[Organ and tissue donation and transplantation: three health care centers' attitude]. / Actitud hacia la donación y el trasplante de órganos y tejidos de tres instituciones de salud.

OBJECTIVE: To assess the knowledge and attitude towards organ donation within health professionals in different institutions of Nuevo Leon. METHODS: A prospective, open, observational, descriptive study of parallel groups, through application of a survey formulated by the Hospital Universitario (HU) "Dr. José Eleuterio González". We applied 208 surveys in the HU (n = 100) and other institutions like IMSS, ISSTE (n = 108). RESULTS: From all the participants, 86% had a positive attitude towards organ donation, associated to a higher education, and information regarding organ donation received by other health professionals. Though having a positive attitude toward organ donation, 14% of health professionals don't support it due to being afraid of not receiving medical assistance, knowing their status of donators, religious reasons, and fear of organ trafficking. CONCLUSIONS: Our study shows that, even within the health professionals, there is a need for information regarding organ donation. A well-instructed health professional shows a higher interest in organ donation; this could have a positive impact in the attitude of the population toward organ donation, as well as in the obtainment of organs inside the medical institutions.

[Urinary protein detection by iTRAQ® associated with renal transplant complications and its modification with therapy]. / Detección de proteínas urinarias por iTRAQ® asociadas a complicaciones del trasplante renal y su modificación con la terapia.

BACKGROUND: After renal transplant, surgical, infection complications, as well as graft rejection may occur; early detection through non-invasive markers is the key to change therapy and avoid biopsy. OBJECTIVE: The aime of the study is to determine urine protein profiles in patients undergoing renal transplant with complications and detect its variation when therapy is modified. MATERIAL AND METHODS: Urine samples were collected from patients prior the transplant and various postoperative stages. Urinary protein profiles were obtained by peptide labeling using isobaric isotopes for relative quantification (iTRAQ(®)). RESULTS: A total of 22 patients were included, of whom 12 developed post-transplant complication: 2 with graft rejection (one male and one female) and 10 (6 males and 4 females) in the group of post-transplant infections. Using iTRAQ(®) 15/345 and 28/113 proteins were identified and fulfilled the acceptance criteria, in graft rejection and post-transplant infections group, respectively. CONCLUSIONS: Albumin was the only protein found in both groups, the remaining proteins were different. The 5 proteins with higher scores in graft rejection were: alpha-1-microglobulin, 5'-nucleotidase cytosolic III, retinol-binding protein 4, membrane protein palmitoylated 4, and serine carboxypeptidase, while post-transplant infections were: mitochondrial acetyl-coenzyme A synthetase, putative adenosyl homocysteinase 2, zinc finger protein GLIS1, putative protein FAM157B, and zinc finger protein 615. It remains to elucidate the involvement of each of these in patients with renal transplantation.

Is Ischemic Preconditioning a Useful Therapeutic Strategy in Liver Transplantation? Results from the First Pilot Study in Mexico.

BACKGROUND AND AIMS: The protective effect of ischemic preconditioning (IP) in liver transplantation (LT) has been studied with controversial results. We undertook this study to investigate whether IP of cadaveric donor livers is protective to allografts. METHODS: IP (LT + IP, n = 6) was induced by 10-min hilar clamping. These were compared to cadaver donors with no IP (LT, n = 7). Clinical data and blood were obtained in donors and recipients for biochemical and inflammatory mediator (IM) measurements (P-selectin, leukotriene B4, myeloperoxidase, ICAM-1, IL-1, IL-6, and TNF-α). Liver tissue samples were obtained from donors and recipients (90 min after reperfusion). RESULTS: No significant differences were found in demographic characteristics between donors and recipients. When comparing both groups (LT + IP vs. LT only), ICU stay was longer in LT + IP group. For biochemical parameters, a significant difference was found only with a higher total bilirubin at postoperative day 3 in LT + IP group. There was no statistical difference in IM between LT and LT + IP groups at different stages of the study. Histological analysis of donor grafts indicated the presence of steatosis (50%) in one graft from the LT + IP group. However, in post-reperfusion biopsies neither neutrophil infiltration nor grade of necrosis showed significant difference between groups. No incidence of primary graft nonfunction (PGNF) was observed and graft and patient survival was similar in the two groups at 24 months. CONCLUSION: IP does not seem to protect against I/R injury in cadaveric LT, and no PGNF was seen.

[Kidney transplantation. Experience at the University Hospital José González, UANL in Monterrey, Mexico]. / Trasplante renal. Experiencia en el Hospital Universitario José E. González, UANL, en Monterrey, México.

BACKGROUND: In patients with end-stage renal disease, successful renal allotransplantation improves the quality of life and increases survival as compared with long-term dialysis treatment. OBJECTIVE: To show our experience, effectiveness and results of renal transplantations at the University Hospital of UANL. MATERIAL AND METHODS: A retrospective study of renal transplantation performed at University Hospital of UANL was done. The transplant cases from 1967 to July 2001 and January 2003 to June 2011 were included. RESULTS: 280 kidney transplants were performed in 264 patients, 146 men and 118 women; 201 from deceased donor and 79 from living donor. The patient survival at 1, 3, and 5 years was 98.8, 85.9 and 85.9%, respectively. The graft survival at 1, 3, and 5 years, censored for death with functioning graft, was 98.8, 85.7 and 74.9%, respectively. CONCLUSIONS: Our results, in this population with unfavorable socioeconomic conditions, are comparable to those obtained in other institutions.

[Posttransplant relapse in non viral hepatopathies]. / Recidiva postrasplante de hepatopatías no virales.

OBJECTIVE: We describe the recurrence of non-viral liver disease after orthotopic liver transplantation (OLT). METHODS AND RESULTS: We studied 39 patients who received an OLT for non-viral chronic liver disease. Six (15.3%) of these patients presented disease recurrence after OLT, one following alcohol abuse, 3 presented autoimmune liver disease [2 received an OLT for primary biliary cirrhosis and recurred as autoimmune hepatitis (AIH) one patient had cryptogenic cirrhosis before OLT and recurred as AIH]. One patient showed recurrence of a non-alcoholic steatohepatitis (NASH). One patient received an OLT for cirrhosis secondary to the use of metothrexate and post OLT developed secondary biliary cirrhosis due to a choledocal stenosis in the anastomotic site. CONCLUSIONS: All patients described here displayed long term recurrence (after 11 months post OLT). The recurrence of alcoholism was 8.3% among patients transplanted for this condition. AIH was observed in 30% of cases and NASH in 20%. All three patients with autoimmune liver disease recurred with a different autoimmune disease post OLT.

Recidiva postrasplante de hepatopatías no virales / Posttransplant relapse in non viral hepatopathies

Objetivo: El objetivo del presente trabajo fue analizar la frecuencia y presentación de recidiva de hepatopatías postrasplante no virales. Métodos y Resultados: Los pacientes con hepatopatías no virales que recibieron un trasplante hepático fueron 39 y de éstos, seis presentaron recidiva de la enfermedad (15.3%): uno con recaída del alcoholismo, tres con enfermedad autoinmune (dos trasplantados por cirrosis biliar primaria recurrieron con hepatitis autoinmune y uno con diagnóstico original de cirrosis hepática criptogénica presentó recurrencia de hepatitis autoinmune), uno con diagnóstico de esteatohepatitis no alcohólica tuvo recurrencia con la misma enfermedad; por último, un paciente se trasplantó por cirrosis hepática secundaria a metotrexate y postrasplante manifestó cirrosis biliar secundaria a estenosis del colédoco en el sitio de la anastomosis. Conclusiones: Todos los pacientes aquí analizados presentaron recidiva en el largo plazo (después de 11 meses postrasplante). La recidiva del alcoholismo se identificó en 8.3%, de las hepatopatías autoinmunes en 30%, y de la esteatohepatitis no alcohólica en 20% de los casos. Las tres pacientes con recidiva de hepatopatía autoinmune presentaron en el postras-plante una enfermedad diferente a la que dio origen al trasplante.

OBJECTIVE: We describe the recurrence of non-viral liver disease after orthotopic liver transplantation (OLT). METHODS AND RESULTS: We studied 39 patients who received an OLT for non-viral chronic liver disease. Six (15.3%) of these patients presented disease recurrence after OLT, one following alcohol abuse, 3 presented autoimmune liver disease [2 received an OLT for primary biliary cirrhosis and recurred as autoimmune hepatitis (AIH) one patient had cryptogenic cirrhosis before OLT and recurred as AIH]. One patient showed recurrence of a non-alcoholic steatohepatitis (NASH). One patient received an OLT for cirrhosis secondary to the use of metothrexate and post OLT developed secondary biliary cirrhosis due to a choledocal stenosis in the anastomotic site. CONCLUSIONS: All patients described here displayed long term recurrence (after 11 months post OLT). The recurrence of alcoholism was 8.3% among patients transplanted for this condition. AIH was observed in 30% of cases and NASH in 20%. All three patients with autoimmune liver disease recurred with a different autoimmune disease post OLT.

Development of a liver unit in Latin America.

The Liver Unit at the "Dr. José E. González" University Hospital and School of Medicine of the Autonomous University of Nuevo León in Monterrey was founded in 1983. Over the years, it has become a referral center for the northeast of Mexico. The frequency of diagnosis has changed: in 1983, the most common liver disease seen was alcoholic liver disease, today it is chronic hepatitis C. Amebic liver abscess, which used to be common, was hardly seen in 2001. Non-alcoholic fatty liver disease was unidentified 18 years ago, whereas in 2001 it was seen in 10% of patients. The development of five laboratories within the unit has allowed us to implement basic and clinical research trials, and to offer a high quality diagnostic service. The experimental liver transplant program started in 1987 and a clinical program in humans in 1991: four patients received an orthotopic liver transplantation in its first phase. In the second phase, 20 patients received allografts from September 1999 to March 2002. Technical complications have been encountered in only one patient, with a biliary leak, and there have been three perioperative deaths. Infections occurred in eight patients; all resolved. Acute postoperative rejection occurred in two patients, and in the first seven months in another five; all of them resolved. The two-year survival rate is 80%. This unit offers a highly specialized diagnosis, standardized specialized laboratory services and a transplant program that guarantees a higher quality of medical attention to patients with liver diseases.

Lesiones traumáticas del diafragma / Traumatic lesions of the diaphragm

Objetivo: Analizar la experiencia de un hospital universitario en el manejo terapéutico de la lesión diafragmática de origen traumático. Sede: Hospital Universitario "Dr. Eleuterio González", Nuevo León, México. Diseño: Estudio clínico de casos, retrospectivo y observacional, sin diseño estadístico. Pacientes y métodos: Se revisaron los expedientes clínicos de 8721 pacientes hospitalizados de enero de 1988 a diciembre de 1992; (5 años). Se analizaron las siguientes variables: sexo, edad, mecanismo de lesión, síntoma más frecuente, hallazgos radiológicos, lavado peritoneal, tipo de cirugía, lesiones asociadas, características de la lesión del diafragma, colocación de sonda en tórax y su duración, antimicrobianos empleados, complicaciones, días de estancia hospitalaria y mortalidad. Resultados: Se encontraron 54 pacientes con lesión diafragmatica, 53 varones y una mujer. Edad promedio 22 años, 25 por ciento tenían entre 17 y 20 años. Los mecanismos de lesión fueron de tres tipos: herida por arma punzo cortante, herida por proyectil de arma de fuego y traumatismo cerrado múltiple. Al 40 por ciento (22 pacientes) se les tomó telerradiografía de tórax, en 10 se observó hemoneumotórax, 8 del lado izquierdo y 2 del derecho. Se practicó lavado peritoneal a 32 pacientes (59 por ciento), todos resultaron positivos. El abordaje quirúrgico más empleado fue la laparotomía media en 44 sujetos (81 por ciento); el hígado fue el órgano más frecuentemente lesionado en 46 por ciento, le siguió el bazo con un 27 por ciento, todos requirieron esplenectomía. El hemidiafragma más lesionado resultó el izquierdo en 33 pacientes (61 por ciento). En el 74 por ciento (40 enfermos) el material de sutura con que se reparó la herida diafragmática fue la seda. Se colocó sonda de tórax a 30 pacientes con duración promedio de la misma de 5 días, el antimicrobiano más empleado fue la cefaxelina seguido de una combinación de cefalotina con metronidazol. Los días de estancia hospitalaria fueron en promedio de 7. La mortalidad fue del 3.7 por ciento. Conclusión: Las lesiones diafragmáticas son de difícil diagnóstico, se debe sospechar en todo paciente con trauma cerrado de tórax o abdomen superior, la telerradiografía de tórax es un buen método de diagnóstico y el lavado peritoneal lo complementa. La mortalidad es baja