Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.014
Filtrar
1.
Mo Med ; 118(1): 74-80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33551490

RESUMO

Convalescent plasma is an old treatment for a new disease. The coronavirus disease 2019 (COVID-19) pandemic caused the analysis of convalescent plasma to reemerge as a possible treatment. First, a systematic review summarizes the available research examining the use of convalescent plasma for the treatment of patients with COVID-19. Second, we describe our experience in establishing a single-center convalescent plasma donation program.


Assuntos
Doadores de Sangue/provisão & distribução , Imunização Passiva/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doadores de Sangue/estatística & dados numéricos , /epidemiologia , Seleção do Doador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /isolamento & purificação , Resultado do Tratamento
2.
Clin Microbiol Rev ; 33(4)2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32792417

RESUMO

Convalescent plasma (CP) therapy has been used since the early 1900s to treat emerging infectious diseases; its efficacy was later associated with the evidence that polyclonal neutralizing antibodies can reduce the duration of viremia. Recent large outbreaks of viral diseases for which effective antivirals or vaccines are still lacking has renewed the interest in CP as a life-saving treatment. The ongoing COVID-19 pandemic has led to the scaling up of CP therapy to unprecedented levels. Compared with historical usage, pathogen reduction technologies have now added an extra layer of safety to the use of CP, and new manufacturing approaches are being explored. This review summarizes historical settings of application, with a focus on betacoronaviruses, and surveys current approaches for donor selection and CP collection, pooling technologies, pathogen inactivation systems, and banking of CP. We additionally list the ongoing registered clinical trials for CP throughout the world and discuss the trial results published thus far.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Anticorpos Neutralizantes/análise , Bancos de Espécimes Biológicos/normas , Seleção do Doador/métodos , Seleção do Doador/normas , Ensaio de Imunoadsorção Enzimática , Humanos , Imunização Passiva/efeitos adversos , Imunização Passiva/normas , Testes de Neutralização/normas , Pandemias , Síndrome Respiratória Aguda Grave/terapia
3.
Transplantation ; 104(8): 1542-1552, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732830

RESUMO

Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.


Assuntos
Seleção do Doador/métodos , Rejeição de Enxerto/prevenção & controle , Parada Cardíaca/mortalidade , Preservação de Órgãos/métodos , Transplante de Órgãos/métodos , Aloenxertos/provisão & distribução , Seleção do Doador/ética , Seleção do Doador/legislação & jurisprudência , Rejeição de Enxerto/etiologia , Acesso aos Serviços de Saúde , Parada Cardíaca/terapia , Humanos , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Perfusão/instrumentação , Perfusão/métodos , Ressuscitação/ética , Resultado do Tratamento , Isquemia Quente/efeitos adversos
4.
Transplantation ; 104(8): 1553-1559, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732831

RESUMO

Although over 90 000 people are on the kidney transplant waitlist in the United States, some kidneys that are viable for transplantation are discarded. Transplant surgeons are more likely to discard deceased donors with acute kidney injury (AKI) versus without AKI (30% versus 18%). AKI is defined using changes in creatinine from baseline. Transplant surgeons can use DonorNet data, including admission, peak, and terminal serum creatinine, and biopsy data when available to differentiate kidneys with AKI from those with chronic injury. Although chronic kidney disease is associated with reduced graft survival, an abundance of literature has demonstrated similar graft survival for deceased donors with AKI versus donors without AKI. Donors with AKI are more likely to undergo delayed graft function but have similar long-term outcomes as donors without AKI. The mechanism for similar graft survival is unclear. Some hypothesized mechanisms include (1) ischemic preconditioning; (2) posttransplant and host factors playing a greater role in long-term survival than donor factors; and (3) selection bias of transplanting only relatively healthy donor kidneys with AKI. Existing literature suggests transplanting more donor kidneys with stage 1 and 2 AKI, and cautious utilization of stage 3 AKI donors, may increase the pool of viable kidneys. Doing so can reduce the number of people who die on the waitlist by over 500 every year.


Assuntos
Lesão Renal Aguda/diagnóstico , Função Retardada do Enxerto/epidemiologia , Seleção do Doador/métodos , Rejeição de Enxerto/epidemiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/patologia , Aloenxertos/patologia , Aloenxertos/fisiopatologia , Aloenxertos/provisão & distribução , Biomarcadores/análise , Biópsia , Creatinina/sangue , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/fisiopatologia , Seleção do Doador/normas , Taxa de Filtração Glomerular/fisiologia , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Sobrevivência de Enxerto/fisiologia , Humanos , Rim/patologia , Rim/fisiopatologia , Transplante de Rim/efeitos adversos , Transplante de Rim/normas , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia
5.
Transplantation ; 104(8): 1560-1565, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732832

RESUMO

The 25th Annual Congress of the International Liver Transplantation Society was held in Toronto, Canada, from May 15 to 18, 2019. Surgeons, hepatologists, anesthesiologists, critical care intensivists, radiologists, pathologists, and research scientists from all over the world came together with the common aim of improving care and outcomes for liver transplant recipients and living donors. Some of the featured topics at this year's conference included multidisciplinary perioperative care in liver transplantation, worldwide approaches to organ allocation, donor steatosis, and updates in pediatrics, immunology, and radiology. This report presents excerpts and highlights from invited lectures and select abstracts, reviewed and compiled by the Vanguard Committee of International Liver Transplantation Society. This will hopefully contribute to further advances in clinical practice and research in liver transplantation.


Assuntos
Congressos como Assunto , Seleção do Doador/organização & administração , Transplante de Fígado , Assistência Perioperatória/métodos , Sociedades Médicas/organização & administração , Adulto , Fatores Etários , Canadá , Criança , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Seleção do Doador/métodos , Doença Hepática Terminal/cirurgia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Hepatectomia/efeitos adversos , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Cooperação Internacional , Doadores Vivos , Preservação de Órgãos/instrumentação , Preservação de Órgãos/métodos , Segurança do Paciente , Seleção de Pacientes , Perfusão/instrumentação , Perfusão/métodos , Melhoria de Qualidade , Alocação de Recursos/organização & administração , Resultado do Tratamento
7.
Ann Hematol ; 99(10): 2295-2301, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32844323

RESUMO

Early detection of individuals with hereditary hemochromatosis (HH) is important to manage iron levels and prevent future organ damage. Although the HFE mutations that cause most cases of HH have been identified, their geographic distribution is highly variable, and their contribution to iron overload is not fully understood. All new registered blood donors at the Sahlgrenska University hospital between 1998 and 2015 were included in the study. Donors with signs of iron overload at baseline and subsequent follow-up testing were recommended genotyping of the HFE gene. Of the 50,493 donors that were included in the study, 950 (1.9%) had signs of iron overload on both test occasions. Of the 840 donors with iron overload that performed HFE genotyping, 117 were homozygous for C282Y, and 97 were compound heterozygotes. The prevalence of C282Y homozygosity was 0.23%. Iron overload screening effectively detects individuals at risk of carrying the C282Y mutation of the HFE gene and enables early treatment to prevent HH complications.


Assuntos
Doadores de Sangue , Seleção do Doador/métodos , Proteína da Hemocromatose/genética , Hemocromatose/diagnóstico , Mutação de Sentido Incorreto , Adulto , Diagnóstico Precoce , Feminino , Ferritinas/sangue , Frequência do Gene , Genótipo , Hemocromatose/sangue , Hemocromatose/genética , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Suécia/epidemiologia , Adulto Jovem
8.
Transplant Proc ; 52(6): 1744-1748, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32448650

RESUMO

BACKGROUND: It is unclear whether both Kidney Donor Profile Index (KDPI) and Kidney Donor Risk Index (KDRI) scores can be applied to elderly deceased donors (DDs). This study aimed to compare the predictive values of KDRI and KDPI for the occurrence of delayed graft function (DGF) in kidney transplantation (KT) from elderly DDs. METHODS: The data for 1049 DD KTs from the database of the Korean Organ Transplant Registry were reviewed retrospectively. RESULTS: The mean age of the 1049 DDs was 50.94 ± 10.57 years. A total of 224 DDs were ≥60 years old (21.35%). The mean KDRI and KDPI were 1.24 ± 0.40 and 63.58 ± 25.16, respectively. Ninety (8.6%) recipients had DGF postoperatively. The right-skewed distributions of KDRI in both elderly and nonelderly DDs were similar. However, the KDPI curve showed a sharp increase from a KDPI score of 60 in DDs aged ≥60 years. The areas under the curve (AUCs) of receiver operator characteristics (ROC) for KDPI and KDRI were different. In DDs aged <60 years, the estimated AUCs of ROC showed significant values for KDPI (0.577, 95% confidence interval, 0.503-0.637; P = .048) and KDRI (0.576, 0.505-0.639; P = .043). However, in DDs aged ≥60 years, KDRI score, not KDPI, was a significant value: KDRI, 0.633 (0.498-0.767; P = .034); KDPI, 0.530 (0.476-0.643; P = .138). CONCLUSION: KDRI was more reliable in predicting graft outcome than KDPI in KT from elderly DDs. A longer follow-up period is needed to assess predictors for postoperative renal functions.


Assuntos
Função Retardada do Enxerto/etiologia , Seleção do Doador/estatística & dados numéricos , Transplante de Rim/efeitos adversos , Doadores de Tecidos/estatística & dados numéricos , Transplantes/estatística & dados numéricos , Adulto , Idoso , Área Sob a Curva , Seleção do Doador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sistema de Registros , República da Coreia , Estudos Retrospectivos , Medição de Risco
9.
Transplant Proc ; 52(6): 1838-1843, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32444130

RESUMO

BACKGROUND: When the donor's left lobe volume is <30%, donor selection for the right posterior section graft (RPSG) is based on the type III portal vein (PV) anatomic variation. Herein, we validated the selection of a donor with a type III PV variation for RPSG to prevent biliary complications (BCs) after single-graft (SG) and dual-graft (DG) living-donor liver transplantation (LDLT). METHODS: The clinical data of recipients and donors with a type III PV variation for LDLT using an RPSG performed between January 2004 and June 2018 were retrospectively collected and analyzed to determine the occurrence of BCs. RESULTS: The 26 LDLTs performed using an RPSG, including 20 DG LDLT cases, accounted for 0.6% of all LDLT cases (n=4292). BCs developed in 6 recipients (23.0%), including biliary stricture in 4 (15.3%) and bile leakage in 2 (7.6%). No vascular complications occurred. The RPSG volume was significantly smaller in recipients with BCs than in those without BCs (400.8±79.9 vs 504.1±96.5 mL, P = .015). The bile duct types were A, B, C1, C2, and D in 6 (18.8%), 5 (15.6%), 3 (9.4%), 13 (40.6%), and 5 (15.6%) patients, respectively. All the RPSGs had a single-orifice bile duct. The bile duct size of the RPSG was relatively smaller in recipients with BCs than in those without BCs (2.8±1.0 vs 3.6±1.4 mm, P = .237). CONCLUSIONS: When the left liver volume is disproportionately small, selection of a donor with a type III PV variation can prevent BCs after SG and DG LDLTs using an RPSG.


Assuntos
Seleção do Doador/métodos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Veia Porta/anormalidades , Transplantes/anormalidades , Adulto , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
11.
Transplant Proc ; 52(4): 1136-1139, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32307147

RESUMO

BACKGROUND: The Kidney Donor Profile Index (KDPI) was created in 2014 to measure the likelihood of graft failure for a given donor compared with the median kidney donor from the previous year. This scale is based on the American population only. Mexico is one of the countries with greater incidence of chronic kidney disease, a long waiting list, and not enough kidney donors with KDPI smaller than 80%. This has led transplant centers to take kidney grafts with a higher KDPI. OBJECTIVE: To investigate the agreement between the KDPI and histologic scores (preimplantation renal biopsy) and assess the relationship between the Kidney Donor Risk Index (KDRI), KDPI, and the histologic score on graft survival. METHODS: A retrospective, analytical, transversal study was performed. Data were collected from patients with kidney grafts from deceased donors from January 1, 2011, to June 30, 2019, at our hospital. The variables analyzed were age, weight, height, sex, race and/or ethnicity, history of hypertension or diabetes, cause of death, serum creatinine, KDPI, KDRI, and biopsy result from each graft prior to transplant. RESULTS: The total population was 59 deceased kidney donors. For our patients, a high KDPI did not increase mortality rate; it provided greater benefit than staying on dialysis. CONCLUSIONS: We conclude that the use of KDRI should only be considered to assess the degree of fibrosis, not to rule out a transplantable kidney, in addition to the consistent demonstration that high KDPI kidneys (even 91%-100%) confer greater survival benefits to patients regarding the waiting list.


Assuntos
Seleção do Doador/métodos , Sobrevivência de Enxerto/fisiologia , Transplante de Rim , Doadores de Tecidos , Adulto , Feminino , Humanos , Transplante de Rim/mortalidade , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
Transplant Proc ; 52(4): 1053-1055, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249053

RESUMO

INTRODUCTION: In 2003, the Glasgow 7 Quality Guarantee Program was put into effect in Argentina with the objective of standardizing the donation and transplant process throughout the country, establishing the observation and registration of all neurocritical patients with a score on the Glasgow Coma Scale of 7 of 15 or less admitted to critical beds of selected establishments. MATERIALS AND METHODS: The following study is retrospective, observational, and cohort-based. It was developed in the Central Hospital of Mendoza, in the critical units, including guard, coronary, cardiovascular surgery recovery, and intensive care therapy. The inclusion criteria were admission to the institution with a score on the Glasgow Coma Scale of 7 or less with a structural cause of coma. Data collection was carried out in the national online database SINTRA. RESULTS: From January 1, 2008, to December 31, 2018, 1757 patients were enrolled at the Central Hospital of Mendoza, Argentina with Glasgow scores of 7 or less. The most frequent cause of coma was brain trauma (934 patients; 53%), followed by stroke (614 patients; 35%). Of those who scored 3 of 15 in the GCS upon admission, 65% progressed to brain death, whereas 72% of those who scored 7 were discharged. Of all these patients, 270 became donors, accounting for 43% of all brain deaths, whereas 187 had refused to become organ donors (30.6%). Of the total real donors, 55% were multiorganic (150 donors).


Assuntos
Morte Encefálica/diagnóstico , Seleção do Doador/normas , Escala de Coma de Glasgow , Doadores de Tecidos , Adulto , Argentina/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/mortalidade , Estudos de Coortes , Coma/epidemiologia , Coma/mortalidade , Seleção do Doador/métodos , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/estatística & dados numéricos
13.
PLoS One ; 15(4): e0230995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240235

RESUMO

BACKGROUND: Historically, liver allografts with >30% macrosteatosis (MaS) on donor biopsy have been associated with early allograft dysfunction and worse graft survival; however, successful outcomes have been reported in small cohorts. This study proposes an elevated MaS threshold for organ utilization without detriment to graft survival. METHODS: The UNOS Standard Transplant Analysis and Research database was evaluated for transplants between 2006-2015. Graft survival up to 1-year was evaluated by Kaplan-Meier (KM) survival analyses, and by univariate and multivariable logistic regression analyses, including donor and recipient characteristics. Odds ratios (OR) with 95% confidence intervals (CI) for risk of graft loss are reported. RESULTS: Thirty-day risk of graft loss was increased with MaS as low as 10-19% (OR [95% CI] 1.301 [1.055-1.605], p<0.0001) and peaked with MaS 50-59% (2.921 [1.672-5.103]). At 1-year, risk of graft loss remained elevated with MaS 40-49% (1.465 [1.002-2.142]) and MaS 50-59% (1.978 [1.281-3.056], p = 0.0224). Multivariable models were created for Lower and Higher MELD recipients and MaS cutoffs were established. In Lower MELD recipients, organs with ≥50% MaS had increased risk of graft loss at 30 days (2.451 [1.541-3.897], p = 0.0008) and 1-year post-transplant (1.720 [1.224-2.418], p = 0.0125). Higher MELD recipients had increased risk of graft loss at 30 days with allografts showing MaS ≥40% (4.204 [1.440-5.076], p = 0.0016). At 1-year the risk remained increased, but MaS was not significant predictor of graft loss.048 [1.131-3.710], p = 0.0616). In both MELD cohorts, organs with MaS levels below threshold had similar survival to those transplanted without a donor biopsy. CONCLUSIONS: In conjunction with recipient selection, organs with MaS up to 50% may be safely used without detriment to outcomes.


Assuntos
Aloenxertos/cirurgia , Sobrevivência de Enxerto/fisiologia , Transplante de Fígado/mortalidade , Adulto , Bases de Dados Factuais , Seleção do Doador/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Transplante Homólogo/mortalidade , Estados Unidos , Adulto Jovem
14.
Transplant Proc ; 52(4): 1049-1052, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32217013

RESUMO

Kidney Donor Profile Index (KDPI), derived from donor characteristics, was developed in the United States in an effort to devise an objective means of assessing donor organ suitability based on predicted graft survival. The objective of this study is to analyze the utility of KDPI to predict renal graft survival in Argentina. We conducted a retrospective national cohort study of adult patients who received a deceased donor renal transplantation in Argentina between January 2008 and December 2017. The graft survival was estimated according to the KDPI stratified by quartiles. A Kaplan-Meier analysis was used to calculate survival. A Cox regression was performed to estimate the probability of graft loss for each quart of the KDPI adjusted by receptor variables (age, diabetes, sex, and dialysis time) and cold ischemia time. In a Kaplan-Meier analysis, the graft survival decreases as the quartile of KDPI increases. Multivariate analysis shows that the increase in KDPI quartile and recipient's characteristics-such as age ≥60 years, diabetes, and dialysis time-were related to the probability of graft loss. In conclusion, the KDPI system could provide a guide to objectively assess the quality of organs offered for transplantation in Argentina.


Assuntos
Seleção do Doador/métodos , Sobrevivência de Enxerto , Transplante de Rim , Doadores de Tecidos , Adulto , Argentina , Estudos de Coortes , Isquemia Fria , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Estados Unidos
15.
Transplant Proc ; 52(4): 1024-1029, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32199648

RESUMO

Primary central nervous system tumors can be the cause of brain death. Not all of them contraindicate the donation of organs and tissues for transplant. A survey of cases was carried out in our country in which it was observed that the number of brain deaths caused by primary tumors was low, of the order of 2%, with an x (media) of 3 by year, which would increase the potential for donation. Medical records, an anatomopathologic study, and a detailed physical examination will be fundamental when applying the donor selection criteria. Nuclear magnetic resonance in expert hands has a sensitivity of 96% to catalog the benignity or malignancy of this type of tumors.


Assuntos
Neoplasias do Sistema Nervoso Central , Seleção do Doador/métodos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Morte Encefálica/diagnóstico , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/patologia , Seleção do Doador/classificação , Humanos , Doadores de Tecidos/classificação , Doadores de Tecidos/estatística & dados numéricos , Doadores de Tecidos/provisão & distribução
16.
Transplant Proc ; 52(5): 1299-1302, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32222385

RESUMO

BACKGROUND: Living donor liver transplant (LDLT) is a well-established treatment for end-stage liver disease. A better recipient selection and hemodynamic evaluation may improve transplant outcomes. The aim of this study was to establish recipient parameters that could enhance the results of adult-to-adult LDLT. METHODS: We performed a retrospective study of all adult-to-adult LDLTs from a single center between January 2006 and December 2018. Variables analyzed included demographic and clinical parameters, laboratory tests, performance of intraoperative temporary portocaval shunt (TPCS), graft weight/recipient weight ratio (GW/RW), preoperative portal vein thrombosis (PVT), previous major abdominal surgery, and patient survival. Patients were divided in 2 groups according to GW/RW (0.8% cutoff point). RESULTS: A total of 92 adult-to-adult LDLTs were analyzed, encompassing 53 male patients (57.6%). Mean Model for End-Stage Liver Disease score was 13.97 (SD, 4.74), and 57 patients (61.95%) had Child-Pugh-Turcotte score B. Mean GW/RW was 1.1% (SD, 0.37%). Group 1 with GW/RW > 0.8% (n = 74) and group 2 with it ≤ 0.8% (n = 13) presented mean GW/RW of 1.14% (SD, 0.24%) and 0.69% (SD, 0.09%) and P < .01, respectively. Eighteen patients (19.56%) presented PVT, with a worse survival than those without PVT (P = .006). Sixteen patients (17.39%) with previous major abdominal or biliary operations also presented higher mortality (P = .341). Forty-six (50%) intraoperative TPCSs were performed with a better 1- and 3-year patient survival. Receiver operating characteristic curve analysis showed PVT area under the curve of 0.701 (95% CI, 0.526-0.876; P = .018), positive predictive value of 0.69, and negative predictive value of 0.62. Multivariate analysis showed important risk regarding PVT (odds ratio, 6.160; 95% CI, 1.566-24.223; P = .004) and retransplant (odds ratio, 4.452; 95% CI, 0.843-23.503; P = .06). CONCLUSIONS: Better recipient selection without PVT or previous major abdominal surgery, an adequate GW/RW, and intraoperative TPCS with hemodynamic modulation significantly improve outcomes of adult-to-adult LDLT.


Assuntos
Seleção do Doador/métodos , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Índice de Gravidade de Doença , Adulto , Feminino , Hemodinâmica , Humanos , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
17.
Rev. cuba. oftalmol ; 33(1): e831, ene.-mar. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126719

RESUMO

RESUMEN Objetivo: Determinar las características del endotelio corneal mediante microscopia endotelial. Métodos: Se realizó un estudio descriptivo y retrospectivo en córneas donantes del banco de ojos del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período de enero a junio del año 2019. La muestra estuvo conformada por 224 córneas donantes. Las variables del estudio fueron: edad, cirugías previas, gerontoxón, pterigion, defectos epiteliales, infiltrado corneal, opacidad corneal, edema, pigmentos endoteliales, guttas, desprendimiento de la Descemet, densidad celular, hexagonalidad y polimegatismo. Resultados: El gerontoxon fue el hallazgo más frecuente (56,69 por ciento); la densidad celular media fue de 2 501 cel/mm2; el coeficiente de variación medio fue 43,32 y la hexagonalidad media 50,02. La densidad celular endotelial entre 2 000 y 2 500 cel/mm2 fue más frecuente entre 60 y 79 años de edad (76,72 por ciento), mientras que entre 20 y 29 años todas las córneas donantes presentaron una densidad endotelial mayor de 2 500 cel/mm2. Conclusiones: En el examen biomicroscópico de la córnea donante fue más frecuente el gerontoxon. Por microscopia endotelial la mayoría de las córneas fueron aptas para trasplante corneal. Un endotelio corneal con densidad celular mayor de 2 500 cel/mm2 no es exclusivo de córneas con menos de 60 años de edad(AU)


ABSTRACT Objective: Determine the characteristics of the corneal endothelium by endothelial microscopy. Methods: A retrospective descriptive study was conducted of donor corneas from the eye bank of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to June 2019. The sample was 224 donor corneas. The variables analyzed were age, previous surgery, gerontoxon, pterygium, epithelial defects, corneal infiltrate, corneal opacity, edema, endothelial pigments, guttae, Descemet's membrane detachment, cell density, hexagonality and polymegethism. Results: Gerontoxon was the most common finding (56.69 percent), mean cell density was 2 501 cell/mm2, mean variation coefficient was 43.32 and mean hexagonality was 50.02. Endothelial cell density from 2 000 to 2 500 cell/mm2 was more common in the 60-79 years age group (76.72 percent), whereas in the 20-29 years age group all the donor corneas had an endothelial density above 2 500 cell/mm2. Conclusions: Gerontoxon was the most common finding in the biomicroscopic examination of the cornea. Endothelial microscopy found that most corneas were suitable for corneal transplantation. A corneal endothelium with a cell density above 2 500 cell/mm2 is not exclusive of corneas under 60 years of age(AU)


Assuntos
Humanos , Transplante de Córnea/efeitos adversos , Bancos de Olhos/ética , Microscopia/métodos , Contagem de Células/tendências , Epidemiologia Descritiva , Estudos Retrospectivos , Células Endoteliais/patologia , Seleção do Doador/métodos
18.
Curr Opin Organ Transplant ; 25(2): 158-162, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32073487

RESUMO

PURPOSE OF REVIEW: To describe the historical and evolving role of quality oversight in the field of transplantation. The review highlights of the prior use and effects of oversight of solid organ transplant centers and discusses potential ramifications of changes for the field. RECENT FINDINGS: There have been a number of studies illustrating unintended consequences associated with regulatory oversight. Although the intent of oversight to ensure safety and high quality of care, research highlights the potential deleterious effects of policies that do not consider the complexities and effects on practice, patient selection and utilization of donor organs in this field. Recent amendment of policy by the Center for Medicare and Medicaid Services (CMS) highlight the recognition and prominence of these concerns and potentially expand opportunities for transplantation prospectively. SUMMARY: The historical development and implementation of regulatory reporting in transplantation is unique and the oversight imposed on transplant organizations is particularly high compared with other healthcare contexts. The effects of recent CMS policy changes and any related developments from other regulators and payers will be important to evaluate in the years to come.


Assuntos
Seleção do Doador/métodos , Transplante de Órgãos/métodos , Humanos
19.
Am J Kidney Dis ; 75(6): 857-867, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32081494

RESUMO

RATIONALE & OBJECTIVE: Less than 4% of patients with kidney failure receive kidney transplants. Although discard rates of hepatitis C virus (HCV)-viremic kidneys are declining, ~39% of HCV-viremic kidneys donated between 2018 and 2019 were discarded. Highly effective antiviral agents are now available to treat chronic HCV infection. Thus, our objective was to examine the cost-effectiveness of transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients. STUDY DESIGN: Markov state transition decision model. Data sources include Medline search results, bibliographies from relevant English language articles, Scientific Registry of Transplant Recipients, and the US Renal Data System. SETTING & POPULATION: US patients receiving maintenance hemodialysis who are on kidney transplant waiting lists. INTERVENTION(S): Transplantation with an HCV-unexposed kidney versus transplantation with an HCV-viremic kidney and HCV treatment. OUTCOMES: Effectiveness measured in quality-adjusted life-years and costs measured in 2018 US dollars. MODEL, PERSPECTIVE, AND TIMEFRAME: We used a health care system perspective with a lifelong time horizon. RESULTS: In the base-case analysis, transplantation with an HCV-viremic kidney was more effective and less costly than transplantation with an HCV-unexposed kidney because of the longer waiting times for HCV-unexposed kidneys, the substantial excess mortality risk while receiving dialysis, and the high efficacy of direct-acting antiviral agents for HCV infection. Transplantation with an HCV-viremic kidney was also preferred in sensitivity analyses of multiple model parameters. The strategy remained cost-effective unless waiting list time for an HCV-viremic kidney exceeded 3.1 years compared with the base-case value of 1.56 year. LIMITATIONS: Estimates of waiting times for patients willing to accept an HCV-viremic kidney were based on data for patients who received HCV-viremic kidney transplants. CONCLUSIONS: Transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients increased quality-adjusted life expectancy and reduced costs compared with a strategy of transplanting kidneys from HCV-unexposed donors.


Assuntos
Benzimidazóis/uso terapêutico , Fluorenos/uso terapêutico , Hepatite C Crônica , Falência Renal Crônica/cirurgia , Transplante de Rim , Complicações Pós-Operatórias , Pirrolidinas/uso terapêutico , Quinoxalinas/uso terapêutico , Sulfonamidas/uso terapêutico , Uridina Monofosfato/análogos & derivados , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Análise Custo-Benefício , Seleção do Doador/economia , Seleção do Doador/métodos , Combinação de Medicamentos , Feminino , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/etiologia , Hepatite C Crônica/virologia , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/virologia , Sofosbuvir , Uridina Monofosfato/uso terapêutico , Viremia/diagnóstico , Viremia/etiologia
20.
Transplant Proc ; 52(3): 807-814, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32088062

RESUMO

BACKGROUND: The consequences of prolonging cold ischemia time (CIT) to facilitate HLA matching in kidney transplantation are not known. METHODS: Patients with a history of kidney transplant in the United States (2000-2016) with 0 HLA mismatch (MM) were categorized based on CIT (< 10; 10 to < 15; 15 to < 20; 20 to < 25; 25 to < 30; and ≥ 30 hours). Time to graft loss was compared for each CIT category to a reference group of individuals with > 0 HLA MM and short CIT (< 10 hours) using a multivariable Cox proportional hazards model. RESULTS: The adjusted risk of graft failure was significantly lower for 0 HLA MM with the shortest CIT compared to the reference group (hazard ratio, 0.82; 95% confidence interval, 0.72-0.94), and this survival advantage persisted to a threshold of < 20 hours of CIT. No survival advantage was observed for the 0 HLA MM group once CIT was > 20 hours. This trend persisted after excluding highly sensitized recipients (panel reactive antibody > 98%) where shipping of organs occurs to achieve more equitable access to organs rather than optimize HLA match. CONCLUSIONS: CIT > 20 hours offsets the benefit of 0 HLA MM in kidney transplantation. This may have implications in organ shipping to facilitate immunologic match.


Assuntos
Isquemia Fria/mortalidade , Seleção do Doador/estatística & dados numéricos , Transplante de Rim/mortalidade , Fatores de Tempo , Adulto , Seleção do Doador/métodos , Feminino , Rejeição de Enxerto/imunologia , Antígenos HLA/imunologia , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...