Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago.

Background: The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T.

Methods: The SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed.

[Renal xenotransplant. Acute vascular rejection].

Introduction And Objectives: Organ transplant is nowadays a usual and succesful practice, although with limited application due to the lack of organs. Yearly thousands of patients get access to the waiting list and finally will death while they are waiting for an organ. In the U.

[Renal xenotransplantation from hDAF pig to baboon. Experience and review].

Unlabelled: The renal xenotransplant could be the solution on the demand of organs for transplantation. We present here our experience and review the actual status of the xenotransplant.

Methods: We have done 20 xenotransplants from transgenic pig h DAF to baboons, with four protocols of immunosuppression.

Liver transplantation from maastricht category 2 non-heart-beating donors: a source to increase the donor pool?

Introduction: The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs).

Liver transplantation from Maastricht category 2 non-heart-beating donors.

Background: The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool.

Methods: The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs).

[Vascular prosthesis in kidney transplantation].

Objective: Three cases of kidney transplantation that required a vascular prosthesis are described and the literature reviewed.

Methods: Of 920 cases of kidney transplantation, 3 required a vascular prosthesis to repair the aortoiliac vessels. One patient with severe atherosclerotic disease had an aorto-bifemoral prosthesis (Gore-Tex) six months before renal transplantation and the other two patients required a vascular prosthesis to repair iliac artery lesions discovered during transplantation.

[Urinary lithiasis in transplanted kidney].

Objective: We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients.

Methods: Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors.

[Kidney transplantation with pediatric grafts. Technique and results].

Objectives: To demonstrate the viability of grafts from pediatric donors transplanted into adult recipients and to analyze new approaches.

Methods: The present series comprised 40 renal transplants in adults utilizing grafts from pediatric donors aged three years or less. A single renal unit was transplanted into each recipient in most of the cases in which grafts from pediatric donors over one year old (n: 26) were used.

[Kidney transplants from asystolic donors].

Review of our experience on renal transplantation with graft from removal in asystole. We have performed 31 transplantations of kidneys removed while in asystole, 25 of which were treated only with cardiocompression and assisted ventilation as support measures, the average asystole time being 45 minutes. Two donors were treated by in situ cold perfusion of the abdominal organs (time of asystole, 70 and 218 minutes).

[Kidney transplant with pediatric grafts from donors under a year old. The implantation technics].

Although the number of renal transplants performed in our country is high, it is far surpassed by the number of patients with end-stage chronic renal failure awaiting transplantation. The foregoing has led to the use of grafts from donors aged less than one year. Our series of 6 renal transplants in adults using grafts from these donors are presented.

[Spontaneous rupture of transplanted kidney. Experience with 500 transplants].

We reviewed a series of 500 transplants and found 21 (4.1%) cases of graft rupture. All the renal grafts had been harvested from cadavers.

[Echo-guided biopsy in renal transplant].

A prospective study of 64 biopsies was undertaken to determine the efficacy of ultrasound-guided biopsy of renal grafts. All the biopsies were performed using real-time ultrasound guidance and a Tru-Cut biopsy needle. Sixty-two (97%) of the biopsies were diagnostic; a total of 85 punctions (mean 1.

[Iatrogenic invagination of the ureteral mucosa in renal transplantation].

A case of antegrade invagination of the ureteral mucosa is described. This iatrogenic complication of endourology resulted from percutaneous dilatation with teflon catheters of a stricture in the ureter of a renal graft transplanted 4 years earlier. Definitive correction was by open surgery, which achieved good results.

[Renal transplantectomy].

During the first ten years (1981-1990) of our organ transplantation program a total of 395 Renal Transplants (RTx) have been carried out in our Unit, 90 of which in 88 patients had to be subsequently transplantectomized. In 32 of them the reason was acute rejection (35%) including 7 renal rhexis, and in 30 chronic rejection (33%) (1 rhexis). There were 22 (24%) (1 rhexis) vascular complications leading to such procedure.

[Ureteral stenosis. Endo-urologic treatment (dilatation). Experience with 43 cases].

Stricture of the ureter has been traditionally treated by open surgical techniques that occasionally had to be performed not without risk to the patient owing to the presence of septic and associated uremic conditions that invariably had a negative influence on the outcome. With the advent of endourological techniques in the last decade, much has been published on endoscopic treatment of the different areas of the urinary tract. One of the fields where important developments have taken place is that relative to endourological treatment of ureteric strictures.

[Vesico-ureteral reflux].

We review the current problem of vesico-ureteral reflux, commenting upon the etiological factors and the physiopathology of the same. We describe the exploratory methods (analysis, urography, cystourethrography, cystoscopy) and assess the data obtained in order to establish the indication of medical or surgical treatment.