RESUMO
The detection of brain death (BD) plays a fundamental role in the management of hospital donation. Delayed diagnosis of BD is the main cause of donor loss. A tool for monitoring and prognosis in the neurocritical patient is essential to meet these objectives. The most used prognostic scores in intensive care units are Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II. A predictive model of good performance (ModSPN) in predicting BD in neurocritical patients with Glasgow Coma Scale score < 8 was published in 2014. With the objective of analyzing the predictive capacity of ModSPN and comparing it with SAPS II and APACHE II, 2307 patients admitted to the neurocritical patient monitoring (SPN) program of the INDT were analyzed. The predictive capacity for death and brain death of SAPS II, APACHE II, and ModSPN was compared using receiver operating characteristic curves. The area under the curve showed a better APACHE II performance for the prediction of death and the ModSPN being a better predictor of the probability of dying in BD. Therefore, for the prediction of death in the neurocritical patient, APACHE II was superior, but for the prediction of encephalic death, the ModSPN presented the best predictive power for all causes of brain injury.
Assuntos
Morte Encefálica , Índice de Gravidade de Doença , APACHE , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Escore Fisiológico Agudo Simplificado , UruguaiRESUMO
The first kidney transplantation (KT) in Uruguay was performed in 1969. We report the rates of KT and survival of patients and grafts up to December 2014. The country has a surface of 176,215 km(2) and a population of 3,286,314 inhabitants (18.6 inhabitants per km(2)). Till December 31, 2014, 1,940 KT have been performed in Uruguay (41.8 pmp that year); 90.4% of them were from cadaveric donors (CD). Median age of recipients (R) was 44 ± 14 years; R older than 55 years increased from 0 to 27% during the period. Our pre-emptive KT program started in 2007. Optimal donors (D) decreased from 65.2% to 35.5%, and D older than 45 years old increased from 9% to 37%. Trauma as cause of death decreased from 49% to 32% and stroke as cause of death increased from 25% to 39%. Patient survival rates at 1, 5, and 8 years were 93%, 87%, and 78%, respectively for KT performed between 1980 and 1989; they were 98%, 93%, and 89%, respectively, for KT performed between 1990 and1999; they were 97%, 91%, and 90%, respectively, for KT performed between 2000 and 2010. In December 2013, there were 1098 patients pmp in renal replacement therapy, 758 pmp in dialysis, and 340 pmp (30.9%) with a functioning graft. Our national KT program is mainly based (90.6%) on cadaveric donation. Epidemiological changes in the characteristics of R and D followed the changes in aging that occurred in the general population and the dialysis population. The survival rates from patients and kidneys are similar to those reported by the European and the American registries.
Assuntos
Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Desenvolvimento de Programas , Obtenção de Tecidos e Órgãos/organização & administração , Adulto , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal/estatística & dados numéricos , Taxa de Sobrevida , Doadores de Tecidos/estatística & dados numéricos , Uruguai/epidemiologiaRESUMO
The National Kidney Transplant Program with cadaveric donors is based on centralized and unique waitlist, serum bank, and allocation criteria, approved by Instituto Nacional de Donación y Trasplante (INDT) in agreement with clinical teams. The median donor rates over last 3 years is 20 per million population and the median number of waitlist candidates is 450. The increased number of waiting list patients and the rapid aging of our populations demanded strategies for donor acceptance, candidate assignment, and analysis of more efficient and equitable allocation models. The objectives of the new national allocation system were to improve posttransplant patient and graft survivals, allow equal access to transplantation, and reduce waitlist times. The objective of this study was to analyze variables in our current allocation system and to create a mathematical/simulation model to evaluate a new allocation system. We compared candidates and transplanted patients for gender, age, ABO blood group, human leukocyte agents (HLA), percentage of reactive antibodies (PRA), and waiting list and dialysis times. Only 2 factors showed differences: highly sensitized and patients >65 years old (Bernoulli test). An agreement between INDT and Engineering Faculty yielded a major field of study. During 2008 the data analysis and model building began. The waiting list data of the last decade of donors and transplants were processed to develop a virtual model. We used inputs of candidates and donors, with outputs and structure of the simulation system to evaluate the proposed changes. Currently, the INDT and the Mathematics and Statistics Institute are working to develop a simulation model, that is able to analyze our new national allocation system.
Assuntos
Transplante de Rim/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Adolescente , Adulto , Distribuição por Idade , Idoso , Algoritmos , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Rim , Masculino , Pessoa de Meia-Idade , Alocação de Recursos/organização & administração , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Uruguai , Listas de EsperaRESUMO
AIM: The aim of this study was to analyze the evolution of the legal framework, health system of donation, and transplantation of cells, tissues, and organs, measured based on processes and rates from 1978 to 2008 in Uruguay. MATERIALS AND METHODS: We analyzed 3 decades (1978-1988/1989-1998/1999-2008) by the following evaluation: the legislation, donation and transplantation system, procurement, registration of pre-state of voluntary donations, actual donations and transplantation rates of solid organs (kidneys, heart, liver, and pancreas), and rates of donation and transplantation of tissues (corneal and laminar [skin, amniotic membrane, and fascialata]), of cardiovascular elements (valves and vases), and of ostearticular tissues (bones and tendons). RESULTS AND CONCLUSIONS: Uruguay has maintained continuous governmental politics in donation and transplantation. In the last decade the elaboration of a strategic plan by promoting Laws and Decrees of Encephalic Death, Presumed Donation and Security of Cells and Tissues, as well as the creation of the Unit Procurement, the registration of nonrelated donors for hematopoietic stem cells, and the re-engineering of tissue banking, has shown a significant increase in deceased donation and cadaveric transplantation, reaching the first highest overall donor rate in Latin America with 24/pmp multiorgan donors.
Assuntos
Transplante de Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Órgãos Governamentais , Humanos , Doadores Vivos/legislação & jurisprudência , Doadores Vivos/estatística & dados numéricos , Transplante de Órgãos/legislação & jurisprudência , Transplante de Órgãos/tendências , Bancos de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/tendências , Uruguai/epidemiologiaRESUMO
Xenografting is increasingly being developed as a response to the shortage of human tissues. However, antigenic components of bone material eliciting immune responses--particularly of cellular nature--are blamed for the reduction of the osteoinductive properties of bone and bone-derived implants. The aim of our study was to compare the immunologic response and osteogenesis induced by antigen-depleted allogeneic and xenogeneic bone-derived implants to that induced by partially antigen-depleted material heterotopically placed (muscular pouch) in rats. Wistar rats received bone-derived implants of different antigeneic condition, from both xenogeneic (rabbit) and allogeneic (rat) origin. After sacrifice, animals were evaluated for osteogenesis and immune response. New bone formation was observed around all bone-derived implants, whether fully or partially antigen-extracted, and from both xenogeneic and allogeneic origin. No significant humoral response resulted following bone implantation. Cellular response showed a similar pattern in partial and fully antigen-extracted bone of both allogeneic and xenogeneic origin. Xenogeneic antigen-extracted bone from safe donor sources could be a suitable solution to human tissue shortage in a near future.
Assuntos
Transplante Ósseo/fisiologia , Transplante Heterólogo/fisiologia , Transplante Homólogo/fisiologia , Animais , Transplante Ósseo/imunologia , Transplante Ósseo/patologia , Osteogênese , Coelhos , Ratos , Ratos Wistar , Transplante Heterólogo/imunologia , Transplante Heterólogo/patologia , Transplante Homólogo/imunologia , Transplante Homólogo/patologiaRESUMO
Uruguay posee un sistema solidario de financiación de trasplante a través del Fondo Nacional de Recursos y dedl banco Nacional de Órganos y tejidos (BNOT). En el trasplante alogénico de médula ósea la compatibilidad HLA es una barrera biológica importante. Las frecuencias alélicas y haplotípicas HLA son utilizadas para determinar la probabilidad de encontrar un donante con un fenotipo particualr HLA y para predecir el efecto de diversos esquemas de adjudicación basados en la compatibilidad en este sistema. El Laboratorio de Inmunogenética e Histocompatibilidad tipifica a todos los receptores y donantes del país. Se ha iniciado un programa cuyo objetivo central es organizar un sistema de registro, tipificación y búsqueda de donantes no relacionados a nivel nacional (SINDOME). Objetivos: analizar los receptores tipificados para trasplante de médula ósea (TMO) alogénico en nuestro servicio en el período enero 1997 - mayo 2002, y caracterizar la constitución genética del sistema HLA para 298 receptores. Material y método: en el lapso indicado se estudiaron 346 receptores y 1.083 donantes. Se realizó la tipificación HLA clase I por reacción de microlinfocitotoxicidad con anticuerpos monoclonales y la reversa, con nivel de resolución intermedio-alta. Se estimaron las frecuencias alélicas y haplotípicas en una muestra de 298 receptores. Resultados: de los 346 receptores de TMO estudiados en el marco del SINDOME, 58 por ciento es menor de 30 años. La relación donante-receptor fue de 3,13 pero sólo el 45 por ciento de los candidatos a trasplante tuvo un donante histocompatible. En el análisis del polimorfismo ded HLA-A, -B, -DR en la muestra de 298 receptores se encontró que los alelos más prevalentes fueron A2 (28,97 por ciento), B35 812,49 por ciento) y DR04 (15,24 por ciento). Sólo para el locus HLA-DRB1 la desviación del equilibrio de Hardy-Weinberg fue altamente significativa. Los haplotipos más comunes fueron A2-B51 y A2-B7 para HLA-A, -B, A2-DR11 y A2-DR04 para HLA-A -DRB1, y el haplotipo B8-DR03 para HLA-B -DR. De los Hplotipos HLA-A -B -DRB1, HLA-A1 -B8 -DR03 y HLA-A2 -B51 -DR13 fueron los más frecuentes. Conclusión: nuestros resultados demuestran que el sistema HLA presenta una considerable heterogeneidad, con un enorme polimorfismo y una amplia distribución de haplotipos. La posibilidad de encontrar donantes compatibles para un subgrupo de jóvenes con enfermedades malignas sin donantes familiares es muy baja.
Assuntos
Histocompatibilidade , Antígenos de Histocompatibilidade , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-DR/genética , Transplante de Células-Tronco Hematopoéticas , Transplante de Medula ÓsseaRESUMO
Uruguay posee un sistema solidario de financiación de trasplante a través del Fondo Nacional de Recursos y del banco Nacional de Órganos y tejidos (BNOT). En el trasplante alogénico de médula ósea la compatibilidad HLA es una barrera biológica importante. Las frecuencias alélicas y haplotípicas HLA son utilizadas para determinar la probabilidad de encontrar un donante con un fenotipo particular HLA y para predecir el efecto de diversos esquemas de adjudicación basados en la compatibilidad en este sistema. El Laboratorio de Inmunogenética e Histocompatibilidad tipifica a todos los receptores y donantes del país. Se ha iniciado un programa cuyo objetivo central es organizar un sistema de registro, tipificación y búsqueda de donantes no relacionados a nivel nacional (SINDOME). Objetivos: analizar los receptores tipificados para trasplante de médula ósea (TMO) alogénico en nuestro servicio en el período enero 1997 - mayo 2002, y caracterizar la constitución genética del sistema HLA para 298 receptores. Material y método: en el lapso indicado se estudiaron 346 receptores y 1.083 donantes. Se realizó la tipificación HLA clase I por reacción de microlinfocitotoxicidad con anticuerpos monoclonales y la reversa, con nivel de resolución intermedio-alta. Se estimaron las frecuencias alélicas y haplotípicas en una muestra de 298 receptores. Resultados: de los 346 receptores de TMO estudiados en el marco del SINDOME, 58 por ciento es menor de 30 años. La relación donante-receptor fue de 3,13 pero sólo el 45 por ciento de los candidatos a trasplante tuvo un donante histocompatible. En el análisis del polimorfismo de HLA-A, -B, -DR en la muestra de 298 receptores se encontró que los alelos más prevalentes fueron A2 (28,97 por ciento), B35 812,49 por ciento) y DR04 (15,24 por ciento). Sólo para el locus HLA-DRB1 la desviación del equilibrio de Hardy-Weinberg fue altamente significativa. Los haplotipos más comunes fueron A2-B51 y A2-B7 para HLA-A, -B, A2-DR11 y A2-DR04 para HLA-A -DRB1, y el haplotipo B8-DR03 para HLA-B -DR. De los Haplotipos HLA-A -B -DRB1, HLA-A1 -B8 -DR03 y HLA-A2 -B51 -DR13 fueron los más frecuentes. Conclusión: nuestros resultados demuestran que el sistema HLA presenta una considerable heterogeneidad, con un enorme polimorfismo y una amplia distribución de haplotipos. La posibilidad de encontrar donantes compatibles para un subgrupo de jóvenes con enfermedades malignas sin donantes familiares es muy baja. (AU)