Corrigendum: Ex vivo normothermic preservation of a kidney graft from uncontrolled donation after circulatory death over 73 hours.

[This corrects the article DOI: 10.3389/fbioe.2023.1330043.].

Ex vivo normothermic preservation of a kidney graft from uncontrolled donation after circulatory death over 73 hours.

The transplant community is focused on prolonging the ex vivo preservation time of kidney grafts to allow for long-distance kidney graft transportation, assess the viability of marginal grafts, and optimize a platform for the translation of innovative therapeutics to clinical practice, especially those focused on cell and vector delivery to organ conditioning and reprogramming. We describe the first case of feasible preservation of a kidney from a donor after uncontrolled circulatory death over a 73-h period using normothermic perfusion and analyze hemodynamic, biochemical, histological, and transcriptomic parameters for inflammation and kidney injury. The mean pressure and flow values were 71.24 ± 9.62 mmHg and 99.65 ± 18.54 mL/min, respectively. The temperature range was 36.7°C-37.2°C. The renal resistance index was 0.75 ± 0.15 mmHg/mL/min. The mean pH was 7.29 ± 0.15. The lactate concentration peak increased until 213 mg/dL at 6 h, reaching normal values after 34 h of perfusion (8.92 mg/dL). The total urine output at the end of perfusion was 1.185 mL. Histological analysis revealed no significant increase in acute tubular necrosis (ATN) severity as perfusion progressed. The expression of KIM-1, VEGF, and TGFß decreased after 6-18 h of perfusion until 60 h in which the expression of these genes increased again together with the expression of ß-catenin, Ki67, and TIMP1. We show that normothermic perfusion can maintain a kidney graft viable ex vivo for 3 days, thus allowing a rapid translation of pre-clinical therapeutics to clinical practice.

Effect of Active and Early Possible Organ and Tissue Donor Detection in the Emergency Room in a University Hospital.

PURPOSE: The emergency room of the hospital is the gateway for patients with severe brain damage due to neurologic or cardiac conditions such as stroke or cardiac arrest. The main purpose is to design an active registry of patients, in the emergency room, to facilitate the detection and follow-up of potential donors according to their clinical evolution. MATERIAL AND METHODS: This is a 1-year prospective study from May 2017 to May 2018 with a register for detection of patients admitted to the emergency room with severe brain damage (Glasgow Coma Scale score ≤ 8), with active follow-up until hospital discharge, who might have died or otherwise become possible organ and tissue donors. RESULTS: One hundred sixty-six (107 men and 59 women) patients met the inclusion criteria: (1) 30.7% recovered from cardiac arrest; (2) 31.3% from stroke; (3) 16.9% from traumatic brain injury and multiple trauma; (4) 10.2% had decreased level of consciousness; (5) 4.8% had other cardiac conditions; and (6) 6.0% had other diagnoses. Seventy-seven out of 166 patients (46.4%) were evaluated as possible organ and tissue donors, with 37 out of 77 (48.0%) of the possible donors becoming real donors. This means that 37 out of 166 (22.3%) of the possible donors admitted to the emergency room became real donors. Twenty-two out of 77 of the patients (28.6%) evaluated had clinical contraindications for donation and in 18 out of 77 (23.4%), there was family refusal for any kind of organ or tissue donation. This record allowed the generation of the following organs and tissues: 4 hearts, 19 livers, 14 lungs, 52 kidneys, 2 pancreata, 29 corneas, 19 donations of bone allografts, 15 donations of skin tissue, 14 donations of valvular allografts, and 11 vascular allografts. CONCLUSIONS: The early and active possible donors registry at the emergency room has facilitated early detection and allow adequate follow-up and evaluation of possible organ and tissue donors.

Optimización del proceso de donación de tejidos en un hospital universitario: 10 años de experiencia / Optimising tissue donation process in a universiy hospital: 10 years of experience

Fundamento y objetivo: La necesidad de tejido para trasplante requiere un esfuerzo continuo en la detección y evaluación de las causas de fallecimiento de los sujetos potencialmente donantes de tejidos. El objetivo de este estudio fue evaluar la capacidad de optimizar la donación de tejidos tras la detección activa de fallecidos y la revisión exhaustiva de las causas de muerte de acuerdo con los estándares internacionales y locales de bancos de tejidos. Material y método. Desde el año 2002 se instauró un procedimiento de detección activa y precoz de fallecidos hospitalarios. Se estudió el incremento de potencialidad de donación modificando los criterios: edad (80 a 85 años), aceptación de facoemulsiones corneales, enfermedades autoinmunitarias y reevaluación de las sepsis. En la década 2002-2011 se mantuvieron los mismos criterios de exclusión absoluta. Se analizó la tasa de conversión de potenciales donantes a donantes reales de uno o varios tejidos. Resultados: Analizamos 16.531 fallecidos en parada cardiorrespiratoria. Cumplían criterios de exclusión absoluta 11.191 casos. La modificación de criterios incrementó los potenciales donantes: un 10,4% la edad, un 4,5% las enfermedades autoinmunitarias/facoemulsión y un 11,8% el criterio de sepsis (p < 0,00), con un incremento global del 16% (p < 0,00) al final del período de estudio. Se generaron un total de 2.371 donantes efectivos. La efectividad de generar donantes pasó del 11 al 21% durante la década (p < 0,00). Conclusiones: La combinación de un sistema de detección proactiva del fallecimiento y la revisión continua de los criterios de aceptación para cada tipo de tejido permite, en un medio hospitalario, incrementar el número de potenciales donantes (AU)

Background and objective: The demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks’ standards. Material and method: An early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed. Results: A total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P < .00). The study indicated a total increase of 16% (P < .00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P < .00). Conclusion: A pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors’ rate (AU)

[Optimising tissue donation process in a university hospital: 10 years of experience]. / Optimización del proceso de donación de tejidos en un hospital universitario: 10 años de experiencia.

BACKGROUND AND OBJECTIVE: The demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks' standards. MATERIAL AND METHOD: An early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed. RESULTS: A total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P<.00). The study indicated a total increase of 16% (P<.00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P<.00). CONCLUSION: A pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors' rate.

Adecuación de un sistema de triaje y del circuito asistencial en urgencias al paciente intoxicado / Triage and assignment of responsibility for care in cases of acute intoxication in the emergency department

Objetivo: Valorar la calidad del triaje y del circuito asistencial de las intoxicaciones. Método: Durante tres meses, se han revisado los informes de triaje de las intoxicaciones agudas. Se incluyeron variables demográficas, toxicológicas, clínicas, nivel de triajeotorgado por el Modelo Andorrano de Triaje (MAT), demora asistencial y área de primera asistencia. Se valoró en cada caso la adecuación en la priorización de la asistencia y en la elección del área de primera asistencia. Los resultados fueron comparados con aquellos que fueron atendidos en urgencias. Resultados: Se han incluido 123 intoxicados, con una edad media de 41,6 años (DE:15). El 51% fueron mujeres. El sistema clasificó a los intoxicados como nivel I el 1,6%, II el 20,5%, III el 36,9%, IV el 32% y V el 9%. Tras el triaje, la asistencia se demoró menos de 5 min (19%), entre 5-10 min en el 27% o más de 10 min (54%). Cuando se compararon estos resultados con los de las urgencias en general, no se observaron diferencias significativas en cuanto a la estratificación de la prioridad asistencial, pero sí respecto alárea de primera asistencia, que es preferentemente medicina (60%) o psiquiatría (37%) en el caso de los intoxicados (p < 0,001). Cuando se compararon las intoxicaciones y las urgencias generales respecto a la demora entre triaje y asistencia, se constató que la demora asistencial fue menor en las intoxicaciones (p < 0,001). El 13,3% de los intoxicados tributarios de descontaminación digestiva fueron clasificados de forma inadecuada por no priorizar la asistencia. Por el mismo motivo, el área de primera (..) (AU)

Objective: To evaluate the quality of triage and care assignment in cases of acute intoxication.Methods: Three months of triage reports for cases of acute intoxication were reviewed. Patient demographic variables,toxicology screen, symptoms, triage level assigned using the Andorran Medical Triage (MAT) scoring system, delay inproviding care, and department assigned to be responsible for care were included in the analysis. We evaluated the appropriateness of the priority level assigned and the choice of responsible department. The results were compared to those for all emergencies attended. Results: The cases of 123 patients with acute intoxication (mean [SD] age, 41.6 [15] years) were included. Fifty-onepercent were female. Priority classifications were as follows: level 1, 1.6%; level 2, 20.5%; level 3, 36.9%; level 4, 32%,and level 5, 9%. Care was delayed after triage for less than 5 minutes in 19% of the cases, between 5 and 10 minutes in 27%, and longer than 10 minutes in 54%. The distribution of priority levels did not differ significantly from the distribution of other emergency department cases. However, assignment of the department responsible for providing care did differ (P<.001); 60% of the acute intoxication cases were assigned to the internal medicine department and 37% to the psychiatry department. The delay in providing care after triage was shorter in intoxication cases than inother emergencies (P<.001). Of the cases sent for gastrointestinal decontamination, an inappropriate level of priority was assigned in 13.3%. The department assigned to be responsible for care was also inappropriate in those 13.3% of (..) (AU)