Arsenite induced oxidative damage in mouse liver is associated with increased cytokeratin 18 expression

Cytokeratins (CK) constitute a family of cytoskeletal intermediate filament proteins that are typically expressed in epithelial cells. An abnormal structure and function are effects that are clearly related to liver diseases as non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma. We have previously observed that sodium arsenite (SA) induced the synthesis of CK18 protein and promotes a dose-related disruption of cytoplasmic CK18 filaments in a human hepatic cell line. Both abnormal gene expression and disturbance of structural organization are toxic effects that are likely to cause liver disease by interfering with normal hepatocyte function. To investigate if a disruption in the CK18 expression pattern is associated with arsenite liver damage, we investigated CK18 mRNA and protein levels in liver slices treated with low levels of SA. Organotypic cultures were incubated with 0.01, 1 and 10 microM of SA in the absence and presence of N-acetyl cysteine (NAC). Cell viability and inorganic arsenic metabolism were determined. Increased expression of CK18 was observed after exposure to SA. The addition of NAC impeded the oxidative effects of SA exposure, decreasing the production of thiobarbituric acid-reactive substances and significantly diminishing the up regulation of CK18 mRNA and protein. Liver arsenic levels correlated with increased levels of mRNA. Mice treated with intragastric single doses of 2.5 and 5 mg/kg of SA showed an increased expression of CK18. Results suggest that CK18 expression may be a sensible early biomarker of oxidative stress and damage induced by arsenite in vitro and in vivo. Then, during SA exposure, altered CK expression may compromise liver function.

[Right hepatectomy and left hepatectomy performed via hand-assisted laparoscopic surgery. Description of an original technique]

INTRODUCTION

Laparoscopic liver surgery in solid tumors presents a number of difficulties. This type of surgery is indicated especially in tumors of less than 5 cm located in the left lobe and in anterior segments of the right lobe. Access to posterior lesions of the right lobe (segments VII and VIII) and performing major regulated hepatectomies (more than 3 segments) are at present difficult for liver surgeons.

OBJECTIVE

To present a regulated right hepatectomy (RH) and left hepatectomy (LH) performed via hand-assisted laparoscopic surgery (HALS) using an original technique.

PATIENTS AND METHOD

RH was performed in a 70-year-old man with hepatic metastases from colorectal carcinoma (pT2N0M1 sigmoid adenocarcinoma). LH was performed in a 44-year-old woman with a 16-cm hemangioma that had shown tumoral growth. Dissection of the hepatic artery was performed between ligations, and the portal vein was sectioned between ligations or with a vascular endostapler. Division of the bile duct and suprahepatic veins was performed with a vascular endostapler. Parenchymal dissection was carried out with a harmonic scalpel and dissection of intrahepatic veins of over 3 mm was performed with a 10-mm Ligasure Atlas.

RESULTS

The operating time for RH was 360 min, with no transfusion or complications, and length of hospital stay was 5 days. The operating time for LH was 240 min, requiring 2 U of blood, with no morbidity and a length of hospital stay of 4 days.

CONCLUSIONS

HALS allows major liver resections to be performed with low morbidity and mortality and with the advantages of laparoscopic surgery.

Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program

INTRODUCTION

A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program.

MATERIALS AND METHODS

The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis.

RESULTS

The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2).

CONCLUSIONS

Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.

[Physicians faced with living liver donation: an attitudinal study in a Spanish hospital with a living donor liver transplant program]

INTRODUCTION

Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes.

PATIENTS AND METHODS

A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of chi2 test, Student's t-test, and a logistic regression analysis.

RESULTS

The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondent's belief that he or she might need a transplant in the future (p = 0.003) -90% of those who believed that they might need a transplant at some point in the future were in favor-, and the respondent's acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondent's belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondent's acceptance of a living donated liver (OR = 7.11).

CONCLUSIONS

Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists.

Ancillary personnel faced with living liver donation in a Spanish hospital with a transplant program

INTRODUCTION

Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude.

PATIENTS AND METHOD

A random sample was taken which was stratified by service (n=401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The c2 test, Student s t-test and logistical regression analysis were used in the statistical analysis.

RESULTS

The questionnaire completion rate was 94% (n=377). Of all the respondents, 20% (n=74) are in favor of donating a living hemi-liver, but an additional 62% (n=233) are in favor if donation is for a relative. Of the rest, 8% (n=30) do not accept this type of donation and the remaining 11% (n=40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p=0.002); a respondent s belief that he or she might need a transplant in the future (p<0.001) and a willingness to receive a donated living liver if one were needed (p<0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent s belief that he or she might need a transplant in the future (OR=1.5); and b) a willingness to receive a living donated kidney if one were needed (OR=16.2).

CONCLUSIONS

Attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital.

Prognostic factors for hepatitis C recurrence in patients undergoing orthotopic liver transplantation

End-stage liver disease caused by the hepatitis C virus (HCV) is a major indication for liver transplantation. HCV re-infection after LT is constant, and it significantly impairs patient and graft survival. Factors that may influence histological recurrence in the graft remain unclear. The aim of our study is to analyse the factors that influence the histological recurrence of HCV in a series of 142 patients undergoing orthotopic liver transplantation. In this series, donors age until 1995 were mostly younger than 30 years, however, from 2000 onwards most of the cases had graft implants from elderly donors. Histological recurrence was 92% after a mean follow-up of 60 months (12-120 months), 17% of which had poor-prognostic recurrence. Half of the patients presenting with recurrence did so in the first six months and more than two thirds developing hepatitis in the graft did so in the first year. The accumulated probability of histological recurrence is 40.1%, 51.5%, 70.3%, 83.5% and 92% at 6, 12, 24, 36 and 60 months respectively. In our experience, the variables associated with the development of histological recurrence in the graft, in the multivariate analysis, are donors age > or =31 years and immunosuppressive treatment without mycophenolate mophetil (MMF). Treatment with MMF still acts as a protection factor and is associated with histological non-recurrence.

Severe acute lower gastrointestinal bleeding: risk factors for morbidity and mortality

BACKGROUND

Many factors can cause morbidity and mortality in patients with severe acute lower gastrointestinal bleeding (LGIB). The objectives of this study are to analyze three aspects related to severe acute LGIB: (1) indications and prognostic factors for urgent surgery, (2) risk factors for morbidity and mortality, and (3) relapse rates.

PATIENTS AND METHODS

A retrospective cohort was collected between 1985 and 2002 in a tertiary referral center. One hundred seventy-one patients with severe acute LGIB were reviewed (LGIB is defined as frank rectal bleeding either with a hematocrit decrease >/=10 points or when a transfusion of at least three units of concentrated red blood cells is needed). The main outcome measures are: (1) indications for urgent surgery and results, (2) morbidity and mortality, and (3) relapse.

RESULTS

There were 158 (92%) stable patients, and in 61% of these, the bleeding was identified via colonoscopy. Bleeding was identified using urgent colonoscopy in a higher percentage of patients compared to delayed colonoscopy (68% versus 14%; p < 0.001). Urgent surgery was indicated in 24 (14%) patients, and the approach was peri-anal in 5 (21%) patients and abdominal in the rest. Local intestinal resection was performed on the 15 patients in which bleeding was identified, whereas a subtotal colectomy was performed on the remaining 4 patients. The presence of hypotension (p = 0.001; 35 versus 10%) and etiology of LGIB (p < 0.001) are prognostic factors of urgent surgery. Morbidity was 6.4%, and mortality was 4.7%. The only morbidity or mortality risk factors detected were the presence of associated comorbidities (p = 0.008) and the need for urgent surgery (p = 0.002). The most frequent etiology was diverticulosis (25%). After a mean follow-up of 132 +/- 75 months, bleeding relapsed in 30% of patients.

CONCLUSIONS

It is difficult to predict which patients are going to need urgent surgery in severe acute LGIB; only the presence of hypotension on arrival at the emergency ward would lead us to suspect a negative outcome for the hemorrhage. In severe acute LGIB, morbidity and mortality is high, and this is mainly due to the high level of associated comorbidity and the need for urgent surgery. It is necessary for strict hemodynamic monitoring of the patients at risk if we want to improve outcomes. The bleeding relapse rate is high in LGIB, although generally, it is not severe.

Information requested about organ donation in primary health care centers

Information provided by primary care workers about organ donation significantly affects the attitude of the general public. The objective of this study was to evaluate information about donation requested by the general public in health centers in an autonomous community (region) of Spain and to find out how many workers provided relevant information.

MATERIALS AND METHODS

A random sample was taken and stratified by sex, job category, and geographical location (six health areas of our autonomous regional community, 45 municipal councils), among primary care health workers in order to obtain a total of 428 respondents in 34 primary care centers. A study was undertaken of information requested and provided about organ donation and transplantation. The chi square test was applied and differences were considered significant at levels of P < .05.

RESULTS

Forty-three percent (n=185) of the workers surveyed indicated that information had been requested from them about organ donation and transplantation. This request for information was much greater from physicians than from the other types of workers (P = .015). Furthermore, 54% of primary care health workers (n=229) reported having provided information about donation, especially physicians (64%), with this being mainly favorable. Information had also been provided by nurses (59%) and ancillary staff (34%).

CONCLUSION

Information requested from primary care health workers by the general public about organ donation and transplantation is increasing when we compare it to data from previous years. Around half of primary care workers have offered information about transplantation. Therefore, it is fundamental that these workers have adequate and correct information to provide patients and families.

Attitude of kidney patients on the transplant waiting list toward related-living donation. A reason for the scarce development of living donation in Spain

INTRODUCTION

Most Spanish transplant centers have on-going living kidney transplant programs. However, such transplants are not increasing as a proportion of the total number of kidney transplants. The objective of this study is to analyze the attitude of kidney patients on the kidney transplant waiting list toward living kidney donation.

MATERIALS AND METHODS

The patients studied were selected from those included on the kidney transplant waiting list from November 2003 until September 2005 (n = 221). Attitude toward living donation was evaluated using a psychosocial questionnaire. It was completed in a direct personal interview with an independent health-care worker from the Transplant Unit. Student's t-test and the chi-squared test were applied.

RESULTS

Two hundred and fourteen patients completed the questionnaire (97%), of which 35% would accept a related living kidney if it were offered to them, 60% would prefer to wait on the waiting list and the remaining 5% are undecided. Up to 66% (n = 134) of patients report that a member of their family or a friend have offered them an organ for donation. Eighty-nine percentage believe that there is some risk involved in living kidney donation, although it is not a factor that affects whether an organ would be accepted or not (p = 0.767). The psychosocial variables that affect attitude toward accepting a related living kidney are: (i) age: the youngest are those who are most likely to accept (40 vs. 45-yr-old; p = 0.010); (ii) descendents: patients without descendents are more likely to accept a living organ (56% vs. 27%; p < 0.000); (iii) marital status: a greater percentage of single respondents would be prepared to receive this type of transplant compared to the group of married respondents (55% vs. 30%. p = 0.007); and (iv) level of education: those with a higher level of education are more likely to accept a living organ (43% have secondary or university studies vs. 28% who only have primary education; p = 0.040).

CONCLUSION

Patients on the waiting list for a kidney transplant do not have a very favorable attitude toward receiving a related-living donor organ, although members of their family have offered them one of their organs. The profile of a patient who would accept a related-living donated kidney is a young, single person, without descendents, and with a high level of education.

Hemodynamic Assessment During Auxiliary Heterotopic Liver Transplantation With Portal Vein Arterialization in a Swine Model: Preliminary Report of 10 Transplants

Portal vein arterialization (PVA) is a technical variation of auxiliary heterotopic liver transplantation (AHLT) that is rarely studied but that simplifies the AHLT surgical technique because it does not act on the portal area. The objective of this study was to analyze the hemodynamic consequences of this auxiliary transplant in an experimental model.

MATERIALS AND METHODS

Ten AHLT-PVA were analyzed in a pig model. A PiCCO (Pulsion) monitor was used for the hemodynamic study of the recipient. The following were measured: cardiac index, (CI), systemic vascular resistance index, (SVRI), mean arterial pressure (MAP), global end-diastolic volume, central venous pressure, and intrathoracic blood volume. The measurements were taken at four times during transplant: at baseline, after inferior vena cava clamping, after graft reperfusion, and at closure.

RESULTS

After graft reperfusion there was a reduction in SVRI (968 +/- 168.03 vs 1686.25 +/- 290.66; P < .05) and in MAP, and there was an increase in CI. At the end of the transplant MAP and SVRI recovered (1254.2 +/- 225.79 vs 968 +/- 168.03; P < .05) but CI remained slightly high. The end-diastolic volume showed greater variation than central venous pressure, although this was only statistically significant at the inferior vena cava clamping phase (244.75 +/- 52.05 vs 333.37 +/- 170.13; P < .05).

DISCUSSION

Heterotopic liver transplantation with portal arterialization is well-tolerated hemodynamically. Graft reperfusion decreases SVRI and increases CI to compensate for this. This behavior, which in healthy recipients like ours is not a problem, could imply a contraindication in patients with a prior hyperdynamic state.

Hospital personnel faced with organ xenotransplantation: an attitudinal survey in a hospital with a pre-clinical liver xenotransplantation program

BACKGROUND

In situations of extreme urgency when there is a need for vital organs, xenotransplantation could provide a bridge until the arrival of a human organ. However, it is important to find out the level of acceptance of this potential therapy among the health care workers who would be involved in its implementation. The objective of this study is to analyze attitude among personnel in a hospital with a pre-clinical xenotransplantation program toward xenotransplantation and to determine the variables that influence this attitude.

MATERIALS AND METHODS

A random sample (n=1168) was taken and stratified according to job category and service. Attitude toward xenotransplantation was evaluated using a validated questionnaire. Contact was made with the head of each service who was given an explanation of the project. This person was made responsible for the distribution and collection of the survey in each service in randomly selected work shifts. Such a survey was completed anonymously and was self-administered. A random sample of 250 individuals from our regional community was used as a control group.

RESULTS

The survey completion rate was 98% (n=1148). Most respondents are in favor (67%), 7% are against and 26% undecided. Such an attitude is more favorable in the control group (74% vs. 67%; P=0.0378). The following factors are positively related to such an attitude: (1) male sex (P<0.0005); (2) a younger age (P=0.013); (3) participation in prosocial voluntary activities (P=0.002); (4) knowing that the church has a positive attitude toward donation and transplantation (P<0.0005); (5) a partner's favorable attitude toward transplantation (P<0.0005); (6) a physician's job category (P<0.0005); (7) a resident physician's job contract situation (P=0.017); (8) a respondent's belief that he or she may need a transplant in the future (P<0.0005); and (9) a favorable attitude toward human donation, whether this be cadaveric or living (P<0.0005). In the multivariate analysis, the following persist as independent variables: (1) sex (odds ratio=1.6); (2) participation in prosocial voluntary activities (odds ratio=2.2); (3) a partner's unfavorable attitude toward transplantation (odds ratio=0.3); (4) a favorable attitude toward cadaveric donation (odds ratio=2); and (5) attitude toward living liver donation (odds ratio=3.8).

CONCLUSIONS

Attitude toward xenotransplantation is not as favorable among hospital personnel as it is in the general public and this is determined by many factors. It will be necessary for research groups to periodically carry out awareness-raising activities about our findings in our own centers, to avoid the rejection that could be generated by a lack of awareness.

What Is the Attitude of Hospital Transplant-related Personnel Toward Donation?

The attitude of health-care workers, especially in transplant-related services, is fundamental in the process of organ procurement. In this study we examine the attitude of workers in transplant-related services toward cadaveric organ donation and transplantation (ODT) in a third-level hospital in Spain. A random sample was stratified according to type of service and job category (n = 309) among personnel in transplant-related services (organ procurement units, transplant units and follow-up units). Attitude toward cadaveric organ donation was evaluated using a validated psychosocial questionnaire. Seventy percent (n = 215) of respondents were found to be in favor of donation, as opposed to 30% against or undecided (n = 94). Regarding job category, attitude was most favorable among physicians (86%, n = 99; p = 0.000). With respect to type of service, attitude tended to be more negative in organ procurement units and more positive in the follow-up units of transplanted patients (41% vs 81%, p = 0.013). Upon analysis of the psychosocial variables, significant results were found with respect to the following factors: (1) age (39 vs 42 years, p = 0.007); (2) having discussed ODT with family members or with a partner (p = 0.007); (3) understanding of the concept of brain death (p = 0.001); (4) attitude toward carrying out an autopsy (p = 0.001); and (5) concern about the possibility of mutilation after organ extraction. Attitude toward cadaveric donation was lower than expected among personnel in transplant-related services, especially among ancillary personnel and workers in organ procurement units.

Risk factors of acute renal failure after liver transplantation

The objective of this study was to determine the risk factors of postoperative acute renal failure (ARF) in orthotopic liver transplantation (OLT). We reviewed 184 consecutive OLT. Postoperative ARF was defined as a persistent rise of 50% increase or more of the S-creatinine (S-Cr). The patients were classified as early postoperative ARF (E-ARF) (first week) and late postoperative ARF (L-ARF) (second to fourth week). Preoperative variables were age, sex, comorbidity, indication for OLT, Child-Pugh stage, united network for organ sharing status, analysis of the blood and urine, and donor's data. Intraoperative variables were systolic arterial pressure, mean arterial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance index. Surgical technique, number of blood products transfused, need for adrenergic agonist drugs, and intraoperative complications were also important. Postoperative variables were duration of stay in the intensive care unit, time on mechanic ventilation, liver graft dysfunction, need for adrenergic agonist drugs, units of blood products infused, episodes of acute rejection, re-operations, and bacterial infections. Firstly we carried out a univariate statistical analysis, and secondly a logistic regression analysis. The risk factors for E-ARF were: pretransplant ARF (odds ratio (OR)=10.2, P=0.025), S-albumin (OR=0.3, P=0.001), duration of treatment with dopamine (OR=1.6, P=0.001), and grade II-IV dysfunction of the liver graft (OR=5.6, P=0.002). The risk factors for L-ARF were: re-operation (OR=3.1, P=0.013) and bacterial infection (OR=2.9, P=0.017). The development of E-ARF is influenced by preoperative factors such as ARF and hypoalbuminemia, as well as postoperative factors such as liver dysfunction and prolonged treatment with dopamine. The predicting factors of L-ARF differ from E-ARF and correspond to postoperative causes such as bacterial infection and surgical re-operation.

Doppler ultrasonographic and scintigraphic assessment of an auxiliary heterotopic liver transplantation with portal vein arterialization in pigs

OBJECTIVE

Our aim was to evaluate liver graft integrity and function using scintigraphy and ultrasonography in a porcine model of auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA).

MATERIALS AND METHODS

Using Doppler ultrasonography we evaluated eight AHLT-PVA by parenchymal echogenicity, portal and arterial anatomy, and portal and biliary system flow. Two types of scintigraphy were performed: microaggregated human albumin colloid scintigraphy and diisopropyl iminodiacetic acid (DISIDA) scintigraphy, both labeled with 99mTc.

RESULTS

The animals were distributed into two groups. The first group consisted of three animals with clinical suspicion of graft dysfunction, in which the ultrasonographic study revealed areas of parenchymal destructuring. In the scintigraphic study, heterogenous uptake was observed; there was no uptake in one animal. Necropsy of these three animals revealed areas of graft necrosis. The second group consisted of five animals with good clinical evolutions, in which the ultrasonographic study showed portal dilation, portal flow with arterial spiculations, and homogenous echogenicity of the hepatic parenchyma. The scintigraphic study revealed homogenous uptake by the graft and an elimination speed of the hepatobiliary agent similar to that of the native liver.

CONCLUSIONS

An heterogenous echostructure of the graft provided a sign of poor prognosis indicating necrosis in the same way as heterogenous uptake or nonuptake of radioisotope upon scintigraphy. Scintigraphy is a good method to evaluate biliary function and bile elimination. In an AHLT-PVA, the main ultrasound findings derived from arterialization were dilation of the portal system and portal flow with arterial spiculations.

[Laparoscopic resection of solid liver tumors. Presentation of our experience]

INTRODUCTION

Laparoscopic liver resection (LLR) of solid liver tumors (SLT) has not become widespread due to technical problems, the risk of air embolism, and possible tumoral spread in malignant lesions. We present our experience of LLR in SLT.

PATIENTS AND METHOD

Between January 2003 and May 2005, we performed the laparoscopic approach in 16 patients with SLT. Preoperative diagnosis was liver metastases from colorectal carcinoma in 11 patients and benign tumor in the remaining five patients. Five of the lesions were located in the left lobe, another 10 in the right lobe (two in S. V, four in S. VI and four in S. VII) and the remaining lesion was bilobar (S. III and VI). LLRs were performed by complete laparoscopic hepatectomy (CLH) (n=8) and assisted laparoscopic hepatectomy (ALH) (n=8). LLR was completed in 13 patients (81%). Surgical technique (n=13) consisted of three left lobectomies, one with partial resection of S. IV, three bisegmentectomies (two of S. VI and VII and one of S. III and IV, the latter associated with metastasectomy in S. VIII), five segmentectomies (one of S. II, two of S. V and two of S. VI, one of the latter associated with metastasectomy in S. VII) and two local resections of benign tumors.

RESULTS

There was no intra- or postoperative mortality. With CLH the LLR was completed in five patients (62%), whereas with ALH there were no conversions. Only one of the 13 resected patients required transfusion. Seventeen nodules were excised in the 13 LLR, and 12 of 17 required the Pringle maneuver. The mean length of hospital stay was 4.9 days (3-14 days). Only one female patient (7.7%) developed an infected hematoma, requiring radiological drainage.

CONCLUSION

LLR of benign SLTs shows all the advantages of laparoscopy. In the case of malignant lesions, greater experience is needed to confirm the safety and effectiveness of the open approach.

Attitudes of Primary Care Professionals in Spain Toward Xenotransplantation

OBJECTIVE

The deficit in transplantable organs is making it necessary to find alternative sources. One possibility is xenotransplantation. However, the use of animal organs may be rejected by society and among health professionals. Primary Care is fundamental for promoting matters of health; in Spain it has access to nearly 100% of the population. Our objective was to analyze the acceptance of this therapy, although it is experimental, among Primary Care professionals, given that they are the ones most involved in spreading information about this therapy if it was confirmed to be useful.

MATERIALS AND METHODS

A random sample was stratified by sex, job category, and geographical location among Primary Care personnel, including 428 professionals in 32 health centers among population of 2851 professionals. Attitudes toward xenotransplantation were evaluated using a questionnaire on psychosocial attitudes validated in our geographical area. Contact was made in each center with the Doctor Coordinator for doctors, the Nursing Coordinator for nurses, and an Administrative Officer for ancillary personnel. The chi-square test and Student t test were applied to evaluate categorical and continuous data, respectively.

RESULTS

Attitudes toward xenotransplantation were similar to those obtained in human organs: favorable in 79% (n = 325), whereas 19% (n = 78) had doubts and 2% (n = 10) were against. The attitude was more favorable in men (89% vs 72%; P < .000), those who had cared for transplant patients (84% vs 71%; P = .009), those with previous experience in organ donation and transplantation (84% vs 75%; P = .033), those with an attitude in favor of cadaveric organ donation (83% vs 66%; P < .0001), and those in favor of living donation of the kidney (P < .000) or the liver (P < .000), as well as those who believed that they may need a transplant at some time in the future (84% vs 74%; P = .045). There was a clear difference in attitude according to job category (P = .018): approval rates were 89% for doctors, 76% for nurses, and 70% for ancillary personnel.

CONCLUSIONS

Attitudes toward future application of xenotransplantation were quite positive among doctors. However, the attitudes of nursing and ancillary personnel were similar to those of the general population. The main factors related to such an attitude depended mainly on the previous relationship and attitude of the respondent toward human organ donation and transplantation.

Primary Care Doctors Faced With Living Organ Donation

OBJECTIVE

The attitudes of health care personnel, specifically doctors, have a significant influence on public attitudes toward organ donation and transplantation. The objective herein was to analyze the attitudes of Primary Care (PC) doctors toward living organ donation and to determine the psychosocial factors that condition these attitudes.

MATERIALS AND METHODS

A random sample was stratified by geographical location (six health areas in our community) among PC doctors, including 155 respondents from 32 health centers. Attitudes toward donation were evaluated using a psychosocial questionnaire validated in our geographical area. Contact was made with the Doctor Coordinator in each center for distribution of the questionnaires, which were completed anonymously. The chi-square test and Student t test were applied to evaluate the data.

RESULTS

When the living donor is not related, only 21% (n = 32) of PC doctors were in favor of living kidney donation, and only 20% (n = 31) for living liver donation (P > .05). In contrast, these percentages were 90% and 89% in favor of kidney and liver related donation, respectively. Upon analysis of the psychosocial variables affecting these attitudes, there was only an association with their partner's opinion (P = .009 for kidney and P = .000 for liver), and the possibility of needing a transplant oneself (P = .000).

CONCLUSIONS

PC doctors have favorable attitudes toward related living donation. If living donation is promoted by transplant coordination units, such PC professionals could act as a source of positive information about the matter for the general public.

Ancillary Hospital Personnel Faced With Organ Donation and Transplantation

OBJECTIVE

To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes.

MATERIALS AND METHODS

A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one's own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data.

RESULTS

We analyzed 277 respondents of mean age 43 +/- 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death (P = .004); attitude toward cadaveric manipulation, especially toward autopsy (P = .013) and cremation (P = .004); concern about mutilation after donation (P = .014); religion (P = .032); partner's attitude toward donation (P < .0001); and possibility of needing an organ in the future (P = .031).

CONCLUSIONS

Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.

Attitudes of Resident Doctors Toward Different Types of Organ Donation in a Spanish Transplant Hospital

OBJECTIVE

Our aim was to analyze acceptance of cadaveric and living organ donation for transplantation among resident doctors, given that they are the new professionals of medicine who will have to encourage and develop transplant programs.

MATERIALS AND METHODS

A random survey was performed on resident doctors in a third-level hospital with an organ transplant program which is accredited for undergraduate and postgraduate education (n = 171). Attitudes toward cadaveric and living donation were evaluated using a questionnaire including various psychosocial variables that might affect such attitudes. We used the Student t test and the chi-square test.

RESULTS

The sample was composed of responses by 171 resident doctors of mean age 28 +/- 4 years with 56% women. Attitudes toward cadaveric donation were favorable in 92% (n = 157). As for living donation, the percentage in favor of nonrelated donation was low: 23% for kidney and 19% for liver. However, when the donation was from a relative, the percentages increased to levels similar to those of cadaveric donation, namely 88% and 85% for kidney and liver, respectively. No differences were observed in attitudes toward cadaveric or living donation according to various psychosocial variables.

CONCLUSIONS

The trainee doctors showed favorable attitudes toward human cadaveric organ donation as well as living related donation, which suggests a relaunch of living donors in the near future. However, there was not much acceptance of nonrelated donation, as has also been seen in studies of the general public in our geographical area.

Attitudes Toward Organ Donation in Rural Areas of Southeastern Spain

OBJECTIVE

Rural areas present a worse attitude toward organ donation. However, the factors conditioning this attitude are not well known. Our aim was to determine the profile of the population opposed to donation in rural areas.

MATERIALS AND METHODS

A random sample stratified by age and sex was obtained from municipalities with less than 10,000 inhabitants. Attitudes toward donation were assessed by a questionnaire which evaluated variables that may influence these attitudes. A descriptive statistical study used the Student t test and chi-square test as well as a logistic regression analysis.

RESULTS

Among 181 respondents, 63% were in favor of donation and 37% against or undecided. Among the reasons to be against donation were rejection of body mutilation (43%) and fear of apparent death (41%). The psychosocial variables against donation were age >or=44 years, primary education or below, no previous experience with donation, no prosocial activities, an unfavorable opinion of the partner, and fear of corpse mutilation. The variables persisting in the multivariate analysis were level of education, previous experience, prosocial activities, and fear of corpse manipulation.

CONCLUSIONS

Among the rural population the profile of a person opposed to donation was someone older than 44 years, with a low level of education and no previous experience with donation, who does not participate in prosocial activities and is opposed to corpse manipulation.

[Toward zero mortality in liver resection. Presentation of 200 consecutive cases]

INTRODUCTION

Liver resection (LR) morbidity and mortality rates have dropped in recent decades. Mortality is now below 5% and morbidity is less than 30%. Our objective was to present a series of 200 LRs without mortality and to analyze the factors that may be related to complications.

PATIENTS AND METHOD

Between January 1996 and October 2003, 200 LRs were performed in 177 patients. The most common indication was liver metastases in 123 patients (61.5%), primary malignant liver tumors in 27 patients (13.5%), bile duct tumors in 27 patients (13.5%) and benign disease in 23 patients (11.5%). Fifty-one percent of the resections were performed under hemihepatic vascular control and 49% were resections of central segments, segmentary and atypical resections. We studied the association between morbidity and age, sex, previous comorbidity, liver status, indication for surgery, number of resections, major and minor resections, resection extended to other organs, type of vascular occlusion, transfusion requirements, operating time, length of hospital stay and experience of the surgical team.

RESULTS

There was no postoperative mortality. The morbidity rate was 17.5% (35 patients) and the most common complications were biliary (8%). Morbidity was related to transfusion (transfused patients presented more complications) (P < .001). Transfusion was greater in major resections, the first 100 resections and prolonged operations. Among the segmentary resections the Pringle maneuver reduced transfusion requirements but this difference was not statistically significant. Morbidity decreased in the second 100 resections, without significant differences.

CONCLUSION

LRs can be performed with low mortality and morbidity. Biliary complications and blood transfusion should be avoided whenever possible.

Prevention of hyperacute rejection in a model of orthotopic liver xenotransplantation from pig to baboon using polytransgenic pig livers (CD55, CD59, and H-transferase)

INTRODUCTION

The search for alternative sources for transplant organs leads us to the search for animals as an inexhaustible source of organs. The objective of this study was to analyze whether livers from polytransgenic pigs expressing the human complement regulatory proteins CD55 (hDAF), CD59, and alfa alpha1,2-fucosyltransferase (H-transferase), protected against hyperacute rejection after orthotopic liver xenotransplantation to a baboon and also to study pig liver function in a nonhuman primate.

MATERIALS AND METHODS

Nine liver transplants from pig to baboon were divided into two groups: a control group (n = 4) of genetically unmodified pigs and an experimental group (n = 5) of pigs transgenic for CD55, CD59, and H-transferase as donors. All the donating piglets obtained through hysterectomy were maintained in specific pathogen-free conditions. The selection of transgenic pig donors followed demonstration of transgene expression using monoclonal antibodies (antiCD55, antiCD59) and immunohistological studies on liver biopsies.

RESULTS

All animals in the control group developed hyperacute rejection with survival rates less than 16 hours without function of transplanted livers. In the experimental group none of the animals suffered hyperacute rejection. Survival in this group was between 13 and 24 hours. The livers were functional, producing bile and maintaining above 35% prothrombin activity. Only in one case was there primary dysfunction of the xenograft.

CONCLUSION

Polytransgenic livers for complement regulatory proteins prevent hyperacute rejection when xenotransplanted into a baboon.

Attitudes toward living liver donation among hospital personnel in services not related to transplantation

INTRODUCTION

The deficiency in livers and waiting list mortality have encouraged more living liver donation, although it is not exempt from morbidity and mortality. The enthusiasm of transplant teams for this kind of donation is increasing; however, the attitudes toward it are not so clear among other health professionals. Our objective was to analyze the attitudes toward living liver donation among hospital professionals in services without habitual relations with transplantation.

MATERIALS AND METHODS

A random sample was stratified for service not related to transplantation and job category, in a third level hospital with a transplant program. Attitudes toward living liver donation were evaluated using a psychosocial questionnaire on living donation.

RESULTS

A total of 419 respondents were analyzed (doctors, n = 184; nurses, n = 119; assistant nurses, n = 80; and non-health workers, n = 36), with a mean age of 37 +/- 10 years. The attitude toward living liver donation was favorable in 82% (n = 344). Among the other respondents, half (9%; n = 38) were against and the other half (9%; n = 37) were undecided. No significant differences were found among the doctors, nurses, assistants, and non-health workers. However, when the three categories were grouped in opposition to the non-health workers, there was greater indecision among non-health workers than the others (19% vs 8%; P = .0001). On analyzing the variables that determine this attitude we observed the following: having commented upon and previously discussed donation (P = .016); believing in the possibility of needing an organ oneself (P = .0001); and being in favor of living kidney donation (P = .0001) and cadaveric donation (P = .004).

CONCLUSIONS

Hospital personnel in services not related to transplantation favor living liver donation, especially if it is a related donation, despite its greater risk, except among non-health workers. However, it is important to conduct informative and awareness-raising campaigns in hospitals if such a type of transplantation is to be encouraged.

Pathology findings in a model of auxiliary liver transplantation with portal vein arterialization in pigs

OBJECTIVE

To determine the histological findings and temporal evolution that occur in auxiliary liver grafts as a consequence of arterialization of the portal vein (PVA).

MATERIALS AND METHODS

We evaluated 10 auxiliary heterotopic liver transplants with arterialization of the PVA. The histological study was performed using an optical microscope to process liver samples with staining using hematoxylin and eosin. A biopsy of native liver tissue was used as a control.

RESULTS

Two animals were excluded from the study, one due to ischemic necrosis of the graft and one that died 4 hours after transplant. All of the remaining eight animals underwent a histological study at 1 day, 7 days, and 14 days. The most significant histological findings were: (1) dilation of portal areas and sinusoids, which were detected at 24 hours and persisted; (2) thickening of the interlobular septum, which was observed after day 7 and progressively increased to day 14; (3) bile duct hyperplasia detected at the seventh day.

CONCLUSIONS

The consistent, early findings in a pig liver with PVA included vascular dilation of the portal area and the sinusoids, with bile duct hyperplasia extending progressively and the thickening of interlobular connective tissue septa with a generalized perilobular connective tissue reaction, which did not seem to alter the internal structure of the lobule, which showed histologically normal hepatocytes. The fibrous reaction may be the first stage in chronic hepatopathy. Further long-term studies are required in this model.

Effects of rapid paracentesis on right ventricular-arterial coupling in liver transplantation

BACKGROUND

In cirrhotic patients intra-abdominal pressure (IAP) changes markedly modify splanchnic and systemic hemodynamics. Previous studies have evaluated the effects of increased IAP on steady-state cardiac performance, showing that right ventricular (RV) function becomes more depressed than that of the left ventricular. We sought to evaluate the effects of paracentesis on RV function and ventricular-arterial coupling among cirrhotics undergoing liver transplantation (OLT).

METHODS

Twelve cirrhotic patients undergoing OLT underwent hemodynamic profiles before and 5 minutes after paracentesis, employing a right ventricular ejection fraction catheter in the pulmonary artery. We studied heart rate, systolic pulmonary artery pressure, central venous pressure (CVP), stroke volume index (SVI), RV end-diastolic volume index (RVEDI), and RV ejection fraction. In addition RV stroke work index (RVSWI), RV end-diastolic compliance (RVEDC), RV end-systolic elastance (Ees), pulmonary artery effective elastance (Ea), and RV coupling efficiency (Ees/Ea ratio) were calculated employing standard formulas.

RESULTS

After removal of mean ascites volume of 5.6 +/- 2.2 L (range 4.0 to 8.04 L), SVI, RVEDI, RVSWI, and RVEDC were significantly increased and conversely CVP, Ees, and Ea were decreased with an ea/ea ratio unchanged.

CONCLUSIONS

Before paracentesis Ees/Ea is preserved by increased of RV contractility; after paracentesis the coupling was maintained.

The primary care physician faced with organ donation: attitudinal study in South-Eastern Spain

INTRODUCTION

Attitude of health personnel, especially of physicians, has a significant influence on populational attitude towards organ donation and transplantation. The objective here is to analyse the attitude of Primary Care (PC) physicians towards cadaveric organ donation and transplantation and to determine the factors which condition this attitude.

MATERIALS AND METHODS

A random sample was stratified by geographical location (six health areas of our community) among PC physicians. A total of 155 responses from 32 health centres were collected. Attitude towards donation was evaluated using a psychosocial attitudinal questionnaire about donation validated in our geographical area. The co-ordinator of physicians in each centre was contacted in each centre and was made responsible for distribution and collection of the questionnaires which were completed anonymously. The chi2 test and Student's t-test were applied.

RESULTS

88% (n=136) of the PC physicians are in favour of organ donation, 1% (n=2) are against and 11% (n=17) are undecided. Up to 84% of the PC physicians (n=130) have attended to transplant patients, although this fact is not related to a more positive attitude towards donation (p=0.059). In addition, 64% (n=99) have provided favourable information about organ donation and transplantation to their patients and one of the physicians admits having provided unfavourable information about the matter. On analysing the psychosocial variables which influence such an attitude, a relationship has only been found with respect to two variables: attitude towards cadaveric manipulation (p=0.035) and a partner's opinion towards the subject (p=0.006).

CONCLUSIONS

PC physicians have a very favourable attitude towards donation of their own organs and constitute a positive source of information on the subject for the general public.

Theoretical Description of the Ion Transport Across Nanopores With Titratable Fixed Charges: Analogies Between Ion Channels and Synthetic Pores

Recently developed nanometer-sized synthetic pores display several properties so far believed to be distinctive features of a large variety of biological wide ion channels. Thus conductance in the pS-nS range, pH-dependent ion selectivity, fluctuations of current between open and closed states, flux inhibition caused by protons or divalent cations, current rectification, and the ability to perform selective macromolecule sizing and counting are found in synthetic and biological channels alike. Despite other differences such as pore size and geometry, the similarities open a new field for exploring specific technological applications via the chemical modification of synthetic pores with biological molecules. This article reviews some of the basic concepts and theories relevant to ion transport in nanopores with titratable charges stressing the analogies between synthetic pores and biological ion channels. The ultimate goal is to show that continuum theories may account for the essential features of these systems. A simple electrodiffusion model and its comparison with experimental results are chosen as a case study.

Evaluation of CD86 gene polymorphism at +1057 position in liver transplant recipients

BACKGROUND

Efficient T cell-APC interaction requires the participation of primary and co-stimulatory signals. The main co-stimulatory pathway involves the interaction of CD80 and CD86, expressed on the APCs, with their T cell counter-receptor, CD28 and CTLA-4. Recently, a G to A transition has been described at position +1057 of the CD86 gene, located in their cytoplasmic tail.

METHODS

CD86 polymorphism was analyzed by sequence based typing in DNA samples obtained from 205 liver transplant recipients. Acute rejection and chronic rejection were diagnosed based upon conventional clinical, biochemical and histological criteria.

RESULTS

The study of CD86 +1057 (G/A) polymorphism revealed that recipients bearing the A allele or the AA genotype have a reduced risk of acute rejection. In fact, the AA genotype was absent in the group of patients showing acute rejection episodes, whereas its frequency in those patients without acute rejection episodes was 8.8% (P=0.009, OR=0.07). This polymorphism did not reveal any association with the incidence of chronic rejection, but patients bearing the AA genotype showed a higher graft survival rate (83.3%) than those bearing the GA genotype (49.3%) or GG genotype (56.5%).

CONCLUSIONS

The results of the present report suggest that the CD86 AA genotype at +1057 position could be involved in liver transplant acceptance, given that its presence is related to a decrease of acute rejection frequency and to a graft survival increase.

Attitudes Toward Xenotransplantation Among Nonhealth Service Workers in a Hospital With a Preclinical Xenotransplantation Program

INTRODUCTION

Our hypothesis was that nonhealth workers (NHW) in our hospital should have a more favorable opinion toward xenotransplantation than the general population, given that this group is in closer contact with a preclinical xenotransplantation program. Therefore, our objective was to determine the attitude of NHW in a hospital with a preclinical liver xenotransplantation program and to determine the factors that influenced this attitude.

MATERIALS AND METHODS

A random sample of 276 subjects in nonhealth services was used. For the distribution of the questionnaire, we contacted the head of each of the services and explained the project. They became responsible for the distribution and collection of the questionnaires in randomly selected work shifts. A random sample of 250 individuals from our community was used as a control group.

RESULTS

As for animal organ donation for humans, if the results could be superimposed on those achieved by human donors, 63% would be in favor, 30% undecided, and the remaining 7% against. The attitude toward xenotransplantation was more favorable in the control group (74% versus 63%, P < .05). On analyzing the variables that influence attitudes toward xenotransplantation, we found that there is no significant relationship to the classical psychosocial variables (P > .05). However, there is a relationship to prior attitudes toward different types of human organ donation and the possibility of needing a transplant oneself.

CONCLUSIONS

The attitudes toward xenotransplantation among NHW are not as favorable as in the general population.

Attitude Survey of Hospital Workers in the Surgical Services Toward Living Kidney Donation

INTRODUCTION

A living donor kidney is currently the most accepted kind of solid organ donation, given the low level of morbidity and mortality and the good results in the recipient. In Spain, its use is still scarce; even many health service workers are not in favor. Our objective was to analyze the attitudes toward living kidney donation in a surgical department.

MATERIALS AND METHODS

A random sample was stratified according to surgical services and job category in a tertiary hospital with an solid organ transplant program. Attitudes toward living kidney donation were evaluated using a questionnaire on donation and transplantation, which evaluated various psychosocial variables. Student's t test and the Chi square test were used.

RESULTS

Two hundred sixty-three respondents of mean age 40 +/- 10 years were analysed for attitudes toward living kidney donation. The level of acceptance was 87% (n = 229) versus 13% undecided or against the procedure (n = 34). No differences were observed according to job category. The variables that showed a relationship with the attitude were the partner's attitude toward donation (P = .049); the possible need for an organ oneself (P = .0001); and belief that medical errors occur (P = .001). The attitude toward cadaveric organ donation was not reflective of that toward living kidney donation (P = .241).

CONCLUSIONS

A favorable attitude toward living kidney donation was high among hospital staff of the surgical department. Those for whom it was not favorable were influenced by personal factors such as partner's attitude and the possibility of needing a kidney in the future.

Attitude Toward Deceased Organ Donation and Transplantation Among the Workers in the Surgical Services in a Hospital With a Transplant Program

INTRODUCTION

There are data that suggest that the percentage of hospital workers not in favor of donation is relatively high, even in services that are directly related to transplantation. The objective was to analyze attitudes toward decreased organ donation in the surgical services.

MATERIALS AND METHODS

A random sample was stratified by the surgical service and the job category (n = 263) in a third-level hospital with a transplant program assessed attitudes toward the donation of ones own organs after death using a questionnaire including psychosocial factors as validated in our geographic surroundings. Student t test and the chi-square test were used for data analysis.

RESULTS

Favorable attitudes toward donation were observed in 68% (n = 178) as opposed to 32% with an attitude that was undecided or against the act (n = 85). The psychosocial variables that showed significant relationships with this attitude were age (most in favor are younger; P = .021); nonmedical surgical staff (50% against donation; P = .0001); resident physicians (94% in favor; P = .001); discussion and prior consideration of donation (P = .016); knowledge of the concept of brain death (an important factor in nonhealth staff; P = .010); attitude toward manipulation of the deceased (P = .011) and concerns about mutilation (P = .026); partner's opinion toward organ donation (P = .0001); and existence of frequent medical errors (P = .003). No significant differences were found, depending on whether the services were involved in a specific transplant program (P = .853).

CONCLUSIONS

Favorable attitudes toward donation among the hospital staff on surgical services, including those who perform transplants, did not reach more than 70% and was determined by multiple psychosocial factors. Donation promotion activities are necessary for these services, given the importance that this group's negative attitude could have on the attitude of the general population.

Attitude Toward Living Related Donation of Patients on the Waiting List for a Deceased Donor Solid Organ Transplant

INTRODUCTION

Spain is the country with the highest rate of donation from deceased individuals. However, given the deficit in organs, living donation is being encouraged. Our objective was to analyze attitudes toward living donation among patients on the waiting list for a transplant.

MATERIALS AND METHODS

Patients on the waiting list for a kidney or liver transplant (n = 96; 46 kidney and 50 liver) in the last year had their attitudes toward living donation evaluated through a psychosocial survey performed in a direct interview with an independent health professional from the transplant unit and analyzed by Student t test and the chi-square test.

RESULTS

Ninety-one percent were in favor of donating their organs when they die, 6% had doubts, and the remaining 3% were against it. Twenty percent would accept living donation from a family member (32% in liver vs 7% in kidney; P < .05), despite 89% of them accepting that there would be a risk to the family member. Twenty percent reported that a family member had suggested donating, but the patient was opposed. Finally, only 6% considered living donation to be their first choice, 42% did not consider this option. Up to 96% would donate an organ to a family member if they were requested to do so.

CONCLUSION

Patients on the waiting list are not favorable to living related donation for themselves, although members of their family have proposed it to them. However, the liver patient is more prepared to accept it, possibly because that patient has no other alternative as do kidney patients have dialysis. Even so, they are favorable toward donating a living organ if a family member were to request one. In general, living donation is not being proposed to these patients as a real option, partly because of their doctors.

Attitude of Primary Care Nurses Toward Living Kidney Donation

INTRODUCTION

Nursing is a fundamental service in caring for the health of the public. The opinion of nurses toward a certain type of donation may have a strong population impact. In this respect, living kidney donation is increasing in Spain; it is important to raise awareness at all levels. The objective here was to analyze the attitudes of primary care nursing personnel toward living kidney donation and to their determinants.

MATERIALS AND METHODS

A random sample of primary care nurses stratified by geographical location (six health areas in our community), included 139 nurses from 32 health centres. Attitudes toward living donation were evaluated using a questionnaire with various psychosocial variables. For the distribution of the questionnaires, contact was made with the nursing coordinator in each centre. They were completed anonymously. The chi-squared test and Student's t test were applied.

RESULTS

The attitudes toward living kidney donation were favorable in 93% of those questioned (n = 129), mainly when the donation is related (78%, n = 109). Only one nurse was against the idea of donating a kidney from a living person (1%); nine had doubts about this kind of donation (7%). Seventy-six percent (n = 106) have cared for patients awaiting a transplant; however, no relationship was found with attitude toward this type of donation (P = .209). Of all analyzed variables, there was only a significant relationship with concern about possible body mutilation (P < .0005) and partner's opinion about the matter (P < .0005). We wish to highlight that no relationship was found with attitudes toward cadaveric organ donation (P = .712).

CONCLUSIONS

Attitudes of primary care nursing personnel toward living kidney donation were favorable, especially if it was related donation.

Attitude Toward Xenotransplantation Among Residents

INTRODUCTION

The deficit in transplant organs has made it necessary to search for alternatives, among them research into xenotransplantation. However, the use of animal organs may cause rejection in society and among health professionals. The objective was to analyze the acceptance of this therapy among Residents, given that they would be the professionals most involved in its application if such a therapy proves to be useful.

MATERIALS AND METHODS

A random sample stratified by the services of the Residents in a third-level hospital with an organ transplant program and accredited for teaching at undergraduate and postgraduate levels (n = 171). The attitude toward xenotransplantation was evaluated using a questionnaire that analyzes different pychosocial variables that may influence such attitude.(5)

RESULTS

The sample consisted of 171 residents (mean age 28 +/- 4 years; 56% women). Attitudes toward xenotransplantation, whether the results were similar to those obtained with human organs, were positive in 81% (n = 138) of cases, with 16% (n = 27) having doubts and 3% (n = 6) being against. The attitude was more favorable among residents in favor of cadaveric donation (83% vs 57%; P < .05) and of living donation either of the kidney (90% vs 55%; P < .001) or of the liver (88% vs 56%; P < .001), and among those who consider that they might need a transplant at a given point in the future (88% vs 73%; P < .05).

CONCLUSION

Residents have a positive attitude toward the application of a possible xenotransplantation in safe conditions similar to those that currently exist in human organ donation. Such a favorable attitude was greatly influenced by a positive attitude toward human organ donation, in cadaveric as well as in living donation, and when considering oneself to be a possible candidate for a transplant.

Attitude Toward Xenotransplantation in Kidney and Liver Patients on the Transplant Waiting List

INTRODUCTION

The deficit in transplant organs is encouraging research into stem cells and xenotransplantation. However, many studies have shown that using animals for human transplantation could be rejected by society. The objective here was to analyze the attitude of patients on the waiting list toward a possible transplant of an organ of animal origin.

MATERIALS AND METHODS

Patients on the waiting list for kidney and liver transplants including last year (n = 96) underwent a direct interview by an independent health professional from the transplant unit. Using a psychosocial survey, an evaluation was made of attitudes toward donation of organs of animal origin and its various options. Student t test and the chi-square test were used for analysis.

RESULTS

If results from xenotransplantation could be superimposed onto those of human transplantation, 71% would accept such an organ. In the case of the kidney, 83% would accept, 4% would not, and 13% have doubts; as opposed to 60%, 12%, and 28%, respectively, of liver cases (P < .05). Supposing that the results were worse than in human organs, only 26% would accept an animal organ. Thus, for kidney, 33% would accept it, 48% would not, and 20% would have doubts; and for liver, it would be 20%, 50%, and 30%, respectively. In a life-threatening situation 98% would accept an animal organ as a bridge of hope in the wait for a human organ. In addition, if the organ functioned correctly, 98% would keep the animal organ, thus avoiding an intervention to substitute a human organ.

CONCLUSION

If xenotransplantation became a clinical reality, acceptance of an animal organ by patients on the waiting list would be low, especially if the results could not be superimposed onto human ones. Only its use as a bridge until the arrival of a human organ would increase its acceptance.