Strategies to keep kidney transplant alive amid the SARS-CoV-2 pandemic

SUMMARY OBJECTIVE: This study aims to describe the result of the strategies adopted to maintain the transplant program amid the COVID-19 pandemic. METHODS: Since March 2020, several measures have been adopted sequentially, including the compulsory use of personal protective equipment and the real-time polymerase chain reaction testing of collaborators, symptomatic patients, potential deceased donors, candidates for recipients, and in-hospital readmissions, regardless of symptoms. The living-donor transplantation was restricted to exceptional cases. RESULTS: Among 1013 health professionals, 201 cases of COVID-19 were confirmed between March and August 2020, with no severe cases reported. In this period, we observed a 19% institutional increase in the number of transplants from deceased donors compared with that observed in the same period in 2019. There was no donor-derived severe acute respiratory syndrome virus (SARS-CoV-2) infection. Four COVID-19-positive patients underwent transplantation; after 28 days, all were alive and with functioning allograft. Among the 11,875 already transplanted patients being followed up, there were 546 individuals with confirmed diagnosis, 372 who required hospitalization, and 167 on mechanical ventilation, resulting in a 27% mortality rate. CONCLUSIONS: These data confirm that the adoption of sequential and coordinated measures amid the pandemic was able to successfully maintain the transplant program and ensure the safety of health professionals and transplanted patients who were already in follow-up.

The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation

Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4 per cent is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35 per cent presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50 per cent), positivity to M. tuberculosis in the sputum (30 per cent) and spinal cerebral fluid analysis (7 per cent). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.

Estudo da necessidade de transplante de orgaos no Brasil e a disponibilidade de doadores / Necessity of the organs transplantation in Brazil, availability of donors

Com o objetivo de estimar o numero de potenciais doadores de orgaos na cidade de Sao Paulo, obteve-se o numero anual de necropsias realizadas nos Instituto Medico Legal nos anos de 1990 e 1991. Foram revisados o boletim de ocorrencia policial, o relatorio hospitalar e o relatorio de necropsia de 1.039 cadaveres encaminhados ao Instituto Medico Legal no mes de maio de 1991. Conclui que na cidade de Sao Paulo existem 5 potenciais doadores de orgaos por dia, numero suficiente para saturar as equipes de transplante em atividade, e que a recusa da doacao por parte dos familiares nao e o principal motivo que leva a escassez de doadores, mas sim a falta de estruturacao das equipes que dao atendimento medico no sentido de reconhece-los e promover a manutencao adequada para que se viabilize a doacao dos orgaos. O numero de transplante de orgaos no pais esta muito aquem da necessidade estimada, pelo pequeno numero de equipes que realizem tal procedimento

Estimativa do número de potenciais doadores de órgäos na cidade de Säo Paulo / Estimation of the number of potential donors of organs in the city of Säo Paulo, Brazil

OBJETIVO. Existe um conceito de que se realiza um número pequeno de transplante de órgäos devido à falta de doadores ou do grande índice de recusa dos familiares com relaçäo à doaçäo. Este trabalho tem por objetivo avaliar o potencial número de doadores de órgäos na cidade de Säo Paulo. MATERIAL E MÉTODOS. Estudamos o número de necrópsias realizadas diariamente por morte violenta no Instituto Médico Legal (IML) da cidade de Säo Paulo, nos anos de 1990 e 1991, e os doadores referidos à central de captaçäo de órgäos do Hospital Säo Paulo (HSP) nesse mesmos período. RESULTADOS. Nos anos de 90 e 91 foram realizadas, respectivamente, 11.601 e 11.607 necrópsias. A análise de 500 necrópsias de 10/90 e 1.039 necrópsias de 5.91 demonstra que 27% destes cadáveres tiveram o traumatismo craniencefálico como causa única de óbito e, destes 70% foram atendidos em algum Hospital antes de serem encaminhados ao IML. Neste mesmo período a equipe de procura de órgäos do HSP recebeu notificaçäo de 296 possíveis doadores, das quais 219 famílias foram abordadas com relaçäo à doaçäo e 59% delas autorizaram a doaçäo. CONCLUSÄO. Considerando o número de óbitos exclusivamente por TCE que passaram por algum hospital e a taxa de doaçöes, existe um número de potenciais doadores em Säo Paulo suficiente para saturar a capacidade de trabalho de todas as equipes em atividade, desde que o sistema de procura seja eficiente