Endovascular stenting with a drug-eluting stent of transplanted renal artery stenosis in a dual kidney transplanted patient.

Renal transplant remains the preferred therapy for end-stage renal disease (ESRD). Given the shortage of suitable donor kidneys, use of an expanded criteria donor (ECD) allows marginal kidneys to be transplanted; albeit at risk of increased graft failure due to lower nephron mass. To reduce the risk of graft failure, double kidney transplant (DKT) is advocated, with favorable outcomes. Transplant renal artery stenosis (TRAS) is one of the most common vascular complications following renal transplant. Unlike single kidney transplants, where TRAS usually presents with fluid overload, uncontrolled hypertension, and worsening kidney functions; it may be clinically silent in DKT patients since they have two functional transplanted kidneys. We hereby report a case of TRAS in a DKT patient who had 2 years of favorable clinical outcomes following successful endovascular stenting. He however recently died of COVID-19 associated pneumonitis.

O transplante renal continua sendo a terapia preferida para doenças renais em fase terminal. Dada a escassez de rins de doadores adequados, o doador com critérios expandidos permite que rins marginais sejam transplantados, embora haja um maior risco de falha do enxerto devido à diminuição da massa nefrótica. Para diminuir o risco de falha do enxerto, recomenda-se o transplante renal duplo (TRD), com resultados favoráveis. A estenose de artéria renal transplantada (EART) é uma das complicações vasculares mais comuns após o transplante renal. Ao contrário dos transplantes de rim simples, nos quais a EART geralmente se manifesta como sobrecarga de fluido, hipertensão descontrolada e piora das funções renais, ela pode ser clinicamente silenciosa em pacientes com TRD, pois eles têm dois rins funcionais transplantados. Relatamos aqui um caso de EART em um paciente com TRD que teve resultados clínicos favoráveis por dois anos após o sucesso do implante de stent endovascular. No entanto, ele morreu recentemente de pneumonite associada à covid-19.

Use of liver grafts from cadaveric donors: Implementation impact of a local evaluation and procurement team in Mexico.

INTRODUCTION AND AIMS: Cadaveric donor liver graft retrieval is complex in Mexico. The aim of the present article was to present the experience in liver graft use during the first year of work of a local evaluation and procurement team. MATERIALS AND METHODS: We reviewed the organ donation report forms and allocation offer records covering the time frame of December 15, 2017 to December 15, 2018, and registered the donor characteristics, causes of organ discard, causes of declined offers, transport time, and graft and recipient survival at 30 days. RESULTS: There were 17 donations and we completed the evaluation of 14. Two donors were considered ideal (14.2%) and 12 were expanded criteria donors (ECDs) (85.7%). Two grafts with steatosis were not offered (14.2%). Twelve liver grafts were offered 88 times (mean 7.6 offers per graft). The acceptance rate was 6% for public hospitals and 23.6% for private hospitals (p = 0.016). One graft was discarded during the procurement process due to steatosis. The rate of use after evaluation was 78.5% (11/14). All the grafts were procured by the local team and 9 (81.8%) were transported by commercial airline (median 240 min, range 85 min). Graft and recipient survival at 30 days was 100%. CONCLUSIONS: The participation of a local evaluation and procurement team notably increased liver graft use with excellent results. Commercial airline transportation of the grafts to all active transplantation centers of the country resulted in cold ischemia times <6 h.

Endovascular stenting with a drug-eluting stent of transplanted renal artery stenosis in a dual kidney transplanted patient / Tratamento endovascular com stent farmacológico em estenose de artéria renal transplantada de paciente com transplante renal duplo

Abstract Renal transplant remains the preferred therapy for end-stage renal disease (ESRD). Given the shortage of suitable donor kidneys, use of an expanded criteria donor (ECD) allows marginal kidneys to be transplanted; albeit at risk of increased graft failure due to lower nephron mass. To reduce the risk of graft failure, double kidney transplant (DKT) is advocated, with favorable outcomes. Transplant renal artery stenosis (TRAS) is one of the most common vascular complications following renal transplant. Unlike single kidney transplants, where TRAS usually presents with fluid overload, uncontrolled hypertension, and worsening kidney functions; it may be clinically silent in DKT patients since they have two functional transplanted kidneys. We hereby report a case of TRAS in a DKT patient who had 2 years of favorable clinical outcomes following successful endovascular stenting. He however recently died of COVID-19 associated pneumonitis.

Resumo O transplante renal continua sendo a terapia preferida para doenças renais em fase terminal. Dada a escassez de rins de doadores adequados, o doador com critérios expandidos permite que rins marginais sejam transplantados, embora haja um maior risco de falha do enxerto devido à diminuição da massa nefrótica. Para diminuir o risco de falha do enxerto, recomenda-se o transplante renal duplo (TRD), com resultados favoráveis. A estenose de artéria renal transplantada (EART) é uma das complicações vasculares mais comuns após o transplante renal. Ao contrário dos transplantes de rim simples, nos quais a EART geralmente se manifesta como sobrecarga de fluido, hipertensão descontrolada e piora das funções renais, ela pode ser clinicamente silenciosa em pacientes com TRD, pois eles têm dois rins funcionais transplantados. Relatamos aqui um caso de EART em um paciente com TRD que teve resultados clínicos favoráveis por dois anos após o sucesso do implante de stent endovascular. No entanto, ele morreu recentemente de pneumonite associada à covid-19.

Standard versus extended criteria graft procurement. Experience at the Hospital de Especialidades La Raza. / Procuración de injertos estándar frente a extendidos. Experiencia en el Hospital de Especialidades La Raza.

BACKGROUND: In Mexico, there are 23 158 patients waiting for an organ or tissue transplant. The increasing demand of grafts justifies the use of expanded criteria donors; however, not even all standard grafts have been procured. OBJECTIVE: To identify the associated factors to the decision of not procuring grafts from brain death donors whose donation was consented. METHOD: Retrospective cohort, univariate and multivariate analysis. 35 donation files with brain death were included from 2014 to 2019. Groups in which the heart wasn't procured versus those in which it was procured were compared; same comparisons were made for liver, kidney, skin, bone tissue and corneas. RESULTS: 20 women (57.1%), 15 men (42.9%) average age of 43.8 ± 16.4 years. High-dose of inotropic or norepinephrine use increased the probability of cardiac procurement (odds ratio [OR] 0.57; 95% confidence interval [95% CI]: 0.0-0.5). It was not detected a sensitive and specific variable for decision making at liver procurement. Implementation of two or more diagnostic methods for BD were associated with kidney loss (OR: 10; 95% CI: 1.2-78.1). Organs and tissues met standard criteria; however, 76 (41.5%) were not procured. CONCLUSIONS: Non-procurement associated factors were different from the standard donor established criteria. It is necessary to follow clear procurement criteria, in order to reduce viable grafts loss.

INTRODUCCIÓN: En México se registraron 23,158 personas en espera de un órgano o tejido para trasplante durante el año 2019. El constante aumento de la demanda sustenta el empleo de donantes con criterios extendidos; sin embargo, no todos los injertos estándar se procuran. OBJETIVO: Identificar los factores asociados a la decisión de no procurar injertos provenientes de donantes con muerte encefálica en quienes se consintió la donación. MÉTODO: Cohorte retrospectiva, análisis univariado y multivariado. Se incluyeron 35 expedientes de donación concretada con muerte encefálica de 2014 a 2019. Se compararon los grupos en los que no se procuró corazón, en los que sí, y para hígado, riñón, tejido óseo, piel y córneas. RESULTADOS: Se incluyeron 20 mujeres (57.1%) y 15 hombres (42.9%) con una edad media de 43.8 ± 16.4 años. El uso de inotrópico a dosis altas o norepinefrina aumentó la probabilidad de procuración cardiaca (razón de momios [RM]: 0.57; intervalo de confianza del 95% [IC95%]: 0.0-0.5). No se detectó ninguna variable sensible y específica para la toma de decisión en la procuración hepática. El empleo de dos o más métodos diagnósticos de muerte encefálica se asoció a pérdida del riñón (RM: 10; IC95%: 1.2-78.1). Cumplieron con criterios estándar 183 órganos y tejidos (74.6%); sin embargo, 76 (41.5%) no fueron procurados. CONCLUSIONES: Los factores asociados a la decisión de no procuración fueron distintos a los criterios de donante estándar establecidos. Es necesario seguir criterios claros de procuración para disminuir la pérdida de injertos viables.

Avaliação da qualidade de vida do paciente transplantado hepático

O aumento da sobrevida com o transplante hepático despertou a preocupação com a qualidade de vida (QV) de pacientes no pós-operatório a curto e longo prazo. O objetivo deste estudo foi avaliar a qualidade de vida dos pacientes transplantados que receberam fígado de doador com idade menor ou igual a sessenta anos e acima de sessenta anos e analizar a influência das variáveis: escore MELD, idade do receptor e tempo decorrido de transplante. Estudoprospectivo, descritivo e analítico, com abordagem quantitativa. Participaram do estudo pacientes submetidos ao transplante hepático no Hospital Universitário Walter Cantídio, no período de 2007 a 2013. Utilizou-se para coleta dos dados formulário para identificação dos participantes da pesquisa e o questionário Short Form-36 (SF-36) para avaliar a QV. A amostra foi composta por 141 participantes, dividida em dois grupos: Grupo A (n=100), composto por receptores que receberam enxerto hepático de doador com idade menor ou igual a 60 anos e Grupo B (n=41), formado por receptores que receberam enxerto hepático de doador com idade acima de 60 anos. No GrupoA,a idade média foi de 52,5 anos, predominou o sexo masculino (71%), a média do tempo de transplante foi 34 meses, a etiologia principal foi cirrose hepática viral (27%) e a média do MELD foi 20. No Grupo B, a idade média foi de 54 anos; predominou o sexo masculino (75,7%), a média do tempo de transplante foi 36 meses, a etiologia principal foi cirrose viral (22%) e a média do MELD foi 20...

Increased survival after liver transplantation aroused concerns with the quality of life (QOL) of patients in the short and long-term postoperative period. The aim of this study was to compare the quality of life of transplant patients who received liver grafts from donors 60 years of age and less with those who received livers from donors older than 60 years and analyze the influence of variables: MELD score, recipient age and time after transplantation. This was a prospective, descriptive and analytical study with a quantitative approach. Participated in the study, patients who underwent liver transplantation between 2007 and 2013 at the Walter Cantídio University Hospital. For data collection it was used a form for identification of research subjects and the Short Form-36 (SF-36) to evaluate QOL. The sample consisted of 141 subjects divided into two groups: Group A (n = 100) composed of recipients who received liver grafts from donors 60 years and less, and Group B (n = 41), composed of recipients receiving liver graft from donors over 60 years. In Group A, the average recipients age was 52.5 years, male prevalent (71%), the average time of transplantation was 34 months, the main cause was viral cirrhosis (27%) and the average MELD was 20...