Publication: Trasplante renal de donante en asistolia: experiencia de 20 años
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2018-04-09
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Universidad Complutense de Madrid
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Abstract
El desequilibrio entre los pacientes a la espera de un trasplante renal y la escasez de órganos es cada vez mayor. El tiempo en diálisis y los períodos prolongados en lista de espera de trasplante renal han demostrado un aumento en la morbilidad y mortalidad de estos pacientes. Diversas estrategias se están desarrollando con la finalidad de dar solución a esta dramática situación. Es importante destacar las estrategias dirigidas a un aumento del pool de donantes, fomentando el empleo de la donación en vivo y de los clásicamente denominados riñones subóptimos: bloque pediátrico, donante añoso y donación en asistolia (DA). La DA presenta un interés creciente. El uso de riñones procedentes de DA controlada ha demostrado aumentar el número de riñones para trasplante, con buenos resultados a largo plazo. Muchos Centros mantienen la negativa al uso de la DA no controlada, debido a los aspectos éticos y legales, a la complejidad organizativa y también a la escasa evidencia sobre su evolución a largo plazo. El Hospital Clínico San Carlos de Madrid y su programa de DA no controlada, instaurado en 1989 e impulsado por el Profesor Barrientos y su equipo, constituye un referente a nivel mundial. Es este Hospital el que presenta, desde el inicio de su programa hasta nuestros días, la mayor actividad trasplantadora en cuanto a DA no controlada se refiere, siendo ésta la alternativa más importante para el aumento de la donación de órganos en España...
The imbalance between patients on the waiting list for a kidney transplant and the scarcity of organs for kidney transplantation is increasing with time. The prolonged period of time on dialysis and on the kidney transplant waiting list has shown to increase both morbidity and mortality of these patients. Diverse strategies have been developed with the aim of solving this dramatic situation. It is important to highlight the strategies taken to expand the donor pool, encouraging the use of live donation and the classically called suboptimal kidneys: en bloc pediatric kidney transplants, aged donors and non-heart-beating donors (NHBD). NHBD present an ever-increasing interest. The use of kidneys from controlled NHBD has shown to increase the amount of organs available for transplantation, with good results on the long term. Many centers are still reluctant to use uncontrolled NBHD on ethical and legal grounds, and also due to the organizational complexity and the limited evidence on its long term results. Hospital Clínico San Carlos in Madrid and its uncontrolled NBHD program, which was launched in 1989 and driven by Professor Barrientos and his team, is considered to be a worldwide referent. This hospital holds out, from its initial days to the present, the highest transplantation activity regarding uncontrolled NBHD, which is the most important alternative for increasing organ donation in Spain...
The imbalance between patients on the waiting list for a kidney transplant and the scarcity of organs for kidney transplantation is increasing with time. The prolonged period of time on dialysis and on the kidney transplant waiting list has shown to increase both morbidity and mortality of these patients. Diverse strategies have been developed with the aim of solving this dramatic situation. It is important to highlight the strategies taken to expand the donor pool, encouraging the use of live donation and the classically called suboptimal kidneys: en bloc pediatric kidney transplants, aged donors and non-heart-beating donors (NHBD). NHBD present an ever-increasing interest. The use of kidneys from controlled NHBD has shown to increase the amount of organs available for transplantation, with good results on the long term. Many centers are still reluctant to use uncontrolled NBHD on ethical and legal grounds, and also due to the organizational complexity and the limited evidence on its long term results. Hospital Clínico San Carlos in Madrid and its uncontrolled NBHD program, which was launched in 1989 and driven by Professor Barrientos and his team, is considered to be a worldwide referent. This hospital holds out, from its initial days to the present, the highest transplantation activity regarding uncontrolled NBHD, which is the most important alternative for increasing organ donation in Spain...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Interna, leída el 22/06/2017