Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE. (AU)

Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022.

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE.

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases.

On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.

Utilidad de la PET/TC en el diagnóstico y estadificación del cáncer de pulmón tras ecobroncoscopia en población minera / Utility of PET/CT in the diagnosis and staging of lung cancer after ecobronchoscopy in mining population

IntroducciónLa tomografía por emisión de positrones (PET) en un único equipo junto a la tomografía axial computarizada (TC) es comúnmente denominada PET/TC. Ha sido ampliamente documentada y validada, de tal manera que hoy día forma parte del eje central en el diagnóstico y la estadificación del cáncer de pulmón. Sin embargo, su fiabilidad no ha sido estudiada en poblaciones específicas. El objetivo de esta investigación se centra en determinar la utilidad de la PET/TC en pacientes expuestos a la minería en los que se ha realizado una ecobroncoscopia (EBUS) para diagnóstico y/o estadificación de cáncer de pulmón.Pacientes y métodosSobre una base de datos prospectiva y en tiempo real, se seleccionaron todos los individuos sometidos a EBUS por sospecha de cáncer de pulmón y que previamente se habían realizado una PET/TC. La unidad de observación fue la adenopatía y, en función del antecedente de exposición a la minería, se dividió la muestra en dos grupos, grupo 1: no expuestos, grupo 2: expuestos. En cada grupo y tomando como variable dependiente los resultados de anatomía patológica, se realizaron modelos logísticos en busca de factores de riesgo independientes de malignidad.ResultadosEn el grupo 1, el tamaño mayor a 1 cm de las adenopatías y la captación en la PET/TC con valor de captación estándar máximo (SUVmáx) superior a 2,5, son factores de riesgo independientes de malignidad. Sin embargo, en el grupo 2 (paciente con exposición) ninguno de los factores anteriormente mencionados predice malignidad.DiscusiónEn la población de individuos con exposición laboral a la minería, la PET/TC es una técnica de imagen con limitaciones diagnósticas en el cáncer de pulmón.

Utility of PET/CT in the diagnosis and staging of lung cancer after ecobronchoscopy in mining population. / Utilidad de la PET/TC en el diagnóstico y estadificación del cáncer de pulmón tras ecobroncoscopia en población minera.

INTRODUCTION: Positron emission tomography (PET) with computerized axial tomography (CT) in a single device is known as PET/CT. It has been widely documented and validated, and it is currently a core part of the diagnosis and staging of lung cancer. However, its reliability has not been analysed in specific populations. The objective of this study is to determine the usefulness of PET/CT in patients exposed to mining activities in which an endobronchial ultrasound (EBUS) has been performed for the diagnosis and/or staging of lung cancer. PATIENTS AND METHODS: With a prospective and real-time database, all the patients who had undergone an EBUS with suspicion of lung cancer and who had previously undergone a PET/CT were selected. The observation unit was the lymph node and, based on their history of exposure to mining activities, the sample was divided into two categories, group 1: not exposed; and group 2: exposed. In each group, and with the results from anatomical pathology as a dependent variable, logistic models were established to look for independent risk factors for malignancy. RESULTS: In group 1, lymph nodes larger than 1 cm and PET/CT uptake with maximum standardized uptake value (SUVmax) over 2.5 were independent risk factors for malignancy. However, in group 2 (exposed patients), none of those factors were predictors for malignancy. DISCUSSION: In the population of individuals with occupational exposure to mining, PET/CT is an imaging technique with diagnostic limitations for lung cancer.

Results from a Spanish national survey on the application of ultrasound in pulmonology services.

BACKGROUND: This was an observational, cross-sectional, and multicentre study carried out from October to December 2020, through a survey sent to Spanish Society of Pulmonology and Thoracic Surgery members in public hospitals with different levels of complexity. Our objective was to complete a national analysis of clinical practice, organisation, infrastructure, the services portfolio, teaching, and research activity related to ultrasound. RESULTS: Data from 104 hospitals were analysed. Ultrasound was used in 56.7% of cases, both in the area of bronchopleural techniques and on conventional wards, with no differences between centres. Lung ultrasound (LUS) was performed more often in the procedures area in intermediate-complexity centres compared to high- and low-complexity centres (36% vs. 31% and 6.25%, respectively). More high-complexity centres had three or more ultrasound scanners than intermediate-complexity centres (38% vs. 16%); 43% of low-complexity centres shared their ultrasound equipment with other specialties. Fewer than 6% of centres did not have an ultrasound machine. LUS was most often used during the treatment of pleural effusion (91.3%), in the differential diagnosis of dyspnoea (51.9%), and to rule out iatrogenic pneumothorax (50.9%). Only 5.7% of the centres had a pulmonologist specialised in LUS. Finally, fewer than 35% of the hospitals were teaching centres and fewer than 18% participated in research projects. CONCLUSIONS: The use and availability of LUS has grown in pulmonology services, however, still relatively few pulmonologists are specialised in its use. Moreover, teaching and research activity in this field is scarce. Strategies are necessary to improve physicians' skill at using LUS and to promote its use, with the ultimate goal of improving healthcare activity.

Valoración por los estudiantes de la formación práctica de grado de Medicina. El caso de la Neumología / Valuation by the students of the practical training of degree of Medicine. The case of pneumology

INTRODUCCIÓN: La formación práctica en el grado de Medicina se imparte en los últimos cursos y está determinada por numerosos factores condicionantes, entre ellos, la formación MIR. En general, la evaluación de la formación práctica recibe mucha menos atención que la teórica, su calidad no es evaluada y el profesorado no recibe retroalimentación. El objetivo de nuestro estudio ha sido conocer la valoración que dan los alumnos a la formación práctica de Neumología después de una rotación de 3semanas, con el objetivo de obtener información para el proceso de mejora continua. MÉTODOS: El estudio incluye 2encuestas anónimas realizadas a los alumnos de grado en el mismo curso académico. Una interna, aplicada por el propio Servicio de Neumología y otra externa, por la Unidad de Evaluación de la Calidad Docente de la USAL. RESULTADOS: En la evaluación interna la opinión de los alumnos acerca de la calidad de la formación práctica es alta (8,26) y la utilidad percibida también es elevada (8,23), en una escala de 0 a 10, y no se observan diferencias por el hecho de que tenga lugar en cuarto, quinto o sexto curso. Estos resultados concuerdan con los obtenidos en la evaluación externa, con un valor medio de 4,56 en una escala de 0 a 5. Las preferencias de los alumnos durante su rotación por el servicio son las unidades de hospitalización y consultas, con menor valoración en las áreas técnicas. CONCLUSIONES: La calidad de la docencia práctica es un reto que es necesario evaluar para que los profesores dispongan de la retroalimentación (interna y externa) oportuna. La rotación por los servicios de Neumología constituye una oportunidad para la mejora de la percepción de la especialidad por los alumnos de grado. Es preciso reflexionar acerca de los contenidos de dicha rotación, buscando un equilibrio entre las áreas clínicas y las de técnicas

INTRODUCTION: Practical training for medical students is provided during the final years of study and is determined by several conditioning factors, including the MIR training that students receive simultaneously. In general, practical training evaluation receives much less attention than the theoretical one; its quality is not evaluated, and the professors do not receive feedback. The objective of our study was to determine how students value practical training in pulmonology rated the experience after completing a three-week rotation, in order to apply the information gained toward a process of continual improvement. METHODS: The study included 2anonymous surveys taken by medical students during the same academic year-one internal, prepared by the Department of Pneumology, itself, and another external one, prepared by the Evaluation Unit for Teaching Excellence at the University of Salamanca. RESULTS: On the internal evaluation, student opinions of their practical training ran high (8.26) and the perceived usefulness was also high (8.23), on a scale of 0 to 10 and no differences were noted according to whether the survey was taken during their fourth, fifth, or sixth year of study. These results agree with those obtained in the external evaluation with a mean value of 4.56 on a scale of 0 to 5. Student preferences during their rotation in the department were for hospitalization and consultation units, with the technical areas being lesser valued. CONCLUSIONS: Achieving and maintaining a high quality of practical training is a goal that should be consistently evaluated so that professors may receive feedback (internal and external). Rotations in the Department of Pneumology provide an opportunity to improve the perception that medical students have regarding this specialty. It is imperative to reflect upon the contents of these rotations, seeking a balance between clinical areas and technical areas

Impacto de la pandemia COVID-19 en los laboratorios de función pulmonar: consideraciones sobre el «hoy» y el «día después» / Impact of the COVID-19 Pandemic on Lung Function Laboratories: Considerations for "Today" and the "Day After"

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Recomendaciones de consenso SEPAR-AEER sobre la utilidad de la ecografía torácica en el manejo del paciente con sospecha o infección confirmada con COVID-19 / SEPAR-AEER Consensus Recommendations on the Usefulness of the Thoracic Ultrasound in the Management of the Patient with Suspected or Confirmed Infection with COVID-19

La gran afectación pulmonar producida por la infección del COVID-19 hace necesaria una herramienta diagnóstica rápida que complemente el test diagnóstico mediante PCR y que además sea útil en la evaluación de la progresión de las lesiones pulmonares. Ya que la mayoría de estas son periféricas, en este documento de consenso proponemos el uso de la ecografía torácica para el diagnóstico precoz y la evaluación diaria de la progresión de lesiones pulmonares por un solo explorador sin necesidad de utilizar la TC de tórax. En este consenso se propone la realización de una exploración sistemática ecográfica del tórax dividiéndolo por cuadrantes e identificando los signos ecográficos que se relacionen con el tipo de afectación parenquimatosa o pleural que tiene el paciente: líneas A, líneas B, condensación parenquimatosa, línea pleural y derrame pleural. Estos hallazgos nos facilitarán la toma de decisiones respecto al manejo del paciente, tanto en la decisión del lugar de ingreso del paciente como en el tipo de tratamiento que debemos pautar

The great pulmonary affectation produced by the COVID-19 infection, requires a fast diagnostic tool that complements the diagnostic test by PCR and which is also useful in evaluating the progression of lung lesions. Since most of these are peripheral, in this consensus document we propose the use of thoracic ultrasound for early diagnosis and for the daily evaluation of the progression of lung lesions by a single explorer without the need to use the chest CT. In this consensus, it is proposed to carry out a systematic ultrasound examination of the thorax dividing it by quadrants and therefore identifying the ultrasound signs that are related to the type of parenchymal or pleural affectation that the patient has: A lines, B lines, parenchymal condensation, pleural line and pleural effusion. These findings will facilitate the decision making regarding the patient management, both when deciding the place of admission of the patient and the type of treatment to be prescribed

Recomendaciones de Consenso SEPAR y AEER sobre el uso de la broncoscopia y la toma de muestras de la vía respiratoria en pacientes con sospecha o con infección confirmada por Covid-19 / Separ and aeer consensus recommendations on the use of bronchoscopy and airway sampling in patients with suspected or confirmed covid-19 infection

Este documento de consenso está elaborado por el área de Técnicas y Trasplante y el área de Enfermería de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) así como la Sociedad Española de Endoscopia Respiratoria (AEER) con el objetivo de proporcionar conocimientos para el uso efectivo y seguro de la broncoscopia en pacientes con sospecha o con confirmación de la infección por COVID-19. Es prioritario proporcionar la mayor seguridad a nuestros pacientes, a los sanitarios que los atienden y a la comunidad en general. En este momento de pandemia, la información de la que disponemos acerca del uso de la broncoscopia en este tipo de pacientes se basa en la experiencia de otros centros y países, y las publicaciones científicas son escasas. El objetivo de este documento es recoger esas experiencias y en base a las recomendaciones de los organismos oficiales ofrecer un documento de ayuda para la práctica clínica diaria

This consensus document has been drawn up by the Techniques and Transplantation and Nursing areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Respiratory Endoscopy (AEER) with the aim of providing information on the safe and effective use of bronchoscopy in patients with suspected or confirmed COVID-19 infection. Our priority is to ensure the safety of our patients, the health workers caring for them, and the community in general.At this stage in the pandemic, our information on the use of bronchoscopy in patients of this type is based on the experience of hospitals in other countries, and scientific publications are scarce. The objective of this document isto compile these experiences, based on recommendations from official agencies, in a document offering guidance in daily clinical practice

Manifestación pulmonar de una enfermedad hereditaria de expresión fundamentalmente mucocutánea / Pulmonary Manifestation of a Primarily Mucocutaneous Hereditary Disease

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Utilidad del aula para la enseñanza de neumología en el grado de medicina. Una oportunidad poco aprovechada / The Usefulness of the Classroom in the Teaching of Pulmonology To Medical Students. An Underexploited Opportunity

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Incremento ponderal en fumadores en proceso asistido de cesación tabáquica / Weight increase in smokers in assisted smoking habit cessation process

Objetivo: Conocer la evolución del peso durante un año en fumadores en proceso de deshabituación tabáquica. Los objetivos secundarios son valorar la evolución del peso en función de características propias de los fumadores y del tipo de tratamiento realizado. Pacientes y métodos: Se recogieron los datos de los pacientes que acudieron a la consulta de deshabituación tabáquica entre 2009 y 2015 de forma prospectiva y se realizó un análisis retrospectivo. Las variables analizadas fueron edad, sexo, IMC, cigarrillos/día, índice de paquetes-año (IPA), test de Fagerström, tratamiento recibido, éxito del tratamiento y peso tras 1, 2, 3, 6, y 12 meses. Resultados: Los pacientes experimentaron una ganancia de peso significativa sostenida a lo largo de los 12 meses de seguimiento, con una media de 3,02 kg. Los pacientes que solo recibieron tratamiento conductual ganaron significativamente menos peso que aquellos que recibieron además tratamiento farmacológico. Los pacientes con un menor IMC inicial, un valor alto de IPA y dependencia alta en el test de Fagerström ganaron significativamente más peso. No se encontraron diferencias significativas en cuanto a género, edad o éxito en el tratamiento a los 12 meses. Conclusiones. Los pacientes fumadores que se plantean dejar de fumar presentan un incremento de peso progresivo, que guarda relación con el IMC inicial, con un consumo elevado y prolongado de tabaco y con un índice de dependencia nicotínica elevado. No guarda relación con otras variables que, a priori, parecerían resultar determinantes como la edad, el género o el tratamiento utilizado

Objective: To know the weight gain in smokers after one year of tobacco cessation, as well as the possible influence of different variables in post-cessation weight gain. Methods: Data from the Tobacco Unit of the University Hospital of Salamanca were collected between 2009 and 2015. The variables analyzed were age, gender, BMI, cigarettes per day, packet-year, Fagerström test score, treatment, success of failure of the treatment and weight after 1, 2, 3, 6 and 12 months. Results: Patients experienced significant weight gain sustained over the 12-month follow-up, with an average of 3.02 kg. Patients who received behavioral therapy alone gained significantly less weight than those who also received drug treatment. Patients with lower initial BMI, a high packet-year, cigarette-day and test Fagerström gained significantly more weight. No significant differences in gender, age or treatment success at 12 months was found. Conclusions: Smokers posed quit smoking show a progressive weight gain, which is related to the initial BMI, a high and prolonged consumption of tobacco, and a high rate of dependency. Not related to other variables, which could seem to be determinants such as age, gender or treatment used

Utilidad del dispositivo portátil Piko-6 para la detección precoz de la enfermedad pulmonar obstructiva crónica en atención primaria / Usefulness of The Piko-6 Portable Device for Early COPD Detection in Primary Care

Introducción: La EPOC es una enfermedad de elevada prevalencia pero infradiagnosticada, debido a la escasa implantación de la espirometría forzada (EF) en atención primaria. Los microespirómetros, baratos y de manejo sencillo, que pueden medir FEV6 y FEV1/FEV6, podrían contribuir a reducir el infradiagnóstico. El objetivo del estudio ha sido validar el dispositivo Piko-6 para el cribado de la EPOC, demostrando una buena correlación con la EF convencional. Métodos: Se han realizado una EF y una determinación con Piko-6 a 155 pacientes susceptibles de padecer EPOC. Se han comparado las correlaciones, curvas ROC e índice de Youden con ambos métodos, considerando la EF como patrón de referencia. Resultados: Los coeficientes de correlación de FEV1, FVC y FEV6 y los cocientes FEV1/FVC y FEV1/FEV6 fueron de 0,87 (IC 95%: 0,836-0,909), 0,729 (IC 95%: 064-0,795) y 0,947 (IC 95%: 0,928-0,961) respectivamente. La curva ROC para el FEV1 determinado por Piko-6 alcanzó un área bajo la curva de 0,86 (IC 95%: 0,78-0,92). El índice de Youden para el punto de corte de 0,70 del FEV1/FEV6 fue 0,97. Conclusiones: El Piko-6 puede ser útil para el cribado de la EPOC en atención primaria. Sus determinaciones presentan buena correlación con las obtenidas mediante EF, especialmente el cociente FEV1/FEV6. Esto, junto a su bajo coste y facilidad de uso, puede contribuir a reducir el infradiagnóstico de la EPOC, aunque su rol exacto en el proceso diagnóstico está aún por determinar

Introduction: COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS. Methods: FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard. Results: FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836-0.909), 0.729 (CI 064-0.795) and 0.947 (95% CI 0.928-0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78-0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97. Conclusions: Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined

Usefulness of The Piko-6 Portable Device for Early COPD Detection in Primary Care. / Utilidad del dispositivo portátil Piko-6 para la detección precoz de la enfermedad pulmonar obstructiva crónica en atención primaria.

INTRODUCTION: COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS. METHODS: FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard. RESULTS: FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836-0.909), 0.729 (CI 064-0.795) and 0.947 (95% CI 0.928-0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78-0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97. CONCLUSIONS: Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined.

[Advances in respiratory health 2010: Techniques and Transplantation Section]. / Avances en salud respiratoria 2010: área de técnicas y trasplante.

Five articles and an editorial on interventional pneumology were published in Archivos de Bronconeumología. Two of these articles deal with bronchoscopy, one with lung biopsy with cryoprobes, one with thermoplasty in asthma and the last with tracheobronchomalacia. We also review several publications in international journals, with special emphasis on endobronchial ultrasound. Four original articles on idiopathic pulmonary fibrosis were published in Archivos de Bronconeumología: one special article comparing two treatments and a Cochrane systematic review on the efficacy of non-steroidal drugs in this disease. Finally, we highlight studies in lung transplantation, consisting of 14 publications from different continents and with highly diverse contents: one editorial, one letter to the editor, one procedures manual and nine international publications on donor characteristics, various types of complications, experimental results in the field of preservation, and the casuistics obtained in distinct diseases in which transplantation is an option.

Avances en salud respiratoria 2010: área de técnicas y trasplante / Advances in respiratory health 2010: Techniques and Transplantation Section

En ARCHIVOS DE BRONCONEUMOLOGÍA se han publicado 5 artículos y un editorial relacionados con neumología intervencionista,2 que tratan sobre broncoscopia, uno sobre biopsia pulmonar con criosonda, otro sobre termoplastiaen asma y el último, que aborda la traqueobroncomalacia. También revisamos varias publicaciones enrevistas internacionales haciendo especial hincapié en el EBUS. Sobre fibrosis pulmonar idiopática se hanpublicado en nuestra revista 4 originales, un artículo especial en el que se comparan 2 tratamientos y unarevisión sistemática de la Cochrane sobre la eficacia de los fármacos no esteroides en esta enfermedad.Finalmente, destacaremos los trabajos en trasplante pulmonar resumidos en 14 publicaciones muy diversasen continente y contenido: un editorial, una carta al director, un manual de procedimientos y 9 publicacionesinternacionales que hacen referencia a las características de los donantes, las complicaciones evolutivas dediversa índole, los resultados experimentales en el campo de la preservación y la casuística obtenida en diferentespatologías objeto de trasplante(AU)

Five articles and an editorial on interventional pneumology were published in ARCHIVOS DE BRONCONEUMOLOGÍA.Two of these articles deal with bronchoscopy, one with lung biopsy with cryoprobes, one with thermoplastyin asthma and the last with tracheobronchomalacia. We also review several publications in internationaljournals, with special emphasis on endobronchial ultrasound. Four original articles on idiopathic pulmonaryfibrosis were published in ARCHIVOS DE BRONCONEUMOLOGÍA: one special article comparing two treatments and aCochrane systematic review on the efficacy of non-steroidal drugs in this disease.Finally, we highlight studies in lung transplantation, consisting of 14 publications from different continentsand with highly diverse contents: one editorial, one letter to the editor, one procedures manual and nineinternational publications on donor characteristics, various types of complications, experimental results inthe field of preservation, and the casuistics obtained in distinct diseases in which transplantation is anoption(AU)