1 h y 32') entre el grupo de pacientes trasladados con cardiocompresión manual y con cardiocompresión mecánica, pero si en la media de órganos por donante potencial en favor de la cardiocompresión manual (1,96 frente a 1,38, p = 0,008). De los 229 riñones extraídos, no se trasplantaron 11 (4%). La mediana de la creatinina a los 6 meses de los riñones fue de 1,37 mg/dl (RIC: 1,10-1,58) y a los 12 meses de 1,43 mg/dl (RIC: 1,11-1,80), sin diferencias entre ambos grupos. CONCLUSIONES: Nuestros datos sugieren que el uso de compresores mecánicos disminuye el reclutamiento de donantes. A largo plazo la concentración de creatinina en los riñones trasplantados es similar independientemente del tipo de compresión usada durante el traslado y ninguna variable extrahospitalaria predice la evolución de los injertos.

Factores que influyen en la evolución de los injertos de donantes tras muerte cardiaca extrahospitalaria / Factors affecting the survival of transplants from donors after prehospital cardiac death

Objetivo: Valorar los factores extrahospitalarios que pueden influir en la viabilidad de los injertos en los receptores. Método: Estudio observacional retrospectivo que recoge datos de los registros del sistema de emergencias (pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar) y del hospital (pacientes trasplantados) de aquellos pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar. Resultados: Se recogen 200 casos entre los años 2008 y 2011, de los que 69 (34,5%) no fueron donantes. De los 131 donantes utilizados se extrajeron 300 órganos [media de 2,32 (DE 0,83) órganos/donante utilizado y 1,52 (DE 1,29) órganos/donante potencial]. De los 200 pacientes, 152 fueron trasladados bajo cardiocompresión mecánica (76%). No hay diferencia significativa en edad (40,1 frente a 43,5 años, p = 0,06) y tiempo de llegada (13' 54'' frente a 12' 54'', p = 0,45) y tiempo de trasferencia (1 h y 27' frente a 1 h y 32') entre el grupo de pacientes trasladados con cardiocompresión manual y con cardiocompresión mecánica, pero si en la media de órganos por donante potencial en favor de la cardiocompresión manual (1,96 frente a 1,38, p = 0,008). De los 229 riñones extraídos, no se trasplantaron 11 (4%). La mediana de la creatinina a los 6 meses de los riñones fue de 1,37 mg/dl (RIC: 1,10-1,58) y a los 12 meses de 1,43 mg/dl (RIC: 1,11-1,80), sin diferencias entre ambos grupos. Conclusiones: Nuestros datos sugieren que el uso de compresores mecánicos disminuye el reclutamiento de donantes. A largo plazo la concentración de creatinina en los riñones trasplantados es similar independientemente del tipo de compresión usada durante el traslado y ninguna variable extrahospitalaria predice la evolución de los injertos

Objective: To evaluate factors that influence the survival of transplanted organs from donors after prehospital cardiac death. Methods: Retrospective observational study of data collected from hospital emergency service records. Information included prehospital cardiac deaths evaluated as donors as well as patients who received transplants. Results: Two hundred cases from 2008 through 2011 were studied. Sixty-nine potential donors (34.5%) were rejected. Three hundred organs were extracted from the remaining 131 donor cases, to yield a mean (SD) of 2.32 (0.83) transplanted organs/donor or 1.52 (1.29) organs/potential donor. One hundred fifty-two potential donors (76%) were treated with mechanical cardiopumps during transport. We detected no significant differences between cases transported with manual chest compressions and cases treated with cardiopumps regarding age (40.1 vs 43.5 years, P=.06), responder arrival times (13 min 54 s vs 12 min 54 s, P=.45), or transport times (1 h 27 min vs 1 h 32 min). However, case transported with manual chest compressions yielded significantly more kidneys (mean, 1.96/potential donor) than those transported with cardiopump compressions (mean, 1.38/potential donor) (P=.008). Eleven of the 229 kidneys harvested (4%) were not transplanted. The median (interquartile range) serum creatinine concentrations after kidney transplants at 6 and 12 months, respectively, were 1.37 (1.10-1.58) mg/dL and 1.43 (1.11-1.80) mg/dL. Conclusions: Our findings suggest that the use of a cardiopump reduces donor recruitment. Long-term creatinine levels are similar after transplantation of kidneys from donors transported with a cardiopump or with manual compressions

Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role?

INTRODUCTION: Perigraft fluid collection (PFC) is a common complication after kidney transplant. Its etiology is not clear and not all the causes have been identified. The influence of the type of donor has never been evaluated. Our aim was to compare the incidence, severity and management of PFC in recipients of grafts from uncontrolled donors after circulatory death (DCD) with normothermic extracorporeal membrane oxygenation (NECMO) versus recipients of grafts from donors after brain death (DBD). MATERIAL AND METHODS: We conducted a retrospective cohort study of 300 kidney transplants performed in our center between 2007 and 2012. Patients were divided in two groups: 150 recipients of Maastricht II DCD graft and 150 recipients of the DBD graft. Incidence, severity according to Clavien scale and management were analyzed in both groups, and comparison was carried out using Chi-square. RESULTS: Of the 300 kidney recipients analyzed, 93 (31.4%) suffered PFC, showing no difference between DBD (32.0%) and DCD (30.8%) groups (p = 0.9). Complicated PFC rate (defined as a PFC generating vascular compression, fever or urinary tract obstruction) was 22.9% in the DBD group versus 22.2% in the DCD group (p = 1); most complicated PFC were due to urinary tract obstruction (81%), with no difference between the groups (p = 1). Concerning Clavien scale, 78.5% of the PFC in our series were Clavien I, 19.4% Clavien IIIa and 2.2% Clavien IIIb, with no difference between both groups (p = 1). CONCLUSIONS: PFC is a frequent complication that appears in a third of our patients, showing no difference in the incidence or severity between DBD and uncontrolled DCD graft recipients.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

¿Puede ser donante de órganos un paciente con enfermedad de Pompe? / Can a Pompe disease patient be an organ donor?

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Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review.

OBJECTIVE: The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL: A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS: A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION: This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria / Mechanical cardiopump use in organ donation after prehospital cardiac death

Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112, en colaboración con dos hospitales de Madrid, está inmerso en un programa de donación de órganos de pacientes que han sufrido una parada cardiaca extrahospitalaria y no han respondido a las maniobras de resucitación. El objetivo de este estudio es valorar los resultados de la aplicación de cardiocompresores mecánicos. Metodología: Estudio descriptivo retrospectivo basado en la base de datos del SUMMA112 de donantes tras muerte cardiaca. El estudio se realizó durante el año 2008 y 2009, año este último en el que se generalizó el uso de estos cardiocompresores. Se usaron dos cardiocompresores, el LUCAS© de Physio-Control y el Autopulse© de Zoll. Se estudiaron como variables independientes la edad, el sexo, el uso de cardiocompresión mecánica (CCM) y el tipo de cardiocompresor, el tiempo de llegada a la escena y el tiempo desde la alerta a la llegada al hospital. Como variables dependientes se registraron si fueron donantes válidos, número de órganos y tipo de órganos. Se compararon los resultados de media por donantes en el año 2008 (periodo sin CCM) y 2009 (periodo con CCM). Resultados: Se registraron un total de 108 casos. El 87% del total de pacientes eran varones, y la mediana (RIQ) de la edad era 40 años (35-49,7). Se obtuvieron un total de 82 donantes válidos, lo que corresponde a 3,18 órganos por donante. La media de órganos en el periodo sin CCM fue de 3,4 y en el de CCM de 2,9 (p < 0,05). No encontramos diferencia significativa en la comparación entre los dos cardiocompresores. Conclusión: Según nuestra serie, el número de órganos extraídos y trasplantados por donante es menor con CCM. Se necesitan más estudios para demostrar que estos dispositivos mejoran el número o la calidad de los órganos extraídos (AU)

Objective: The SUMMA112 emergency health service of Madrid is working with area hospitals on a program to facilitate organ donation from persons who have suffered cardiac death outside the hospital and who have not responded to resuscitation maneuvers. The aim of this study was to assess the usefulness of mechanical cardiopumps. Methods: Retrospective, descriptive study based on SUMMA112 data available for organ donors after cardiac death. The data analyzed were from 2008, before cardiopumps, and 2009, the year when cardiopumps became widely used. Two models were available; one was the LUCAS pump, from Physio-Control, and the other was the Autopulse, from Zoll. Independent variables studied were age, sex, cardiopump use and model, time from arrival at the emergency site until notification of arrival at the hospital. Dependent variables were categorization as a valid donor, number of organs donated, and types of organs donated. We compared the mean number of organs donated in 2008 (period without mechanical cardiopumps) to the number donated in 2009 (with cardiopumps). Results: A total of 108 cases were on record. Eighty-seven percent of the patients were men. The median (interquartilerange) age was 40 (35-49.75) years. Overall, 82 cadavers were valid donors and a mean of 3.18 organs per donor were obtained. In the period without cardiopumps, the mean number of organs obtained was 3.4; with cardiopumps themean was 2.9 organs (P<0.05). There were no significant differences between the 2 cardiopumps. Conclusion: Fewer organs per donor were extracted and transplanted in the year the mechanical cardiopumps were used. Further studies are needed to demonstrate whether or not these devices can increase the number or quality ofextracted organs (AU)

Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions.

OBJECTIVE: This study aims to determine the failure rate of transplanted kidney grafts in recipients of organs from non-heart beating donors (NHBDs) who have had mechanical chest compressions to maintain a circulation before organ retrieval. METHODS: A retrospective observational study based on review of the emergency medical service database and case histories of NHBDs, and information periodically sent by transplant units about donors and organs. The following variables were studied: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical chest compression devices, and kidney function in graft recipients. The study covered the period between January 2008 and November 2009. During 2008 standard manual chest compressions were used and during 2009 mechanical chest compression devices were used. RESULTS: In 39 transplanted kidneys from donors receiving mechanical chest compressions primary failure was documented in recipients on two occasions (5.1%). Kidneys transplanted from donors who had manual chest compressions resulted in three primary failures in recipients (9.1%). The difference between the two groups was not significant (p=0.5). Three patients achieved successful return of spontaneous circulation in the mechanical chest compression group after initiation of the NHBD donor protocol. CONCLUSION: We have described our experience and protocol for non-heart beating donation using victims of out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation has been unsuccessful as donors. Primary kidney graft failure rates in organs from non-heart beating donors is similar when manual or mechanical chest compression devices are used during cardiopulmonary resuscitation.