RESUMEN
BACKGROUND: The lack of viable organs for transplantation led to the creation in Argentina of the Glasgow 7 Program based on the detection and follow-up of acute neurologic patients admitted with Glasgow scores ≤7 in selected hospitals. The objective of this study was to determine the likelihood of hospitalized acute neurologic patients progressing to brain death (BD) based on several variables, including age, sex, and admission diagnosis. METHODS: This study was a retrospective cohort analysis of data obtained from the SINTRA (Procurement and Transplantation National Information System) database between 2006 and 2015. Independent variables included the following: age, sex, and diagnosis at admission; ischemic stroke; spontaneous intracerebral hematoma (SIH); subarachnoid hemorrhage (SH); anoxia, meningitis; penetrating head injury (PHI); closed head injury; and tumors. A multivariate analysis was performed adjusting the diagnosis at admission according to age and sex. RESULTS: A total of 31,877 patients were included: 19,308 (61%) patients died and 9736 (30%) evolved to BD. Overall, 36% of women and 28% of men evolved to BD (relative risk, 0.87 [95% confidence interval (CI), 0.86-0.89]; P < .001). In the multivariate analysis adjusted for age and sex, we observed the following: SIH OR, 1.79 (95% CI, 1.69-1.9; P < .001); ischemic stroke OR, 0.82 (95% CI, 0.73-0.92; P < .001); SH OR, 2.33 (95% CI, 2.16-2.52; P < .001); anoxia OR, 0.71 (95% CI, 0.64-0.79; P < .001); closed head injury OR, 0.41 (95% CI, 0.38-0.43; P < .001); PHI OR, 2.64 (95% CI, 2.38-2.94; P < .001); and tumors OR, 1.07 (95% CI, 0.93-1.24; P = .31). CONCLUSIONS: Thirty percent of the patients who entered the Glasgow 7 Program evolved with BD. The characteristics most likely to result in BD were age, female sex, PHI, SH, and SIH.
Asunto(s)
Muerte Encefálica/patología , Encefalopatías/patología , Escala de Consecuencias de Glasgow/estadística & datos numéricos , Adulto , Anciano , Argentina , Hemorragia Cerebral/patología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Accidente Cerebrovascular/patología , Hemorragia Subaracnoidea/patologíaRESUMEN
INTRODUCTION: Pig islet xenotransplantation represents an attractive way to solve our human organ shortage. In this preclinical protocol, we implanted adult porcine islets microencapsulated in alginate-polylysin into insulin-dependent diabetic dogs. METHODS: Pancreata were obtained from animals weighing 100 to 150 kg in a slaughterhouse. The islets were isolated by collagenase digestion. The encapsulation technique was a modification of Sun's method. Isolated islets (5000 islet equivalents per kilogram of dog weight) were mixed with 1.6% low-viscocity alginate. Microcapsules were cultured for 36 hours before implantation. The five dogs were in healthy prior to induction of diabetes mellitus at least 1 year prior. Under sedation, we implanted microcapsules. We performed determinations of peripheral blood insulin at baseline and every 3 months as well as glycosylated hemoglobin at baseline and every 4 months. During follow-up, glycemia was estimated twice a day at 3 hours after morning and night meals using a blood glucose monitoring system. RESULTS: We observed significant decrease (20%-80%) in insulin needs (P < .01). Of note, before the procedure no hormone was detected in the blood at 6 to 12 months after transplantation, plasma insulin had improved significantly (P < .05) and glycosylated hemoglobin also showed a significant decrease (P < .01). All owners subjectively claimed that their animals were enjoying a better quality of life. DISCUSSION: Our preliminary data suggested that pig islet microencapsulation achieved metabolic control in type I diabetic dogs without the risk of immunosuppression using one or two procedures per year.
Asunto(s)
Diabetes Mellitus/cirugía , Diabetes Mellitus/veterinaria , Enfermedades de los Perros/cirugía , Insulina/metabolismo , Trasplante de Islotes Pancreáticos/métodos , Trasplante Heterólogo/métodos , Animales , Glucemia/metabolismo , Cápsulas , Técnicas de Cultivo de Célula , Diabetes Mellitus/sangre , Diabetes Mellitus/tratamiento farmacológico , Enfermedades de los Perros/sangre , Enfermedades de los Perros/tratamiento farmacológico , Perros , Supervivencia de Injerto , Insulina/sangre , Insulina/uso terapéutico , Secreción de Insulina , PorcinosAsunto(s)
Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Trasplante/estadística & datos numéricos , Adolescente , Adulto , Anciano , Argentina , Muerte Encefálica/clasificación , Familia , Humanos , Consentimiento Informado , Persona de Mediana Edad , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/estadística & datos numéricosRESUMEN
Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.(Au)
Asunto(s)
Humanos , Masculino , Adulto , Trasplante de Riñón , Porfiria Cutánea Tardía/etiología , Hidroxicloroquina/uso terapéutico , Porfiria Cutánea Tardía/diagnóstico , Porfiria Cutánea Tardía/tratamiento farmacológico , Diálisis Renal/efectos adversos , Factores de TiempoRESUMEN
Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.
Asunto(s)
Humanos , Masculino , Adulto , Trasplante de Riñón , Porfiria Cutánea Tardía/etiología , Diálisis Renal/efectos adversos , Hidroxicloroquina , Porfiria Cutánea Tardía/diagnóstico , Porfiria Cutánea Tardía/tratamiento farmacológico , Factores de TiempoRESUMEN
Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.
Asunto(s)
Trasplante de Riñón , Porfiria Cutánea Tardía/etiología , Adulto , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Porfiria Cutánea Tardía/diagnóstico , Porfiria Cutánea Tardía/tratamiento farmacológico , Diálisis Renal/efectos adversos , Factores de TiempoRESUMEN
Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.