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1.
Rev Med Chil ; 149(2): 171-177, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479260

RESUMO

BACKGROUND: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. AIM: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. MATERIAL AND METHODS: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. RESULTS: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). CONCLUSIONS: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.


Assuntos
Transplante de Pulmão , Circulação Extracorpórea , Humanos , América Latina , Pulmão/cirurgia , Perfusão , Doadores de Tecidos
2.
Rev Med Chil ; 149(3): 385-392, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479317

RESUMO

BACKGROUND: The rates of organ donation are alarmingly low in Chile. AIM: To determine the relationship between social and family characteristics that influence the decision to donate organs and tissues among adults. MATERIAL AND METHODS: The questionnaire developed in Spain by the international collaborative project on organ transplantation and donation, developed and validated in Chile was applied to 383 adults aged 40 ± 17 years (mostly women), living in Coquimbo, Chile. RESULTS: Seventy seven percent of respondents would agree to be a donor. The main features of eventual donors are: being young adult in 62% of respondents, single in 48%, with complete secondary education in 29%, non-practicing Catholic in 37% and being informed on television about transplantation in 66%. In a logistic regression model, the features significantly associated with being an eventual donor were the decision of donating organs of relatives (Odds Ratio [OR] 9.1 95% confidence intervals [CI] 4.8-17-2), commenting and knowing the opinion of relatives (OR 2.3 95%CI 1.2-4.1), especially parents and partner, and a lower age (OR 0.98 95% CI 0.96-0.99). CONCLUSIONS: The decision to donate organs is influenced by commenting and knowing the opinion of relatives, especially parents and partners. Also, a lower age is associated with a better attitude towards donation.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Chile , Características da Família , Feminino , Humanos , Inquéritos e Questionários , Doadores de Tecidos , Adulto Jovem
3.
Rev Assoc Med Bras (1992) ; 67(4): 602-606, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34495068

RESUMO

OBJECTIVE: A survey among medical students in a Brazilian public university was performed to investigate the acceptance of organ donation in Brazil, particularly donation after circulatory death (DCD). METHODS: A questionnaire including 26 objectives and Likert scale questions was validated and sent to all medical students of our institution. The answers were analyzed considering the whole set of individuals as well as by dividing the medical students into two groups: less graduated students and more graduated students. RESULTS: From 1050 students, 103 spontaneous answers (9.8%) were retrieved after 3 weeks. A total of 89.3% agreed totally with deceased donor organ donation and 8.7% agreed partially. However, only 50.5% of the students agreed totally and 31.1% agreed partially to living donation. Students revealed that 82.6% know the concept of brain death. On the other hand, 71.8% of them declared not knowing the concept of planned withdrawal of life-sustaining therapy, mainly cardiorespiratory support. A total of 85.4% of students agreed totally with donation after brain death and 11.7% agreed partially. However, when questioned about donation in awaiting circulatory death after a planned withdrawal of life-sustaining therapy, only 18.4% agreed totally and 32% agreed partially. Both groups of less and more graduated students showed similar results. CONCLUSIONS: Our study found a clear lack of information and consequently in acceptance of DCD. Education in the field of end-of-life management may improve not only the acceptance of DCD donation but also the whole understanding of planned withdrawal of life-sustaining therapy.


Assuntos
Estudantes de Medicina , Obtenção de Tecidos e Órgãos , Atitude , Morte Encefálica , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e Questionários , Doadores de Tecidos
4.
Rinsho Ketsueki ; 62(8): 1327-1333, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497223

RESUMO

Inherited bone marrow failure syndromes (IBMFS) are caused by genetic mutations at loci associated with DNA repair, telomere maintenance, and ribosome function. Hematopoietic stem cell transplantation (HSCT) can result in a permanent cure in transfusion-dependent patients if reduced-intensity conditioning and long-term screening for relapse can be successfully implemented. Primary immunodeficiency diseases (PIDs) arise from inborn errors of the host immune system and affected patients must protect themselves against intractable infections and immune system dysregulation. HSCT is curative in many pediatric patients; however, specific immunomodulatory therapies are now available for controlling autoimmune and/or autoinflammatory diseases. Advanced clinical sequencing technologies have continued to identify novel monogenic diseases that share the phenotype of hematological and immunological abnormalities, along with adult cases of IBMFS and/or PIDs. Importantly, genetic counseling is required for carrier detection while selecting sibling donors for HSCT. Here, we describe treatment strategies for IBMFS and/or PIDs and associated pitfalls.


Assuntos
Doenças da Medula Óssea , Transplante de Células-Tronco Hematopoéticas , Doenças da Imunodeficiência Primária , Doenças da Medula Óssea/genética , Doenças da Medula Óssea/terapia , Criança , Síndrome Congênita de Insuficiência da Medula Óssea , Humanos , Doadores de Tecidos , Condicionamento Pré-Transplante
5.
Chirurgia (Bucur) ; 116(4): 451-465, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34498564

RESUMO

Background: The need to maximize the use of donor organs and the issue of ischemia-reperfusion injury led to the use of thermoregulated oxygenated machine perfusion that improves the function of liver graft prior to transplantation. Among these methods, the HOPE (hypothermic oxygenated perfusion) protocol shows significant benefits. The aim of the paper is to analyze the early experience in using such procedure in a high-volume liver transplantation center. Methods: Normal liver grafts with cold ischemia time â?¥6 hours, marginal grafts and discarded (beyond ECD criteria) grafts were perfused using HOPE. Our selection criteria for dual HOPE (hepatic artery and portal perfusion) were steatosis, at least 3 associated ECD criteria, and discarded grafts. The main criteria to establish graft improvement were the progressive increase of arterial and portal flows, with lactate under 3 mmol/L or, even if over this value, with a decreasing trend during perfusion. Results: Whole liver grafts harvested from 28 donors between February 2016 and June 2021 benefitted from HOPE: 9 otherwise discarded grafts were assessed and considered not fit for transplantation, while the other 19 were ECD or standard grafts that were subsequently transplanted. Dual HOPE was used in 8 out of the 19 procedures (42.1%). We obtained a significant increase of arterial and portal flow (p=0.005 and p=0.001, respectively). In recipients, significant improvement of AST, ALT, INR and lactate values were recorded (p 0.001, p 0.001, p 0.001, and p=0.05, respectively). The rate of major postoperative complications (Dindo-Clavien grade 3) after LT was 26.3%, while the rate of early graft dysfunction was 15.8%. No PRS or acute rejection was recorded. The postoperative mortality rate was 15.8%. After a median follow-up of 9.3 months (range 2-44), the late major complication rate was 15.8%, without mortality. Conclusion: Machine perfusion is nowadays part of current clinical practice. This way, marginal liver grafts (DCD, ECD-DBD) may be safely used for transplantation improving the outcome, thus effectively enhance the use of a persistent scarce pool of donors. For best results, we believe that both techniques of HOPE (mono and dual HOPE) should be used based on specific selection criteria.


Assuntos
Transplante de Fígado , Sobrevivência de Enxerto , Humanos , Fígado/cirurgia , Preservação de Órgãos , Perfusão , Doadores de Tecidos , Resultado do Tratamento
6.
Cardiol Young ; 31(8): 1238-1240, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34493355

RESUMO

The growing unmet demand for suitable organ donors increases each year. Despite relative contraindications for thoracic organ donation after previous cardiac surgery, experienced programmes and surgeons can successfully utilise the lungs from select donors who have undergone prior cardiac surgery. This is the first reported case of double lung en bloc procurement from a donor who had a previous arterial switch operation as an infant.


Assuntos
Transposição das Grandes Artérias , Procedimentos Cirúrgicos Cardíacos , Transplante de Pulmão , Obtenção de Tecidos e Órgãos , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Doadores de Tecidos
7.
Saudi Med J ; 42(9): 927-968, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470833

RESUMO

The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country's high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a significantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.


Assuntos
Diabetes Mellitus Tipo 2 , Transplante de Fígado , Obtenção de Tecidos e Órgãos , Adulto , Humanos , Arábia Saudita/epidemiologia , Sociedades Médicas , Doadores de Tecidos
9.
Urologiia ; (4): 87-92, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34486280

RESUMO

INTRODUCTION: In recent months, with the spread of COVID 19, the number of kidney transplants from deceased donors has declined significantly in most countries. One of the reasons is the possibility of infection of the recipient with SARS-CoV-2. Determining the risk of transmission of COVID 19 with a donor organ is very important for developing a kidney transplantation policy during a pandemic. MATERIAL AND METHOD: We present cases of kidney transplantation from COVID 19 positive deceased donor to two dialysis patients in single center. Deceased donor: a 45 years old man with diabetes, who had a major hemorrhagic stroke resulting in brain death. He had normal urine output and serum creatinine level for last 24 hours before kidney harvesting. For a few hours after organ harvesting, the donor was diagnosed COVID 19 (retrospective nasopharyngeal swab rRT-PCR which was confirmed by morphological examination and RNA-PCR of specimens from the trachea and bronchus). Recipient 1: a 49 years old man with polycystic kidney disease had been on hemodialysis for 28 months. He was in urgent list because of problems with vascular access. So non identical ABO (0-donor, B-recipient) kidney transplantation from this deceased donor was done in May 2020. Recipient 2: a 45 years old man with polycystic kidney disease on continuous ambulatory peritoneal dialysis (CAPD). was registered on urgent waiting list because of low transport capacity of peritoneum. Kidney transplantation from the same deceased donor was done at the same time. In both cases we completely abandoned any antilymphocytic agents for induction, despite non ABO identical transplantation in one of the recipients and the delayed graft function. Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone and a mycophenolic acid. RESULTS: In first case cold ischemia time was 22 hours. The recipient had delayed graft function with increasing of urine output on day 8 post-transplant. No other deviations from the usual course were seen during hospital stay. The patient was discharge from hospital with serum creatinine level 122 mkmol/L. The cold ischemia time was 21 hours in another patient. Graft function was immediate with a decrease serum creatinine to 92.5 mkmol/L at discharge. Both patients had no febrile and no other symptoms of acute respiratory disease during all hospital stay. No abnormalities on chest X-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs rRT-PCR were negative during all the period. Both recipients were discharged for 5 weeks after surgery to prevent out-of-hospital contamination of COVID 19, which would be difficult to differentiate from transmission infection. After 9 months both patients are doing well with no clinical or laboratory signs of COVID-19. CONCLUSION: Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-Cov-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level. Avoiding the use of anti-lymphocyte drugs for induction of immunosuppression may also reduce the risk of developing COVID19 after transplantation. A careful collection and analysis of such dates is necessary to develop modern practical recommendations for transplant centers.


Assuntos
COVID-19 , Transplante de Rim , Doadores de Tecidos , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Neurol India ; 69(4): 995-996, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507427

RESUMO

Formal brainstem reflex testing remains one of the most important procedures in identification and evaluation of patients who meet clinical criteria for brainstem death. Early identification of such patients is critical since willing donors may contribute to the organ donation process. During the first two waves of the coronavirus disease of 2019 (COVID-19) pandemic, organ transplantation from brainstem dead donors has declined significantly due to several reasons, including perceived increased risk of virus transmission to both physicians as well as patients as well as lack of awareness regarding donor workup in the context of the COVID-19 pandemic.


Assuntos
Morte Encefálica , COVID-19 , Morte Encefálica/diagnóstico , Humanos , Pandemias , SARS-CoV-2 , Doadores de Tecidos
12.
Indian J Ophthalmol ; 69(9): 2441-2445, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427240

RESUMO

Purpose: To describe a simple manual surgical technique for splitting a single-donor eye for performing both deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) without using a microkeratome. Methods: Twenty-three eyes with anterior stromal pathology and 23 eyes with irreversible endothelial dysfunction were evaluated for keratoplasty at a tertiary eye care referral center. Twenty-three healthy donor corneas were split into two parts. The Descemet's membrane was stripped and used for DMEK. The stripped stroma was used for DALK. Best-corrected visual acuity (BCVA) of both DALK and DMEK, endothelial cell density, and endothelial cell loss in DMEK were noted at 1-year follow-up, along with any intraoperative or postoperative complications and failures. Results: In the DALK group, mean BCVA improved from 1.264 ± 0.25 log Mar preoperatively to 0.355 ± 0.27 log Mar at 12 months follow-up. There were no complications and failures. In the DMEK group, mean BCVA improved from 1.537 ± 0.61 log Mar preoperatively to 0.592 ± 0.67 log Mar and the mean donor ECD was 3071.66 (range, 2783-3487) cells/mm2 preoperatively, which was reduced to 1989.33 (range, 1546-2543) cells/mm2 at 12 months follow-up indicating a mean endothelial cell loss of 35%. The failure rate was 21.7%. Conclusion: This study demonstrates that with a single donor corneal tissue, both DALK and DMEK can be performed successfully without any complications. Our technique will help corneal surgeons in all developing countries to cost effectively perform more lamellar surgeries and help in reducing the magnitude of corneal blindness without the need for expensive microkeratomes.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Córnea , Doenças da Córnea/cirurgia , Lâmina Limitante Posterior/cirurgia , Humanos , Doadores de Tecidos
13.
Indian J Ophthalmol ; 69(9): 2452-2456, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427243

RESUMO

Purpose: To compare the physical and microbiological characteristics of McCarey-Kaufman (MK), Cornisol, and Optisol-GS media and evaluate the outcomes of keratoplasty performed using corneas stored in these three media. Methods: The study involved 60 donor corneas which were distributed in 3 groups: MK, Cornisol, and Optisol-GS. Corneas in these groups were further analyzed based on the type of keratoplasty performed (full thickness versus endothelial keratoplasty). At baseline, the endothelial cell density and death to preservation time of donor corneas were recorded. Following keratoplasty, patients were evaluated on day 1, at 1 month, 3 months, and 6 months follow-up. Outcomes were assessed in terms of corrected distance visual acuity (CDVA), endothelial cell density, percentage endothelial cell loss, and corneal thickness. The storage media were also assessed for their physical quality and their microbiological characteristics. Results: Physical characteristics of all three media were found to be within normal limits. Mean CDVA was comparable among the 3 groups at 6-month follow-up. The absolute endothelial cell count values were significantly lower for corneas stored in MK medium (1873.7 ± 261.1 cells/mm2) compared to the Cornisol (2085.0 ± 230.3 cells/mm2) and Optisol-GS media [(2180.3 ± 217.2 cells/mm2) (P = <0.001)]. Corneas stored in Optisol-GS medium were significantly thinner at 1-month follow-up with no significant difference at 6 months (P = 0.66). Conclusion: Optisol-GS and Cornisol media were found to preserve endothelial cell density better and stabilize corneal thickness earlier as compared to the MK medium. However, the functional outcomes were comparable among the three groups.


Assuntos
Endotélio Corneano , Preservação de Órgãos , Córnea/cirurgia , Meios de Cultura Livres de Soro , Humanos , Doadores de Tecidos
14.
Nat Commun ; 12(1): 4844, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34381053

RESUMO

Acute leukemia relapsing after chemotherapy plus allogeneic hematopoietic stem cell transplantation can be treated with donor-derived T cells, but this is hampered by the need for donor/recipient MHC-matching and often results in graft-versus-host disease, prompting the search for new donor-unrestricted strategies targeting malignant cells. Leukemia blasts express CD1c antigen-presenting molecules, which are identical in all individuals and expressed only by mature leukocytes, and are recognized by T cell clones specific for the CD1c-restricted leukemia-associated methyl-lysophosphatidic acid (mLPA) lipid antigen. Here, we show that human T cells engineered to express an mLPA-specific TCR, target diverse CD1c-expressing leukemia blasts in vitro and significantly delay the progression of three models of leukemia xenograft in NSG mice, an effect that is boosted by mLPA-cellular immunization. These results highlight a strategy to redirect T cells against leukemia via transfer of a lipid-specific TCR that could be used across MHC barriers with reduced risk of graft-versus-host disease.


Assuntos
Antígenos CD1/imunologia , Glicoproteínas/imunologia , Leucemia/imunologia , Lisofosfolipídeos/imunologia , Receptores de Antígenos de Linfócitos T/imunologia , Linfócitos T/imunologia , Doadores de Tecidos , Animais , Apresentação do Antígeno , Antígenos CD1/metabolismo , Glicoproteínas/metabolismo , Humanos , Imunoterapia Adotiva , Leucemia/metabolismo , Leucemia/terapia , Ativação Linfocitária , Camundongos , Receptores de Antígenos de Linfócitos T/genética , Receptores de Antígenos Quiméricos/genética , Receptores de Antígenos Quiméricos/imunologia , Resultado do Tratamento , Ensaios Antitumorais Modelo de Xenoenxerto
16.
J Health Care Poor Underserved ; 32(3): 1276-1287, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421030

RESUMO

The DHR Health Institute for Research and Development spearheaded a region-wide initiative to establish a Rio Grande Valley (RGV) Collaborative for early diagnosis, prevention, and treatment of COVID-19. The Collaborative was established on March 23, 2020, to conserve resources and provide the best clinical care in the face of an imminent regional health crisis in an underserved community, predominantly of Hispanic heritage with some of the highest rates of chronic diseases in the United States. The use of plasma obtained from convalesced SARS-CoV-2-infected donors was approved by the FDA and the RGV Collaborative took this as its initial challenge. To date, over 2,200 patients with severe and life-threatening COVID-19 have successfully received transfusion of convalescent plasma in various health care facilities in the RGV. The RGV Collaborative is a unique model for creating an effective public health strategy for the delivery of quality clinical care, especially in underserved communities.


Assuntos
COVID-19/terapia , Imunização Passiva , COVID-19/sangue , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Aprovação de Drogas , Hispano-Americanos , Humanos , Área Carente de Assistência Médica , Texas/epidemiologia , Doadores de Tecidos
17.
Nutrients ; 13(8)2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34444713

RESUMO

Herein, we investigate whether: (1) the administration of glucose or a lipid emulsion is useful in liver transplantation (LT) using steatotic (induced genetically or nutritionally) or non-steatotic livers from donors after brain death (DBDs); and (2) any such benefits are due to reductions in intestinal damage and consequently to gut microbiota preservation. In recipients from DBDs, we show increased hepatic damage and failure in the maintenance of ATP, glycogen, phospholipid and growth factor (HGF, IGF1 and VEGFA) levels, compared to recipients from non-DBDs. In recipients of non-steatotic grafts from DBDs, the administration of glucose or lipids did not protect against hepatic damage. This was associated with unchanged ATP, glycogen, phospholipid and growth factor levels. However, the administration of lipids in steatotic grafts from DBDs protected against damage and ATP and glycogen drop and increased phospholipid levels. This was associated with increases in growth factors. In all recipients from DBDs, intestinal inflammation and damage (evaluated by LPS, vascular permeability, mucosal damage, TLR4, TNF, IL1, IL-10, MPO, MDA and edema formation) was not shown. In such cases, potential changes in gut microbiota would not be relevant since neither inflammation nor damage was evidenced in the intestine following LT in any of the groups evaluated. In conclusion, lipid treatment is the preferable nutritional support to protect against hepatic damage in steatotic LT from DBDs; the benefits were independent of alterations in the recipient intestine.


Assuntos
Morte Encefálica , Fígado Gorduroso , Glucose/administração & dosagem , Transplante de Fígado , Fígado/metabolismo , Fosfolipídeos/administração & dosagem , Óleo de Soja/administração & dosagem , Trifosfato de Adenosina/metabolismo , Animais , Modelos Animais de Doenças , Emulsões/administração & dosagem , Fígado Gorduroso/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Intestinos/patologia , Intestinos/fisiopatologia , Fígado/patologia , Glicogênio Hepático/metabolismo , Masculino , Obesidade , Fosfolipídeos/metabolismo , Ratos , Ratos Zucker , Doadores de Tecidos
18.
Nephrol Nurs J ; 48(4): 367-387, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463465

RESUMO

Major changes were made to the U.S. kidney allocation system (KAS) on December 4, 2014, in the effort to address disparities in kidney transplantation (KT) and achieve equity in organ allocation. Research is necessary to examine whether KAS achieved its goal; first, a firm understanding of the disparities that existed prior to implementation of KAS is needed. This systematic review examined the literature on disparities in access to deceased donor KT (DDKT) after listing in the pre-KAS era and discussed mechanisms to explain these disparities. Thirty-two articles were included. Racial, gender, age, socioeconomic, physiologic, geographic, and health care system disparities existed in the pre-KAS era. Findings of this review will inform the agenda for future disparities research in the post-KAS era.


Assuntos
Transplante de Rim , Obtenção de Tecidos e Órgãos , Disparidades em Assistência à Saúde , Humanos , Rim , Doadores de Tecidos
20.
Rinsho Ketsueki ; 62(6): 593-601, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34219086

RESUMO

A human leukocyte antigen (HLA)-matched related donor is considered as the first donor candidate in case of allogenic hematopoietic stem cell transplantation (allo-HSCT). Given the declining birthrate and aging population in Japan, the number of sibling donors is also decreasing. Hence, candidates other than HLA-matched siblings, named "alternative donors," have attracted increasing attention. Improved graft-versus-host disease (GvHD) prophylaxis with posttransplant cyclophosphamide or pretransplant antithymocyte globulin represented a major breakthrough in allo-HSCT with alternative donors by overcoming the barriers of HLA mismatch. In addition, there have been improved outcomes of unrelated cord blood transplantation, owing to better unit selection along with improved GvHD prophylaxis and supporting strategies. These changes have expanded the range of donor options and consequently, increased donor availability at the critical moment for allo-HSCT. The next challenge that warrants further investigation is the development of personalized strategies to select the best donor from the available multiple options according to the status of each patient.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Idoso , Soro Antilinfocitário , Humanos , Japão , Irmãos , Doadores de Tecidos
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