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3.
Indian J Ophthalmol ; 68(11): 2368-2371, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33120619

RESUMO

Purpose: The purpose of this study was to discuss the guidelines and modification of practices with respect to corneal transplantation and eye banking during the COVID-19 pandemic lockdown period and beyond, at a network of tertiary care centers in India. Methods: Descriptive study of the challenges faced in eye banking during the lockdown, and practices adopted to overcome the critical aspects in the clinical care of patients who presented with emergency corneal diseases requiring keratoplasty. Results: Complete lockdown orders from the Indian government, as a strategy to control the Coronavirus pandemic, resulted in drastic reduction of all types of elective corneal transplants and eye banking activities from March 24, 2020 to May 31, 2020. The sudden cessation of eye banking resulted in an acute demand and supply imbalance of fresh donor corneas for transplants during this time. Our network of eye banks addressed this issue by adopting glycerol preservation of donor corneas, which were subsequently utilized for tectonic penetrating keratoplasty. The donor cornea retrieval was resumed in a strategized manner 3 weeks prior to the date of exit of the lockdown, with modified guidelines on donor suitability, screening, retrieval, processing, and harvesting from various sources. A triage of keratoplasty priority was formulated to tide over the post lockdown shortage of corneas. We performed 31 therapeutic keratoplasties during the nationwide lockdown among our network of tertiary eye care centers. Conclusion: The study highlights the approach and strategies to manage and tide over an unprecedented crisis situation faced by corneal surgeons in general and, specifically, the eye banking community.


Assuntos
Betacoronavirus , Doenças da Córnea/cirurgia , Transplante de Córnea/métodos , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Bancos de Olhos/métodos , Pneumonia Viral/transmissão , Quarentena/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Bancos de Olhos/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária , Doadores de Tecidos/provisão & distribução
7.
J Cardiothorac Vasc Anesth ; 34(11): 3073-3077, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32660929

RESUMO

Worldwide, the majority of heart transplant organs are from donation after brain death. However, the shortage of suitable donors places severe limitations on this route. One option to increase the donor pool is to use organs from donation after circulatory death (DCD). Transplant centers for solid organs have been using DCD organs for years. At this time, 40% of solid organ transplantation in the United Kingdom uses organs from DCD. Use of DCD for solid organ transplants in Canada is also rising. Recently, there has been interest in using DCD organs for heart transplantation. The authors will discuss their experience of 4 heart transplants with organs from DCD donors after normothermic regional perfusion (NRP). The authors' first heart transplant using a DCD organ was in January 2020, and the fourth was in March 2020, just before the coronavirus disease 2019 (COVID-19) pandemic. The authors' protocol using NRP allows adequate evaluation of the donor heart to confidently determine organ acceptance. The co-location of the donor and the recipient in neighboring operating rooms limits ischemic times. Avoidance of an expensive ex vivo organ perfusion machine is an additional benefit for programs that may not have the resources required to purchase and maintain the machine. Some hospitals may not have the resources and space to be able to co-locate both the donor and recipient. Use of cold storage may be an option to transport the procured organ, similar to donation after brain death organs. The authors hope that this technique of NRP in DCD donors can help further increase the donor pool for heart transplantation in the United States.


Assuntos
Anestesia/métodos , Anestésicos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cardiopatias/cirurgia , Transplante de Coração/métodos , Pneumonia Viral/epidemiologia , Doadores de Tecidos/provisão & distribução , Adolescente , Adulto , Comorbidade , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
8.
J Card Surg ; 35(8): 1802-1810, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652710

RESUMO

BACKGROUND AND AIM OF THE STUDY: In developed countries, the shortage of viable donors is the main limiting factor of heart transplantation. The aim of this study is to determine whether the same reality applies to Brazil. METHODS: Between January 2012 and December 2014, 299 adult heart donor offers were studied in terms of donor profiles and reasons for refusal. The European donor scoring system was calculated, being high-risk donors defined as more than 17 points. The donor scoring system was used to objectively determine the donor profile and correlate with donor acceptance and posttransplant primary graft dysfunction and recipient survival. Cox proportional hazard model was used in determining the predictors of long-term mortality. RESULTS: The rates of donor acceptance and heart transplants performed were 45.8% and 19.3%, respectively. Reasons for refusal were mostly nonmedical (53.7%). The majority of donors were classified as high-risk (65.5%). Hearts from high-risk donors did not impact primary graft dysfunction (14.3% vs 10%; P = .6), neither long-term survival (P = .4 by logrank test). Recipient's age was greater than 50 years (hazard ratio, 6.02; 95% confidence interval, 2.41-16.08; P < .0001) and was the only predictor of long-term mortality. CONCLUSIONS: The shortage of donors is not the main limiting factor of heart transplantation in the Mid-West of Brazil. Nonmedical issues represent the main reason for organ discard. Most of the donors are classified as high risk which indicates that an expanded donor pool is a routine practice in our region, and donor scoring does not seem to influence to proceed with the transplant.


Assuntos
Transplante de Coração , Doadores de Tecidos/provisão & distribução , Brasil/epidemiologia , Humanos
9.
Transplant Proc ; 52(9): 2684-2687, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32620390

RESUMO

Coronavirus disease 2019 (COVID-19) has been recently declared a global pandemic. As of June 5, 2020, over 75,000 cases have been reported with nearly 2500 deaths in India alone. COVID-19 has severely impacted deceased donor liver transplant (DDLT) programs throughout the world. Acceptance of deceased liver donors has decreased worldwide because of the unknown risks associated with COVID-19 transmission or postoperative infection in the immediate post-transplant period, along with the risks to the health care workers in a multidisciplinary setting. In India, DDLT has come to a standstill in the setting of a national lockdown. Many national guidelines have emerged on how to safely perform transplant as well on immunosuppressive regimens and care of patients posttransplant. Here, we take a look at the current situation and summarize the different guidelines and future perspectives of DDLT in India in the COVID-19 era.


Assuntos
Infecções por Coronavirus , Transplante de Fígado , Pandemias , Pneumonia Viral , Doadores de Tecidos/provisão & distribução , Betacoronavirus , Humanos , Índia , Transplante de Fígado/estatística & dados numéricos , Transplante de Fígado/tendências
10.
Transplant Proc ; 52(6): 1643-1646, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32624231

RESUMO

OBJECTIVES: Organ allocation is of decisive importance in the current situation of organ shortage. The aim of this study is to compare the long-term graft outcomes of deceased donor recipients before and after the new nationwide allocation system in Taiwan. METHODS: From April 1, 2000 to March 31, 2010, 181 deceased kidney transplantations were reviewed retrospectively, and recipients were divided by the enforcement day (April 1, 2005) of nationwide allocation into group 1 (before) and group 2 (after). Baseline demographics were reviewed. Outcomes, including graft survival (GS) and patient survival, at 1-, 3-, 5-, and 10-years after transplantation were analyzed. RESULTS: The baseline demography was similar between the 2 groups except that group 1 is younger. Group 2 has less HLA-B (P < .001) and HLA mismatches (P = .005). There were significantly more 0-mismatch recipients in group 2 (6 vs 27, P = .001), as well as extended criteria donor (ECD) recipients (0 vs 7). Group 2 has less optimal 1-year GS (95.6% vs 86.8%, Log-Rank P = .037), which becomes nonsignificant at 3-, 5-, and 10-years after transplantation. By excluding ECD recipients, the GS were similar at all time. There was no difference in patient survival between the 2 groups. CONCLUSION: The new nationwide allocation system provided us more 0-mismatch kidneys. The nationwide scheme remains beneficial to kidney recipients after the acute adverse effects of ECD and aging vanish.


Assuntos
Seleção do Doador , Transplante de Rim , Doadores de Tecidos/provisão & distribução , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan , Resultado do Tratamento
11.
Nephrol Dial Transplant ; 35(6): 1043-1070, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32516809

RESUMO

BACKGROUND: Most studies comparing the efficacy of hypothermic machine perfusion (HMP) versus static cold storage (SCS) are based on short-term outcomes. We aimed to better evaluate the mid-term impact of HMP in patients receiving expanded criteria donor (ECD) kidneys. METHODS: The analyses were based on the French Données Informatisées et VAlidées en Transplantation (DIVAT) observational cohort. Patients aged ≥45 years transplanted for the first or second times from an ECD donor since 2010 were studied. Our study reported the graft and/or patient survivals and the incidence of acute rejection episode. The Cox models and the Kaplan-Meier estimators, weighted on the propensity score, were used to study the times-to-events. RESULTS: Among the 2019 included patients, 1073 were in the SCS group versus 946 in the HMP group. The mean life expectancy with functioning graft was 5.7 years [95% confidence interval (CI) 5.4-6.1] for the HMP cohort followed-up for 8 years post-transplantation versus 6.0 years (95% CI 5.7-6.2) for the SCS group. These mid-term results were comparable in the patients receiving grafts from donors aged ≥70 years and in the transplantations with cold ischaemia time ≥18 h. CONCLUSIONS: Our study challenges the utility of using HMP to improve mid-term patient and graft survival. Nevertheless, the improvement of the short-term outcomes is indisputable. It is necessary to continue technological innovations to obtain long-term results.


Assuntos
Criopreservação/métodos , Função Retardada do Enxerto/prevenção & controle , Hipotermia Induzida/métodos , Transplante de Rim/métodos , Perfusão/instrumentação , Perfusão/métodos , Doadores de Tecidos/provisão & distribução , Idoso , Estudos de Coortes , Seleção do Doador , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade
13.
Transplant Proc ; 52(6): 1647-1649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32576472

RESUMO

OBJECTIVES: This report presents an audit of utilization of various organs from deceased donors in different states of India over a 3-year period METHODS: Data released by the various regions on their official website was analyzed from 2015 to 2017.Regions with less than 25 donations per year were excluded while calculating utilization rates. RESULTS: Total organ donation in India had increased from 570 to 843 donations from 2015 to 2017 (47.8% increase) with southern states performing exceedingly well compared with northern states. Total organs retrieved during the 3-year period were 6659 with a 54.7% increase in organ retrieval in 2017 compared with 2015 (2592 vs 1675 respectively). The net utilization rate of kidneys was 87.35%. Total liver transplants done during this period were 1894. Net liver utilization rate was 86.81% over 3 years. Total Heart transplants during this period were 641 with net utilization rate of 28.98%. An increase in utilization rates was observed from 2015 to 2017 (19.33%-34.46%). A total of 217 lung transplants were done with net utilization rate of 8.86% with an increase in yearly utilization rate from 6.5% in 2015 to 11.97% in 2017. Total pancreas transplants remained low with 48 transplants over 3 year duration with net utilization rate of 2.25% but an increase in utilization rate was observed. (0.92% in 2015 to 2.1% in 2017). CONCLUSION: There is a significant regional variability in organ utilization in India. Evaluating and addressing the cause of high variability can further increase the transplant activity.


Assuntos
Transplante de Órgãos/estatística & dados numéricos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Transplantes/estatística & dados numéricos , Feminino , Humanos , Índia , Estudos Retrospectivos , Doadores de Tecidos/provisão & distribução
14.
Sci Rep ; 10(1): 8109, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415140

RESUMO

Kidney transplantations using expanded criteria donors (ECD) are being increasingly adopted, but no consensus tools are available to evaluate donor kidney status. Beta-2 microglobulin (B2MG) is a marker of kidney function, and herein, we evaluate the usefulness of assessing B2MG to evaluate donor kidney status. Fifty-seven kidney transplantations were performed from March 2017 to April 2019. Medical records were retrospectively reviewed, and relationships between clinical and laboratory variables and transplant outcomes were investigated. Thirty-eight patients received a standard criteria donor kidney and 19 patients an ECD kidney. Ten patients experienced delayed graft function (DGF), but no patient experienced primary nonfunction. Of the parameters studied, only donor renal replacement therapy (RRT) [odds ratio (OR) 24.162; p = 0.018] and donor serum B2MG (OR 22.685; p = 0.022) significantly predicted DGF. The presence of either of these two risk factors can better reflect the condition of the donor than previous classification. However, on their last follow-up creatinine and estimated glomerular filtration rate values in those with or without these risk factors were not significantly different. For an ECD with a B2MG level of <7.18 and no history of RRT, kidney transplantation can be undertaken without considering the possibility of kidney discard.


Assuntos
Função Retardada do Enxerto/diagnóstico , Sobrevivência de Enxerto , Transplante de Rim/métodos , Rim/fisiopatologia , Doadores de Tecidos/provisão & distribução , Microglobulina beta-2/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Função Retardada do Enxerto/sangue , Função Retardada do Enxerto/epidemiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
15.
Am J Transplant ; 20(9): 2593-2598, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32359194

RESUMO

Spain has been one of the most affected countries by the COVID-19 outbreak. As of April 28, 2020, the number of confirmed cases is 210 773, including 102 548 patients recovered, more than 10 300 admitted to the ICU, and 23 822 deaths, with a global case fatality rate of 11.3%. From the perspective of donation and transplantation, the Spanish system first focused on safety issues, providing recommendations for donor evaluation and testing, and to rule out SARS-CoV-2 infection in potential recipients prior to transplantation. Since the country entered into an epidemiological scenario of sustained community transmission and saturation of intensive care, developing donation and transplantation procedures has become highly complex. Since the national state of alarm was declared in Spain on March 13, 2020, the mean number of donors has declined from 7.2 to 1.2 per day, and the mean number of transplants from 16.1 to 2.1 per day. Increased mortality on the waiting list may become a collateral damage of this terrible pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transplante de Órgãos , Pneumonia Viral/epidemiologia , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/organização & administração , Humanos , Pandemias , Espanha/epidemiologia , Listas de Espera
17.
Transplant Proc ; 52(6): 1891-1900, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32389486

RESUMO

BACKGROUND: Liver transplantation from donors after cardiac death (DCDs) can increase the pool of available organs. Recently, mesenchymal stem cells (MSCs) have been used to treat various diseases. Some studies have reported that MSCs improve the outcome of liver transplantation from DCDs in mice. The aim of this study was to evaluate the cytoprotective effects and safety of MSC transplantation on liver grafts from DCDs in swine. METHODS: For the MSCs, we used swine adipose-derived stem cells (ADSCs). Landrace swine were divided into 3 groups (n = 5) as follows: 1. the heart-beating (HB) group, from which liver grafts were retrieved and transplanted; 2. the DCD group, from which liver grafts were retrieved 10 minutes after apnea-induced cardiac arrest and transplanted; and 3. the ADSC group, from which liver grafts were retrieved as with the DCD group, transplanted, and then infused with 1.0 × 107 ADSCs 2 hours after reperfusion. RESULTS: In the HB group, all 5 recipients survived for >7 days, whereas all 5 recipients in the DCD group died within 24 hours after transplantation. In the ADSC group, 3 recipients survived for >7 days, whereas 2 recipients died within 4 days after transplantation. The survival rate was significantly higher in the ADSC group than in the DCD group. CONCLUSIONS: MSCs could protect the function of liver grafts from warm ischemia-reperfusion injury and improve the viability of DCD liver grafts.


Assuntos
Sobrevivência de Enxerto , Transplante de Fígado/métodos , Transplante de Células-Tronco Mesenquimais , Animais , Morte , Masculino , Suínos , Doadores de Tecidos/provisão & distribução , Isquemia Quente/efeitos adversos
18.
Transplant Proc ; 52(5): 1318-1324, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32439332

RESUMO

OBJECTIVES: No study has investigated the short-term effect of acute insulin resistance on liver steatosis in critically ill condition. We analyzed the effects of critically ill conditions of brain-dead donors (BDDs) on the development and progression of liver steatosis to investigate the influencing factors. METHODS: This study was conducted retrospectively between January 2003 and December 2017. BDDs were for organ procurement. BDDs with body mass indexes (BMIs) < 18.5 kg/m2 and ≥ 30 kg/m2 were excluded. Liver steatosis was defined as ≥5% of the fat vacuole. The serum glucose level (SGL) was used to reflect insulin resistance. RESULTS: Of the 179 BDDs, 87 (48.6%) had liver steatosis. BMI (r = 0.176, P = .019) and SGL (r = 0.267, P < .001) were correlated with steatosis. The length of the predonation period (LPDP) was negatively correlated with steatosis (r = -0.379, P < .001). BMI (odds ratio 1.266, P = .002), SGL ≥180 mg/dL (odds ratio 2.825, P = .003), and LPDP (odds ratio 0.885, P = .001) were independent risk factors for liver steatosis. CONCLUSION: Liver steatosis is related to the SGL and BMI. Liver steatosis develops acutely in the early phase of critical illness and patients recover gradually.


Assuntos
Fígado Gorduroso , Transplante de Fígado , Doadores de Tecidos/provisão & distribução , Transplantes/patologia , Adulto , Índice de Massa Corporal , Morte Encefálica , Estado Terminal , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
19.
PLoS One ; 15(5): e0233392, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437464

RESUMO

Fresh corneal donation is essential for basic and preclinical research, but more unknown to public and the medical teams than donation for transplantation: it may raise concerns. We prospectively compared the acceptance rates and the characteristics of targeted corneal donation for research versus donation for transplantation during one year. The Agence de la Biomédecine authorized us to procure fresh corneas targeted for research, only from the donors with medical contraindications for transplantation, in order not to increase grafts shortage. Three nurses from the hospital coordination team of Saint-Etienne University Hospital, obtained consent for research and transplantation in parallel, screening all intra-hospital deaths cases, following standard protocol to check no refusal from families, despite the French opt-out system. They contacted 127 families for research and 244 for transplantation, in 71% of cases by telephone. Consent was obtained in 62% of cases for research and 54% for transplantation (P = 0.135). The main contraindication for transplantation was the cognitive disorders (66%) followed by the blood cancers (8%). This new specific activity, providing new source of fresh corneas for research immediately usable without any eyebank storage steps, didn't reduce the number of corneas procured for transplantation versus previous years (P = 0.998). Donors in the research group were 10 years older (P<0.001) without difference regarding endothelial cell quality (P = 0.071), allowing maximal clinical relevance for protocols using these fresh human scientific corneas provided by targeted donation.


Assuntos
Córnea , Transplante de Córnea , Bancos de Olhos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pesquisa
20.
Transplant Proc ; 52(6): 1858-1859, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32434745

RESUMO

OBJECTIVES: Although pancreas transplants were started at our center in 2014, the number of pancreases procured have remained low. This report presents an audit of donors over the past 18 months with the aim to identify factors preventing pancreas utilization. METHODS: This was a retrospective study. All deceased donors from January 2018 to July 2019 were included in this study. The medical records of deceased donors were reviewed with regard to donor characteristics such as demographics, biochemical parameters, and preterminal management. RESULTS: Organs were retrieved from 49 deceased donors over the duration of the study. Mean age of the donors was 35.34 ± 18.2 years (11 months to 72 years). Most donors were men (M:F 41:8). In total, 45/49 (92%) donors had central nervous system trauma as a cause of brain death. Out of 49, multiple abdominal organs were retrieved from 21 donors (42.8%), whereas kidneys alone were retrieved from the rest. Pancreases were retrieved from 8 donors (16.3%). Pancreases were rejected in 21 donors (42.8%) because of age limit criteria. Other reasons for refusal included donor sepsis (n = 12, 24.5%), severe hemodynamic instability (n = 5, 10.2%), donation after cardiac death (DCD) (n = 2, 4.1%), and ischemic hepatitis (n = 7, 14.3%) while 3 (6.1%) donations happened while awaiting license renewal. A suitable recipient was not available for 1 donor (2.0%). CONCLUSION: Pancreas retrieval rates remain low because of donor-related factors. Expansion of age limits and better donor management could improve pancreas transplant activity.


Assuntos
Transplante de Pâncreas , Doadores de Tecidos/provisão & distribução , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Índia , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adulto Jovem
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