Transplantation proceedings
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The aim of this study was to evaluate infection complications as the reason for intensive care unit (ICU) admission among transplant recipients. ⋯ The mortality rate of renal transplant recipients admitted to ICU owing infection complications was higher than that of noninfected renal transplant patients. These data suggest that infections and septic shock in renal transplant recipients requiring ICU admission worsen their outcome significantly.
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Pulmonary capillary wedge pressure (PCWP) can be estimated from transmitral or color M-mode Doppler flow propagation velocities. However, it has been recommended to not use these indices in heart transplant recipients. Our aim was to compare the accuracy of color M-mode, Doppler, and Doppler tissue imaging (DTI)-derived indices to predict PCWP in heart transplant recipients. ⋯ Compared with other indirect Doppler indices, E/Vp showed the best correlation to predict PCWP in heart transplant recipients. Despite previous recommendations, PCWP can be accurately estimated from color M-mode indices, giving useful information and avoiding the risks of invasive measurements.
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Despite the high rate of kidney transplantation in Spain, a disparity still exists between the numbers of donors and waiting-list patients. Donors after circulatory death (DCD) have been propagated as a promising approach to reduce the donor kidney shortage. In Europe most of the countries use controlled DCD, but in Spain, mainly uncontrolled DCD are harvested and until 2010 at only four institutions. ⋯ There were no cases of primary nonfunction, but delayed graft function was present in 85% of recipients. Despite this impairment, about 75% of patients reached a serum creatinine below 2 mg/dL in the second month, with 1-year graft and patient survivals of 85% and 100%. Although, our preliminary results with a not very long follow-up and small number of patients suggested that utilization of DCD should be expanded because this type of donor increases the number of cases and opportunities of end-stage renal disease patients to reduce the waiting times for transplantation.
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Comparative Study
Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support.
The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support. ⋯ In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients.
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During the two last decades remarkable progress has been made among transplantations in Greece. However, organ donation remains a controversial issue. ⋯ Despite knowledge and willingness regarding organ donation, only a small percentage of Greeks are actually registered to be donors.