Kidney transplantation as treatment for end stage renal disease.

Within this review the author presents what kidney transplantation can and cannot do; it's state of the art; experience in Puerto Rico; major problems, obstacles and pitfalls; and the cutting edge of clinical transplantation and of transplantation immunology.

Factors and outcome in BK virus nephropathy in a Hispanic kidney transplant population.

Unlabelled: BK virus nephropathy (BKVN) is an increasingly recognized cause of kidney allograft loss and is thought to be related to the newer, more potent immunosuppressive agents. Conflicting information has been reported on risk factors for BK infection.

Purpose: To determine incidence, associated factors, and outcome of BKVN in our kidney transplant population in order to improve identification and management.

A 16-fold increase in organ donation in a Hispanic population.

Unlabelled: Organ transplantation as a substitute for diseased organs in end-stage organ failure has led to a worldwide increase in this treatment modality, but donation has not kept pace with the demand, despite scientific, social, and government efforts. For many years, Hispanic donation in Puerto Rico was meager and lagged behind major centers in North America and Europe. Studies signaled mostly cultural factors in this limited donation.

Assessing the risk of infection and rejection in Hispanic renal transplant recipients by means of an adenosine triphosphate release assay.

Introduction: Because of the necessary immunosuppression, transplant recipients have a high risk of infection. Conversely, underimmunosuppression carries with it the risk of rejection. It would be quite useful to have a test that could differentiate between infection and rejection in renal transplant patients and better still, to predict which patients are at risk of complications.

HLA is not predictive of posttransplant diabetes mellitus.

Aims: New-onset posttransplant diabetes mellitus (PTDM) is a frequent complication of kidney transplantation. The goal of this study was to identify if the tendency to develop PTDM was associated to the HLA, as is seen in the general population.

Methods: A retrospective study was made of 525 patients who underwent renal transplantation between 1997 and 2004.

Study of factors that affect complications after renal transplantation.

There are no multifactorial studies of complications after renal transplant in the Hispanic population. The objective of this study was to identify which factors are associated with the development of complications after renal transplantation. This retrospective study was performed on all patients transplanted in the Puerto Rico Transplant Program during 2002.

The fate of organs refused locally and transplanted elsewhere.

Unlabelled: The number of kidney allografts procured from deceased donors has been fairly constant in the past few years, while organs from living donors steadily increase. In our program, existing protocols refused some kidneys which were subsequently accepted and transplanted at other hospitals. Thus, a review of our criteria to accept kidneys became necessary.

A marked increase in organ donation in Puerto Rico.

During its first years of existence, the Puerto Rico Transplant Program barely reached 18 to 20 renal transplants per year. A brain death amendment to the law improved the numbers but only to a stable thirty/year. Polls and studies showed that, although people knew about transplantation and expressed willingness to donate, the powerful emotional grief reaction, as well as a peculiar decision-making process, all militated against effective donation.

The endothelium and early immune activation: new perspective and interactions.

Far from being just a membrane for the passive transport of cells, molecules, and water between blood vessels and their interstitium or a passive target for humoral immunological reactions, the endothelium is now being viewed as an active modulator of both normal physiological homeostasis and the early inflammatory response. The repertoire of receptors and mediators produced by endothelial cells overlap those traditionally assigned to the immune system. This new paradigm together with the changes caused by brain death in the cadaver donor have far-reaching repercussions on how rejection is conceived, while opening new venues for its prevention.

Ethical dilemmas: transplantation in prisoners and the mentally disabled.

The particular case of organ transplantation in prisoners and the mentally disabled gives rise to discussions within the context of several aspects of bioethics. After medical and legal aspects are considered, the most important problem relates to the allocation of scarce resources to subsets of patients that are viewed differently from other citizens. The legal and basic rights of these individuals are discussed, as is the validity of social worth as a criterion of access to this treatment care modality.

Organ transplants in Latin America.

Latin America has carried out kidney transplantation for 45 years. Twenty-four countries perform kidney transplantations, 14 perform heart transplantations, 12 perform liver transplantations, 9 perform pancreas transplantations, and, 2 perform small bowel transplantations. Seventeen countries have nephrology societies, 10 have transplantation societies, and 10 have national transplant organizations.

Organ transplantation in Latin America.

Organ transplantation is currently a form of treatment for end-stage organ disease in Latin America for which enthusiasm appears to be growing both in individual countries as well as in the whole region. The Latin-American Transplant Registry has been a factor in the development of communication among the different countries of the region and a focus for unification. Both renal and extra-renal organ transplantation have increased significantly during 1999 and for kidneys the activity is currently 12% of the world renal transplant statistics.