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2.
Curr Opin Ophthalmol ; 32(4): 338-342, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34010230

RESUMO

PURPOSE OF REVIEW: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious coronavirus causing the COVID-19 pandemic. Although airborne spread through infectious respiratory droplets is the primary source of transmission, recent literature has suggested the ocular surface may be able to harbor viral particles. Here, we aim to discuss how SARS-CoV-2 affects the ocular surface and updated guidance on how SARS-CoV-2 transmission should be considered in the setting of eye banking and corneal transplantation procedures. RECENT FINDINGS: SARS-CoV-2 RNA can be found on the ocular surface, which may suggest the eye as a site of viral replication. However, there is poor correlation between PCR positivity on the ocular surface and ocular symptoms. To date, although viral particles can be found on the ocular surface, use of standard antiseptic procedures during corneal tissue procurement appears to sufficiently reduce viral load. In addition, preprocedure testing may further decrease the chances of transplanting an infected cornea without significantly impacting the overall accessibility to corneal tissue by decreasing the donor pool. SUMMARY: Corneal transplantation remains a well tolerated and highly successful procedure with no evidence of viral transmission with transplantation. Although the ocular surface has the required receptors to allow for viral replication, there is no clear evidence that the eye is a site for primary viral infection.


Assuntos
COVID-19/prevenção & controle , Córnea/virologia , Transplante de Córnea/normas , Bancos de Olhos , Obtenção de Tecidos e Órgãos/métodos , COVID-19/transmissão , Humanos , Guias de Prática Clínica como Assunto , SARS-CoV-2/isolamento & purificação , Doadores de Tecidos/provisão & distribuição
3.
Ned Tijdschr Geneeskd ; 1652021 03 15.
Artigo em Holandês | MEDLINE | ID: mdl-33720554

RESUMO

In the Netherlands, the average quality of donor organs continues to decrease as a result of the increasing life expectancy, as well as higher incidence of obesity, diabetes mellitus, and other comorbidities in the general population. Storing donor organs on ice, the current standard practice, appears to be inadequate for preserving these high-risk donor livers. Consequently, an increasing number of donor organs is discarded for transplantation. Over the past years, a novel dynamic preservation technique using a machine perfusion device has been developed. Preservation by machine perfusion enables optimisation and viability testing of high-risk donor livers prior to liver transplantation. A large proportion of initially declined donor livers appeared to be suitable for transplantation after evaluation during machine perfusion. Testing of donor livers has led to a significant increase in the number of liver transplantations performed in the Netherlands. This technique has the potential for use in other organs, such as kidney allografts.


Assuntos
Transplante de Fígado/métodos , Fígado , Preservação de Órgãos/métodos , Perfusão/métodos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Humanos , Fígado/cirurgia , Países Baixos , Preservação de Órgãos/instrumentação , Perfusão/instrumentação
4.
Transpl Int ; 34(4): 612-621, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33545741

RESUMO

The COVID-19 pandemic has significantly changed the landscape of kidney transplantation in the United States and worldwide. In addition to adversely impacting allograft and patient survival in postkidney transplant recipients, the current pandemic has affected all aspects of transplant care, including transplant referrals and listing, organ donation rates, organ procurement and shipping, and waitlist mortality. Critical decisions were made during this period by transplant centers and individual transplant physicians taking into consideration patient safety and resource utilization. As countries have begun administering the COVID vaccines, new and important considerations pertinent to our transplant population have arisen. This comprehensive review focuses on the impact of COVID-19 on kidney transplantation rates, mortality, policy decisions, and the clinical management of transplanted patients infected with COVID-19.


Assuntos
COVID-19 , Política de Saúde , Falência Renal Crônica/cirurgia , Transplante de Rim/tendências , Assistência Perioperatória/tendências , Obtenção de Tecidos e Órgãos/tendências , Listas de Espera/mortalidade , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Europa (Continente)/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Pandemias , Assistência Perioperatória/métodos , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Estados Unidos/epidemiologia
5.
J Card Surg ; 36(3): 1148-1149, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33448478

RESUMO

Coronavirus disease-2019 has created unprecedented challenges for society, and specifically the medical community. While the pandemic continues to unfold, the transplant community has had to pivot to keep recipients, donors, and institutional transplant teams safe given the unique circumstances inherent to solid organ transplantation.


Assuntos
COVID-19/epidemiologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Pandemias , Obtenção de Tecidos e Órgãos/métodos , Transplantados , Comorbidade , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Doadores de Tecidos
6.
Am J Clin Pathol ; 155(4): 515-521, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33399201

RESUMO

OBJECTIVES: Serologic testing for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in potential donors of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) may not be performed until after blood donation. A hospital-based recruitment program for CCP may be an efficient way to identify potential donors prospectively. METHODS: Patients who recovered from known or suspected COVID-19 were identified and recruited through medical record searches and public appeals in March and April 2020. Participants were screened with a modified donor history questionnaire and, if eligible, were asked for consent and tested for SARS-CoV-2 antibodies (IgG and IgM). Participants positive for SARS-CoV-2 IgG were referred for CCP collection. RESULTS: Of 179 patients screened, 128 completed serologic testing and 89 were referred for CCP donation. IgG antibodies to SARS-CoV-2 were detected in 23 of 51 participants with suspected COVID-19 and 66 of 77 participants with self-reported COVID-19 confirmed by polymerase chain reaction (PCR). The anti-SARS-CoV-2 IgG level met the US Food and Drug Administration criteria for "high-titer" CCP in 39% of participants confirmed by PCR, as measured by the Ortho VITROS IgG assay. A wide range of SARS-CoV-2 IgG levels were observed. CONCLUSIONS: A hospital-based CCP donor recruitment program can prospectively identify potential CCP donors. Variability in SARS-CoV-2 IgG levels has implications for the selection of CCP units for transfusion.


Assuntos
Teste Sorológico para COVID-19/métodos , COVID-19/terapia , Obtenção de Tecidos e Órgãos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Imunização Passiva , Modelos Lineares , Masculino , Pessoa de Meia-Idade , São Francisco , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/organização & administração , Adulto Jovem
7.
Transplant Proc ; 53(3): 865-871, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33358526

RESUMO

BACKGROUND: In December 2014, the Kidney Donor Profile Index (KDPI) was developed to give more precise information on donor kidney quality. Kidneys with KDPI scores ≥ 85 (K ≥ 85) have been reported to have inferior outcomes to kidneys with KDPI scores < 85. METHODS: After the implementation of the new Kidney Allocation System, we developed a protocol to evaluate K ≥ 85 use. We analyzed the safety and efficacy of our institutional criteria and evaluated post-transplant outcomes. K ≥ 85 recipients were stratified based on their 1-year creatinine and estimated glomerular filtration rates to elucidate characteristics associated with serum creatinine < 1.7 mg/dL or estimated glomerular filtration rates ≤ 45 mL/min/1.73 m2. RESULTS: From December 2014 to December 2019, 304 deceased donor kidney transplants were performed at Hartford Hospital; 58 (19%) were K ≥ 85 with an average KDPI of 91%. There were 4 graft losses; 2 were death censored. Prolonged cold ischemia time and black recipient race were associated with inferior recipient graft function at 1 year. CONCLUSIONS: High KDPI kidney use requires a multifaceted evaluation that takes into account donor and recipient characteristics for an ideal match. We have identified several characteristics that may predict optimal post-transplant kidney function.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Seleção de Pacientes , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Isquemia Fria/mortalidade , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/fisiopatologia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplantes/fisiopatologia
8.
Am J Transplant ; 21(3): 925-937, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33319449

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exploded onto the world stage in early 2020. The impact on solid organ transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on health care by the pandemic also disrupted transplant systems. We address the impact of COVID-19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID-19 in SOT recipients.


Assuntos
COVID-19/epidemiologia , Transplante de Órgãos/tendências , Pandemias , SARS-CoV-2 , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos , Transplantados/estatística & dados numéricos , Comorbidade , Humanos
10.
PLoS One ; 15(12): e0243504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370296

RESUMO

The ultimate treatment for patients with end-stage heart failure is heart transplantation. The number of donor hearts which are primarily procured from donation after brain death (DBD) donors is limited, but donation after circulatory death (DCD) donor hearts can increase the heart donor pool. However, ischemia and reperfusion injuries associated with the DCD process causes myocardial damage, limiting the use of DCD hearts in transplantation. Addressing this problem is critical in the exploration of DCD hearts as suitable donor hearts for transplantation. In this study, rat hearts were procured following the control beating-heart donor (CBD) or DCD donation process. Changes in mitochondria and cardiac function from DCD hearts subjected to 25 or 35 minutes of ischemia followed by 60 minutes of reperfusion were compared to CBD hearts. Following ischemia, rates of oxidative phosphorylation and calcium retention capacity were progressively impaired in DCD hearts compared to CBD hearts. Reperfusion caused additional mitochondrial dysfunction in DCD hearts. Developed pressure, inotropy and lusitropy, were significantly reduced in DCD hearts compared to CBD hearts. We, therefore, suggest that interventional strategies targeted before the onset of ischemia and at reperfusion could protect mitochondria, thus potentially making DCD hearts suitable for heart transplantation.


Assuntos
Coração/fisiologia , Mitocôndrias/metabolismo , Traumatismo por Reperfusão/etiologia , Obtenção de Tecidos e Órgãos/métodos , Animais , Morte Encefálica , Cálcio/metabolismo , Frequência Cardíaca , Transplante de Coração , Peróxido de Hidrogênio/metabolismo , Masculino , Contração Miocárdica , Fosforilação Oxidativa , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Doadores de Tecidos , Função Ventricular Esquerda/fisiologia , Isquemia Quente
12.
J Card Surg ; 35(10): 2814-2816, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32939787

RESUMO

OBJETIVES: ECMO is progressively being adopted as a last resort to stabilize patients receiving cardiopulmonary resuscitation (ECMO CPR). A significant number of these patients will present recovery of end-organ function, but evolve with brain death, accounting for only 30% of patients discharged from the hospital alive. Harvesting organs from donors on VA ECMO has recently been proposed as a strategy to expand the pool of available organs for transplantation. METHODS: We present a case of combined heart and kidney transplantation from a brain death donor with recent out of hospital cardiac arrest rescued with eCPR. RESULTS: A 31 year old male patient was admitted to local hospital with diagnosis of drowning after seizure episode. Patient received two rounds of CPR for 8 and 30 minutes respectively, and required emergency insertion of VA ECMO. Patient developed compartment syndrome of right lower extremity (RLE) with CPK = 30,720, prompting discontinuation of ECMO support within 48 hours as cardiac function had recovered, reflected on echocardiographic and enzymatic parameters. Patient was declared brain death and became organ donor. Multiple organ procurement was performed. Combined heart and right kidney transplant was then performed on a 61-year-old male with uneventful course, and with normal function of all implanted allografts at 3 months follow up. CONCLUSION: Our experience supports the concept that VA ECMO is not a contraindication for solid organ donation. Individual evaluation of organ function can lead to successful transplantation of multiple organs from donors with recent history of VA ECMO support.


Assuntos
Morte Encefálica , Reanimação Cardiopulmonar/métodos , Afogamento , Oxigenação por Membrana Extracorpórea/métodos , Transplante de Coração/métodos , Transplante de Rim/métodos , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Síndromes Compartimentais , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Plast Reconstr Surg ; 146(4): 922-934, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970015

RESUMO

BACKGROUND: Since the 1990s, the field of vascularized composite allotransplantation has gained momentum, offering unprecedented solutions for patients with defects not amenable to autologous reconstruction. As with solid organ donation, the vascularized composite allotransplant donor pool remains limited. This systematic review identifies past successes and failures in organ donation campaigns to guide future strategies for expanding vascularized composite allotransplant donation. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed/MEDLINE, PsycINFO, and Embase) were searched through July 31, 2019. The study compiled solid organ and vascularized composite allotransplant campaigns that aimed to increase donor registration. Articles depicting the current state of vascularized composite allotransplant donation were also assessed. RESULTS: Of an initial 3318 articles identified, 40 were included. Six articles described direct mail or print interventions, 10 depicted Web-based interventions, 13 dealt with interpersonal interventions, and seven used multimodal interventions. Four articles described the current state of vascularized composite allotransplant donation. A qualitative synthesis was conducted. The authors found that social media campaigns can have a robust but fleeting effect on registration trends and that interpersonal interventions are effective at increasing registration rates. In addition, the opportunity for participants to immediately register as organ donors, by means of either return mail, in-person, or online, is vital to campaign success. CONCLUSIONS: Public organ donation campaigns have had success in increasing organ donor registration rates, particularly through the use of social media and interpersonal interventions that allow for immediate registration. Synthesizing this information, we propose a multimodal campaign to expand the vascularized composite allotransplant donor pool.


Assuntos
Obtenção de Tecidos e Órgãos/métodos , Alotransplante de Tecidos Compostos Vascularizados/tendências , Previsões , Promoção da Saúde , Humanos
15.
BMC Gastroenterol ; 20(1): 259, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762651

RESUMO

The global health crisis due to the fast spread of coronavirus disease (COVID-19) has caused major disruption in all aspects of healthcare. Transplantation is one of the most affected sectors, as it relies on a variety of services that have been drastically occupied to treat patients affected by COVID-19. With this report from two transplant centers in Italy, we aim to reflect on resource organization, organ allocation, virus testing and transplant service provision during the course of the pandemic and to provide actionable information highlighting advantages and drawbacks.To what extent can we preserve the noble purpose of transplantation in times of increased danger? Strategies to minimize risk exposure to the transplant population and health- workers include systematic virus screening, protection devices, social distancing and reduction of patients visits to the transplant center. While resources for the transplant activity are inevitably reduced, new dilemmas arise to the transplant community: further optimization of time constraints during organ retrievals and implantation, less organs and blood products donated, limited space in the intensive care unit and the duty to maintain safety and outcomes.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transplante de Órgãos/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Obtenção de Tecidos e Órgãos/métodos , Transplantes/virologia , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Humanos , Programas de Rastreamento/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
16.
Pediatrics ; 146(Suppl 1): S42-S47, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737231

RESUMO

The case of Jamie Fiske and subsequent public appeals for particular children by President Ronald Reagan represent classic cases in pediatric bioethics in which parents or others publicly appealed for a donor organ for a particular child. These raise questions about the appropriate boundaries for public appeals for a limited resource for a particular child and how the press and medical community should respond to such appeals. Public appeals by parents to advocate for their child to receive a limited resource above others promote rationing by morally irrelevant factors and shift the public focus from the national shortage of organs for transplant to the needs of a particular child. Yet these appeals are understandable and will likely continue. Recognizing this, we consider appropriate responses by the media, transplant community, hospitals, and individual clinicians.


Assuntos
Temas Bioéticos , Doação Dirigida de Tecido/ética , Alocação de Recursos para a Atenção à Saúde/ética , Defesa do Paciente/ética , Alocação de Recursos/ética , Doação Dirigida de Tecido/tendências , Seleção do Doador/ética , História do Século XX , Hospitais , Humanos , Lactente , Meios de Comunicação de Massa/ética , Pais/psicologia , Defesa do Paciente/tendências , Papel do Médico , Política , Opinião Pública , Alocação de Recursos/métodos , Alocação de Recursos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos
19.
Xenotransplantation ; 27(5): e12623, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32596829

RESUMO

Many patients who would undergo organ transplantation cannot proceed due to the inability of human organ donation to satisfy medical needs. Xenotransplantation has the potential to offer unlimited availability of pig organs for transplantation, and pig-to-non-human primate models have demonstrated outcomes that may soon justify clinical trials. However, one of the unique ethical challenges faced by xenotransplantation is that the risk of introducing potential zoonotic disease into the community must be weighed along with the benefit to the patient. While most experts believe that zoonosis is manageable, apprehension over disease transmission from animal donors to human recipients remains a frequent concern of many who are undecided or opposed to clinical xenotransplantation. The COVID-19 pandemic represents a scenario (rapid worldwide spread of a highly contagious novel zoonotic disease with no natural defense in humans) that would seem to justify apprehension, especially in the United States, which has largely avoided previous pandemic outbreaks. However, there are many differences between zoonosis found in the wild or after xenotransplantation that favor the safety of the latter. Still, these differences, as well as the benefits of xenotransplantation, are not widely understood outside of the field. We must therefore ask what impact the COVID-19 pandemic will have on attitudes toward xenotransplantation.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Xenoenxertos , Pneumonia Viral/complicações , Transplante Heterólogo , Xenoenxertos/virologia , Humanos , Pandemias , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Transplante Heterólogo/ética , Estados Unidos
20.
Updates Surg ; 72(3): 913-915, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32542560

RESUMO

Optimization of donor-recipient matching is a common concept in liver transplantation. In emergency transplant for acute liver failure, outcome is influenced by timing, patient clinical condition, and graft quality. Although factors like advanced donor age have been linked to a poorer outcome, use of suboptimal or marginal grafts can be inevitable in very unstable patients, if no other graft is available. We present a case of a liver transplant performed in an extremely sick patient suffering from HBV-related fulminant hepatitis, in which a compatible graft from a 76-year-old deceased donor became available only after 3 days of waiting time, during which his conditions further deteriorated. Given the suboptimal matching, normothermic machine perfusion was applied to minimize ischemia-reperfusion injury. Use of machine perfusion could find an indication to modulate the risk associated with an unfavorable donor-recipient matching in high-risk cases.


Assuntos
Sobrevivência de Enxerto , Hepatite B/cirurgia , Transplante de Fígado , Fígado/cirurgia , Preservação de Órgãos/métodos , Perfusão/métodos , Traumatismo por Reperfusão/prevenção & controle , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Humanos , Masculino , Índice de Gravidade de Doença
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