ABSTRACT
BACKGROUND: Donor-specific antibodies (DSAs) play a fundamental role in kidney transplantation. The identification of DSAs is an essential rejection parameter. PATIENTS AND METHODS: We evaluated a protocol in 237 patients receiving kidneys from living (LDs) and deceased donors (DDs). Recipients were classified as being at low (LR), medium (MR), high (HR), or strong (SR) risk of rejection based on Luminex panel reactive antibody (PRA)-single antigen beads (SABs). Grafts that survived for 1 year were evaluated. RESULTS: Of the 237 transplanted patients, 129 (54.43%) received a kidney from an LD and 108 (45.57%) from a DD. Of 95 LR recipients receiving kidneys from LDs, 2 patients lost the graft due to non-immunological causes. Of 34 MR recipients, 13 had rejection episodes, and 2 lost the graft by AMR and one by cellular rejection (CR). Of 108 recipients receiving a kidney from a DD, 59 (54.63%) were LR, 31 (28.70%) MR, 11 (10.19%) HR, and 7 (6.48%) SR. Twenty of all transplanted recipients lost their grafts; 4 were due to clinical causes, 4 by cellular rejection, and 12 by antibody-mediated rejection (AMR) with PRA-SAB mean fluorescent intensity of 530 to 12,591. One-year graft survival for LD transplanted LR and MR patients was 97.6% and 94.1%, respectively (P = .004). In DD recipients, the LR vs MR SD was P = .011, and for LR vs HR + SR it was P = .001. For MR vs HR+SR no SD was found (P = .323). CONCLUSION: Rejections were detected in 51 patients (21.52%). Graft failure occurred in 16 patients (6.75%). A total of 218 (91.98%) recipients maintained good kidney function after 1 year. This protocol based on fluxogram risk assessment of AMR provided fast and precise immunological evaluation of recipients and donors and stratification by immunological risk of AMR.
Subject(s)
Graft Rejection/immunology , Histocompatibility Testing/methods , Kidney Transplantation , Renal Insufficiency/surgery , Adult , Antibodies/chemistry , Creatinine/blood , Female , Graft Survival , HLA Antigens/chemistry , Humans , Immunosuppressive Agents/therapeutic use , Kidney/pathology , Living Donors , Male , Middle Aged , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
UNLABELLED: We sought to unfold the causes of nonuse of donated corneas in 2007 in the state of Minas Gerais, seeking to show the flaws in the process that could be repaired in to achieve a better rate of collection and transplantation. METHODS: We analyzed, the medical records of multiple organ donors (with brain death) and tissue donors (with heart stopped) in the data system of Tissue Banks and the Human Eye of Minas Gerais to identify the reasons for discard of donated and collected corneas for transplantation. RESULTS: The survey showed that 14% of donated corneas were not removed, 62% were used for transplantation (optical and tectonics), and 24% were removed but not transplanted. There were several reasons for transplantation failure after the withdrawal, including contraindications (sepsis, positive serology [anti-HIV, anti-hepatitis B and C], beyond 6 hours after death, and unsatisfactory quality of the donated tissue upon biomicroscopic evaluation and/or endothelial counting). CONCLUSIONS: Recognition of the causes of rejecting donated corneas allows the possibility of actions to reduce preventable causes of discard, thereby reducing the number of donated and not transplanted corneas. Causes, such as extended time between death and removal of corneas or between death and preservation of corneas, can be reduced to effectively increase the number of cornea transplantations.
Subject(s)
Corneal Transplantation/statistics & numerical data , Patient Selection , Tissue and Organ Procurement/statistics & numerical data , Waiting Lists , Brain Death , Brazil , Cadaver , Cornea/pathology , Humans , Medical Records , Tissue and Organ Procurement/standardsABSTRACT
In a 36-year-old man with severe aortic stenosis and refractory cardiogenic shock, an emergency percutaneous balloon aortic valvuloplasty was performed, followed by clinical improvement, allowing elective aortic valve replacement at the 48th day post-valvuloplasty. Clinical follow-up for eight months after surgery showed significant functional improvement. Aortic balloon valvuloplasty is a life-saving approach to patients with severe aortic stenosis and high surgical risk and should be considered as a bridge to planned valve replacement or cardiac transplantation. Aortic valve replacement should be considered even in patients with severe ventricular dysfunction, while the cardiac transplantation should be indicated for patients with a very marked and irreversible depression of myocardial contractility.
Subject(s)
Angioplasty, Balloon, Coronary , Aortic Valve Stenosis/therapy , Adult , Humans , Male , Severity of Illness IndexABSTRACT
Homem de 36 anos, com quadro de estenose aórtica crítica e choque cardiogênico refratário, foi submetido avalvuloplastia aórtica por baläo como procedimento desalvamento, seguindoÄse compensaçäo clínica, o que possiblitou a realizaçäo de cirurgia de troca valvar aórtica no 48§ dia após esse procedimento. O acompanhamento clínico e ecocardiográfico demonstrou melhora funcional significativa até o presente, oito meses apósa cirurgia. A valvuloplastia aórtica por baläo constitui opçäo terapêutica de salvamento em pacientes com estenose aórtica grave e elevado risco cirúrgico, servindo como ponte para a cirurgia de troca aórtica ou transplante cardíaco. A cirurgia de troca aórtica deve ser considerada, mesmo em pacientes com disfunçäo ventricular grave, reservandoÄse transplante cardíaco aos pacientes em que se supöe depressäo muito acentuada e irreversível da contratilidade miocárdica.
