Laura Martínez

Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program

Abstract:  Introduction:  A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program.

Immunosuppression withdrawal improves long-term metabolic parameters, cardiovascular risk factors and renal function in liver transplant patients

Abstract:  After liver transplantation, long‐term immunosuppression (IS) administration is commonly complicated by renal dysfunction and cardiovascular complications. Twenty liver transplant patients on cyclosporine (CyA)‐based IS were followed up prospectively after IS withdrawal. They consisted of 10 electively weaned patients and 10 either forcibly or incidentally weaned patients. Liver biochemical tests, blood pressure, serum creatinine, serum urea, serum uric acid, triglycerides, cholesterol and glucose were monitored after the start of weaning. Eight of the 20 patients (40%) were IS therapy free for a mean period of 61 ± 39 months (range: 10–132 months). Of the remaining 12 patients, mild or moderate acute rejection occurred in six patients (30%), and mixed inflammatory portal tract infiltrate was seen in another six patients (30%). At the end of the study, mean (SD) serum creatinine had fallen by 0.28 (0.10) mg/dL (p < 0.001) in operationally tolerant (T) patients whereas the serum creatinine level increased in IS‐dependent patients [+0.35 (0.35) mg/dL] (p = 0.005). In T patients, serum cholesterol, serum uric acid, fasting glucose and diastolic arterial pressure values significantly decreased. IS withdrawal can be achieved in selected liver transplant patients, and can improve not only kidney function, but also other CyA‐associated side effects, such as hypercholesterolemia, hyperuricemia, hypertension and diabetes.

Actitud hacia la donación renal de vivo entre el personal sin relación con el trasplante en un hospital con programa de trasplante de órganos sólidos de cadáver y de vivo

Introduction: Because of the shortage of kidney organs available for transplantation and the favorable outcomes ORIGINALES

Are Dominicans in favor of xenotransplantation? A study of the attitude of immigrants resident in Spain and the United States

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain. METHODS The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents. RESULTS A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family. CONCLUSIONS The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable.

CARTA AL DIRECTOREnfermedad de Whipple: ¿podemos hacer un diagnóstico por técnicas de PCR?Can Whipple's disease be diagnosed through PCR techniques?

1. Brullet E, Guevara MC, Campo R, Falcó J, Puig J, Presa A, et al. Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy. Endoscopy. 2000;32:792–5. 2. Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: Results of a prospective European prostate cancer detection study. J Urol. 2001;166:856–9. 3. Brewsler SF, Rooney N, Kabala J, Feneley RC. Fatal anaerobic infection following transrectal biopsy of a rare prostatic tumor. Br J Urol. 1993;72:977–8. 4. Rodrı́guez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy. A prospective study and review of the literature. J Urol. 1998;160:2115–20. 5. Gonen M, Resim S. Simplified treatment of massive rectal bleeding following prostate needle biopsy. Int J Urol. 2004;11:570–2. 6. Wachsberg RH. Transrectal color Doppler sonographically guided compression to treat active extravasation after transrectal prostate biopsy. AJR. 2004;183:1706–7. 7. Strate LL, O‘Leary MP, Carr-Locke DL. Endoscopic treatment of massive rectal bleeding following prostate needle biopsy. Endoscopy. 2001;33:981–4. 8. Kimmey T, Kozarek R, Wiessman R. Sigmoidoscopic evaluation and treatment of hemorrhage after prostate biopsy. Am J Gastroenterol. 1999;94:2675–7. 9. Braun KP, May M, Helke C, Horchke B, Ernst H. Endoscopic therapy of a massive rectal bleeding after prostate biopsy. Int Urol Nephrol. 2007;39:1125–9.

Enfermedad de Whipple: ¿podemos hacer un diagnóstico por técnicas de PCR?

1. Brullet E, Guevara MC, Campo R, Falcó J, Puig J, Presa A, et al. Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy. Endoscopy. 2000;32:792–5. 2. Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: Results of a prospective European prostate cancer detection study. J Urol. 2001;166:856–9. 3. Brewsler SF, Rooney N, Kabala J, Feneley RC. Fatal anaerobic infection following transrectal biopsy of a rare prostatic tumor. Br J Urol. 1993;72:977–8. 4. Rodrı́guez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy. A prospective study and review of the literature. J Urol. 1998;160:2115–20. 5. Gonen M, Resim S. Simplified treatment of massive rectal bleeding following prostate needle biopsy. Int J Urol. 2004;11:570–2. 6. Wachsberg RH. Transrectal color Doppler sonographically guided compression to treat active extravasation after transrectal prostate biopsy. AJR. 2004;183:1706–7. 7. Strate LL, O‘Leary MP, Carr-Locke DL. Endoscopic treatment of massive rectal bleeding following prostate needle biopsy. Endoscopy. 2001;33:981–4. 8. Kimmey T, Kozarek R, Wiessman R. Sigmoidoscopic evaluation and treatment of hemorrhage after prostate biopsy. Am J Gastroenterol. 1999;94:2675–7. 9. Braun KP, May M, Helke C, Horchke B, Ernst H. Endoscopic therapy of a massive rectal bleeding after prostate biopsy. Int Urol Nephrol. 2007;39:1125–9.

El personal médico ante la donación hepática de vivo. Estudio de opinión en un hospital español con programa de trasplante hepático de donante vivo

INTRODUCTION: Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. PATIENTS AND METHODS: A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of chi2 test, Students t-test, and a logistic regression analysis. RESULTS: The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondents belief that he or she might need a transplant in the future (p = 0.003) -90% of those who believed that they might need a transplant at some point in the future were in favor-, and the respondents acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondents belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondents acceptance of a living donated liver (OR = 7.11). CONCLUSIONS: Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists.INTRODUCTION Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. PATIENTS AND METHODS A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of chi2 test, Students t-test, and a logistic regression analysis. RESULTS The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondents belief that he or she might need a transplant in the future (p = 0.003) -90% of those who believed that they might need a transplant at some point in the future were in favor-, and the respondents acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondents belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondents acceptance of a living donated liver (OR = 7.11). CONCLUSIONS Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists.

Estudio sobre la actitud del auxiliar de enfermería hospitalario hacia el xenotrasplante de órganos en un centro con programa preclínico de xenotrasplante

Resumen Objetivo La hipotesis es que el personal auxiliar de enfermeria de nuestro hospital debe tener una actitud hacia el xenotrasplante superior a la poblacion general, dado su contacto mas estrecho con un programa preclinico de xenotrasplante. Por ello, el objetivo es determinar la actitud de los auxiliares de enfermeria en un hospital con un programa preclinico de xenotrasplante y los factores que influyen en ella. Material y metodo Muestra aleatoria de 151 auxiliares de enfermeria estratificada por servicio. La actitud se valora mediante un cuestionario. Para su distribucion se contacto con el supervisor de enfermeria de cada unidad, al que se explico el proyecto y fue el encargado del reparto y la recogida de los cuestionarios en los turnos de trabajo seleccionados aleatoriamente. Dicha encuesta fue anonima y autoaplicada y el proceso fue coordinado por 2 sanitarios de la Coordinacion Regional de Trasplantes. Grupo control: muestra aleatoria poblacional (n = 250). Resultados En cuanto a la donacion de organos animales para humanos, si los resultados fueran superponibles a los conseguidos con donantes humanos, el 54 % (n = 82) estaria a favor, el 34 % (n = 52), indeciso, y el 11 % (n = 17) restante, en contra. La actitud hacia el xenotrasplante es mas favorable en la poblacion general (grupo control) que entre los profesionales encuestados (el 74 y el 54 %; p Conclusiones La actitud hacia el xenotrasplante es mas desfavorable entre los auxiliares de enfermeria que entre la poblacion general. Es necesario que los grupos de investigacion hospitalarios realicemos difusion de nuestros hallazgos en nuestros propios centros, para evitar el rechazo que su desconocimiento pudiera generar.