ABSTRACT
BACKGROUND: The National Transplant Center in Mexico has ruled that deceased-donor kidney allocation is a function of each hospital's Internal Transplant Committee. The aim of this study was to compare and analyze results for of the traditional method and a point-score system in the allocation of deceased patient's kidneys. METHODS: The 12 major kidney transplant centers in the country having a deceased-donor program were invited to participate. Only 3 of them replied to the invitation during 2010. A point-score system was proposed to them, comprising blood group, waiting list time, HLA type, and donor and recipient ages. Once the final recipient was chosen, an explanation of reasons for the choice was requested. Thirty-eight transplants were presented. Kappa coefficient was used to measure degree of agreement in both allocation systems. Organs donated for transplantation came from patients between 4 and 54 years old, including 52% female, 52% O+ blood type, 31% A+, and 11% B+, 44% cranial-encephalic trauma, and 44% brain hemorrhage. RESULTS: Global agreement was 52.6% (kappa = 0.343), and partial agreement was 76.3% (weighted kappa = 0.204), assigning more intensity to extreme values, but with a lower correlation index. A more intense agreement, without discriminating by hospital, was found for "A" category (blood group), followed by "B" category (waiting list time). DISCUSSION: Taking into consideration the determining factors for long-term graft survival, it is indispensable to include criteria such as donor and recipient ages and HLA typife in the allocation process. This first draft of a point-score system in organ allocation included waiting list time, blood group, urgency related to vascular/peritoneal access for dialysis, clinical condition, donor/recipient age ratio, and HLA antigenic compatibility.
Subject(s)
Kidney Transplantation/methods , Tissue Donors , Tissue and Organ Procurement/methods , Adolescent , Adult , Child , Child, Preschool , Ethics, Medical , Female , HLA Antigens/metabolism , Humans , Intracranial Hemorrhages/mortality , Male , Mexico , Middle Aged , Reproducibility of Results , Tissue and Organ Procurement/standardsABSTRACT
Six cases of aneurysm of the thoracic aorta, four located in the 1st segment and two in the 3rd, are reported. The four cases in the ascending aorta presented a different aetiology: a) aneurysm on aortic stenosis (case 1); b) atheromatous aneurysm (case 2); c) aortic dissection (case 5); d) aneurysm due to dystrophy of the media in a patient with Marfan's disease (case 6). 3 tubular prosthetic substitutions of the ascending aorta were made (with a valvular substitution and commissural relocation associated with right aorto-coronary venous by-pass) and one plastic intervention on the aorta with valvular substitution. The aneurysms of the descending thoracic aorta presented traumatic aetiology and were treated with resection-dacron graft, using femoral artero-venous partial CEC.
