Geographic Information System Analysis: Promoting the Organ Donation Process in Andalusia

ObjectiveThe objective is to study the geographic distribution of public awareness and acceptance of organ donation in Andalusian municipalities and determine its relationship with each population and the rate of aging.MethodsData on organ donors from the Information System for Autonomous Regional Transplant Coordination in Andalusia were analyzed from 2006 to 2017. The geographic analysis was performed using free software from the Generalitat Valenciana Geographic Information System (gvGIS, Valencia, Spain). Data from the Spanish National Statistics Institute for the year 2017 were used as a reference for population estimates and calculating the rate of aging.ResultsFrom 2006 to 2017, a total of 3698 donors were registered in Andalusia, 28 of whom were residing in another autonomous community and 120 who were not censored as residents of their municipality, leaving a final total of 3550 donors. The rate of aging in 2017 was 1.02. Choropleth mapping was used to identify donors in each municipality. Population and aging rate in 2017 for these areas were also analyzed.ConclusionGeoreferenced data on organ donation not only reveals spatial differences in the distribution of public acceptance; it also provides insight into the relationship between this distribution and the sociodemographic characteristics of each community. In this study, areas with the least number of donors seem to coincide with difficult accessibility, higher aging index, and low population rates. These maps can assist transplant coordinators in targeting areas for public education and information campaigns to heighten awareness of the positive results of organ donation and potentiate its acceptance.     

False-Positive Tumor During Organ Retrieval: All Cats Are Gray in the Dark

ObjectiveEfforts to expand the organ donor pool to meet growing transplant demands remains a top priority, as does maintaining the quality and safety standards of potential recipients. There is a short window of time from organ retrieval to decision making on organ acceptance, based on the available data. Furthermore, the limitations of intraoperative biopsy can often lead to donor or organ refusal due to a suspected tumor, which, if not confirmed in the final biopsy, results in the loss of a transplant opportunity.MethodsDonor characteristics and organs discarded on suspicion of neoplastic disease at the time of extraction were analyzed in Andalusia between January 2014 and July 2018. The variable analysis included sociodemographic data, type of donor, location of the potential malignancy, histopathologic examination, and discarded organs.ResultsA total of 43 cases were identified. The organs of 33 donors (76.7%) were discarded. Kidneys were the most frequent location for a suspected tumor (44%), followed by the liver (21%). In 18 of the 43 cases (42%), the suspected malignancy was not confirmed, and of these, only 3 livers and 1 kidney were implanted. Sixty potentially transplantable organs were discarded, including those that would have been extracted and/or implanted in the absence of a suspected tumor.ConclusionsThese results highlight the need not only to improve the accuracy of intraoperative biopsies but to seek new decision-making strategies for the short interval after organ retrieval. This involves avoiding both extremes of donation contraindications, while maintaining quality and safety standards.     

Changes in the Risk of Mortality and Morbidity After Lung Resection in the Last 20 Years

IntroductionThe aim of this study is to evaluate changes in the risk of cardiorespiratory mortality and morbidity calculated by Eurolung risk models 1 and 2 in the last 20 years, and to identify variations in patient selection or surgical practice that might have altered the risk of death and complications after anatomical lung resections.MethodThis was a retrospective analysis of a series of 2435 consecutive patients who underwent anatomical lung resection. The population was divided into three time periods: 1994–2006 (976 cases), 2007–2015 (945 cases), and 2016–2017 (420 cases). Eurolung models 1 and 2 were applied to the series, and the individual probability of adverse effects was calculated. We compared this mean probability, and the prevalence or means of each of the variables included in the models in each period and plotted the evolution of the risk.ResultsA progressive decrease was observed in both adverse effects over time. The prevalence of the binary variables, except for coronary heart disease, was higher in the last period. The percentage of pneumonectomies and extended resections fell in the last two periods and the number of cases treated with VATS increased substantially in 2016–2017.ConclusionsThe decline in the number of pneumonectomies and the increase in the rate of minimally invasive procedures appear to be the variables most closely associated with decreased risk. Other changes in the clinical characteristics of the patients do not seem to have influenced the outcomes.     

Yearly Trends of Chronic Kidney Disease III Progressions in Living Kidney Donors

PurposeWe aim to see the rate of progression to chronic kidney disease stage III after living donor nephrectomy in a single institution annually.MethodsBetween May 2006 and July 2017, a total of 753 living kidney donors who were followed up more than 6 months were enrolled in the study. We divided normal function vs chronic kidney disease III at 6 months postoperatively. We compared the incidence rate of chronic kidney disease stage III annually. For analysis, the entire period was divided into Era 1 (2006–2008), Era 2 (2009–2011), Era 3 (2012–2014), and Era 4 (2015–2017).ResultsDuring the period, the incidence of chronic kidney disease stage III was 258 living donors (34.3%). The prevalence of chronic kidney disease stage III was 39.3%, 36.6%, 35.5%, and 29.3% in Era 1, Era 2, Era 3, and Era 4, respectively. The rate of chronic kidney disease stage III incidence serially decreased as the era passed (P = .046). There was no difference in age, smoking status, drinking status, body mass index, preoperative cholesterol, and uric acid among the eras. However, preoperative estimated glomerular filtration rate was 90.86 (SD, 4.12), 94.47 (SD, 16.62), 103.82 (SD, 0.68), and 105.66 (SD, 19.57) mL/min/1.73 m² in Era 1, Era 2, Era 3, and Era 4, respectively (P = .001).ConclusionsThe incidence of chronic kidney disease stage III in living kidney donors for the last 3 years (Era 4) has decreased compared with the past (Era 1 and 2). The reason for this might be the effect of the change in the living donor guideline. Also, pre- and postoperative management method had an effect on renal function at 6 months.     

A Retrospective Evaluation of 728 Kidney Donors Who Applied for Organ Donation

ObjectiveThe aim of this study was to determine the sociodemographic characteristics of people who applied to be kidney donors at an organ transplantation center.Material and MethodsA total of 728 participants in the kidney donor program were included in the study between 2015 and 2018 at Istanbul Yeniyüzy?l University Gaziosmanpa?a Hospital. The sociodemographic data of the participants were retrospectively analyzed through computer records, and data were analyzed.ResultsTwo hundred thirty-nine men and 489 women were included into the study. Six hundred ten were live donors, and 118 were cadaveric donors. Of the donors included in the study, 24.9% were illiterate, 52.1% were primary school graduates, 17.3% were high school graduates, and 5.7% were university graduates. Of the living donors, 156 (25.5%) were spouses, 91 (14.9%) were mothers, 72 (11.9%) were siblings, 65 (10.5%) were fathers, 64 (10.7%) were children, 46 were (7.5%) were other relatives, and 116 (19.0%) were nonrelatives.ConclusionsIn recent years, the number of live kidney transplantations has increased. Therefore, it is necessary to protect their well-being by using evidence-based donor evaluation and treatment strategies to prevent and treat negative consequences of donations.     

Effectiveness of Thymoglobulin Induction Therapy in Kidney Transplant From Deceased Donor With Mild to Moderate Acute Kidney Injury

BackgroundThe clinical benefit of rabbit antithymocyte globulin (Thymoglobulin) compared with basiliximab for induction therapy in kidney transplant (KT) resulting from acute kidney injury (AKI) donors remains controversial. In cases of severe AKI, the degree of kidney injury is too great to reveal influence of different induction therapies on clinical outcomes. We aimed to compare clinical outcomes of Thymoglobulin and basiliximab induction therapy in KTs from deceased donors (DDs) with mild to moderate AKI.MethodsWe retrospectively studied 147 patients who received KTs from DDs between 2009 and 2017 in our center; 91 patients received kidneys from AKI donors. The AKI severity was classified based on the Acute Kidney Injury Network (AKIN) staging, and patients with AKIN stage 3 (43 patients) were excluded. Clinical outcomes were compared according to the type of induction therapy.ResultsThymoglobulin and basiliximab induction groups showed no significant differences in demographic and baseline characteristics except donor age and follow-up period. The Thymoglobulin group had lower incidences of acute rejection and a trend toward a lower incidence of delayed graft function and better graft survival than the basiliximab group. There was no significant difference in BK infection rate; however, cytomegalovirus infection rate showed a trend toward a lower incidence in the basiliximab group.ConclusionsIn cases of KT from AKIN stage 1 and 2 donors, Thymoglobulin showed better clinical outcomes than basiliximab, although it had a somewhat high rate of cytomegalovirus infection. It seems beneficial to use Thymoglobulin induction therapy in KTs from DDs with mild to moderate AKI.     

Transplant of Tissue-Engineered Artificial Autologous Human Skin in Andalusia: An Example of Coordination and Institutional Collaboration

A new model of tissue-engineered artificial autologous human skin developed in Andalusia is currently being transplanted into patients suffering from large burns within the Andalusian Public Healthcare System. This product is considered an advanced therapy medicinal product (ATMP) in Europe, and its clinical use implies meeting transplant and medicinal product legal requirements, being the Guidelines of Good Manufacturing Practice for ATMPs of particular importance. The preclinical research and clinical translation of the product have represented a technical, regulatory, and organizational challenge, which has taken 10 years since the first preclinical experiments were designed. Twelve patients with large burns, including 3 pediatric patients, have hitherto received artificial autologous skin grafts with an overall survival rate of 75% and positive clinical, homeostatic, and histologic results. Achieving such a milestone within our Healthcare System was possible through a multidisciplinary approach and the joint efforts of multiple publicly funded institutions and units under the coordination of the Andalusian Initiative for Advanced Therapies. In this article, we present the organizational model set up to facilitate collaboration and logistics among the professionals involved, totaling more than 80 people. The similarities between the tissue-engineered artificial autologous human skin transplant and other organ and tissue transplants, in terms of logistic requirements, reveal how regional and hospital transplant coordination have played a crucial role.     

Geographic Distribution of Multiple Arteries and Veins of 878 Kidney Donors From a Transplant Center in Turkey

AimThe diagnosis and management of multiple renal arteries and veins have gained importance with the increasing number of kidney transplantations and improved techniques in interventional radiology and vascular reconstructions. The aim of this study is to define and to detect the rate of multiple renal arteries and veins in our living kidney transplant donors coming from all parts of our country.MethodsAbdominal computed tomography angiogram findings of 878 kidney transplant donors were analyzed. The presence and the distribution of multiple renal arteries and veins in donors coming from 7 geographic regions in Turkey were noted.ResultsThe presence of multiple renal arteries was observed in 34% (48/141) of patients in the Marmara Region, 36.7% (79/215) of patients in the Black Sea Region, 37.2% (64/172) of patients in the Central Anatolia Region and 36.1% (30/83) of patients in the Southeastern Anatolia Region. The highest incidences of multiple renal arteries were observed in the Mediterranean and Aegean regions, affecting 40% (32/80) and 41.9% (26/62) of patients, respectively, while East Anatolia was found to have the lowest incidence, affecting 28% (35/125) of patients. The incidence of multiple renal veins also varied across regions. The highest incidence was observed in the Central Anatolia Region, where 23.3% (40/172) of patients were affected; the lowest was seen in the Aegean Region, where 11.3% (7/62) of patients were affected. In Turkey as a whole, 35.8% (314/878) of patients presented with multiple renal arteries, while the rate of multiple renal veins was found to be 19% (167/878) among our donors.ConclusionsAs 80% of the kidney transplantations performed in Turkey involve living donors, we think it will be useful to have knowledge of not only the presence of multiple renal arteries and veins, but also the distribution of this feature throughout the different regions of the country.     

Survey for the Opinion of Medical Students and Medical Staff on a Financial Incentive System for Deceased Organ Donation in an Asian Country

BackgroundFinancial incentives for deceased organ donation are associated with many controversial ethical issues. This study examines the perspectives of medical students and staff members on financial incentives for the families of brain-dead organ donors.MethodologyA structured survey form was used between December 7, 2017 and January 28, 2018 to elicit opinions on financial incentives for the families of brain-dead organ donors. Forty-three medical staff members and 81 medical students participated in the survey voluntarily. The opinions on the financial incentive system and the relationship between willingness to give information about organ donation to families and a financial incentive system were assessed.ResultsThe majority of the participants (81.4%) had positive thoughts on organ donation. More than half of the participants (60.5%) thought that the financial incentive system did not erode the ethical purity of organ donation. As charge doctors, most respondents (84.6%) were willing to give information about organ donation to family members in the presence of financial incentives. However, the percentage decreased significantly to 60.5% when financial incentive was no longer factored into consideration (P < .001).LimitationThe study population is small, and the participants are not representative of the general population.ConclusionThe opinions of medical students and medical staff on financial incentives for deceased organ donation were generally positive. Financial incentives proved to be a potential influencing factor as an option of organ donation to be given to families.     

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand.MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4^th to 6^th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5.ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points).ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.     

Primary Nonfunction on Kidney Transplant Recipients From Donation After Circulatory Death Donors

BackgroundThe need for donor pool expansion remains an important task for kidney transplantation. The aim of this study is the evaluation of primary nonfunction (PNF) from donation after circulatory death (DCD) kidneys.MethodsBetween 1996 and 2017, 100 kidney transplants from DCD donors were conducted in our department. We retrospectively analyzed PNF of kidney transplant recipients from DCD donors in terms of donors’ and recipients’ epidemiologic characteristics.ResultsOf 100 grafts, 95 recipients (95.0%) had discontinued hemodialysis at the time of hospital discharge. Only 5 recipients (5.0%) developed PNF. All 5 PNF recipients received a single graft from an expanded criteria donor (ECD). The mean donor age in the PNF group was 65.0 (SD, 6.2) years. Significant differences between the PNF group and discontinued dialysis group were found for donor age (P < .01) and for the use of ECD kidneys (P < .02). Nevertheless, no significant difference was found between groups for several factors: a history of hypertension and cerebrovascular events, terminal creatinine levels, and graft weight.ConclusionThe incidence of PNF from DCD kidneys was very low. Although ECD kidneys in older donors might be a significant risk factor for PNF, these findings suggest that DCD kidneys should be used more frequently for donor expansion.     

Acute Exacerbation According to GOLD 2017 Categories in Patients with Chronic Obstructive Pulmonary Disease

IntroductionThe association between GOLD categorizations and future exacerbations has not been fully investigated. This study elucidates whether the GOLD 2017 classification is associated with different future exacerbation risk in patients with chronic obstructive pulmonary disease (COPD) compared with the previous GOLD categorization. Another objective was to investigate the impacts of the symptoms and FEV1 on the predicted future exacerbation independently of previous exacerbation history.MethodsWe analyzed patients from three prospective COPD cohorts (SNUH, KOCOSS, and KOLD) and evaluated the risk of moderate to severe exacerbation among different models, including GOLD grade (FEV1), GOLD 2011, and GOLD 2017.ResultsIn total, 611 COPD patients were included (36 from SNUH, 257 from KOCOSS, and 318 from KOLD). GOLD 2017 classification, excluding FEV1% for categorization criteria, showed no differences in future exacerbation risk compared with GOLD grade and GOLD 2011 based on c-statistics. Among those with no frequent exacerbation history and FEV1 ≥50%, the group with more symptoms was significantly associated with future exacerbations than the group with less symptoms. A lower FEV1 (FEV1 <50%) was not associated with a higher future exacerbation risk than a higher FEV1 (FEV1 ≥50%), regardless of prior exacerbation history and symptom group.ConclusionThe GOLD 2017 classification was not different from GOLD grade and GOLD 2011 regarding the association with future exacerbation risk, and there were no significant differences in exacerbation risk according to FEV1%. This suggests that FEV1 might not be an important factor in future exacerbation risk. These results partly support the GOLD 2017 assessment tool.     

Impact of Donor Age on the Outcomes of Kidney Transplantation From Deceased Donors With Histologic Acute Kidney Injury

PurposeKidney transplantation from elderly donors with acute kidney injury (AKI) has increased recently due to donor shortage, but the safety and prognosis are not well known. We examined the effect of donor age on the outcomes of kidney transplantation (KT) from donors with histologic AKI.Materials and methodsWe retrospectively analyzed the medical records of 59 deceased-donor KTs with acute tubular necrosis (ATN) on preimplantation donor kidney biopsy between March 2012 and October 2017. Histologic evaluations of ATN, inflammation, glomerulosclerosis (GS), interstitial fibrosis, tubular atrophy, and arterial sclerosis were performed.ResultsTwenty and 39 recipients received kidneys from elderly (> 60, 68.9 ± 5.0 years) and young (≤ 60, 45.9 ± 9.6 years) donors with ATN, respectively. Among the elderly donors, significantly increased donor creatinine was observed in only 44% donors, and there were more diabetic patients and women and a higher proportion of GS than among the young donors. Six months after KT, estimated glomerular filtration rate was significantly lower in recipients who received kidneys from elderly donors compared to young donors. Donor creatinine level and AKI severity did not significantly affect the recipient outcomes in either group. However, the presence of ATN and GS were significant factors that exacerbated renal outcomes after KT from elderly donors only. On multivariate analysis, severe ATN was the strongest independent predictor of elderly recipient renal function.ConclusionsHistologic injury may predict renal outcomes in KT from elderly donors. A donor allocation protocol including preimplantation renal histology should be established for KT from elderly donors.     

Results of living kidney donation in Andalusia: 2006-2009

Renal transplantation is the best therapeutic choice in patients with end-stage renal disease (ESRD), with donation from living donors the alternative that offers the best medium- and long-term results. Because of the limited number of cadaver donors and the progressive increase in donor age, transplantation from living donors has become the renal replacement treatment of choice. Several studies have demonstrated that donation does not increase the donor's risk of developing ESRD in the long term. Some studies have asserted that a donor's life expectancy increases as a result of the comprehensive study and screening process they must undergo. The objective of the present study was to evaluate the vital status and onset of chronic renal disease in 101 living kidney donors in Andalusia, Spain, during 2006-2009, based on data obtained from the Sistema de Información de la Coordinación Autonómica de Trasplantes de Andalucía (Regional Transplants Coordination of Andalusia). Donor survival was 99%, and the only death, from lung cancer, was not associated with the surgical procedure. Only 5 transplants failed during this period, and no donors developed ESRD. Neither the probability of survival nor the risk of developing ESRD in donors was influenced by kidney donation.     

Resultados y evolución histórica de las redes sociales en el American College of Surgeons Clinical Congress y el Congreso Nacional de Cirugía. Análisis del #ACSCC20 y #CNCirugia2020

AimThe objective of this study is to analyze the impact of the American College of Surgeons Clinical Congress (ACSCC2020) and the National Surgery Congress of the Spanish Association of Surgeons (CNC2020) in virtual format due to the SARS-CoV-2 pandemic according to the fingerprint.Material and methodsThe Twitter hashtags # ACSCC20 and # CNCirugia2020 were studied to determine tweets, retweets, users and impressions. The data on the accounts with the greatest influence and the historical evolution of the congresses between 2015 and 2020 were analyzed. We used the symplur software to collect and analyze the data.ResultsBetween 2015 and 2017 there was a consistent increase in the number of tweets, participants and impressions. Between 2018 and 2020, the ACS maintains the number of impressions with the fewest number of tweets. However, the CNC continues to grow and achieves its best metrics in 2020. We found statistically significant differences between the most prolific accounts of the ACSCC versus the CNC (P < .002) but there are no differences between the 10 most influential accounts (P = .19) or the accounts with the highest number of impressions (P = .450).ConclusionsVirtual congresses generate a global impact through the use of Twitter for the dissemination of knowledge. In the present 2020, the growth of the impact on social networks has been proportionally greater in the CNC than in the ACSCC. However, the ACS virtual congress generated the greatest impact on social networks measured by the number of users, tweets and impressions between 2015 and 2020.     

Short-term Results of Liver Transplantation With Octogenarian Donors

Background

There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old.

The mortality of prostate cancer in Andalusia. Contributions to mass screening

BackgroundTo describe the mortality of prostate cancer in Andalusia from 1975 to 2001.MethodsEstimation of crude rates, age-adjusted rates, Potential Years of Life Lost (PYLL) adjusted rates, risk of death and the changes produced in the adjusted rates.ResultsProstate cancer deaths rise from 407 to 767. Crude rates increased from 13,54 to 21,35 per 100.000 persons-years. However, the age adjusted rates showed a steady trend over the study period, with an annual percent change of –0,21%, and the premature mortality indicators declined. The cumulative risk of death increased with age, and presented an exponential increase after the age of 50 years, in both the periods, as 1997 2001, with highest values in the second one.ConclusionsProstate cancer mortality in Andalusia has increased in absolute values due to the ageing of the population. When adjusted for age, the mortality has remained stable, with a shift of deaths toward the more extreme age groups, as indicated by the decrease of premature deaths. The results of this study do not support the starting-up of mass screening programs.     

Veterinary Spanish Students’ Attitude Toward Presumed Consent in Organ Donation

Veterinarians often are involved in transplantation research projects. They are a fundamental social group who can influence public opinion about organ donation and transplantation (ODT). Objective. The objective was to determine the knowledge of Spanish veterinary students about the concept of brain death and the law of presumed consent.MethodsA sociologic, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in a complete academic year. A sample of 2815 students was stratified by geographic area and academic year. The students’ attitudes on the psychosocial aspects of ODT were evaluated using a psychosocial validated questionnaire (PCID-DTO Rios). It was self-administered and completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions.Statistical analysisStudent t test, χ2 test, and logistic regression analysis were used.ResultsThe completion rate was 91% (n = 2558). Of students, 66% (n = 1664) understood the concept of brain death, 30% had doubts, whereas 5% believed that a person with brain death can recover and lead a normal life. Concerning legislation, 63% (n = 1615) were against the law of presumed consent, and 37% were in favor. An analysis of variables determining more favorable acceptance of the law showed that year of study (P = .000), knowing a donor (P = .020), and attitude toward ODT (P = .000) did have an effect on acceptance. Most students, 71% (n = 1875), were interested in attending a talk about ODT.ConclusionOnly 37% of Spanish veterinary students would accept the law of presumed consent. Most students were interested in attending an informative talk about ODT.     

La simulación mejora la confianza de los estudiantes para adquirir competencias en urología

ObjectiveTo know the level of confidence of fifth year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method.Material and methodsThe study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique.ResultsAll the evaluations made on the different abilities were significantly higher after training (P < .001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (P < .05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5.ConclusionsSimulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination.