Andalusian Public Eye-Banks: a decade of continuous improvement.

OBJECTIVES: To show donation data, number of keratoplasties and the changes in transplant indications and techniques that occurred in Andalusia in the period from 2013 to 2022. MATERIALS AND METHODS: The present work is a retrospective and descriptive study that included all keratoplasties performed between January 2013 and December 2022 in Andalusia, as well as the evolution of the cornea donation and transplant activity of the public and private hospitals pertaining to the waiting list management system of the Public Health System of Andalusia. Transplants performed in private centers with corneas from outside Andalusia were excluded. RESULTS: Cornea donation activity in Andalusia in the decade 2013-2022 has experienced a growth of more than 126%, while overall transplant activity has increased by 157% in public hospitals. Penetrating keratoplasty has decreased from 83% in 2013 to 43% in 2022, while lamellar techniques have increased from 17% to 57% in this same period. Since 2018, more lamellar transplants are performed than penetrating transplants. Regarding indications, endothelial conditions already represent the first cause of transplantation. In 2022 alone, the public Andalusian Eye Banks evaluated 1,054 corneas and prepared 281 endothelial grafts. CONCLUSION: In the decade from 2013 to 2022 in Andalusia there has been an increase in donation activity and the number of keratoplasties. The public Eye Banks implementation in this period has played a key role in the widespread adoption of lamellar keratoplasty techniques and has enabled the transition to perform a greater number of lamellar keratoplasties compared to penetrating keratoplasty.

Mesenchymal stromal cells: properties and role in management of cutaneous diseases.

This review describes the current understanding and the potential use of mesenchymal stromal cells (MSCs) in cell-based therapies for clinical management of difficult wounds and other dermatoses. MSCs have been shown to possess many advantageous properties that make them a promising therapeutic modality in dermatology still under investigation. In fact, MSCs' ability to promote wound healing through its paracrine function and pro-angiogenic properties have generated increasing interest for treating acute and chronic wounds. There is also great interest in utilizing MSCs' immunological characteristics for therapeutic use especially for patients with debilitating systemic autoimmune and inflammatory skin conditions who have failed other therapies. Its role in aesthetics has also been explored with clinical data showing improvement of acne scars and wrinkles from photoaging. Clinical trials are underway investigating the safety and efficacy of MSCs in the treatment of different skin conditions such as acute burns, diabetic and venous stasis ulcers, epidermolysis bullosa and systemic sclerosis, among others. We anticipate that as our understanding of the characteristics and function of MSCs grow, so will its role in cell-based treatments of dermatological conditions.

Gestión de la lista de espera para trasplante hepático en Andalucía / No disponible

No disponible

Liver transplantation for hepatocellular carcinoma: results of a multicenter study with common priorization criteria.

OBJECTIVE: To evaluate the results of liver transplantation (OLT) performed for hepatocellular carcinoma (HCC) among a multicenter cohort of patients with predefined common inclusion and priorization criteria. PATIENTS AND METHODS: Over a 5-year period (January 2002-December 2006), 199 HCC patients underwent OLT in four centers in Andalusia. The morphological (Milan) inclusion criteria were priorized in two consecutive periods, according to the Model for End-stage Liver Disease score: group I, 53 patients (HCC < 2 cm = 24 points; > or = 2 cm or multinodular = 29 points) and group II, 146 cases (HCC < 3 cm without priorization; HCC > or = 3 cm or multinodular = 18 points). RESULTS: Among the 199 HCCs, 186 (93.5%) subjects were transplanted and 13 (6.5%) were excluded. There were 18 cases (9.7%) where the diagnosis was incidental and 168 were known HCC cases; 144 (85.7%) complied with the Milan criteria (Milan+); 24 (14.3%) exceeded there criteria (Milan-). According to preoperative imaging, the number of nodules and tumor mean sizes among the excluded-Milan+ and Milan- groups-were 1.8/5.3 cm, 1.4/3.5 cm, and 2.3/6.7 cm, respectively (P < .001). Percutaneous treatment during listing was delivered to 55% of the excluded cases: 49% of Milan+ and 96% of Milan-. The median time on the list was 88 days for known HCC (53 days for group I, and 97 days for group II), and 172 days for the incidental HCCs. Staging (pTNM) was correct in 64% of cases: 23% were understaged and 13% were overstaged. Overall mortality within the first 90 days was 9%, and transplant patient survival at 5 years was 61%. No differences were observed in survival rates between both study periods, although there were differences between the Milan+ (65%) and Milan- (23%) groups (P < .04). In addition, the difference in the recurrence rates was also significant between the Milan+ (7%), Milan- (24%), and the incidental (25%) groups (P < .02). CONCLUSIONS: A common priorization policy of HCC for OLT based on morphological criteria results in a low exclusion rate on the waiting lists (6.5%). The Milan criteria are still a good cutoff to stratify the risk of recurrence, despite preoperative tumor staging being correct in only two-thirds of cases.

Effect of population aging on the international organ donation rates and the effectiveness of the donation process.

This study analyzed the effect of population aging on organ donation for transplants in 43 countries and on the effectiveness of the donation process by comparing the results between Spain and the United States. The percentage of the population aged 65 or over accounted for 33% of the difference in the donation rates between the countries and for 91% of the variation in the rates after age adjustment. However, the level of aging of the Spanish (16.5%) and American (12.3%) populations failed to account for the percentages of deceased donors 65 or over (28% vs. 10%), due to the different age-specific donation rates, much higher in Spain above 50 years. These differences lead to a higher effectiveness of the process in the United States (3.1 transplanted organs per donor vs. 2.5 in Spain), though at lower rates of transplant per million population (73 vs. 87). We conclude that older populations have a greater donation potential as donation rates are strongly associated with population aging. It should therefore be mandatory to adjust donation rates for age before making comparisons. Additionally, effectiveness decreases with older donors, so age should be considered when establishing standards relating to organ donation and effectiveness of the process.

Emergency organ transplantation in Spain: liver emergency and outcomes.

The 2 main indications for emergency liver transplantation are severe acute hepatic insufficiency and emergency retransplantation. In Spain, since the creation of the National Transplant Organisation (NTO), known as "the Spanish model," there have been high rates of donation, with a mean of 33.9 donors per million inhabitants in 2003 and 34.6 donors per million inhabitants in 2004. According to data provided by the NTO, there were 169 liver emergencies in the 2-year period 2003-2004. The time on the waiting list in an emergency situation was limited; 82.8% of cases were resolved in less than 48 hours. During this 2-year period, there were 2077 liver transplantations, including 128 emergence patients, which accounted for 6.1% of transplantations.

Mortalidad hospitalaria en unidades de críticos y muertes encefálicas según los códigos de la Clasificación Internacional de Enfermedades / In-hospital mortality in critical care units and brain death according to the International Classification of Diseases codes

Fundamento. Caracterizar el potencial de donación de órganos en los hospitales según la enfermedad neurológica atendida y los procedimientos de neurocirugía y neurorradiología intervencionista realizados, codificados mediante la Novena Clasificación Internacional de Enfermedades (CIE-9).Material y método. Estudio multicéntrico de tipo transversal, realizado en 3 hospitales españoles con servicios de neurocirugía y 2 sin neurocirugía. Las principales variables de interés son: número de altas hospitalarias, número de fallecidos en el hospital y en las unidades de cuidados intensivos (UCI) y número de muertes encefálicas (ME) en pacientes con alguna de las enfermedades, o que se les practicó alguno de los procedimientos, correspondientes a los códigos de la CIE seleccionados. Resultados. Las principales causas de diagnósticos al alta hospitalaria fueron las mismas en ambos tipos de hospitales (contusión craneal, hemorragia intracerebral, accidentes cerebrovasculares [ACV] isquémicos y enfermedad cerebrovascular aguda mal definida). Sin embargo, las principales causas de ME difieren; la hemorragia intracerebral y los ACV isquémicos son más frecuentes en los hospitales sin neurocirugía, mientras que los traumatismos craneoencefálicos y la hemorragia subaracnoidea predominan en los hospitales con neurocirugía. Las 5 primeras causas de ME en los hospitales con neurocirugía representaron el 76,1 por ciento del total, y en los hospitales sin neurocirugía, el 86,7 por ciento. Respecto a los procedimientos seleccionados, la evolución a ME fue del 10,4 por ciento de las embolizaciones intracraneales, del 6,4 por ciento en el caso de la neurocirugía y del 2,3 por ciento en las arteriografías. Conclusiones. Es difícil obtener una información homogénea en los hospitales a partir de fuentes administrativas. Existen grandes diferencias entre hospitales con y sin neurocirugía respecto a las causas específicas de ME. Mediante el análisis de tan sólo 5 de los códigos seleccionados, se puede predecir un alto porcentaje de pacientes que fallecen en ME. En los hospitales con neurocirugía y neurorradiología intervencionista es más útil la información de diagnósticos que de procedimientos para predecir el porcentaje de fallecimientos en ME (AU)

Disparities in access to liver transplantation in Spain.

BACKGROUND: The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. METHODS: The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. RESULTS: A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. CONCLUSION: Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.

Kidney donor profile in Spain: risks factors and characteristics of the organs rejected for transplantation.

During recent years organ donation in Spain has increased by 100%, with important changes seen in the donor profile. Mean age has increased by more than 10 years, being nowadays more than 33% of our donors over 60 years. Ten years ago road traffic trauma was the main cause of death, while now most of our donors die due to stroke and only 21% die in a traffic accident. This changes lead to an increase in the number of kidneys discarded for transplantation every year. Among the 2517 kidneys retrieved during 2001, 567 were discarded, mainly due to different glomerular, interstitial or vascular pathologic damage. The older is the donor the higher is the percentage of kidneys discarded. It has to be underlined that an increased number of livers from donors, whose kidneys could not be used, are being grafted (141 in 2001 over 281 donors from whom no kidney could be grafted and over a total number of 1335 donors). Only 5% of kidneys were discarded due to technical problems. An important number of kidneys were discarded due to malignancy suspicion or diagnosis (12.3%). Organ donation has improved but kidney transplantation did not in parallel, due to the increasing number of kidneys discarded for transplantation in close relation with the evolution of donor's characteristics. Organ donation rate is around 33 donors per million population while efficient organ donation rate is around 30 donors per million. Only from 67% of donors both kidneys can be grafted and from 20% of donors no kidney can be used. These data will not change our policy, at least by the moment, we will continue to evaluate every potential brain death donor with the aim of studying if organs can be used. It is true that in 50% of cases over 70 years no organ can be used after retrieval and microscopic exam, but in the other 50% we can proceed.

Donación y trasplante renal en España durante el 2002 / Renal donation and transplantation in Spain 2002

No disponible