Surgical issues in retrieval and implantation

How are Organs Transported for Transplantation in Chile? An Exploratory Study

BACKGROUND

To determine how organs are transported and the safety of the process in Chile. Little is said in the medical literature about how to transport organs for transplantation. Is it safe?

METHODS

Exploratory study that characterizes the transport of organs in Chilean health centers in 2021. An interview was applied to selected groups, which were composed by expert health personnel in procurement and transplantation including nurses and surgeons. Seven semistructured interviews were conducted to deeply understand the organ packaging process, transportation, and advantages/disadvantages identified in these processes. Being an exploratory study, the sample was justified by the importance of the stories, details, and perceptions of each interviewee.

RESULTS

Seventy-one percent of the sample indicated that the organs are transported in polystyrene devices. One hundred percent of the respondents stated that to optimally preserve the organ, common ice is used. Eighty-six percent reported that "there is no record/monitoring of temperature," and 100% indicated that the quality of the receptacle does not keep the organ under the necessary care for its conservation and does not ensure, in the least, a safe transfer. The experts also indicated that according to figures from the Chilean Ministry of Health, in 2019, 5% of organs were not implanted due to transport problems, that is, 27 organs.

CONCLUSION

Chile needs modernization and professionalization in its organ transport procedures. It is necessary to raise standards, upgrade guidelines, and develop new technology in this area. In Chile, the way of transporting organs could be safer.

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

Introduction: Liver transplantation (LT) is burdened by the risk of post-operative morbidity. Identifying patients at higher risk of developing complications can help allocate resources in the perioperative phase. Controlling Nutritional Status (CONUT) score, based on lymphocyte count, serum albumin, and cholesterol levels, has been applied to various surgical specialties, proving reliable in predicting complications and prognosis. Our study aims to investigate the role of the CONUT score in predicting the development of early complications (within 90 days) after LT.

Methods: This is a retrospective analysis of 209 patients with a calculable CONUT score within 2 months before LT. The ability of the CONUT score to predict severe complications, defined as a Comprehensive Complication Index (CCI) ≥42.1, was examined. Inverse Probability Treatment Weighting was used to balance the study population against potential confounders.

Results: Patients with a CCI ≥42.1 had higher CONUT score values (median: 7 vs. 5, P-value < 0.0001). The CONUT score showed a good diagnostic ability regarding post-LT morbidity, with an AUC = 0.72 (95.0%CI = 0.64–0.79; P-value < 0.0001). The CONUT score was the only independent risk factor identified for a complicated post-LT course, with an odds ratio = 1.39 (P-value < 0.0001). The 90-day survival rate was 98.8% and 87.5% for patients with a CONUT score <8 and ≥8, respectively.

Conclusions: Pre-operative CONUT score is a helpful tool to identify patients at increased post-LT morbidity risk. Further refinements in the score composition, specific to the LT population, could be obtained with prospective studies.