Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago.

BACKGROUND: The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T. METHODS: The SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed. RESULTS: Thus far, thanks to implementation of the SEUSA program in Trinidad and Tobago 175, healthcare professionals have been exposed to training programs in the organ donation field. The Living Kidney Program was reinforced and the structure of the Deceased Donation (DD) network was defined. Since 2010, 485 potential organ donors have been detected, and 9 have become actual organ donors; 74 patients have received a kidney transplant (59 from living and 15 from deceased donors). CONCLUSIONS: This project results demonstrate that the application of the SEUSA program is an efficient methodology to develop DD programs that increase and consolidate transplant programs in the Caribbean region.

[Urinary lithiasis in transplanted kidney]. / Litiasis urinaria en riñón trasplantado.

OBJECTIVE: We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients. METHODS: Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors. Three had donor graft lithiasis. The calculi were located predominantly in the calyces, at multiple sites in 7 patients and the mean size was 8.3 mm. The composition of the calculi was predominantly uric acid. Four patients who developed sudden obstructive anuria with elevated serum creatinine, underwent percutaneous drainage. RESULTS: All patients had one or more stone-predisposing factors, such as obstructive uropathy, recurrent urinary tract infection or metabolic abnormalities (predominantly hyperuricosuria). Five patients passed their stones spontaneously, 7 patients with uric acid stones were treated with urinary alkalinization, two patients underwent open pyelolithotomy, one underwent percutaneous nephrolithotomy and one patient with a small asymptomatic caliceal stone was managed conservatively (watchful waiting). During long-term follow-up (mean 69 months), 4 patients lost the real graft [only one case was related to urinary calculi (primary hyperoxaluria)] and 4 patients had recurrent calculi. CONCLUSION: Urinary lithiasis after renal transplantation is a relatively uncommon complication. A multifactorial etiology for calculus formation has been observed. The predisposing factors and composition of the calculi, but not frequency, are identical to those of non-transplant patients. A variety of methods are used to treat posttransplant calculi. The least invasive treatment available should be utilized according to the likelihood of recurrence and the need to preserve renal function. With adequate treatment and prophylaxis, posttransplant urolithiasis does not appear to affect graft function.

[Kidney transplantation with pediatric grafts. Technique and results]. / Trasplante renal con injertos pediátricos. Técnica y resultados.

OBJECTIVES: To demonstrate the viability of grafts from pediatric donors transplanted into adult recipients and to analyze new approaches. METHODS: The present series comprised 40 renal transplants in adults utilizing grafts from pediatric donors aged three years or less. A single renal unit was transplanted into each recipient in most of the cases in which grafts from pediatric donors over one year old (n: 26) were used. When the donor was less than one year old and in 3 cases aged over one year (n: 14), both renal units were transplanted en bloc (4 patients) or sequentially (10 patients) into each recipient. RESULTS: Graft survival rate was 58% at 29 months' mean follow-up (range 5-67) when a single unit was transplanted, 50% at 51 months' mean follow-up (range 49-53) when both renal units were transplanted en bloc and 70% at 22 months' mean follow-up (8-26) when both both renal units were transplanted sequentially. Most of the grafts that were lost were due to problems arising from vascular thrombosis; the incidence of failed grafts from immunological causes was very low. No technical problems were encountered and the urological complications were minimal. Only one case of bladder fistula was observed. CONCLUSIONS: Kidney grafts from pediatric donors of any age are viable for transplantation into adults. In the light of current technological and pharmacological developments, we believe that both renal units should be transplanted into the same recipient-preferably sequentially-if the donor is less than a year old. A single renal unit can be used if the donor is over one year old.

[Iatrogenic invagination of the ureteral mucosa in renal transplantation]. / Invaginación iatrogénica de mucosa ureteral en trasplante renal.

A case of antegrade invagination of the ureteral mucosa is described. This iatrogenic complication of endourology resulted from percutaneous dilatation with teflon catheters of a stricture in the ureter of a renal graft transplanted 4 years earlier. Definitive correction was by open surgery, which achieved good results.

[Ureteral stenosis. Endo-urologic treatment (dilatation). Experience with 43 cases]. / Estenosis ureteral. Tratamiento endourológico (dilatación). Experiencia en 43 casos.

Stricture of the ureter has been traditionally treated by open surgical techniques that occasionally had to be performed not without risk to the patient owing to the presence of septic and associated uremic conditions that invariably had a negative influence on the outcome. With the advent of endourological techniques in the last decade, much has been published on endoscopic treatment of the different areas of the urinary tract. One of the fields where important developments have taken place is that relative to endourological treatment of ureteric strictures. Since we started our therapeutic protocol for our patients in 1983 to date, we have treated 43 patients by dilatation. Patient follow up ranging from 6 months to 6 1/2 years (mean follow up greater than 30 months) revealed good results were achieved in 76.74%. The complications have been scant, mortality nil, and patients have been able to resume social and occupational activities early. All the foregoing prompt us to consider this therapeutic modality as the treatment of choice.

[Vesico-ureteral reflux]. / Reflujo vesico-ureteral.

We review the current problem of vesico-ureteral reflux, commenting upon the etiological factors and the physiopathology of the same. We describe the exploratory methods (analysis, urography, cystourethrography, cystoscopy) and assess the data obtained in order to establish the indication of medical or surgical treatment.