Caracterización inmunogenética de donantes cadavéricos cubanos en el año 2019 / Immunogenetic characterization of Cuban cadaveric donors in 2019

Introducción: El trasplante es la opción terapéutica más favorable para las personas con insuficiencia renal crónica. El donante puede ser cadavérico o donante vivo, emparentado o no. Los resultados del trasplante están en relación con varios factores inmunológicos y no inmunológicos. Objetivo: Caracterizar inmunogenéticamente a los donantes cadavéricos cubanos para trasplante renal. Métodos: Se realizó un estudio transversal y descriptivo de los donantes cadavéricos durante el año 2019. Se analizó la región de procedencia, sexo, color de la piel y rangos de edades de los donantes, así como, grupo sanguíneos ABO y Rhesus Rh; serología para VIH, Virus de hepatitis B(VHB) y Virus de hepatitis C (VHC); y hábitos tóxicos. Resultados: Se estudió un total de 95 donantes cadavéricos, 62 provenientes del occidente y 33 del centro del país. El 63,2 por ciento fueron masculinos y 36,8 por ciento femenino. El grupo de edad de mayor frecuencia fue 40 - 60 años y la edad media de 49,45 años. El 58,95 por ciento de los pacientes fueron de grupo sanguíneo O; 30,53 por ciento grupo A y los grupos B y AB tuvieron 5,26 por ciento de prevalencia; y solo 8 fueron Rh negativos. Todos tuvieron serología para VIH, VHB y VHC negativas. Las enfermedades asociadas más frecuentes fueron la hipertensión arterial y la diabetes mellitus. Conclusiones: Los donantes cadavéricos durante el año 2019 mostraron características similares a las reportadas por otros estudios. El aumento de las edades de los donantes incide en la aparición de enfermedades asociadas y esto pudiera repercutir en el resultado del trasplante(AU)

Introduction: Transplantation is the most favorable therapeutic option for people with chronic renal failure. The donor can be a cadaveric or living donor, related or not. Transplant outcomes are related to various immunological and non-immunological factors. Objective: To characterize Cuban cadaveric donors for renal transplantation Materials and methods: A cross-sectional and descriptive study of cadaveric donors was carried out during the year 2019. The region of origin, sex, skin color and age ranges of the donors were analyzed, as well as ABO and Rhesus Rh blood groups; serology for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), and toxic habits. Results: A total of 95 cadaveric donors were studied, 62 from the West and 33 from the Center of the country. 63.2 percent were male and 36.8 percent female due to the most frequent age group being 40-60 years and the mean age of 49.45 years. 58.95 percent of the patients were of blood group O, 30.53 percent group A and groups B and AB had 5.26 percent prevalence; and only 8 were Rh negative. All had negative serology for HIV, HBV and HCV. The most frequent associated diseases were arterial hypertension and diabetes mellitus. Conclusions: The cadaveric donors during the year 2019 showed characteristics similar to those reported by other studies. The increase in the age of the donors affects the appearance of associated diseases and this could affect the result of the transplant(AU)

Cadaveric donor skin allograft as a temporary dressing material in the management of complicated wounds

Introduction: Wounds resulting from various causes are the most common health problem in developing countries like India. Management of these wound is very difficult, requiring longer hospital stay, loss of income, psychological problems like depression. In our study, we used cadaveric donor skin as a temporary dressing material for wound cover and see the outcome of definitive splitthickness skin graft following cadaveric donor skin application. Previously cadaveric skin was used for covering the burns wound. Only very few studies are available regarding the use of cadaveric donor skin in the management of complicated wounds. Materials and methods: This was a prospective, non-randomized, uncontrolled study conducted in the Department of General Surgery, Government Stanley Medical College Hospital from October 2017 to September 2018. Once the wound scheduled for cadaveric grafting, the cadaveric skin was meshed in the laminar flow cabinet, the skin was washed in the normal saline, to ensure that all the preservative fluid had been removed. The skin is transported in a sterile container. The cadaveric graft was applied to the wound. No fixation done. Limb was immobilized using POP. Sterile was dressing done. Results: In our study 44 patients underwent cadaveric donor skin grafting. In 40 out of 44 patients (90.9%), the cadaveric donor skin had good take. All 40 patients underwent definitive split-thickness skin grafting. The mean graft take was 90.35%, with maximum graft take was 96% and minimum graft take was 82%. The standard deviation was 3.512%. When reviewing the literature which showed the success rate of STSG was 78% at closing 90% of the wound by 8 weeks. In our study, the mean duration of hospital stay was 34.2 days, with maximum of 57 days and a minimum of 17 days. Most Jim Jebakumar, S. Ranjith Kumar. Cadaveric donor skin allograft as a temporary dressing material in the management of complicated wounds. IAIM, 2019; 6(3): 65-72. Page 66 of the wounds required only single cadaveric graft application, 37 (84.1%) out of 44 patients and 7 patients (15.9%) required more than one cadaveric donor skin grafting. Conclusion: By this study, we can able to minimize the expenses by using the cadaveric skin to predict the success of definitive split-thickness skin grafting. We can also minimize the duration of hospital stay and prolonged use of antibiotics if the cadaveric skin take is successful.

Comparative study on the preservation quality of intestinal grafts from donors of donation after cardiac ;death and cadaveric donors / 器官移植

Objective To compare the preservation quality of intestinal grafts from donors of donation after cardiac death (DCD)and cadaveric donors.Methods Quality of intestinal grafts from 7 cadaveric donors (group N)and 7 DCD donors (group DCD)in Beijing from 201 3 to 201 4 was evaluated.The grafts were preserved after perfusion and resection,and then intestinal tissue was collected 30 min and 6 h later.Meanwhile,histopathological examination and intestinal graft injury score (Chiu's integral method)were performed.The content of malondialdehyde (MDA)in intestinal tissue was detected by thiobarbituric acid assay,and the apoptosis of intestinal mucosa cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)method.Results Intestinal graft injury scores for group N and DCD were (1 .46 ±0.81 )and (1 .76 ±0.21 )respectively at 30 min after preservation,and (3.86 ± 0.42)and(4.1 7 ±0.71 ),respectively at 6 h after preservation(both in P >0.05).Compared with the preservation of 30 min,intestinal graft injury scores increased significantly in both groups at 6 h after preservation (both in P <0.05).The contents of MDA in intestinal tissue of the small intestinal graft in group N and DCD were (1 00 ±1 0)pmol/mg and (1 1 0 ±1 3)pmol/mg,respectively at 30 min after preservation (P >0.05),and (1 70 ±1 8)pmol/mg and (31 0 ±29) pmol /mg,respectively at 6 h after preservation,of which the difference was statistically significant between the two groups at the same time (P <0.05).Compared with the preservation of 30 min,the contents of MDA increased significantly in both groups at 6 h after preservation (both in P <0.05 ).The number of apoptotic intestinal mucosal cells in small intestinal grafts for group N and DCD was (9.78 ±2.56)and (1 5.78 ±2.84),respectively at 30 min after preservation (P >0.05),and (31 .32 ±1 .38)and (53.42 ±1 .95),respectively at 6 h after preservation,of which the difference was statistically significant between the two groups (P <0.05).Compared with the preservation of 30 min,the number of apoptotic intestinal mucosal cells in small intestinal grafts increased significantly in both groups at 6 h after preservation (P <0.05).Conclusions Preservation quality of small intestinal grafts in DCD donors is roughly equivalent to that in traditional cadaveric donors,which suggests that small intestinal grafts in DCD donors may be used in clinical intestinal transplantation.

Rh-positive patients receiving kidney grafts from Rh-negative cadaver donor:a report of two cases and literature review / 器官移植

Objective To discuss the safety of Rh-positive patients receiving kidney grafts from Rh-negative cadaver donor. Methods On November 29 th 2013, two Rh-positive patients received renal transplantation with kidney grafts from Rh-negative cadaver donor at the Department of Urinary Surgery of Xijing Hospital,the Fourth Military Medical University. The clinical data of the two patients were analyzed retrospectively and the relevant literatures were reviewed. Results The two patients underwent renal transplantation successfully and no hyperacute rejection or acute rejection occured after the surgery.The two patients were followed up for 12 months.The kidney grafts survived well and the patients had no obvious discomfort.Conclusions Through enhanced immunosuppression before operation,sufficient perfusion and close postoperative monitoring,it is safe for Rh-positive patients receiving kidney grafts from Rh-negative cadaver donor.

Analysis of Panel Reactive Antibody in Patients Awaiting Renal Transplantation / 대한이식학회지

BACKGROUND: We performed panel reactive antibody (PRA) tests in renal transplantation candidates registered to the Korean Network for Organ Sharing (KONOS) and analyzed the results of PRA tests in relation to the results of HLA crossmatch (XM) tests and transplantation history. METHODS: From 833 patients awaiting cadaveric renal transplantation in the KONOS registry, 122 (98 patients) XM (NIH or AHG)-positive and 147 (147 patients) XM-negative serum samples were selected for PRA test. Enzyme linked immunosorbent assay (ELISA)-PRA screening test was performed and HLA antibody specificities were identified by NIH and AHG PRA methods. RESULTS: PRA positive rate was significantly higher in XM-positive group compared with XM-negative group (ELISA-PRA, 70.5% vs. 21.8%; AHG-PRA [PRA > or =10%], 73.9% vs. 9.6%). Donor specific antibodies were defined in 52.5% (64/122), whereas false positive XM results were suspected in 20.5% (25/122) of the XM-positive samples. Patients with transplantation histories showed significantly higher positive rates for ELISA-PRA (78.7% vs. 30.8%) and AHG-XM tests (78.2% vs. 29.3%). Highly sensitized patients (AHG-PRA > or =80%) showed significantly higher cumulative waiting rate (88.9% vs. 60.2% at 4 years) and longer waiting time (3.8 vs. 3.6 years) (Kaplan Meier method, P=0.037). PRA positive rate in the total renal transplantation candidates in the KONOS registry was estimated to be 33.9% for ELISA-PRA and 21.7% for AHG-PRA (PRA > or =10%), and the proportion of highly sensitized (PRA > or =80%) patients was estimated to be 5.4%. CONCLUSIONS: Pre-transplantation PRA as a routine test is needed in cadaveric renal transplantation for effective and fair allocation of organs in Korea.

Steatotic Graft for Liver Transplantation / 대한이식학회지

It is common practice to reject potential grafts with fatty change over 30%. We report a case of successful liver transplant using a graft with 70% fatty liver. The patient was a 53 year old male with alcoholic liver cirrhosis who had received endoscopic varix ligation (EVL) for esophageal varix bleeding 4 months ago. He presented with esophageal varix bleeding and drowsy mentality, and was admitted to the ICU via the emergency room. He received EVL again. Preoperative total bilirubin was 11.4 mg/dl, prothrombin time was 40%. The donor was a 50 year old male with diabetes. Liver biopsy showed 70% fatty liver. The operation took 10 hours, and there was no intraoperative complication. Sixteen days after the operation, liver enzymes were normal but total bilirubin was elevated up to 10.26 mg/dl. Liver biopsy was done. Biopsy showed almost no fatty liver but it showed moderate rejection, so steroid recycling was done. Total bilirubin decreased steadily. But 38 days after the operation, ascites increased, and follow-up liver biopsy again showed almost no fatty change but showed severe rejection. Steroid pulse therapy was done, and after pulse therapy the amount of ascites decreased, and the patient was discharged 56 days after the transplantation in tolerable condition. Brain death donor liver grafts with severe fatty liver increase the risk of post transplant complications such as renal failure. But since severe fatty liver does not always cause primary nonfunction, it may be considered as transplant grafts in selected cases.

Influence on Graft Function with Modified Method of Combined Liver and Kidney Procurement and Rapid En Bloc Kidney Procurement / 上海第二医科大学学报

Objective To compare the graft function of 2 methods of kidney harvesting,the modified method of combined liver and kidney procurement and rapid en bloc kidney procurement. Methods The clinical data of 220 cadaveric renal transplantation recipients were collected(12 months follow-up),174 cases from en bloc kidney procurement and 46 from combined liver and kidney procurement.The average harvesting time,the incidence of renal vein injury,1 year kidney survival and incidence of acute rejection were compared between the two methods.Results In average harvesting time and incidence of renal vein injury,the en bloc kidney procurement were better than the method of combined liver and kidney procurement.However,the method of combined liver and kidney procurement was better than the en bloc kidney procurement in 1 year kidney survival,1 year incidence of acute rejection and average warm ischemia time.There was no difference in 1 year survival of patients and 24 h,1 week and 1 year graft function after transplantation. Conclusion Although the method of combined liver and kidney procurement is better than the en bloc kidney procurement in 1 year kidney survival and 1 year incidence of acute rejection,there is no difference between the 2 methods in 1 year survival of patients and graft function after transplantation.

Clinical Review of Post-transplantation Diabetes Mellitus after Liver Transplantation / 대한이식학회지

PURPOSE: Liver transplantation (LT) can cure abnormality of glucose metabolism, but cause altered glucose metabolism with immunosuppressive treatment. Up to now, almost all studies have been performed in cadaveric donor liver transplantation (CDLT). We underwent study in CDLT and also living donor liver transplantation (LDLT) recipients. METHODS: Among 397 adult-to-adult LT recipients between January 1994 and August 2001, we selected 81 patients who could be followed more than 12 months by using the table of random sampling numbers. We reviewed the change of blood glucose and risk factors, complications and survival retrospectively between post-transplantation diabetes mellitus (PTDM) and no PTDM patients. RESULTS: Clinical data showed 34 : 47 in frequency of PTDM to no PTDM. Age, family history of DM, preoperative DM history over 6 months had a significant risk of PTDM. There was no difference of PTDM frequency between CDLT and LDLT and its subgroup. The worse post-transplant graft function causes the more incidence of PTDM (P=0.051). FK506 had higher relation with PTDM than cyclosporine and mycophenolate mofetile (P=0.058). The incidence of DM after operation has been decreased by 6 months, but thereafter no further. There were 18 of De Novo DM among 34 PTDM patients, and only 1 preoperative DM patient improved after LT. Between PTDM and no PTDM group, there were no significant difference of complication rate and 5-year survival rate. CONCLUSIONS: The types of graft would not affect the incidence of PTDM if the graft function were preserved. Other clinical data showed similar results to previous reports.

Liver Transplantation for Hepatocellular Carcinoma

PURPOSE: Surgery remains the treatment of choice for a hepatocellular carcinoma (HCC) confined within the liver. When there is no underlying liver disease, resection is the preferred option. In cases of HCC with cirrhosis, impaired hepatic reserve often precludes safe resection. Recently, acceptable transplantation outcomes have been shown in selected HCC patients. The aim of this study was to review the results of liver transplantation for HCC at the Asan Medical Center. METHODS: 73 HCC patients were treated by liver transplantation between August 1992 and April 2001. There were 7 in-hospital mortalities. The mean age of the patients was 51 years. The period of the median follow-up was 22 months. By reviewing the patients' medical records, we investigated tumor size, and number, TNM stage, survival rates, and recurrences. Statistical analysis was performed using Statistica 5.1 and SPSS 9.0. RESULTS: Among 67 patients, 8 (12%) developed a tumor recurrence or distant metastasis following the liver transplantation. The 3 year and 5 year survival rate were 88 and 57%, respectively. There were 12 incidentalomas. The 1 year and 3 year disease free survival rates of 54 cases, with the exception of the incidentalomas, were 80 and 50%, respectively. There were no statistically significant differences in the survival rates between the groups, with and without preoperative TACE (P=0.70). Also, there were no statistically significant differences in the survival rates between cadaveric donor liver transplantations (CDLT) and living donor liver transplantations (LDLT). CONCLUSION: We assume that transplantation for HCC, in carefully selected patients, may be the solution to HCC in cirrhotic livers. If the donor safety with a LDLT can be ensured, its application to patients with cirrhosis and early HCC may be a solution to the donor shortage, which could improve the survival of this group of patients.

Enfermeiros e médicos de Unidade de Terapia Intensiva e Pronto Socorro face à manutenção e notificação de potenciais doadores de órgãos: crenças e valores / Nurses and physicians from intensive care unit and emergency unit facing maintenance and notification of potential cadaveric donor: beliefs and value

Este estudo, realizado junto a enfermeiros e médicos atuantes em unidade de terapia intensiva (UTI) e pronto socorro (PS), em dois hospitais distintos (hospital escola/ hospital privado), teve como objetivo identificar crenças e valores contidos no universo de pensamentos dos sujeitos envolvidos, face ao comportamento sugerido de realizar a manutenção e notificação do potencial doador de órgãos. Para tanto, foi utilizado o referencial Theory of Reasoned Action (TRA), classificado como uma teoria de prognóstico de comportamento. Além de possibilitar a identificação de crenças salientes junto aos sujeitos envolvidos, a TRA permitiria em uma segunda etapa, a correlação matemática das crenças que influenciam com maior ou menor intensidade na realização do comportamento sugerido. Foram encontradas cinco unidades temáticas que sustentam a vivência dos profissionais com o comportamento sugerido e então, identificadas crenças normativas e comportamentais diretamente relacionadas à prática profissional, preparo para o cuidado do potencial doador e as controvérsias geradas em relação ao cuidar. Foram percebidos referentes sociais sob dois aspectos: aspecto pessoal (contato com determinadas pessoas) e o aspecto de outras formas de pressão social. Em ambos os aspectos, as relações positivas e negativas foram identificadas. Apesar da formação técnica diferente, enfermeiros e médicos compartilham a mesma vivência face ao comportamento sugerido. Não houve diferença significativa na identificação de crenças quanto ao campo de atuação (UTI ou PS) ou categoria da instituição (hospital escola/ hospital privado). As crenças encontradas de forma direta ou indireta apontam para um possível distanciamento da realização do comportamento sugerido.

This study, carried out together with nurses and physicians working in intensive care unit (ICU) and emergency unit (EU), in two different hospitals (school hospital/private hospital), aims to identify beliefs and value in the thought universe of involved people, in comparision with suggested behavior for maintenance and identification of a potential cadaveric donor. For this purpose, Theory of Reasoned Action (TRA), considered a behavior prognosis theory, was used as a reference. In addition to making outstanding beliefs identification possible to involved people, TRA allows in a second step identifying the mathematics of beliefs that exert more or less influence on the suggested behavior performance. Five thematic units supporting professional experience with the suggested behavior were found, and then normative and behavioral beliefs directly related to professional experience, preparation to the potential cadaveric donor care, and controversies related to this care were identified. Social references were observed under two aspects: personal aspect (contact with certain people), and other social pressure form aspects. In both aspects, positive and negative relations were identified. Despite different technical background, nurses and physicians share the same experience regarding the suggested behavior. There was no significant difference when identifying beliefs according to the work field (ICU or EU), or institution category (school hospital/private hospital). Beliefs that were directly or indirectly found point to a possible deviation from the suggested behavior performance.

The Comparison of Coagulation Status in the Cadaveric Donor and Living-Related Liver Transplantation / 대한마취과학회지

BACKGROUND: Orthotopic liver transplantation is widely regarded as the only effective treatment for many acute or chronic end-stage liver diseases. However, the shortage of cadaveric organs is one of the most crucial limitations to the liver transplantation. Recently, in our hospital, living-related liver transplantation (LR LT) cases have remarkably increased during the last two years. Because there are differences in the surgical procedure and graft volume between the cadaveric donor liver transplantation (Cd LT) and LRLT, the intraoperative coagulation status may be different, too. With the knowledge of coagulation status, the anesthetic mangement of liver transplantation will be improved. METHODS: A retrospective evaluation was performed on 36 patients, who underwent an orthotopic liver transplantation between October 1999 and April 2001. Seventeen patients received a Cd LT and 19 patients underwent a LRLT. We compared the two groups in the aspects of coagulation related parameters; 1) ischemic time, 2) venovenous bypass (VVB) flow, 3) the percentages of occurrence of postreperfusion syndrome (PRS), 4) the ratio of activated clotting time (ACT) exceeding 200 seconds after reperfusion, 5) the ratio of hyperfibrinolysis, LY60 > 20%, on a thromboelastograph (TEG) after reperfusion, and 6) the amounts of transfusion and fluid administration before and after reperfusion. RESULTS: The ischemic time was shorter in the LR LT group than the Cd LT group (115.4 +/- 25.4 min versus 409.2 +/- 115.6 min). The VVB flow was greater in the Cd LT group than the LR LT group. The ratio of occurrence of PRS was also lower in the LR LT group (11%) than the Cd LT group (53%). The percentage of ACT exceeding 200 seconds after reperfusion was only 11% in the LR LT group, but 59% in the Cd LT group. The percentages of LY 60 > 20% on the TEG after reperfusion were not statistically different in each group, but the percentage of tranexamic acid administration due to persistent, severe hyperfibrinolysis was higher in the Cd LT group than the LR LT group. The amounts of transfusion and fluid administration were significantly smaller in the LR LT group compared to those in the Cd LT group. CONCLUSIONS: We found that there were many differences in the coagulation status between the Cd LT and the LR LT groups. Therefore, anesthesiologists should consider these differences and manage each case of liver transplantation properly.

Major Complications after Orthotopic Liver Transplantations

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.