Transplantation proceedings
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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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Kidney transplantations (KT) from expanded criteria donors (ECD) show a higher rate of delayed graft function (DGF) that increases postoperative costs because of the prolonged hospital stay as well as the needs for dialysis and additional diagnostic procedures. Hypothermic machine perfusion (MP) might be superior to cold storage (CS) to reduce the relative risks of DGF and primary nonfunction (PNF) as well as to increase 1-year graft survival. ⋯ The introduction of the MP preservation technology in a KT program form ECD is cost-effective in terms of savings for DGF and PNF cases.
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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.
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Brain death (BD) is defined as the total irreversible loss of brain stem function. According to the Greek legislation, BD diagnosis is based on clinical criteria that test brain stem function. Bispectral Index Scale (BIS), a parameter derived from a mathematical analysis of the electroengephalogram depicts brain activity. The aim of our study was to record BIS alterations in brain-dead patients. ⋯ BIS is a noninvasive, easily interpreted method to monitor cerebral activity. According to our results, BIS could be helpful in BD confirmation but cannot replace the valid clinical tests, which are consistent with Greek legislation for this diagnosis.