Impact of COVID-19 on brain death and organ donation; a single center study in Turkey / Impacto del COVID-19 sobre la muerte cerebral y la donación de órganos; estudio de un centro en Turquía

ABSTRACT Objectives: More than 50 million people in the world have been diagnosed with COVID-19 and more than 1 million 250 thousand patients have died. With the increasing number of COVID-19 patients admitted to hospitals, problems related to non- COVID-19 patient care have emerged. Organ transplant organizations have had to adapt to this difficult time. The current and long- term impact due to the COVID-19 pandemic is an important factor to be taken into account. An important question to ask is how this outbreak has changed the organ donation process and how long it will take to address a potentially growing waiting list. Methods: We analized the effects of the pandemic COVID-19 in 2020 inTurkey between March and May. We have counted the number of brain deaths and organ donations in these months. We retrospectively compared the same months in 2019, the months before and after the pandemic in 2020, and the years 2019-2020. Results: When examined in other months, it is seen that the effect of the pandemic on brain death and organ donation continues not only in the months when the pandemic is intense, but also in other months. The total number of brain deaths in 2019 was 37, and family donations were 22; In 2020, the number of brain deaths decreased to 13, and family donations decreased to 7. This corresponds to a decrease of 64.86% and 68.18%, respectively, compared to the previous year. Conclusions: Brain death, organ onation and organ transplantation have decreased significantly with the onset of the pandemic compared to the previous years and the pre- pandemic period. Studies from different countries and regions have also shown that this decrease becomes even more pronounced where the number of cases is high.

RESUMEN Objetivos: Más de 50 millones de personas en el mundo han sido diagnosticadas con COVID-19 y más de 1 millón 250 mil pacientes han fallecido. Con el creciente número de pacientes con COVID-19 ingresados en hospitales, han surgido problemas relacionados con la atención de pacientes que no son de COVID-19. Las organizaciones de trasplantes de órganos han tenido que adaptarse a este momento difícil. El impacto actual y a largo plazo de la pandemia de COVID-19 es un factor importante a tener en cuenta. Una pregunta importante que debemos hacernos es cómo este brote ha cambiado el proceso de donación de órganos y cuánto tiempo llevará abordar una lista de espera potencialmente creciente. Material y métodos: Analizamos los efectos de la pandemia COVID-19 en 2020 en Turquía entre marzo y mayo. Hemos contado el número de muertes cerebrales y donaciones de órganos en estos meses. Comparamos retrospectivamente los mismos meses de 2019, los meses antes y después de la pandemia en 2020 y los años 2019-2020. Resultados: Cuando se examina en otros meses, se observa que el efecto de la pandemia sobre la muerte cerebral y la donación de órganos continúa no solo en los meses en que la pandemia es intensa, sino también en otros meses. El número total de muertes cerebrales en 2019 fue de 37 y las donaciones familiares fueron 22. En 2020, el número de muertes cerebrales disminuyó a 13 y las donaciones familiares disminuyeron a 7. Esto corresponde a una disminución del 64,86% y 68,18%, respectivamente, en comparación con el año anterior. Conclusiones: La muerte cerebral, la donación de órganos y el trasplante de órganos han disminuido significativamente con el inicio de la pandemia en comparación con los años anteriores y el período prepandémico. Los estudios de diferentes países y regiones también han demostrado que esta disminución se vuelve aún más pronunciada donde el número de casos es alto.

First Resection of a Cavoatrial Renal Tumor Thrombus in a Pediatric Patient in Central America Based on a Multistage Surgical Safety Strategy Combining Liver Transplant Techniques and Cardiac Surgery.

We herein report the challenging evaluation and planning process involved in performing the first successful surgical resection of a renal tumor with extensive inferior vena cava tumor thrombosis reaching the right atrium in a pediatric patient within the Central American region. In November 2018, the Oncology Department of the National Children's Hospital in Costa Rica consulted our Center for Liver Transplantation and Hepatobiliary Surgery for the evaluation of a clinical case involving a 6-year-old female patient with progressive Budd-Chiari syndrome caused by a Wilms' tumor of the right kidney with tumor thrombosis of the inferior vena cava reaching the right atrium. A multistage surgical safety strategy combining liver transplant techniques and cardiac surgery was thereafter designed and implemented, achieving complete excision of the tumor thrombus from the inferior vena cava with right nephrectomy. Postoperatively, the patient exhibited complete clinical resolution of Budd-Chiari syndrome and has remained tumor free with excellent quality of life while pursuing her second grade of primary school education 22 months after the successful implementation of this multistage surgical safety strategy. The combination of liver transplantation techniques and cardiac surgery based on a multistage surgical safety strategy minimized the occurrence of unexpected intraoperative events and allowed for complete renal tumor resection and level IV thrombectomy for the first time in a pediatric patient of a public health system in a developing country within the Central American region.

Decreased Incidence of Hepatic Artery Thrombosis in Pediatric Liver Transplantation Using Technical Variant Grafts: Report of the Society of Pediatric Liver Transplantation Experience.

OBJECTIVE: To evaluate risk factors for hepatic artery thrombosis (HAT) and examine the long-term outcomes of graft and patient survival after HAT in pediatric recipients of liver transplantation. STUDY DESIGN: Using multicenter data from the Society of Pediatric Liver Transplantation, Kaplan-Meier and Cox regression analyses were performed on first-time pediatric (aged <18 years) liver transplant recipients (n = 3801) in the US and Canada between 1995 and 2016. RESULTS: Of children undergoing their first liver transplantation, 7.4% developed HAT within the first 90 days of transplantation and, of those who were retransplanted, 20.7% developed recurrent HAT. Prolonged warm ischemia times increased the odds of developing HAT (OR, 1.11; P = .02). Adolescents aged 11-17 years (OR, 0.53; P = .03) and recipients with split, reduced, or living donor grafts had decreased odds of HAT (OR, 0.59; P < .001 compared with whole grafts). Fifty percent of children who developed HAT developed graft failure within the first 90 days of transplantation (adjusted hazard ratio, 11.87; 95% CI, 9.02-15.62) and had a significantly higher post-transplant mortality within the first 90 days after transplantation (adjusted hazard ratio, 6.18; 95% CI, 4.01-9.53). CONCLUSIONS: These data from an international registry demonstrate poorer long-term graft and patient survival in pediatric recipients whose post-transplant course is complicated by HAT. Notably, recipients of technical variant grafts had lower odds of HAT compared with whole liver grafts.