Relación entre la compatibilidad del HLA y la pérdida del injerto en trasplante renal de donante cadavérico: Un análisis por propensity score matching en Colombia / Relationship between HLA compatibility and graft loss in renal transplant from a deceased donor: An analysis by propensity score matching in Colombia

Introducción. En Colombia, solo un 24 % de los pacientes en lista recibieron un trasplante renal, la mayoría de donante cadavérico. Para la asignación de órganos se considera el HLA A-B-DR, pero la evidencia reciente sugiere que el HLA A-B no está asociado con los desenlaces del trasplante. El objetivo de este estudio fue evaluar la relevancia del HLA A-B-DR en la sobrevida del injerto de los receptores de trasplante renal. Métodos. Estudio de cohorte retrospectivo que incluyó pacientes trasplantados renales con donante cadavérico en Colombiana de Trasplantes, desde 2008 a 2023. Se aplicó un propensity score matching (PSM) para ajustar las covariables en grupos de comparación por compatibilidad y se evaluó la relación del HLA A-B-DR con la sobrevida del injerto renal por medio de la prueba de log rank y la regresión de Cox. Resultados. Se identificaron 1337 pacientes transplantados renales, de los cuales fueron mujeres un 38,7 %, con mediana de edad de 47 años y de índice de masa corporal de 23,8 kg/m2. Tras ajustar por PSM las covariables para los grupos de comparación, la compatibilidad del HLA A-B no se relacionó significativamente con la pérdida del injerto, con HR de 0,99 (IC95% 0,71-1,37) para HLA A y 0,75 (IC95% 0,55-1,02) para HLA B. Solo la compatibilidad por HLA DR fue significativa para pérdida del injerto con un HR de 0,67 (IC95% 0,46-0,98). Conclusión. Este estudio sugiere que la compatibilidad del HLA A-B no influye significativamente en la pérdida del injerto, mientras que la compatibilidad del HLA DR sí mejora la sobrevida del injerto en trasplante renal con donante cadavérico

Introduction. In Colombia, only 24% of patients on the waiting list received a renal transplant, most of them from cadaveric donors. HLA A-B-DR is considered for organ allocation, but recent evidence suggests that HLA A-B is not associated with transplant outcomes. The objective of this study was to evaluate the relevance of HLA A-B-DR on graft survival in kidney transplant recipients. Methods. Retrospective cohort study that included kidney transplant recipients with a cadaveric donor in Colombiana de Trasplantes from 2008 to 2023. A propensity score matching (PSM) was applied to adjust the covariates in comparison groups for compatibility, and the relationship of HLA A-B-DR with kidney graft survival was evaluated using the log rank test and Cox regression. Results. A total of 1337 kidney transplant patients were identified; of those, 38.7% were female, with median age of 47 years, and BMI 23.8 kg/m2. After adjusting the covariates with PSM for the comparison groups, HLA A-B matching was not significantly related to graft loss, with HR of 0.99 (95% CI 0.71-1.37) and 0.75 (95% CI 0.55-1.02), respectively. Only HLA DR matching was significant for graft loss with an HR of 0.67 (95% CI 0.46-0.98). Conclusions. This study suggests that HLA A-B matching does not significantly influence graft loss, whereas HLA DR matching does improve graft survival in renal transplantation with a cadaveric donor.

Descripción de polimorfismos genéticos en CYP3A5 y MDR-1 y su impacto en el rechazo agudo clínico de pacientes trasplantados de hígado del Hospital San Vicente Fundación Rionegro / Description of genetic polymorphisms in CYP3A5 and MDR-1 and their impact on clinical acute rejection in liver transplant patients at Hospital San Vicente Fundación Rionegro

Introducción. El tacrolimus es un medicamento inmunosupresor ampliamente usado en trasplante hepático, que presenta una gran variabilidad interindividual la cual se considera asociada a la frecuencia de polimorfismos de CYP3A5 y MDR-1. El objetivo de este estudio fue evaluar la frecuencia de los polimorfismos rs776746, rs2032582 y rs1045642 y su asociación con rechazo clínico y toxicidad farmacológica. Métodos. Se incluyeron pacientes inmunosuprimidos con tacrolimus a quienes se les realizó trasplante hepático en el Hospital San Vicente Fundación Rionegro entre 2020 y 2022, con supervivencia mayor a un mes. Se evaluaron las variables clínicas, rechazo agudo y toxicidad farmacológica. Se secuenciaron los genes de estudio mediante PCR, comparando la expresión o no en cada uno de los pacientes. Resultados. Se identificaron 17 pacientes. El 43 % de los pacientes se clasificaron como CYP3A5*1/*1 y CYP3A5*1/*3, entre los cuales se encontró asociación con aumento en la tasa de rechazo agudo clínico, al comparar con los pacientes no expresivos (100 % vs. 44 %, p=0,05); no hubo diferencias en cuanto a la toxicidad farmacológica u otros desenlaces. Se encontró el polimorfismo rs2032582 en un 50 % y el rs1045642 en un 23,5 % de los pacientes, sin embargo, no se identificó asociación con rechazo u otros eventos clínicos. Conclusiones. Se encontró una asociación entre el genotipo CYP3A5*1/*1 y CYP3A5*1/*3 y la tasa de rechazo clínico. Sin embargo, se requiere una muestra más amplia para validar estos datos y plantear modelos de medicina personalizada.

Introduction. Tacrolimus is an immunosuppressive drug widely used in liver transplantation, which presents great interindividual variability which is considered associated with the frequency of CYP3A5 and MDR-1 polymorphisms. The objective of this study was to evaluate the frequency of the rs776746, rs2032582 and rs1045642 polymorphisms and their association with clinical rejection and drug toxicity. Methods. Immunosuppressed patients with tacrolimus who underwent a liver transplant at the Hospital San Vicente Fundación Rionegro between 2020 and 2022 were included, with survival of more than one month. Clinical variables, acute rejection and pharmacological toxicity were evaluated. The study genes were sequenced by PCR, comparing their expression or not in each of the patients. Results. Seventeen patients were identified. 43% of the patients were classified as CYP3A5*1/*1 and CYP3A5*1/*3, among which an association was found with increased rates of clinical acute rejection when compared with non-expressive patients (100% vs. 44%, p=0.05). There were no differences in drug toxicity or other outcomes. The rs2032582 polymorphism was found in 50% and rs1045642 in 23.5% of patients; however, no association with rejection or other clinical events was identified. Conclusions. An association was found between the CYP3A5*1/*1 and CYP3A5*1/*3 genotype and the clinical rejection rate. However, a larger sample is required to validate these data and propose models of personalized medicine.

Understanding the dynamics of deceased organ donation and utilization in Colombia / Examen de la dinámica de la donación y utilización de órganos de personas fallecidas en Colombia / Entendendo a dinâmica da doação e do aproveitamento de órgãos de pessoas falecidas na Colômbia

ABSTRACT Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

RESUMEN Objetivo. Presentar una descripción integral de la donación, utilización y descarte de órganos en todo el proceso de donación en Colombia. Métodos. Estudio retrospectivo de 1 451 donantes posibles, distribuidos en tres regiones de Colombia, que fueron evaluados en el 2022. Se describen las características generales, el diagnóstico y las causas de contraindicación de los donantes potenciales. Resultados. De los 1 451 donantes posibles, 441 (30,4%) cumplían con los criterios de muerte encefálica y constituyeron el conjunto de donantes potenciales. Las familias consintieron la donación de órganos en 141 casos aptos desde el punto de vista médico, mientras que en 60 casos se recurrió a la presunción legal, con lo que se llegó a 201 donantes aptos (13,9%). De estos, 160 (11,0%) fueron donantes reales (en los que se les practicó una incisión quirúrgica para la extracción de órganos o se obtuvo al menos un órgano). En última instancia, hubo 147 donantes utilizados (10,1%) (de los que se trasplantó al menos un órgano). Se observaron diferencias estadísticamente significativas entre las regiones en cuanto a edad, sexo, diagnóstico de muerte encefálica y vía crítica del donante. Se trasplantaron un total de 411 órganos procedentes de 147 donantes utilizados; los riñones fueron los órganos obtenidos y trasplantados con mayor frecuencia, ya que supusieron 280 (68,1%) del total de órganos, seguidos del hígado (85, 20,7%), el corazón (31 , 7,5%), los pulmones (14, 3,4%) y el páncreas (1, 0,2%). La tasa de descarte de los donantes fallecidos disponibles fue del 8,1%. Conclusiones. Aproximadamente una décima parte de los donantes son utilizados, de hecho, para realizar trasplantes. Estos datos destacan las áreas en las que se han obtenido buenos resultados y aquellas en las que se presentan desafíos, lo cual proporciona una base para futuras mejoras en Colombia.

RESUMO Objetivo. Obter uma visão geral e abrangente da doação, do aproveitamento e do descarte de órgãos em todo o processo de doação na Colômbia. Métodos. Estudo retrospectivo de 1 451 possíveis doadores em três regiões da Colômbia que foram avaliados em 2022. Foram descritas as características gerais, o diagnóstico e os motivos para a contraindicação de potenciais doadores. Resultados. Dentre os 1 451 possíveis doadores, 441 (30,4%) preencheram os critérios de morte encefálica, formando o grupo de potenciais doadores. Em 141 casos considerados clinicamente aptos, as famílias consentiram com a doação de órgãos, e em 60 casos utilizou-se o princípio da presunção legal, resultando em 201 doadores elegíveis (13,9%). Desses, 160 (11,0%) foram doadores efetivos (ou seja, doadores nos quais foi feita uma incisão cirúrgica com a intenção de remover um órgão ou pessoas com pelo menos um órgão removido). Por fim, foram identificados 147 doadores utilizados (10,1%) (ou seja, que doaram pelo menos um órgão que foi transplantado). Foram encontradas diferenças estatisticamente significantes entre idade, sexo, diagnóstico de morte encefálica e itinerário crítico de doação entre as regiões. Um total de 411 órgãos foram transplantados de 147 doadores utilizados. Os rins foram os órgãos mais frequentemente removidos e transplantados, representando 280 (68,1%) do total, seguido de 85 fígados (20,7%), 31 corações (7,5%), 14 pulmões (3,4%) e 1 pâncreas (0,2%). A taxa de descarte de doadores falecidos com órgãos removidos foi de 8,1%. Conclusões. Cerca de um décimo dos doadores são efetivamente usados para fins de transplante. Nossos achados destacam áreas de sucesso e desafios, oferecendo uma base para futuras melhorias na Colômbia.

Clinical treatment and management of invasive fungal disease in recipients of solid organ transplantation / 器官移植

With widespread application of solid organ transplantation (SOT), the incidence of postoperative invasive fungal disease (IFD) in SOT recipients has been increased year by year. In recent years, the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened. However, the problem of fungal resistance has also emerged, leading to unsatisfactory efficacy of original standardized antifungal regimens. Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians. In this article, the characteristics of drug-drug interaction and hepatorenal toxicity among triazole, echinocandin and polyene antifungal drugs and immunosuppressants were reviewed, and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized, aiming to provide reference for physicians in organ transplantation and related disciplines.

Research progress in risk factors of post-transplantation diabetes mellitus / 器官移植

Solid organ transplantation has significantly prolonged the survival of patients with end-stage diseases. However, long-term use of immunosuppressants will increase the risk of post-transplantation diabetes mellitus (PTDM) in the recipients, thereby elevating the risk of infection, cardiovascular disease and death. In recent years, with persistent improvement of diagnostic criteria of PTDM, clinicians have deepened the understanding of this disease. Compared with type 2 diabetes mellitus, PTDM significantly differs in pathophysiological characteristics and clinical progression. Hence, different treatment strategies should be adopted. Early identification of risk factors of organ transplant recipients, early diagnosis and intervention are of significance for improving the quality of life of recipients, prolonging the survival of grafts and reducing the fatality of recipients. Therefore, the diagnosis, incidence and risk factors of PTDM were reviewed in this article, aiming to provide reference for clinicians to deliver prompt diagnosis and intervention for PTDM.

Ethic analysis of the role of incentive system in the organ donation after citizen’s death / 器官移植

Organ transplantation has demonstrated its significant values by its excellent effectiveness in health reconstruction and life survival, where organ donation is a major component in promoting the development of organ transplantation in China. In recent years, an important progress has been made in organ transplantation in China with an annually increased organ donation rate. In spite of this, there is a serious fact confronted by us that the donated organ quantity is insufficient, which may be solved by further improvement of medical science and public health policy. According to the international experience, an incentive system may improve the organ donation rate effectively although the hidden ethic property of the incentive system itself may have an essentially conflict with the altruism contained in the organ donation. Therefore, in this article, the property of the incentive system, the interaction between organ donation and incentive system and the ethic justification of the system was reviewed, aiming to provide a reference for the further development of the organ donation and transplantation business in China.

Construction and validation of a prediction model for public acceptance of kidney xenotransplantation in China / 器官移植

Objective To explore the public attitude towards kidney xenotransplantation in China by constructing and validating the prediction model based on xenotransplantation questionnaire. Methods A convenient sampling survey was conducted among the public in China with the platform of Wenjuanxing to analyze public acceptance of kidney xenotransplantation and influencing factors. Using random distribution method, all included questionnaires (n=2 280) were divided into the training and validation sets according to a ratio of 7:3. A prediction model was constructed and validated. Results A total of 2 280 questionnaires were included. The public acceptance rate of xenotransplantation was 71.3%. Multivariate analysis showed that gender, marital status, resident area, medical insurance coverage, religious belief, vegetarianism, awareness of kidney xenotransplantation and whether on the waiting list for kidney transplantation were the independent influencing factors for public acceptance of kidney xenotransplantation (all P<0.05). The area under the curve (AUC) of receiver operating characteristic (ROC) of the prediction model in the training set was 0.773, and 0.785 in the validation set. The calibration curves in the training and validation sets indicated that the prediction models yielded good prediction value. Decision curve analysis (DCA) suggested that the prediction efficiency of the model was high. Conclusions In China, public acceptance of kidney xenotransplantation is relatively high, whereas it remains to be significantly enhanced. The prediction model based on questionnaire survey has favorable prediction efficiency, which provides reference for subsequent research.

Investigation of patients’preferences regarding therapeutic drug monitoring of mycophenolic acid in solid organ transplantation / 中国药房

OBJECTIVE To investigate the preferences of patients who underwent solid organ transplantation regarding therapeutic drug monitoring （TDM） of mycophenolic acid （MPA） and explore the factors influencing patients’ decision-making process， so as to provide support for the development of individualized medication guidelines for MPA and improvement of clinical decision-making. METHODS The cross-sectional study was used to design the questionnaire on the patients’ preferences to accept MPA TDM， and involved patients who underwent solid organ transplantation and received MPA treatment at two tertiary hospitals in Beijing from April 14， 2022， to June 27， 2022. The Likert 5-level scoring method was used to score the patients’ preferences to accept MPA TDM， the influencing factors and their correlation of the patients’ preferences to accept MPA TDM were analyzed by Pearson correlation analysis and binary Logistic regression analysis， and the nonparametric test and chi-square test were used to rank and analyze the consistency of the factors affecting patients’ preference decision. RESULTS A total of 140 questionnaires were collected， and the effective recovery rate was 77.35%. The average preference score of 140 patients to receive MPA TDM was （4.01±0.65）， and the overall preference value was high. There were 116 （82.86%） patients agreed or strongly agreed with MPA TDM. Significant differences were observed in preference scores between patients who had previously undergone MPA TDM and those who had never undergone it （[ 4.30±0.53） scores vs. （3.80±0.65） scores， P＜0.001]. Additionally， patients’ preference scores were significantly influenced by their understanding level and attention level （P＜0.001）. The ranking of factors contributing to decision-making exhibited consistency （P＜0.001）. The factors were ranked in descending order of clinical efficacy， safety， comfortability， economy and time cost. CONCLUSIONS The patients who underwent solid organ transplantation hold high preferences towards MPA TDM. The primary factors influencing their decisions are their prior experience， understanding level， and attention level.

Indicación de amigdalectomía en pacientes pediátricos por sospecha de trastorno linfoproliferativo postrasplante / Indication for tonsillectomy in pediatric patients with suspected post-transplant lymphoproliferative disorder

Un sitio común de hiperplasia linfoidea en los trastornos linfoproliferativos postrasplante (TLPT) son las amígdalas palatinas. Sin embargo, la hipertrofia amigdalina es extremadamente común en niños, lo que dificulta la sospecha de estos trastornos. Se realizó un estudio de una serie de casos de pacientes trasplantados intervenidos de amigdalectomía por sospecha de TLPT en un hospital pediátrico de alta complejidad en Argentina desde enero de 2014 hasta diciembre de 2021. El objetivo de este trabajo es exponer las características clínicas de los pacientes trasplantados a los que se les indicó amigdalectomía con fin diagnóstico de TLPT.

A common site of lymphoid hyperplasia in post-transplant lymphoproliferative disorders (PTLD) is the palatine tonsils. However, tonsillar hypertrophy is extremely common in children, which hinders the suspicion of PTLD. A case series of transplanted patients undergoing tonsillectomy for suspected PTLD was conducted at a tertiary care children's hospital in Argentina between January 2014 and December 2021. The objective of this study is to expose the clinical characteristics of transplanted patients who underwent a tonsillectomy to diagnose PTLD

Morte encefálica: conhecimento dos fisioterapeutas a respeito dos conceitos e protocolo em um hospital de urgências / Brain death: knowledge of physiotherapists about the concepts and protocol in an emergency hospital

INTRODUÇÃO: A morte encefálica (ME) é caracterizada pela presença de coma aperceptivo e ausência de reflexos de tronco encefálico. O sucesso no processo de doação de órgãos é complexo e depende do envolvimento ativo dos profissionais no processo de busca ativa e notificação de potenciais doadores (PD). O fisioterapeuta lida diretamente com o paciente crítico e, dentre outras funções, gerencia a ventilação mecânica, sendo fundamental no processo de manutenção do PD. OBJETIVO: Avaliar o conhecimento dos fisioterapeutas sobre os conceitos e protocolo de ME em um hospital de urgências. METODOLOGIA: Estudo transversal, analítico, realizado por meio de perguntas sociodemográficas e um questionário constituído por nove questões objetivas, elaborado com base na resolução nº 2.173/2017 do CFM. RESULTADOS: Participaram do estudo 27 fisioterapeutas que obtiveram uma pontuação média de 4,74 (DP ± 1,65) no questionário. As perguntas com maiores índices de erros foram as que indagaram sobre o tempo mínimo para abertura do protocolo de ME (92,6%) e a manutenção do suporte de vida em não doador (66,7%). CONCLUSÃO: Os fisioterapeutas avaliados demonstraram possuir conhecimento limitado acerca dos conceitos e protocolo de ME diante do número limítrofe de acertos. Além disso, a maioria dos profissionais referiu não ter recebido nenhum tipo de capacitação, podendo configurar um dos determinantes para o baixo desempenho no questionário.

INTRODUCTION: Brain death (BD) is characterized by the presence of apperceptive coma and the absence of brainstem reflexes. The success o the organ donation process is complex and depends on the active involvement of professionals in the process of active search and notification of potential donors (PD). The physiotherapist deals directly with the critical patient and, among other functions, manages mechanical ventilation, being essential in the process of maintaining the PD. OBJECTIVE: To assess the knowledge of physiotherapists regarding the concepts and protocol of BD in an emergency hospital. METHODOLOGY: Cross-sectional, analytical study carried out using sociodemographic questions and a questionnaire consisting of nine objective questions, prepared based on CFM Resolution No. 2,173/2017. RESULTS: The study included 27 physiotherapists who obtained an average score of 4.74 (SD ± 1.65) in the questionnaire. The questions with the highest error rates were those that asked about the minimum time to open the BD protocol (92.6%) and maintenance of life support in non-donor (66.7%). CONCLUSION: The physical therapists evaluated showed limited knowledge about BD concepts and protocol in view of the borderline number of correct answers. In addition, most professionals did not receive any type of training, which could be one of the determinants of low performance in the questionnaire.

The impact of COVID-19 on kidney transplant activities in Brazil: a descriptive study

ABSTRACT BACKGROUND: The coronavirus 19 (COVID-19) pandemic has reached services, systems, and world society. Despite its certified efficiency, the Brazilian National Transplant System is not exempt from the side effects of COVID-19. OBJECTIVE: To compare kidney transplantation activity registered in Brazil between the pandemic (2020) and pre-pandemic (2019) periods. DESIGN AND SETTING: A descriptive study was conducted in March 2021. The annual reports of the Brazilian Transplantation Registry for 2019 and 2020 were included in this study. METHODS: We conducted a descriptive study of kidney transplant activity in Brazil in 2019 and 2020. RESULTS: A 23.9% decrease in kidney transplants per million population was observed during the pandemic period (22.9 in 2020 versus 30.1 in 2019). Kidney transplants with a living donor (-58.8%) and in the North Region (-79.5%) experienced the greatest declines. The pandemic waiting list increased by 6.8%, and deaths during the waiting period increased by 36.8%. The number of patients on the waiting list and transplant teams decreased by 31.3% and 9.5%, respectively. CONCLUSION: The COVID-19 pandemic drastically affected Brazil and had a significant negative impact on KT activities in the country.

Advances in application of regulatory T cells in transplant immune tolerance: from basic to clinical research / 器官移植

Regulatory T cells (Treg) are important inhibitory immune cells to establish immune tolerance, which play a pivotal role in regulating excessive immune response and autoimmune diseases of the host. Previous studies related to transplant immune tolerance have confirmed that increasing the number of Treg in vivo or enhancing the function of Treg serve as a therapeutic strategy to induce transplant immune tolerance. At present, Treg-based induction methods for transplant immune tolerance include adoptive infusion of Treg, in vivo amplification of Treg and utilization of antigen-specific Treg. In this article, the characteristics and mechanism of Treg, the latest research progress on basic experiments and clinical practice of Treg related to transplant immune tolerance at home and abroad were reviewed, and future challenges and development of Treg therapy were prospected, aiming to unravel the significance and application prospect of Treg in transplant immune tolerance, explore the advantages and limitations of Treg therapeutic strategies, and provide reference and evidence for subsequent research in this field.

Construction of post competency model of human organ donation coordinators based on onion model / 器官移植

Objective To construct a scientific and rational post competency model of human organ donation coordinators. Methods Based on the onion model, the index pool was initially constructed by literature research and behavioral event interview. The index system was screened, modified and improved using Delphi method. The weight of indexes at all levels was determined by analytic hierarchy process. Results The effective response rates of two rounds of Delphi expert inquiries were both 100%, indicating that the expert opinions were highly dependable. The experts' judgment coefficient (Ca), familiarity (Cs) and authoritative coefficient (Cr) were all above 0.7, indicating that the experts' opinions were highly reliable. The expert coordination coefficients (W) were 0.294 and 0.342 (both P<0.001), indicating that experts delivered coordinated opinions and yielded slight difference in understanding the importance of indexes. Finally, according to the "onion model" theory and experts' opinions, a set of coordinator's post competency model including 6 first-level and 55 second-level indexes was established, which comprised an index surface layer, a middle layer and a core layer. Among them, the core layer represented core professional values, the middle layer was personal quality and professional ethics and quality, and the surface layer was interpersonal communication capability, organizational cooperation capability and professional knowledge and lifelong learning capability. Conclusions The post competency model of organ donation coordinators established in this study consists of 6 first-level and 55 second-level indexes, which is highly effective and reliable.

Role and prospect of ferroptosis in ischemia-reperfusion injury during organ transplantation / 器官移植

Ferroptosis is a newly-emerged pattern of programmed cell death discovered in recent years, which is defined as iron-dependent programmed necrosis mediated by lipid peroxidation damage. As a conservative procedure, ferroptosis plays a vital role in the development and diseases of multiple organisms including plants and animals. Since ferroptosis was first reported in 2012, growing interests have been diverted to the process of ferroptosis and its role in disease treatment. Ischemia-reperfusion injury is a common pathological process during organ transplantation, and ferroptosis is considered as one of the main patterns inducing ischemia-reperfusion injury. Consequently, the definition, regulatory mechanism and the mechanisms of ferroptosis in ischemia-reperfusion injury after kidney, liver, heart and lung transplantations were reviewed, aiming to provide theoretical basis for the prevention and treatment of ischemia-reperfusion injury in organ transplantation.

Expert consensus on diabetes mellitus after solid organ transplantation in adults / 器官移植

Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.

Application progress in the role of vitamin D3 in transplantation immunity / 器官移植

Vitamin D3 is a kind of vitamin that plays important roles in maintaining the normal physiological function of the human body, and its metabolites and analogues exhibit strong anti-inflammatory activity. Vitamin D3 could be activated and converted into 1α, 25-dihydroxyvitamin D3, a kind of steroid hormone, in the human body, which participates in the regulation of cellular metabolism by activating vitamin D receptor (a kind of transcription factor), thus exerting immunomodulatory effects. This is essential for maintaining the physiological health of the body. Currently, there is a growing number of studies that suggest important roles for 1α, 25-dihydroxyvitamin D3 in organ transplantation immunomodulation and tolerance. Therefore, we reviewed the overview and physiological effects of 1α, 25-dihydroxyvitamin D3, the immunomodulatory effects of vitamin D3 and the application of vitamin D3 in clinical organ transplantation, and summarized the value of applying vitamin D3 in inducing immune tolerance in transplantation, with the aim of providing a reference for promoting the application of vitamin D3 in transplantation immunity.

Doação e transplante de órgãos e tecidos: concepções de adolescentes escolares pelo uso do photovoice / Organ and tissue donation and transplantation: school adolescents' conceptions through the use of photovoice / Donación y trasplante de órganos y tejidos: concepciones de adolescentes escolares mediante el uso de fotovoz

Este artigo objetivou compreender as concepções de adolescentes escolares sobre a doação e transplante de órgãos e tecidos. Trata-se de um estudo participativo, descritivo, de natureza qualitativa, desenvolvido com 60 adolescentes escolares do ensino médio da rede pública de ensino do Estado do Paraná. A coleta de dados foi realizada em julho de 2018, com auxílio da técnica Photovoice, e os dados foram analisados na óptica da análise de conteúdo de Bardin. Dos 60 adolescentes, 38 eram meninas (63,3%) e 22 eram meninos (36,7%), sendo a faixa etária dos 16 anos a prevalente (38,3%). Foram selecionadas nove imagens para compor o corpus fotográfico, que deram origem a quatro categorias: com a doação de órgãos existe uma certa união; um gesto de humildade que salva muitas vidas; ter a esperança de que no outro dia alguém pode vir e fazer uma doação e; a real importância de se formar doadores de órgãos. Constatou-se que promover a conscientização para doação e transplante de órgãos e tecidos, principalmente em grupos ativos na sociedade, como os adolescentes escolares, é fundamental para disseminação de informações seguras, construção de novos paradigmas e transformação de concepções e comportamentos.

This article aimed to understand the conceptions of adolescent students about organ and tissue donation and transplantation. This is a participatory, descriptive, qualitative study, developed with 60 high school teenagers from public schools in the State of Paraná. Data collection was carried out in July 2018, with the aid of the Photovoice technique, and the data were analyzed from the perspective of Bardin's content analysis. Of the 60 adolescents, 38 were girls (63.3%) and 22 were boys (36.7%), with the age group of 16 years being the most prevalent (38.3%). Nine images were selected to compose the photographic corpus, which gave rise to four categories: with organ donation there is a certain union; a gesture of humility that saves many lives; hope that the next day someone can come and make a donation and; the real importance of training organ donors. It was found that promoting awareness of organ and tissue donation and transplantation, especially in groups that are active in society, such as school adolescents, is essential for disseminating reliable information, building new paradigms and transforming concepts and behaviors.

Este artículo tuvo como objetivo comprender las concepciones de los adolescentes escolares sobre la donación y el trasplante de órganos y tejidos. Se trata de un estudio participativo, descriptivo y cualitativo, desarrollado con 60 adolescentes de enseñanza media de escuelas públicas del Estado de Paraná. La recolección de datos se llevó a cabo en julio de 2018, con la ayuda de la técnica Photovoice, y los datos fueron analizados desde la perspectiva del análisis de contenido de Bardin. De los 60 adolescentes, 38 eran chicas (63,3%) y 22 eran chicos (36,7%), siendo el grupo de edad de 16 años el más prevalente (38,3%). Se seleccionaron nueve imágenes para componer el corpus fotográfico, que dieron lugar a cuatro categorías: con la donación de órganos hay una cierta unión; un gesto de humildad que salva muchas vidas; la esperanza de que al día siguiente alguien pueda venir a hacer una donación y; la importancia real de la formación de donantes de órganos. Se constató que la promoción de la concientización sobre la donación y el trasplante de órganos y tejidos, especialmente en grupos activos en la sociedad, como los adolescentes escolares, es fundamental para difundir informaciones confiables, construir nuevos paradigmas y transformar conceptos y comportamientos.

Software para apoio à decisão logística no processo de captação e transplante de órgãos / Software de apoyo a la decisión logística en el proceso de obtención y trasplante de órganos / Software to support logistic decision in the process of organ acquisition and transplantation

Objetivo: desenvolver e avaliar um software para apoio à tomada de decisão dos profissionais da central de transplantes nas definições logísticas envolvidas no processo de captação e distribuição de órgãos para transplante. Método: estudo de produção tecnológica aplicada, sustentado pelo método Design Science Research Methodology. Participaram da etapa de avaliação da usabilidade dez enfermeiros da Central de Transplantes de Santa Catarina. A coleta de dados ocorreu de 1 a 20 de julho de 2021 por meio do questionário System Usability Scale. Resultados: o software utilizou linguagem JavaScript com ReactJS e PHP com Laravel, para o banco de dados PostgreSQL. A avaliação obteve escore médio de 98,25, sendo sua usabilidade considerada como melhor alcançável. Conclusão: o software demonstrou ser adequado e funcional, com fácil manuseio, reunindo informações integradas e objetivas. Representa um avanço na área, propondo uma inovação tecnológica para a gestão e apoio às decisões logísticas envolvidas no processo de captação e transplante de órgãos.

Objetivo: desenvolver e avaliar um software para apoio à tomada de decisão dos profissionais da central de transplantes nas definições logísticas envolvidas no processo de captação e distribuição de órgãos para transplante. Método: estudo de produção tecnológica aplicada, sustentado pelo método Design Science Research Methodology. Participaram da etapa de avaliação da usabilidade dez enfermeiros da Central de Transplantes de Santa Catarina. A coleta de dados ocorreu de 1 a 20 de julho de 2021 por meio do questionário System Usability Scale. Resultados: o software utilizou linguagem JavaScript com ReactJS e PHP com Laravel, para o banco de dados PostgreSQL. A avaliação obteve escore médio de 98,25, sendo sua usabilidade considerada como melhor alcançável. Conclusión: o software demonstrou ser adequado e funcional, com fácil manuseio, reunindo informações integradas e objetivas. Representa um avanço na área, propondo uma inovação tecnológica para a gestão e apoio às decisões logísticas envolvidas no processo de captação e transplante de órgãos.

Objective: to develop and evaluate a software to support the decision-making of transplant center professionals in the logistic definitions involved in the process of organ procurement and distribution for transplantation. Method: applied technological production study, supported by the Design Science Research Methodology method. Ten nurses from the Transplant Center of Santa Catarina participated in the usability evaluation stage. Data collection took place from 1 to 20 July 2021 through the System Usability Scale questionnaire. Results: the software used JavaScript language with ReactJS and PHP with Laravel, for the PostgreSQL database. The evaluation obtained a mean score of 98.25, and its usability is considered as best achievable. Conclusion: the software proved to be adequate and functional, with easy handling, gathering integrated and objective information. It represents a breakthrough in the area, proposing a technological innovation for the management and support to the logistic decisions involved in the process of organ procurement and transplantation.

Biovigilância e notificação de eventos adversos na doação e transplante de órgãos: revisão sistemática / Biovigilancia y notificación de eventos adversos en la donación y trasplante de órganos: revisión sistemática / Biosurveillance and reporting of adverse events in organ donation and transplantation: a systematic review

Resumo Objetivo Sintetizar e avaliar criticamente as evidências científicas oriundas de estudos observacionais sobre sistemas de biovigilância e notificação de eventos adversos na doação e transplante de órgãos. Métodos Revisão sistemática de estudos observacionais seguindo as recomendações das Diretrizes Metodológicas (REBRATS) e Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Foram incluídos estudos primários e relatos de caso conduzidos sobre biovigilância e/ou eventos adversos na doação e/ou transplante de órgãos, sem restrição de data de publicação ou idioma. Foram utilizadas seis bases de dados eletrônicas para a realização das buscas na literatura científica: - Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus e a biblioteca eletrônica Scielo. Realizou-se também busca de dados nas seguintes bases secundárias: Notify - World Health Organization (WHO), Organização Pan-Americana de Saúde (OPAS) e Google Scholar. Para a avaliação da qualidade dos estudos foi utilizada a ferramenta MINORS. Resultados Foram identificados 551 estudos, após as etapas de avaliação, foram incluídos oito deles para a revisão sistemática. Estes foram divididos entre resultados, processos e estratégias de prevenção de eventos adversos. Quanto a classificação da qualidade dos estudos, dois obtiveram classificação boa. Conclusão Os resultados apontam a ocorrência de eventos adversos ocorridos em alguma etapa do processo de doação e transplante de órgãos e tecidos, como: reações adversas relacionadas a medicamentos; neurotoxicidade; aumento do tempo de hospitalização; reintervenções cirúrgicas; queda; coma; óbito; falha ou perda do enxerto. Destaca-se que os eventos adversos possivelmente ainda são subnotificados.

Resumen Objetivo Sintetizar y evaluar críticamente las evidencias científicas provenientes de estudios observacionales sobre sistemas de biovigilancia y notificación de eventos adversos en la donación y trasplante de órganos. Métodos Revisión sistemática de estudios observacionales guiada por las recomendaciones de las Directrices Metodológicas (REBRATS) y Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Se incluyeron estudios primarios y relatos de caso realizados sobre biovigilancia o eventos adversos en la donación o trasplante de órganos, sin restricción de fecha de publicación o idioma. Se utilizaron seis bases de datos electrónicas para realizar las búsquedas en la literatura científica: Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus y la biblioteca electrónica Scielo. También se realizó la búsqueda de datos en las siguientes bases secundarias: Notify - World Health Organization (WHO), Organización Panamericana de la Salud (OPS) y Google Scholar. Para evaluar la calidad de los estudios se utilizó la herramienta MINORS. Resultados Se identificaron 551 estudios y, luego de las etapas de evaluación, se incluyeron ocho en la revisión sistemática, que fueron divididos entre resultados, procesos y estrategias de prevención de eventos adversos. Respecto a la clasificación de la calidad de los estudios, dos obtuvieron una clasificación buena. Conclusión Los resultados indican casos de eventos adversos ocurridos en alguna etapa del proceso de donación y trasplante de órganos y tejidos, como: reacciones adversas relacionadas con medicamentos, neurotoxicidad, aumento del tiempo de hospitalización, reintervenciones quirúrgicas, caída, coma, fallecimiento, falla o pérdida del injerto. Se destaca que los eventos adversos probablemente aún son subnotificados.

Abstract Objective To synthesize and critically evaluate the scientific evidence from observational studies on biosurveillance systems and adverse event reporting in organ donation and transplantation. Methods Systematic review of observational studies following the recommendations of the Methodological Guidelines (REBRATS) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Primary studies and case reports on biosurveillance and/or adverse events in organ donation and/or transplantation, without restriction of publication date or language were included. Six electronic databases were used in the scientific literature search: Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus and the electronic library Scielo. A data search was also performed in the following secondary databases: Notify - World Health Organization (WHO), Pan American Health Organization (PAHO) and Google Scholar. The MINORS tool was used to assess the quality of studies. Results 551 studies were identified, and after the evaluation steps, eight of them were included in the systematic review. These were divided into results, processes and strategies for preventing adverse events. Regarding the classification of the quality of studies, two obtained a good classification. Conclusion The results indicate the occurrence of adverse events at some stage of the organ and tissue donation and transplantation process, such as: adverse drug-related reactions; neurotoxicity; longer length of hospital stay; surgical reinterventions; falls; coma; death; graft failure or loss. The fact that adverse events are possibly still underreported is noteworthy.

Research status on the role of heat shock protein in organ transplantation / 器官移植

Organ transplantation is an effective treatment for multiple end-stage diseases. In recent years, rapid progress has been made in the field of organ transplantation, which has been widely accepted and applied in clinical practice. However, low utilization rate of donors and high postoperative complications remain to be urgently resolved. Heat shock protein (HSP) is a category of protein family induced by heat shock or other stressors. Upon stress stimulation, HSP plays an anti-inflammation, anti-oxidation and anti-apoptosis role in mitigating the stress-induced damage. HSP is also involved in the processes of promoting immune response and anti-rejection, etc. Organ transplantation, as a stress stimulus, could induce HSP to function in the process of organ transplantation through many patterns, thereby alleviating the allograft damage, improving the utilization rate of donors and prolonging the postoperative survival of recipients. In this article, research status on the role of HSP in lung transplantation, heart transplantation, liver transplantation and kidney transplantation were reviewed, aiming to provide reference for donor protection of organ transplantation and treatment of postoperative complications.