Calidad de vida en pacientes trasplantados renales de una institución prestadora de servicios de salud en Medellín, Colombia / Quality of life in transplanted renal that consulted in an institution of health in Medellin, Colombia

Resumen Introducción: El trasplante renal que se realiza en pacientes con enfermedad renal crónica (ERC) en estadio cinco, es una alternativa de tratamiento que prolonga la supervivencia, reduce la morbilidad, acelera la rehabilitación social y médica; sin embargo es necesario realizar estudios para evaluar la calidad de vida de estos pacientes. Objetivo: Determinar características sociodemográficas, clínicas y de servicios en salud, que explican la calidad de vida de pacientes trasplantados renales de una institución de salud de Medellín en 2016. Materiales y métodos: Estudio cuantitativo transversal realizado en 228 pacientes. Se aplicó el instrumento SF-36. Se realizaron pruebas estadísticas Kolmogorov Smirnov, U de Mann Whitney, Kruskal Wallis y el coeficiente de correlación de Spearman; el análisis multivariado seleccionado fue el modelo de regresión mediana. Resultados: El 50% de los pacientes obtuvo 83,3 o menos puntos en su calidad de vida. El modelo de regresión multivariado mostró diferencias significativas en las variables tiempo después del trasplante y reingreso a hospitalización en el último año. Por cada reingreso a hospitalización su calidad de vida disminuyó en 3,82 puntos. Pacientes con un periodo superior a 36 meses después del trasplante disminuyen su calidad de vida en 12,03 puntos, en comparación con aquellos que llevan periodos entre 7 y 36 meses. Conclusiones: Las variables que mejor explicaron la calidad de vida en la población participante fueron el tiempo de trasplantado y el número de reingresos a hospitalización.

Abstract Introduction: Renal transplantation performed on patients with chronic renal disease (CRD) stage five, is an alternative treatment that prolongs survival, reduces morbidity, accelerate social and medical rehabilitation. However it is necessary to carry out studies to evaluate the quality of life of these patients. Objective: Establishing the socio-demographic, clinical and service characteristics of the health insurer that explain the life quality of kidney transplanted patients who consulted a health institution in Medellin in 2016. Materials and methods: Quantitative and transversal survey carried out in 228 patients to whom the SF-36 instrument were applied. There were calculated the statistical tests of Kolmogorov Smirnov for normality, U de Mann Whitney, Kruskal Wallis and the Spearman correlation coefficient. In the multivariate analysis the median regression model was selected. Results: 50% of the patients got 83.3 or less in its life quality score. The multivariate regression model shown significant differences in the time variables after transplantation and readmission to hospital in the last year; by each readmission to hospital, the values of life quality decreased in 3.82 points; according to the time after the transplantation, it was found that going from a state where the patient has a term between 7 and 36 months, to a state where the patient has a term over 36 months, shown a decrease of 12.03 points in life quality, adjusted by the other variables. Conclusions: The variables that best explained the life quality of the kidney transplanted patients who consulted a health institution were the time of transplantation and the number of readmissions to hospital.

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidney-pancreas transplantation vs those with combined en bloc' liver-pancreas transplantation / 中华器官移植杂志

Objective To compare the effects of combined ‘en bloc' liver-pancreas transplantation (LPT) with portal vein drainage and simultaneous combined kidney-pancreas transplantation (KPT) with systemic venous drainage on the pancreatic endocrine function and related metabolism.Methods Four LPT patients and 6 KPT ones with normal hepato-renal function, good quality of life and periodic follow-up received measurement of serum insulin, insulin provocation test, fasting glucose, oral glucose tolerance test, C-peptide, glycated hemoglobin, triglyceride and total cholesterol; and their laboratory test parameters were compared and analyzed.Results In KPT group, 2-h insulin level, C-peptide level and total cholesterol level were significantly higher at 6th month, 3rd and 6th month postoperation (all P<0.05). But there was no significant difference in other parameters between the two groups at 6th month after operation.Conclusion Either KPT or LPT can achieve excellent endocrine function, carbohydrate and lipid metabolism; and the results show that portal venous drainage does not offer major metabolic advantages within 6 months after operation.

Morte encefálica: conceitos essenciais, diagnóstico e atualização / Brain death: essential concepts, diagnosis an update

A morte encefálica representa o estado clínico irreversível em que as funções cerebrais (telencéfalo e diencéfalo) e do tronco encefálico estão irremediavelmente comprometidas. São necessários três pré-requisitos para defini-la: coma com causa conhecida e irreversível; ausência de hipotermia, hipotensão ou distúrbio metabólico grave; exclusão de intoxicação exógena ou efeito de medicamentos psicotrópicos. Baseia-se na presença concomitante de coma sem resposta ao estímulo externo, inexistência de reflexos do tronco encefálico e apneia. O diagnóstico é estabelecido após dois exames clínicos, com intervalo de no mínimo seis horas entre eles, realizados por profissionais diferentes e não vinculados à equipe de transplantes. É obrigatória a comprovação, por intermédio de exames complementares, de ausência no sistema nervoso central de perfusão ou atividade elétrica ou metabolismo. Morte encefálica significa morte tanto legal quanto cientificamente. É necessário que todo profissional de saúde, especialmente o médico, esteja familiarizado com o conceito de morte encefálica, para que a aplicação da tecnologia na sustentação da vida seja benéfica, individual e socialmente comprometida, e não apenas promovedora de intervenção inadequada, extensão do sofrimento e angústia familiar e prolongamento inútil e artificial da vida.

Brain death represents the irreversible medical condition in which the brain functions (telencephalon and diencephalons) and the brainstem are hopelessly compromised. Three prerequisites are necessary to define it, that is: irreversible coma with known cause; absence of hypothermia, hypotension or severe metabolic disorder; exclusion of exogenous intoxication, or psychotropic drugs effect. It is based on the concomitant presence of coma unresponsive to external stimuli, absence of brain stem reflexes, and the presence of apnea. The diagnosis is established after two clinical tests with an interval of at least six hours, carried out by two different professionals not linked to the transplant team. It is mandatory to prove, through complementary exams, the absence of central nervous system perfusion, or electric activity or metabolism. Brain death means death both legally and scientifically. It is necessary for all health care professionals, especially the physician, to be familiar with the concept of brain death, so that the application of life support technology is beneficial, individually and socially committed, not only to promote inadequate intervention, extension of suffering and familiar distress and futile and artificial prolongation of life.

The management of single brain death donor for the successful five organs transplantation.

The demand of organs for transplantation in Thailand has been increasing enormously since the successful transplantation became well established. However there is the limited number of available cadaveric donors. One of the solutions for this problem is the maximal use of the organs from a single donor. The proper assessment and care of donor, good surgical techniques and well-organized coordination system could make significant contributions to successful multiorgan retrievals. We report the management of the first single cadaveric donor to bring five organs i.e., heart, lung, liver and both kidneys for the successful transplantations.