Equity, Diversity and Inclusion (EDI) in Organ Transplantation: An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and Science

The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT's Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Background

We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients.

Methods

From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study.

Results

The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection.

Conclusions

The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

Predictive and Comparative Study Between Clinic Consensus Document for Pancreas Acceptance and Predictive Value of Preprocurement Pancreas Allocation Suitability Score (P-PASS)

The strict selection of pancreas for transplant has forced the development of different documents to select the suitable organ in order to minimize the risks and complications of the transplant. In 2008, Eurotransplant published the Preprocurement Pancreas Allocation Suitability Score (P-PASS) for pretransplant selection. In 2001 the Hospital Clinic of Barcelona developed a Clinical Consensus Document (CCD).

OBJECTIVES

We aimed to analyze the predictive decision of the pancreas acceptance to offers received in the hospital, according to the CCD criteria and compare it with the recommended value of suitability for accepting the pancreas according to the P-PASS value.

MATERIAL AND METHODS

We performed a retrospective comparative study between the criteria of selection of the CCD for pancreas from 2016-2017 in comparison with the values obtained if the P-PASS had been used: ≤ 17, acceptance criteria and P-PASS; > 17, risk criteria. We defined the organ reported as rejected or accepted. The accepted organ could be procured and transplanted or discarded.

RESULTS

With the CCD criteria, 7 more organs were transplanted than if we only applied the potential P-PASS criteria. In contrast, P-PASS would have ruled out an additional 9% of pancreases in relation to CCD criteria.

CONCLUSIONS

According our experience, it is difficult to find an adequate prediction model to select pancreas for transplantation. The application of the DCC criteria increases the number of organs valid for transplantation. At present, new criteria should be re-evaluated within multicenter studies.

Selecting native perennial plants for ecological intensification in Mediterranean greenhouse horticulture

Natural control by predators and parasitoids provides an important and often unnoticed ecosystem service to agricultural landscapes by reducing pest populations in crops. The current model of horticultural intensification in south-eastern Spain produces high yields but has also resulted in a landscape almost completely covered by plastic. Promoting natural areas among greenhouses could enhance biodiversity, by being beneficial insects, and reduce pest pressure outdoors. The first step is to ascertain how pests and their natural enemies (NEs) use Mediterranean vegetation for selecting the best plants for pest suppression outdoors. The abundance of the two major horticultural pests, the tobacco whitefly, Bemisia tabaci, and the western flower thrips, Frankliniella occidentalis, together with their NEs, were assayed in 22 flowering perennial plants, which were newly planted in an experimental field surrounded by greenhouses. Eight plant species were identified as the most critical species for sustaining pest populations outdoors. A set of five plant species supported a medium level of pests, and another set of ten plant species supported the lowest level of both pests. Tobacco whitefly occurred in a few plants species, whereas western flower thrips occurred on almost all the plant species studied, and was favoured by the presence of flowers in perennial plants. The results suggest that plant diversity may provide relatively few acceptable host plants for tobacco whitefly than for western flower thrips. NEs were generally collected in plants that also supported abundance of pests, indicating that host/prey availability, more than food resources from flowers, was a stronger predictor of NE abundance in perennial plants. Field trials using the plants with the lowest host acceptance by pests are needed in order to ascertain whether pest abundance outdoors is reduced.

Relatives' Perception After Tissue Donation Experience: Results of a Postdonation Phone Survey

INTRODUCTION

Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process.

METHODOLOGY

A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues.

RESULTS

From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD.

CONCLUSION

The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach.

Association of Brain-Dead Donors' Terminal Inflammation With Delayed Graft Function in Kidney Transplant Recipients

BACKGROUND

Systemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response.

OBJECTIVE

To analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation).

MATERIALS AND METHODS

Retrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135).

RESULTS

Donors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage (P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non-expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group (P = .67).

CONCLUSIONS

Terminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors.

Association between preterm birth and its subtypes and maternal sociodemographic characteristics during the post-transitional phase in a developing country with a very high human development index

OBJECTIVES

Chile is a post-transitional country evolving towards a stationary population pyramid, which may be associated with increasing preterm birth (PTB) rates. This study aimed to compare maternal sociodemographic characteristics between the start of the post-transition phase (1994) and an established stage (2013) and to evaluate associations between these characteristics and PTB.

STUDY DESIGN

An observational analytic design was conducted using national birth records (n = 4,956,311).

METHODS

Variables analysed in the 20 birth cohorts from 1994 to 2013 were: length of gestation (preterm <37 weeks) subdivided by gestational age (extreme, moderate/severe and late); maternal age (≤19, 20-35 and >35 years); education level (<8, 8-12 and >12 years of education); employment; marital status; area of residence; and type of birth (singleton, twins, and triplets or higher order). The prevalence of PTB was expressed as a percentage, and associations between PTB and predictor variables were analysed using logistic regression models.

RESULTS

Education level, age >35 years, maternal employment, unmarried status, twin delivery and urban residency rates increased between 1994 and 2013. According to the adjusted models, age >35 years and delivery of more than two foetuses were risk factors for all PTB subtypes. Maternal employment was a risk factor for moderate/severe, late and total PTB, and a low level of education was a risk factor for late and total PTB. On the other hand, age ≤19 years was protective against all PTB subtypes.

CONCLUSIONS

All maternal characteristics changed between 1994 and 2013. Furthermore, the prevalence of PTB increased for all predictor variables studied over this period.

Successful Pancreas Transplantation From a Deceased Donor Intoxicated With Oral Antidiabetic Agent: A Case Report

Simultaneous kidney pancreas transplantation (SKP) is a common procedure for the patient with long-term type 1 diabetes mellitus (DM) with terminal renal failure. It is unusual to consider the pancreas from a deceased donor who died after an acute intoxication with oral antidiabetic agent (OAA), which would suggest an abnormal functionality of the organ and preclude the potential use of the graft. We present a case of a successful pancreatic transplantation from a donor who died of acute cerebral edema secondary to severe hypoglycemia induced by OAA acute intoxication.

Coagulation profiles of unexpected DCDD donors do not indicate a role for exogenous fibrinolysis

It has been suggested that vascular stasis during cardio-circulatory arrest leads to the formation of microvascular thrombi and the viability of organs arising from donation after circulatory determination of death (DCDD) donors may be improved through the application of fibrinolytic therapy. Our aim was to comprehensively study the coagulation profiles of Maastricht category II DCDD donors in order to determine the presence of coagulation abnormalities that could benefit from fibrinolytic therapy. Whole blood from potential DCDD donors suffering out-of-hospital cardiac arrest was sampled after declaration of death in the emergency department, and rotational thromboelastomeric analysis was performed. Between July 2012 and December 2013, samples from 33 potential DCDD donors were analyzed. All patients demonstrated hyperfibrinolysis (HF), as reflected by maximum clot lysis of 98-100% in all cases, indicating that there is no role for additional fibrinolytic therapy in this setting. As well, we observed correlations between thromboelastomeric lysis parameters and maximum hepatic transaminase levels measured in potential donors and renal artery flows measured during ex situ hypothermic oxygenated machine perfusion, indicating that further studies on the utility of thromboelastometry to evaluate organ injury and perhaps even viability in unexpected DCDD may be warranted.

Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors

In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.

Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation

Maastricht type 2 donation after cardiac death (DCD) donors suffer sudden and unexpected cardiac arrest, typically outside the hospital; they have significant potential to expand the donor pool. Herein, we analyze the results of transplanted livers and all potential donors treated under our type 2 DCD protocol. Cardiac arrest was witnessed; potential donors arrived at the hospital after attempts at resuscitation had failed. Death was declared based on the absence of cardiorespiratory activity during a 5-min no-touch period. Femoral vessels were cannulated to establish normothermic extracorporeal membrane oxygenation, which was maintained until organ recovery. From April 2002 to December 2010, there were 400 potential donors; 34 liver transplants were performed (9%). Among recipients, median age, model for end-stage liver disease and cold and reperfusion warm ischemic times were 55 years (49-60), 19 (14-21) and 380 (325-430) and 30 min (26-35), respectively. Overall, 236 (59%) and 130 (32%) livers were turned down due to absolute and relative contraindications to donate, respectively. One-year recipient and graft survivals were 82% and 70%, respectively (median follow-up 24 months). The applicability of type 2 DCD liver transplant was <10%; however, with better preservation technology and expanded transplant criteria, we may be able to improve this figure significantly.

EULID project: European living donation and public health

The choice of transplantation from a living donor offers advantages over a deceased donor. However, it also carries disadvantages related to donor risks in terms of health and safety. Furthermore, there are several controversial ethical aspects to be taken into account. Several national and international institutions and the scientific community have stated standards that have great influence on professional codes and legislations. Living organ donation and transplantation are to some extent regulated by parliamentary acts in most European countries. It is necessary to take a step forward to develop a legal framework to regulate all of these processes to guarantee the quality and to prevent illegal and nonethical practices. It is also necessary to develop and implement living donor protection practices not only in terms of physical health, but also to minimize potential impacts on the psychological, social, and economic spheres. Finally, an additional effort should be made to create a database model with recommendations for registration practices as part of the standardized follow-up care for the living donor. The European Living Donation (EULID) project's (http://www.eulivingdonor.eu/) main objective was to contribute to a European consensus to set standards and recommendations about legal, ethical, and living donor protection practices to guarantee the health and safety of living donors.

Characterization of the Organ Donor With Bacteremia

INTRODUCTION

The presence of bloodstream infection in the donor is a common finding that could be transmitted to the recipient. To safely expand the donor pool, we examined its relevance.

MATERIALS AND METHODS

We described the clinical characteristics of organ donors grafted in our center between 1997 and 2006 who had bacteremia detected in blood cultures obtained during organ procurement.

RESULTS

Among 1353 organ donors, 75 were non-heart-beating donors type II and the others brain-dead donors. Only 186 donors (14%) showed bacteremia during retrieval. This mean age was 49.8 years (range 12 to 86 years, SD 18) including 63% men. Causes of death were cerebrovascular accident in 60%; craneoencephalic trauma, 25%; and other causes, 15%. The average length of the intensive care unit stay was 3 days (interquartile range: 2 to 7 days). Twenty-nine percent of donors presented previous infectious complications (90% from respiratory origin). The most prevalent pathogen isolated in blood cultures was coagulase negative Staphylococci (46,2%), followed by S aureus (15%), Streptococcus group viridans (9.1%), enterobacteria (9%), Enterococcus faecalis (7.5%) and gram-negative bacilli nonfermentative (6.2%). In 3.1%, the bloodstream infections were polymicrobial. The bronchial aspiration cultures were positive in 50% of cases and the urine culture in 8,6%. In 17% of donors the isolated microorganism was coincident between blood and bronchial cultures. Pseudomonas spp and S aureus were more common than the others (P = .004 and P = .058, respectively).

CONCLUSIONS

The incidence of bacteremia in our cohort was 14%. The respiratory tract was the most common clinical focus. Pseudomonas spp or S aureus isolated in bronchial cultures are risk factors to develop bacteremia. According to these findings, it is important to start specific antibiotics against those microorganisms in the donor and the recipients.

Telephone Consent in Tissue Donation: Effectiveness and Efficiency in Postmortem Tissue Generation

One reason for the loss of donors is the impossibility to contact family members for an interview. We sought to determine the effectiveness [(donors/total deaths) x 100] and efficiency [(donors/potential donors) x 100] of the telephone interview to obtain tissue for transplant purposes.

METHODS

A prospective, comparative cross-sectional study was performed on the personal and telephone interviews with family members during the tissue donation application process from January 1, 2004 to December 31, 2005.

RESULTS

Of the 3625 deaths hospital registered, we obtained 770 potential donors (21%). On 65% of occasions (503/770), the interview was held personally; on 29% (222/770), it had to be held over the telephone; and on 6% (45/770), family members could not be located. The refusals by family members over the telephone represented 48% (106/222), and the refusals during personal interviews were 37% (188/503). A positive family answer was obtained over the telephone on 116/431 donations (27%), and in the physical presence of the coordinator for 315/431 donors (73%). The donations obtained over the telephone were only for corneas in 83% (96/116) of cases, and for multiple tissues in 17% (20/116). The donor-generation effectiveness reached 9% in personal interviews and 12% if the telephone interviews were included. The donor generation efficiency reached 43% for personal interviews and 59% when telephone interviews were included. The use of the telephone enabled a 16% increase in tissue generation with a year-on-year increase of 4%.

CONCLUSIONS

The telephone has shown itself to be a useful tool for obtaining tissues postmortem.

Effects of NGF and BDNF on baseline glutamate and dopamine release in the hippocampal formation of the adult rat

It has been shown using in vitro techniques that BDNF and NGF evoke neurotransmitter release in the hippocampus but this phenomenon has not been demonstrated in vivo to date. We therefore performed in vivo microdialysis in urethane-anesthetized Fischer 344 rats. The microdialysis probe was implanted stereotaxically into the CA1 area of the hippocampus. Three hours after the implantation of the probe, glutamate (Glu) and dopamine (DA) levels had reached a stable baseline. Four baseline samples were collected every 15 min at a flow rate of 1 microL/min. The growth factors were delivered (1 microL/10 min) using a microinjector attached to the microdialysis probe. We found that BDNF and NGF, when administered into the hippocampus, evoked dopamine and glutamate release in a dose-dependent fashion. NGF produced a biphasic response in the release of Glu, and a uniphasic response in the release of DA, both of which were calcium dependent. The neurotransmitter release induced by NGF was blocked by tetrodotoxin, indicating neuronal origin of this response. The BDNF induced release of DA and Glu was decreased in low calcium conditions, indicating that it is at least partially calcium dependent. Furthermore, BDNF-induced neurotransmitter release was partially blocked by pre-treatment with K252a, an antagonist for tyrosine kinase receptors, indicating that BDNF is acting through Trk receptors to induce neurotransmitter release. These results demonstrate a close relationship between the growth factors BDNF and NGF and the neurotransmitters DA and Glu in the hippocampus of intact animals.

Effects of type of flow, plants and addition of organic carbon in the removal of zinc and chromium in small-scale model wetlands

Constructed wetlands are used for the treatment of wastewater containing metals. In order to clarify the role of plants, flow and the impact of organic matter, an investigation of three factors, each at two different levels, was carried out in small-scale model wetlands. The evaluated factors and levels were: type of flow (subsurface and surface); presence of plants (planted with Typha latifolia and unplanted) and addition of organic matter (with and without). Eight different experimental units were run for a year. The units were fed with synthetic wastewater containing chromium (VI) (1.5 mg L(-1)), zinc (1.5 mg L(-1)), macro, micronutrients and organic matter (to those units in which this factor was being investigated). Subsurface flow wetlands showed a significantly higher rate of chromium removal in comparison with surface flow systems (97 and 60 mg m(-2) d(-1), respectively). Planted systems removed significantly more chromium compared to unplanted systems (85 and 76 mg m(-2) d(-1), respectively), and the addition of organic matter increased the removal rate in a comparison with the units without it (88 and 69 mg m(-2) d(-1), respectively). Similar results were found for zinc; however, the addition of organic matter made no significant difference to zinc removal.

Model experiments on improving nitrogen removal in laboratory scale subsurface constructed wetlands by enhancing the anaerobic ammonia oxidation

Anaerobic ammonia oxidation (Anammox) has been identified as a new general process-strategy for nitrogen removal in wastewater treatment. In order to evaluate the role and effects of the Anammox process in wetlands, laboratory-scale model experiments were performed with planted fixed bed reactors. A reactor (planted with Juncus effusus) was fed with synthetic wastewater containing 150-200 mg L(-1) NH4+ and 75-480 mg L(-1) NO2(-). Under these operating conditions, the plants were affected by the high ammonia and nitrite concentrations and the nitrogen removal rate fell within the same range of 45-49 mg N d(-1) (equivalent to 0.64-0.70 g Nm(-2)d(-1)) as already reported by other authors. In order to stimulate the rate of nitrogen conversion, the planted reactor was inoculated with Anammox biomass. As a result, the rate of nitrogen removal was increased 4-5-fold and the toxic effects on the plants also disappeared. The results show that, in principle, subsurface flow wetlands can also function as an "Anammox bioreactor". However, the design of a complete process for the treatment of waters with a high ammonia load and, in particular, the realisation of simple technical solutions for partial nitrification have still to be developed.

Use of Quality Index in the Evaluation of Organ Procurement and Transplant Programs in a University Hospital

AIM

To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results.

METHODS

Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival.

RESULTS

During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants.

DISCUSSION

The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.

Evaluation of transplant procurement management courses: an educational project as a tool for the optimization of transplant coordination

The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1-5) for content, presentation, and ability to answer questions. Likewise, the program's organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1-10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge.

The process of adult living liver donation

OBJECTIVE

To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation.

MATERIAL AND METHODS

Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002.

RESULTS

15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation.

DISCUSSION

Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death

OBJECTIVE

The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS).

MATERIALS AND METHODS

From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done.

RESULTS

All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF.

CONCLUSION

The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistence of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

The living kidney donation process: the donor perspective

OBJECTIVE

To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life.

MATERIALS AND METHODS

From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation.

RESULTS

Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation.

DISCUSSION

LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.

Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors

Our aim was to analyze the short- and long-term function of kidneys procured from non- heartbeating donors (NHBD) by means of three techniques: in situ perfusion (ISP), total body cooling (TBC) and normothermic recirculation (NR). Fifty-seven potential NHBD were included. Mean warm ischemia time was 68.9 +/- 35.6 min. Forty-four kidneys were obtained from donors perfused with ISP, 8 with TBC, and 8 with NR. Eighteen kidneys (32%) started functioning immediately, 29 (52%) showed delayed graft function (DGF) and 9 (16%) showed primary non function (PNF). The actuarial graft survival rate was 76.4% at 1 year and 56% at 5 years. The patient survival rate was 89.3% at 5 years. Incidence of DGF and PNF was significantly lower in kidneys perfused with NR than those with ISP or TBC (P < 0.01). Duration of DGF was shorter in kidneys obtained through TBC than in kidneys obtained with ISP (P < 0.05). In conclusion, NR reduces the incidence of DGF and may be considered the method of choice for kidney procurement from NHBD.

Medial prefrontal transection enhances social interaction. I: behavioral studies

Behavioral effects of a medial prefrontal cortex (MPFC) transection were assessed in animal tests of anxiety. Social investigation and plus-maze open arm exploration increased in MPFC damaged animals relative to sham ones. MPFC lesions prevented D-amphetamine (2 mg/kg, i.p.) induced social investigation decrease and exaggerated general locomotion increase. Diazepam (1 mg/kg, i.p.) and MPFC synergistically increased open arm exploration on a second (repeated) plus-maze trial. These results suggest that the MPFC would be implicated in a generalized mechanism of warning enabling emission of appropriate responses to anxiogenic stimuli. Although, this lesion did not modify motor activity itself, the pattern of the motor activation induced by amphetamine was altered. The role of the MPFC areas in the behavioral response associated with fear is discussed.

Melatonin acts on the nucleus accumbens to increase acetylcholine release and modify the motor activity pattern of rats

Brain microdialysis coupled to high performance liquid chromatography with electrochemical detection (HPLC-ED) was used to evaluate the influence of melatonin on extracellular concentration of acetylcholine (ACh) in the nucleus accumbens (NAc) of rats. Motor activity was simultaneously monitored during the dialysis sessions with an activity meter. Melatonin and prazosin were administered locally through the dialysis probe. It was found that melatonin dose-dependently increased accumbens ACh. Melatonin (3 microM) decreased horizontal activity and increased vertical activity, while another dose (100 microM) enhanced both horizontal and vertical activity. Prazosin, a putative melatonin antagonist, blocked the effects of melatonin on both motor activity and ACh release when given 20 min before melatonin. Overall, these results suggest that melatonin modulates the release of ACh in the NAc and the pattern of motor activity in the rat.

Renal transplantation with limit donors: to what should the good results obtained be attributed?

BACKGROUND

With the aim of offsetting the reduction in donors of kidneys for transplantation, we extended the acceptance criteria, considering donors over 60 years old.

METHODS

The results obtained in 84 transplants carried out with this type of donor (group A) was compared with those of a control group of 125 transplants carried out with kidneys from donors under 60 years old (group B). The protocol for selection of donors was appropriate creatinine clearance, minimum proteinuria, and normal renal scan. The histological study was not included because it was not considered appropriate to assess the extent of the possible glomerulosclerosis, as this has a focal, segmented distribution. There were no significant differences between the recipients except for age (57.8 years old in group A vs. 39.2 years in group B).

RESULTS

After the transplantation, there were significant differences in the duration of hospitalization (26.8 days vs. 21.8 days, P<0.009), annual plasma creatinemia (177, 225, 233, 235, and 205 micromol/L vs. 136, 150, 121, 111, and 133 micromol/L, P<0.0002/0.0004), graft survival (87%, 85%, 81%, 81%, and 81% vs. 89%, 88%, 86%, 86%, and 85%, P<0.03), and patient survival (92%, 89%, 85%, 85%, and 85% vs. 99%, 99%, 97%, 96%, and 95%, P<0.0004). Death of the patient was the only significantly more frequent cause of graft loss among group A patients (7 vs. 1 death, P<0.004). No kidney was "never working" and none were lost because of chronic rejection.

CONCLUSIONS

It was concluded that elderly donors should be considered as suitable for transplantation irrespective of their chronological age, provided that they fulfill the acceptance criteria. The quality of life achieved was comparable in both groups. Despite the lower renal function in group A, this remained constant during the follow-up period.