Influence of splenic implants in the subcutaneous tissue on asplenic animals survival / Influência de implante esplênico em subcutâneo na sobrevida de animais esplenectomizados

ABSTRACT Background: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. Aim: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. Method: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. Results: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). Conclusion: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.

RESUMO Racional: O melhor sítio para implante esplênico não foi definido, principalmente avaliando a funcionalidade do implante. Objetivo: Avaliar os efeitos do implante esplênico autógeno subcutâneo na sobrevida de ratos esplenectomizados. Métodos: Foram estudados 21 ratos alocados aleatoriamente em três grupos (n=7): grupo 1 - manipulação da cavidade abdominal e preservação do baço; grupo 2 - esplenectomia total; grupo 3 - esplenectomia e implante do tecido retirado no subcutâneo. Os animais foram acompanhados por 90 dias pós-operatórios. Resultados: Houve mortalidade maior nos grupos 2 (p=0,0072) e 3 (p=0,0172) em relação ao grupo 1. Não houve diferença entre os grupos 2 e 3 (p=0,9817). Conclusão: O implante esplênico no subcutâneo é ineficaz na sobrevida de ratos submetidos à esplenectomia.

Caracterização dos potenciais doadores e estrutura de unidades hospitalares que desenvolvem o transplante / Characterization of the potential donors and structure of hospital units that develops the transplantations

Objetivou-se caracterizar os potenciais doadores e descrever a estrutura onde se desenvolve o processo de doação de órgãos e tecidos para transplantes. Estudo descritivo e quantitativo realizado em seis unidades hospitalares. A amostra compôs-se por 65 potenciais doadores e a coleta de dados ocorreu entre agosto de 2010 e fevereiro de 2011. A maioria era do sexo masculino (50,8%), com até 45 anos de idade (53,8%), cuja principal causa de Morte Encefálica (ME) foi acidente vascular encefálico (53,9%) e 86,2% foram assistidos em hospital público. Quanto à estrutura, a planta física apresentou como maior inadequação a climatização (80,0%) e espaço físico (40,0%). Nos recursos materiais, verificou-se a ausência de radiologia móvel, glicosímetro e cama hospitalar, ambos com o mesmo percentual (32,3%). Nos recursos humanos, o menor quantitativo era de técnicos em enfermagem (53,8%) e na estrutura organizacional observou-se a falta de protocolos assistenciais (86,2%).Concluiu-se que a estrutura dos serviços onde se desenvolve o processo de transplante encontrou-se inadequada. Para tanto, faz-se necessário a implementação de ações complementares a fim de melhorar a estrutura dos hospitais para atender melhor aos pacientes em ME.

It was aimed to characterizing potential donors and describing the structure of the units donated of organs and tissues for transplantations. This is a descriptive and quantitative study carried in six hospitals units. The probability consisted of 65 potential donorsand the data collection occurredbetween August 2010 and February 2011. The majority were male (50.8%), with up to 45 years of age (53.8%), whose main cause of Encephalic Death (ED) was vascular encephalic accident (53.9%) and86.2% were assisted in public hospital.Regarding the structure, the physical plant presented as highest inadequacy the climatization (80.5%) and physical space (40.0%). In material resources, it was found the absence mobile radiology, glucometer and hospital bed, both of with the same percentage (32.3%).In the human resources, the smallerquantity was nursing technicians (53.8%) and in the organizational structure there was a lack of care protocols (86.2%). It was concluded that the structure of services where develops the process of transplantationit was find inadequate. For both, becomes necessary to implement of complementary actions in order to improving the structure of the hospitals to better meet patients in ED.

Long-term outcomes of children after solid organ transplantation

Solid organ transplantation has transformed the lives of many children and adults by providing treatment for patients with organ failure who would have otherwise succumbed to their disease. The first successful transplant in 1954 was a kidney transplant between identical twins, which circumvented the problem of rejection from MHC incompatibility. Further progress in solid organ transplantation was enabled by the discovery of immunosuppressive agents such as corticosteroids and azathioprine in the 1950s and ciclosporin in 1970. Today, solid organ transplantation is a conventional treatment with improved patient and allograft survival rates. However, the challenge that lies ahead is to extend allograft survival time while simultaneously reducing the side effects of immunosuppression. This is particularly important for children who have irreversible organ failure and may require multiple transplants. Pediatric transplant teams also need to improve patient quality of life at a time of physical, emotional and psychosocial development. This review will elaborate on the long-term outcomes of children after kidney, liver, heart, lung and intestinal transplantation. As mortality rates after transplantation have declined, there has emerged an increased focus on reducing longer-term morbidity with improved outcomes in optimizing cardiovascular risk, renal impairment, growth and quality of life. Data were obtained from a review of the literature and particularly from national registries and databases such as the North American Pediatric Renal Trials and Collaborative Studies for the kidney, SPLIT for liver, International Society for Heart and Lung Transplantation and UNOS for intestinal transplantation.

Epidemiology of neglected tropical diseases in transplant recipients: review of the literature and experience of a Brazilian HSCT center / Epidemiologia das doenças tropicais negligenciadas em receptores de transplantes: revisão da literatura e experiência de um centro brasileiro

The rising success rate of solid organ (SOT) and haematopoietic stem cell transplantation (HSCT) and modern immunosuppression make transplants the first therapeutic option for many diseases affecting a considerable number of people worldwide. Consequently, developing countries have also grown their transplant programs and have started to face the impact of neglected tropical diseases (NTDs) in transplant recipients. We reviewed the literature data on the epidemiology of NTDs with greatest disease burden, which have affected transplant recipients in developing countries or may represent a threat to transplant recipients living in other regions. Tuberculosis, Leprosy, Chagas disease, Malaria, Leishmaniasis, Dengue, Yellow fever and Measles are the topics included in this review. In addition, we retrospectively revised the experience concerning the management of NTDs at the HSCT program of Amaral Carvalho Foundation, a public transplant program of the state of São Paulo, Brazil.

O sucesso crescente dos transplantes de órgãos sólidos (TOS) e de células tronco-hematopoiéticas (TCTH) e as novas drogas imunossupressoras fizeram dos transplantes a primeira opção terapêutica para muitas doenças que afetam milhares de pessoas em todo o mundo. Também os populosos países em desenvolvimento investiram no crescimento de seus programas de transplante e desde então começaram a vivenciar o impacto das doenças tropicais negligenciadas (DTNs) nestes pacientes. Revisamos os dados da literatura sobre a epidemiologia das DTNs de maior impacto clinico e social que afetam receptores de transplante de países em desenvolvimento, ou que podem representar um risco para receptores de transplante vivendo em outras regiões não afetadas por estas doenças. Tuberculose, hanseníase, doença de Chagas, malaria, leishmaniose, dengue, febre amarela e sarampo são os tópicos incluídos nesta revisão. Além disso, revisamos retrospectivamente a experiência referente ao manejo das DTNs do Serviço de Transplante de Medula Óssea da Fundação Amaral Carvalho, atualmente o maior centro de TCTH alogênico do Brasil.

Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53 percent to 88 percent. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.