Transplantation activity in the Organizzazione Centro-Sud Trapianti: A retrospective study from 1999 to March 2004

Background. The Organizzazione Centro-Sud Trapianti (OCST) was set up in 1998 to coordinate the organ procurement and transplantation activity of 9 Italian regions (Abruzzo, Basilicata, Calabria, Campania, Lazio, Molise, Sardinia, Sicily, and Umbria), each referring to a local Regional Transplant Center. The aim of the present study was to estimate organ donation and transplantation rates in the OCST from 1999 to March 2004. Materials and Methods. A retrospective study of organ donors and transplantation activity in the OCST during the study period was performed, pointing out donor epidemiological data, such as age and sex ratio, causes of death, reasons for discarding, and transplantation rate. Donors reported to the OCST were divided into 6 groups: A (October 1998-December 1999), B (2000), C (2001), D (2002), E (2003), and F (January-March 2004). Results. From 1999 to March 2004, 2272 potential donors were reported to the OCST. The nonharvested donors rate increased up to 52% (Group F), which was lower than the previous period (Group E, 64%), but higher than in 1999 (Group A, 43%). The major contributing factor was family opposition, which was 38% in 2002 and 41% in 2003. Conclusions. The introduction of the OCST into the field of organ transplantation has yielded an increase in organ donation and transplantation activity within the regions that set it up from 1999-2003. This trend is a consequence of the growth of reported donors from the intensive care unit, which grew 12.7% from 2002 to 2003. From the data analysis of the first months of 2004, we expect confirmation of this trend

The organizational model of the Interregional Transplant Agency Organizzazione Centro-Sud Trapianti

In Italy, all donation and transplant activities were officially disciplined in 1999 by the law 91 of April 1, 1999. This law enacted a coordinator-based model of transplantation, instituted the National Center for Transplantation (Centro Nazionale Trapianti-CNT), and endorsed the existing interregional transplant agencies (ITA), such as the Nord Italia Transplant program (NITp), the Associazione InterRegionale Trapianti (AIRT), and the Organizzazione Centro-Sud Trapianti (OCST). Within its borders each ITA has adopted its own organizational model; there is no overt centralized control exerted by the CNT according to the law 91/1999. The aim of the current work is to report on the organizational model adopted by OCST, the ITA gathering the Italian regions of Abruzzo, Basilicata, Calabria, Campania, Latium, Molise, Sardinia, Sicily, and Umbria

Renal papillary carcinoma developed in a kidney transplant recipient with late IgA-nephropathy

With improvements in immunosuppressive therapy, patient and graft survival in renal transplant recipients have been prolonged. Increasing donor age and patient survival rates have been related to an increase in the number of de novo tumors. Posttransplant malignancy in these patients is an important cause of graft loss and death in these patients. Among cancers occurring after a kidney transplant, renal cell carcinoma is the fifth most common malignancy after lymphoproliferative disorders, and skin, gastrointestinal, and lung cancers. When nonmelanoma skin cancers and in situ carcinoma of the cervix are excluded from malignancies, renal cell carcinoma accounts for 2% of all cancers in the general population, which increases to 5% in solid-organ recipients. The majority of renal cell carcinomas found in transplant recipients develop in the recipient 's native kidneys, but only 9% of tumors develop in the allograft itself. Tumors transmitted by donors represent only 0.02% to 0.2% of cases. Most de novo allograft renal cell carcinomas are single tumors. The mechanisms of development of renal cell carcinoma in renal grafts are not completely understood

Il sistema organizzativo dei trapianti in Italia

Il capitolo descrive l'attuale modello organizzativi del "Sistema Trapianti Italiano

Organizzazione Centro-Sud Trapianti: Outcome analysis 1999 to 2002

Background. The Organizzazione Centro-Sud Trapianti (OCST), which was created in 1998, is organized into eight regional areas, each referring to a local Regional Transplant Coordinating Center. Organs are primarily allocated to meet the demands of transplant C, centers in each regional area. Urgencies, pediatric grafts, and paybacks are managed by an Interregional Transplant Coordinating Center. The aim of the current work is to report on the impact of introduction of OCST on organ donation and transplant activity over the period from 1999 to 2002. Materials and methods. A retrospective analysis of donor and transplant data charts over the period from 1999 to 2002 focused on outcome analysis based on donor epidemiological data, cause of death, reasons for discards and grafts performed at OCST local transplant centers. Results. From 1999 to 2002, we observed a remarkable increase in organ donation from 8.8 to 22.5 donors per million people. Donor epidemiology showed an increase in median a(ye and stroke incidence rates and a decrease in trauma cases. The nonharvested donor rate rose steadily over the study period, plateauing at 58%, which was compensated for by a threefold increase in donation. Family oppositions ranged as high as 35.5% on average, despite public efforts to support donation. Transplant activity rose by 76%. Conclusions. The institution of OCST and the efforts from central and regional authorities have yielded a significant increase in organ donation and transplant activity rates over the period from 1999 to 2002. Major areas of concern are the high opposition rate and the decreasing quality of harvested grafts. Long-term analysis is underway to assess the impact of OCST on the quality of transplants performed in the catchment area

Supporti extracorporei nelle patologie epatiche

Il capitolo descrice l'indicazione e le tecniche di utilizzo dei supporti extracorporei nelle patologie epatich

LIVING UNRELATED KIDNEY TRANSPLANTATION

The use of living donors, particularly if unrelated, in kidney transplantation is still not recommended although many transplant centers have come to accept the procedure. Usually the main argument against this approach is ethical. Acknowledging this problem, we accept biologically unrelated donors only if they have an emotional closeness to the recipient. From November 1982 to November 1997, 527 kidney allografts from living donors were performed at our institution. Of these 302 living donors were first-degree relatives of the recipient and shared one haplotype (LRD) and 172 were unrelated (LURD). Among the LURD group 146 donors were "emotionally related"-wife to husband 110 cases and husband to wife 35 cases and 1 case from a nun to a friar. Statistical analysis of the results was performed with the chi(2) method. Actuarial graft survival rates in the LRD and LURD groups were 91% and 87% at 1 year, 77% and 79% at 5 years, and 66% and 69% at 9 years (p = n.s.). In conclusion kidney transplantation between unrelated donors and recipients may be a valid alternative in view of the cadaver organ shortage. It is a procedure that can be performed successfully and that provides a "gift of life" for both the patient and the family