Eduardo Márquez Martín

Donantes de órganos en España: evolución de las tasas de donación por comunidades autónomas y factores determinantes

Fundamento y objetivo El proposito del estudio ha sido analizar la evolucion de las tasas de donacion en las diferentes comunidades autonomas durante los ultimos anos y describir los factores con un mayor peso especifico en relacion con el numero de donantes. Material y metodo Se ha realizado un estudio descriptivo y retrospectivo, con datos de donacion y poblacion general, poblacion en individuos de 70 anos o mas, siniestralidad vial, numero de entrevistas para la donacion y porcentaje de respuestas negativas, en las diferentes comunidades autonomas entre 2001 y 2006. Tambien se analizo la correlacion entre los factores estudiados estratificando por ano. Para evaluar la evolucion temporal se realizo un analisis de regresion lineal para medidas repetidas. Resultados El numero de habitantes, la poblacion de 70 anos o mas y el numero de victimas mortales por accidente de trafico se correlacionaron con el numero de donantes general, de ese grupo de edad y fallecidos por esa causa, respectivamente. Estas relaciones no se cumplieron en todas las comunidades autonomas. El porcentaje de negativas no guardo relacion con el numero de entrevistas realizadas, si bien su disminucion se relaciono con un aumento de la tasa de donantes. Aunque de forma no tan constante, el aumento del porcentaje de donantes de 70 anos o mas y la disminucion del de fallecidos por accidentes de trafico se relacionaron con mayores tasas de donantes. Conclusiones La evolucion del numero de donantes sigue el crecimiento de la poblacion y el descenso del porcentaje de negativas, si bien se explica de forma diferente segun la comunidad autonoma.

Pancreas transplantation: differences in activity between Europe and the United States

Background. Although pancreas transplantation (PT) is the treatment of choice in selected diabetic patients, the International Pancreas Transplant Registry (IPTR) has reported important differences in activity between USA and Europe. Of all cases reported, 75% are from USA and only 23% from Europe. Therefore, an analysis of PT activity in selected European countries (SEC) and USA was performed. Materials and methods. We compared national data reports (2002–06) of deceased donors (DD) and deceased solid organ transplantation (DSOT), with special attention to PT activity from 13 SEC countries (375 million inhabitants) and USA (298 million inhabitants). Results. The number of PT performed in USA was 2-fold higher than in SEC, with the annual rate >2.4 times higher in USA [5.08–4.64 versus 1.61–1.91 per million population (p.m.p.)]. DD and other DSOT activity rates were only slightly higher in USA. In SEC, important differences in PT activity rate were found between countries in the same year (0–6.21 p.m.p.) and in the same country between different years (6.21–2.47 p.m.p.), unrelated to DD or other DSOT activity rate. PT activity rate increased in SEC from 1.61 to 1.91 p.m.p. but decreased in six countries. The waiting list for PT at the end of 2006 was almost 2-fold higher in USA than in SEC. Conclusions. Differences in PT activity rate between 13 SEC countries and USA were not related to DD or other DSOT activity. Different waiting list inclusion criteria or incidence of diabetes complications may be considered in more specific studies.

Síndrome hepatopulmonar en pacientes con hepatopatía avanzada: estudio de 24 casos

BACKGROUND AND OBJECTIVE: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed. RESULTS: 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. CONCLUSIONS: HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases.