Ondas de choque. Evidencias y recomendaciones SETOC (Sociedad Española de Tratamientos con Ondas de Choque) / Current evidences in shockwave treatment. SETOC (Spanish Society of Shockwave Treatment) recommendations

El documento consenso SETOC muestra la evidencia científica de la tecnología en ondas de choque extracorpóreas (OCE) y ondas de presión radial (OPR) en diversidad de patologías musculoesqueléticas, cutáneas, espasticidad, urológicas, etc. Las OCE y las OPR son un tratamiento eficaz, seguro, no invasivo, coste-efectivo, bien tolerado por el paciente, sin necesidad de anestesia, que reduce la necesidad de cirugía, con menor riesgo de complicaciones y menor tiempo de recuperación que una cirugía. Por todo ello, las OCE y las OPR deberían ser la primera opción terapéutica de las patologías crónicas mencionadas, cuando las alternativas conservadoras hayan fallado, teniendo en cuenta las recomendaciones de este artículo, de las sociedades científicas y de la evidencia para cada tecnología (AU)

This SETOC consensus document shows the scientific evidence of the technology in shockwaves (SW) and radial pressure waves (RPW) in a variety of spasticity disorders, musculoskeletal, skin, urological diseases, etc. SW and RPW, without anesthesia, are an effective, safe, non-invasive, cost-effective treatment, which reduces the need for surgery, lower risk of complications, faster recovery and greater acceptability to patients than surgery. Consequently, SW and RPW should be the first therapeutic option in the aforementioned chronic pathologies, when conservative alternatives have failed. SETOC advises to follow the recommendations given in this article, including the ones given by SW scientific societies and best evidence for each technology as well (AU)

[Current evidences in shockwave treatment. SETOC (Spanish Society of Shockwave Treatment) recommendations]. / Ondas de choque. Evidencias y recomendaciones SETOC (Sociedad Española de Tratamientos con Ondas de Choque).

This SETOC consensus document shows the scientific evidence of the technology in shockwaves (SW) and radial pressure waves (RPW) in a variety of spasticity disorders, musculoskeletal, skin, urological diseases, etc. SW and RPW, without anesthesia, are an effective, safe, non-invasive, cost-effective treatment, which reduces the need for surgery, lower risk of complications, faster recovery and greater acceptability to patients than surgery. Consequently, SW and RPW should be the first therapeutic option in the aforementioned chronic pathologies, when conservative alternatives have failed. SETOC advises to follow the recommendations given in this article, including the ones given by SW scientific societies and best evidence for each technology as well.

Evaluation of the reasons for nonacceptance of kidneys retrieved or offered in Rio Grande do Sul and Pais Vasco.

In Rio Grande do Sul (RS), as in Pais Vasco (PV), some kidneys are retrieved or offered and not accepted for transplantation. This study aimed to evaluate the profile of the available kidneys and the reasons for them not being accepted in the 2 regions, and to compare the characteristics of the organs and reasons for refusal. All of the kidneys retrieved or offered in RS in December 2012 and in PV from September to December 2012 were evaluated. Data were collected from each local donation registry. There were 61 kidneys available in RS and 61 in PV in the study period. Of these, 16 kidneys (26%) in RS and 27 (44%) in PV were not implanted. The age of the donors was higher in PV (59 years) than in RS (45 years; P = .000), as was the age of the donors of accepted kidneys (62 and 41 years old, respectively; P = .000). The proportion of donors considered to be "extended criteria" was higher in PV (78%) than in RS (47%; P = .001), and the refusal rate of the kidneys from these donors was the same in the 2 regions. The reasons for not using the kidneys in RS and in PV were similar and absolute. It is concluded that there is no organ waste in the 2 regions, but that the offer of kidneys can be expanded in RS by considering elderly donors for evaluation, even if this means a higher number of refused organs.

Utilization of advanced-age donors in renal transplantation.

The shortage of organ availability in recent years has made it necessary to use grafts from advanced-aged donors to maintain the rate of renal transplantation in our country. The objective of this study was to evaluate the graft function and patient survival using kidneys from deceased donors of over 65 year of age. From 2005 until 2010, we compared the outcomes of patients who received grafts from donors over 65 years old vs less than 65 years. We observed no significant difference in sex, time on dialysis, or cold ischemia time between the groups. As expected the recipient age was significantly different. For the analysis of survival, we used the Tablecloth-Haenzel test and the Kaplan-Meier survival estimator. Actuarial survivals at 3 years after transplantation showed 84.8% among patients transplanted with kidneys from donors over 65 years old versus 97.5% in the control group. The graft survival was 78.8% among expanded criteria versus 86.85% in the control group. When we analyzed graft survival using an "exitus-censured" analysis, we obtained graft survivals of 89.1% in the expanded criteria kidney group versus 88.6% among the controls. We concluded that the use of kidney from donors over 65 years of age allows us to increase the rate of renal transplantation to about 15 to 20 per million population, with good graft and patient survivals provided that the protocol for expanded criteria organs ensured proper macroscopic and microscopic evaluation of the organ for transplantation.

Organ donation in the Basque country: 18 years experience.

PURPOSE: We reviewed of the trends in organ donation within a coordinated transplant program over the last 18 years. METHODS: Two thousand three hundred and fifty five potential donors (PD) were evaluated in 18 years including 1282 who were effective donors (EDs) and the 4081 harvested organs. A retrospective analysis of various parameters was performed comparing four different periods: 1981 to 1986 (P0); 1987 to 1992 (P1); 1993 to 1998 (P2); and 1999 to 2004 (P3). RESULTS: The potential donor detection rate (PD/PMP) increased from 18 in P0 to 47 in P3. The ED rate (ED/PMP) was 10 in P0 and 47 in P3. Organs donated ED evolved from 2.8 in P1 to 3.3 in P3. Mean donor age increased: 32 years in P1 and 53 in P3. ED/PD rate did not vary significantly in the three periods: P1, 54%; P2, 53%; and P3, 55%. There was a change in the main causes of death among our EDs: 54% head trauma, 36% stroke, and 16% other causes in P1 versus 30% head trauma and 64% stroke in P3. Failed donations due to medical contraindications were in P1 17% and in P3; whereas failed donation due to donor management problems and family denials to donation, both dropped: P1 16%; P3 10% and P1 13%; P3 7%, respectively. CONCLUSIONS: The ED rate increased almost fivefold since 1981 to 1986. We think that this was the result of a better detection since the beginning of our program. Failed donation due to medical exclusion criteria along with the mean donor age of our donors increased, but we noticed a significant drop in family denials and exclusions secondary to donor management problems. Our donor profile has changed considerably during 18 years: an increase of more than 20 years in the mean donor age along with an increase of more than 28% among strokes as the cause of death, leading to more failed donations secondary to medical exclusion criteria.

Evaluación de los politraumatizados fallecidos en la provincia de Gipuzkoa como fuente potencial de donantes a corazón parado / Evaluations of deaths from multiple injuries in the province of guipuzkoa (Spain) as a potential source of non-heart beating donors

Introducción. La extracción de órganos a partir de donantes a corazón parado puede ser un complemento a los programas tradicionales de donación en muerte encefálica. Antes de iniciar un programa de este tipo creemos necesario realizar una estimación del número de donantes potenciales. Material y métodos. Estudio prospectivo de todos los fallecidos por politraumatismo en la provincia de Gipúzkoa entre el 1 de enero de 1995 y el 31 de diciembre de 1998. Los criterios de potencial donante a corazón parado fueron los siguientes: posibilidad de inicio de maniobras de resucitación cardiopulmonar en menos de 15 min y posibilidad de inicio de los métodos de perfusión antes de 120 min tras la parada cardíaca, politraumatismo no secundario a homicidio o suicidio, edad superior a 16 e inferior a 50 años, ausencia de lesiones penetrantes torácicas y abdominales. Resultados. Durante el período de estudio fallecieron tras politraumatismo 687 pacientes (244 por millón de población [pmp]/año), de los que 329 hubieran podido ser reanimados en menos de 15 min y trasladados en un tiempo adecuado al hospital terciario; en 198 se daba algún motivo de exclusión. De los 131 pacientes restantes, 77 presentaron en el estudio necrópsico alguna lesión interna que habría hecho ineficaces las maniobras de resucitación, por lo que el número de potenciales donantes sería de 13,5/año 19,3 pmp. Conclusiones. Nuestros resultados pueden ser extrapolables a otras áreas geográficas de similares características. La metodología usada en nuestro estudio puede ser válida para este fin. (AU)

Evaluation of a small organ procurement organization in the Basque country, Spain.

A limited supply of organs is the main obstacle for organ transplantation. The shortage reflects not only a shortage of donors but also a failure to make use of existing donors. The Basque Country Transplant Coordination Team is an organ procurement organization that operates in the Basque country, an area of 7260 km2 with 2.1 million inhabitants. From January 1, 1990, to December 31, 1995, the number of potential cadaveric organ donors found by the team increased, to 70 donors per million inhabitants in 1995. Since 1993, the organization has had more than 30 donors per million persons and has procured more than 90 cadaveric organs, including more than 60 cadaveric kidneys, per million persons. Because of these rates, the team coordinated 61.7 cadaveric kidney transplants per million persons during 1995. This paper describes some characteristics of the Basque organ procurement organization that might explain these results.