TRANSPLANTACIJA BUBREGA KOD DECE. Cenatr za hemodijalizu i transplantaciju “Prof. Dr Milana Popović-Rolović” 31 godina hemodijalize 25 godina transplantacije

TRANSPLANTACIJA BUBREGA KOD DECE

Centar za dijalizu i transplantaciju“Prof. dr Milana Popović-Rolović”

Pedijatrijska nefrologija i urologija

Univerzitetska dečja klinika

Cenatr za hemodijalizu i transplantaciju

“Prof. Dr Milana Popović-Rolović”

31 godinahemodijalize

25 godinatransplantacije

30 godina Centra za hemodijalizu i transplantaciju“Prof. Dr Milana Popović-Rolović”

Prva hemodijaliza 10. januar 1980. godine


Prva bikarbonatna hemodijaliza 1986. godine

Prva hemodijafiltracija 2002. godine

Prva hemofiltracija 2004. godine

Prva kontinuirana terapija zamene bubrežne funkcije 2004. godine


Broj hemodijaliza: 116 293468 505 sati dijalize 53 godine dijalize

Broj dijaliziranih bolesnika: 331

Broj transplantiranih bolesnika: 120

36,3% ukupnog broja dece lečene dijalizom U inostranstvu transplantirano 50,1% U zemlji transplantirano 49,9% (od čega 91,5% na UDK)

Danas

Broj mesta za hemodijalizu: 7 Broj aparata za hemodijalizu: 9 Aparata za kontinuiranu

zamenu bubrežne funkcije i plazmaferezu (Prizma): 2

Aparata za albuminsku dijalizu (MARS): 1


Prva transplantacija bubrega na UDK 1986. godine

21. mart 1986. godine


Transplantacija bubrega postaje rutinska metoda lečenja na UDK 2001. godine

Prva kadaverična transplantacija bubrega na UDK 2004. godine

Mortalitet dece na dijalizi je 30-150 puta veći nego u opštoj dečjoj populaciji

Procenjena dužina života dece uzrasta od 0-14 god. je dvadeset godina od započinjanja dijalize

(US renal data system 2004)

Preživljavanje dece svih uzrasta nakon transplantacije je značajno bolje nego na

dijalizi preživljavanje 5 god.

transplantiranih bolesnika je 94%-97% na dijalizi 75%-87%

Transplantacije bubrega učinjene na UDK od 2001-2011 godine

Godina živi srodni davaoci kadaverični davaoc Svega

2001 3 0 3

2002 4 0 4

2003 3 0 3

2004 2 1 3

2005 7 1 8

2006 4 1 5

2007 3 1 4

2008 8 1 9

2009 4 1 5

2010 0 6 6

2011 5 1 6

ukupno 43 13 56

Napomena: navedeni podaci se odnose na transplantacije koje su urađene samo na UDK od 2001. godine do danas. Dopunjeni podaci.

preemptivna transplantacija čini 24% (2003, US)

23,4%

76,5%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

preemptivna

D 3g1m

UDK

2001-2008

Children's Hospital of Wisconsin in Milwaukee, serving Wisconsin, Northern Illinois and

Michigan's Upper Peninsula and beyond through nationally-recognized programs

Hospital locations: Milwaukee and Fox Valley

Report any problems or comments about this Web site to [email protected] of Use and Privacy Policies. © 2011 Children's Hospital and Health System

eHealthcare Leadership Award

Median time on wait list

Why we measure it –

Generally, shorter wait times to transplant result

in better outcomes. Shorter wait times mean patients generally are healthier, have fewer complications and experience fewer deaths while waiting.

What this means - Children's Hospital has shorter median wait times to transplant for heart and kidney transplants than the national median.About the data - These data reflect the number of months patients waited for pediatric kidney transplants and pediatric heart transplants compared to the national median. The national comparison data include all adult and pediatric transplant centers.

uzrast bolesnika u vreme transplantacije

50,0%

43,3%

6,7%

0,0%0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

40,0%

45,0%

50,0%

>12 g.

6-12 g.

2-5 g.

<2 g.

UDK2001-2008

Distribucija transplantiranih bolesnika po uzrastu u vreme transplantacije

0

1

2

3

4

5

6

1 3 5 7 9 11 13 15 17 19

Uzrast (godine)

Bro

j bol

esni

ka

Transplant by age Why we measure it - Pediatric transplant

programs should be able to care for children of all ages from the smallest infants to full-grown young adults.

What this means - Our talents and resources allow us to take care of any age child, which shows the breadth and depth of our program.About the data - These data show the breakdown of pediatric kidney transplant and pediatric heart transplant patients by age from 2001 through 2008.

P rež ivljavanje trans plantiranih boles nika na UD K (43 boles nika, 2001-2009)

0,96

00,10,20,30,40,50,60,70,80,9

1

0 12 24 36 48 60 72 84 96

Me se c i

Ku

mu

lati

vno

p

reži

vlja

van

je

Survival - kidney transplant

Why we measure it - Overwhelmingly, survival is the first and most important statistic parents and others ask about. In general, centers that have high survival rates for the most complex cases, including transplants, generally have high survival rates for all types of kidney transplants.

What this means - Survival at one month, one year and three years is 100 percent for kidney transplant patients from 2002 through 2009.About the data - These data reflect survival rates for pediatric kidney transplant patients from 2002 through 2009 for the first 1,200 days after transplant. These data are publicly reported to the Scientific Registry of Transplant Recipients for benchmarking purposes.

5 god. za sve graftove 78% 1 god. je 95% a 5 god. 83% za graftove sa živih donora 1 god. je 91% a 5 god. 73% za kadaverične graftove

Preživljavanje grafta

G raft s urvival

00,10,20,30,40,50,60,70,80,9

1

0 10 20 30 40 50 60

Months

Cu

m.

Su

rviv

al

C umulative s urvival probability

1 god-87%5 god-78%

Graft survival - kidney transplant

Why we measure it - Graft survival indicates the proportion of transplanted kidneys that continue to function well enough that the patient does not need dialysis.

AWhat this means - Graft survival is 100 percent for one month and one year post transplant and 85 percent for three years post transplant for patients transplanted from 2003 to 2005. Children's Hospital consistently has a higher graft survival than that reported for children nationally.

About the data - The graft survival data table reflects the graft survival for pediatric kidney transplant patientsfrom 2003 through June 2008, as specified in the table, for the timeframes of one month, one year and three years post transplant. These data are publicly reported to the United Network for Organ Sharing and Scientific Registry of Transplant Recipients for benchmarking purposes.






P rež ivljavanje g rafta kod boles nika s a T T < 20 kg u vreme trans plantac ije

0,90

00,10,20,30,40,50,60,70,80,9

1

0 12 24 36 48 60 72 84

Me se c i

Ku

mu

lati

vno

p

reži

vlja

van

je

Preživljavanje grafta kod bolesnika sa TT > 20 kg u vreme transplantacije

0,760,87

00,10,20,30,40,50,60,70,80,91

0 12 24 36 48 60 72 84 96

Me se c i

Kum

ulati

vno

prež

ivljav

anj

e

Aktuelne prosečne vrednosti sCr

124

80

0

20

40

60

80

100

120

140

<20 kg >20 kg

Telesna težina (grupe bolesnika)

Ser

um

ski

krea

tin

in (

um

ol/

l)Aktuelna prosečna vrednost ClCr

77

63

0

10

20

30

40

50

60

70

80

90

<20 kg >20 kg

Telesna težina (grupe bolesnika)C

lCr

(ml/

min

/1.7

3m

2)

Aktuelne prosečne vrednosti Cys C

1,491,41

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

<20 kg >20 kg

Telesna težina (grupe bolesnika)

Cy

sta

tin

C

(m

g/l)


We realize the importance of not having a child

stay in the hospital any longer than necessary. The time a child is in the hospital depends on many factors including how serious the illness or injury. Medical therapies can have a significant impact on recovery and length of hospital stay.

What this means - Patients receiving a heart transplant typically stay in the hospital less than one month post-transplant. Patients receiving a kidney transplant stay one week or less.About the data - These data represent the median number of inpatient days post transplant stratified by organ type. National standards for length of stay do not currently exist for pediatric solid organ transplants.






Overview of the Pediatric Kidney Transplant Program

Since 1986, Children's Hospital of Wisconsin has been offering new hope for children with chronic kidney failure through the Kidney Transplant Program. We have performed more than 165 kidney transplants.

The Kidney Transplant Program strives to provide the best quality of life for children suffering from kidney diseases. Out goal is to assist you in understanding the care, medical issues and treatment options for kidney disease and the steps involoved in kidney tranplantation.

Our pediatric kidney transplant team has a track record of performing unique, successful kidney transplants, such as heart-kidney, liver-kidney, bone marrow-liver-kidney. We perform transplants using donors who are relatives of the child; living nonrelatives; and deceased donors. We also collaborate with recipient pairs and highly human leukocyte antigen (HLA) sensitized donors. For some patients this can alleviate the long wait for a kidney.

An indicator of quality of life for our patients, we are pround to report that 100 percent of patients return to school about a month after transplant.

The United Network for Organ Sharing (UNOS) is the private, nonprofit organization that manages the nation's organ transplant system under contract with the federal government. They provide up-to-date information on transplant trends including the number of children waiting for a liver transplant in the United States.

bolesnik Operator dr anastomoza komplikacije

Vukašinović S Krstić, Vukanić v.r.+ račva VCI TL

a.r.+a.iIiaca int. TT

limfocela

Milovančević A Xavier, Krstić v.r.+VCI. TL

a.r.+A TL

Tešnjak H Krstić, Borić v.r.+v.iliaca ext. TL

a.r.+a.iliacaI ext. TL

limfocela

Gugleta M Krstić, Sretenović v.r.+v.iliaca.com. TL

a.r.+a.iliaca int. TT

Nikolić S Bretto, Krstić v.r.+kolater. TL

a.r.+a.iliaca ext. TL

Alavanja S El Mekresh, Krstić v.r.+VCI TL

a.r.+A TL

disproporcija

Pekeč N El Mekresh, Krstić v.r.+VCI TL

a.r.+A TL

limfocela

Jasnić B Borić, Krstić v.r.+v. ilca ext. TL

a.r.+ a. hipogas. TT

Miljković V Krstić, Borić v.r.+v.iliaca.ext. TL

a.r.+a.iliaca int. TT

kinking

period HD Tx zemlja inostr.

1980-05 236 80

(33,8%)

28

(35%)

52

(65%)

2005 26 9

(34,6%)

7

(77,8%)

2

(22,3%)

2006 18 6

(33,3%)

5

(83,3%)

1

(16,7%)

2007 14 5

(35,7%)

4

(80%)

1

(20%)

2008 14 9

(64,3%)

9

(100%)

0

2009 12 6

(50%)

5

(83%)

1

(17%)

Broj dece koja su transplantirana na UDK od 2001. godine do danas je 55 (kod jednog deteta na UDK rađena retransplantacija).

Transplantacije bubrega učinjene u inostranim centrima od 2001-2011 godine

Godina živi srodni davaoci kadaverični davaoc Svega

2001 1 1 2

2002 1 1 2

2003 2 3 5

2004 0 2 2

2005 1 2 3

2006 0 1 1

2007 0 3 3

2008 0 0 0

2009 1 1 2

2010 0 2 2

2011 0 1 1

ukupno 6 17 23

Većina transplantacija obavljenih u inostranim centrima su bile kadaverične, najveći broj u Italiji i to u skladu sa It.8 konvencijom.

Transplantacija jetre

Pediatric Liver Transplant Program

Program inception: May 1988. First successful liver and lung transplant in the United States in 1995. Patient mortality and graft survival better than national average. Youngest patient – 3 weeks old. Successful transplants for Maple Syrup Urine Disease and other

metabolic liver diseases.






Overview of Pediatric Liver Transplant Program

A liver transplant may be the best and only alternative for children and their families who have exhausted other approaches to the treatment of severe liver disease.

Children's Hospital of Wisconsin's Pediatric Liver Transplant Program provides medical care to pediatric patients before and after transplant. As the largest pediatric liver transplant center in Wisconsin, we follow the most children with liver disease in the state. We have performed 100 liver transplants.

Children's Hospital is the only center in the Midwest with three board-certified or board-eligible pediatric transplant hepatologists.

Liver transplants offer an acceptable treatment for many forms of end-stage liver disease. Liver transplants performed include live donor, in which a healthy person donates a part of his or her liver, deceased donor, and split and reduced liver transplants, which involve use of an organ from a cadaver. Families dealing with the overwhelming nature of a chronic childhood disease need innovative care and strong integrated support.

The experts at Children's Hospital of Wisconsin are leaders in the field of pediatric liver transplantation and will work with your child and entire family to ensure the best outcomes possible. Our highly skilled multidisciplinary team develops pre- and post-transplant treatment options for our patients.

The experts at Children's Hospital of Wisconsin are leaders in the field of pediatric liver transplantation and will work with your child and entire family to ensure the best outcomes possible. Our highly skilled multidisciplinary team develops

pre- and post-transplant treatment options for our patients.

Our specialists includes:

Pediatric transplant surgeons specialize in liver and kidney transplants and perform the surgery.

Pediatric hepatologists specialize in the care of children with end-stage liver disease before and after surgery.

Pediatric anesthesiologists play an important role during transplant surgery. They have a special interest in children and have special training in pediatrics.

Transplant coordinators are instrumental in the management of care for these children and the education of their families before, during and after surgery.

Social workers provide individual as well as family counseling and support.

Pediatric dietitians help keep patients nourished before a transplant and during the recovery phase.

Pediatric nurse clinicians experienced in caring for liver transplant recipients provide excellent care and help parents understand the daily care of their child, including medication management and overall well-being.






Transplantacija srca

Highlights and milestonesPediatric Heart Transplant Program

Program inception – December 1990.

Availability of extracorporal membrane oxygenation (ECMO) and state of the art pulsatile mechanical support.

Linked to one of the top ten pediatric heart programs in the nation, Children's Hospital of Wisconsin's Herma Heart Center.

Recent actuarial survival analysis demonstrates excellent results with most patients having no limitations to normal childhood activities.

Youngest patient – 7 days old. Longest survivor is 12 years old and thriving. Pioneered the systematic use of the virtual crossmatch for sensitized pediatric heart transplant

recipients.

In 2006, The Pediatric Heart Failure program was developed to promote early recognition and optimize care of children with advanced pediatric heart failure who may need transplantation services.

Overview of Pediatric Heart Transplant Program

Decades of experience in mending children's hearts stands behind our heart transplant

program. Children's Hospital of Wisconsin is one of the country's top pediatric cardiothoracic surgery centers with more than 725 cases per year.

Our surgical programs have consistently demonstrated one of the lowest mortality rates in the country for children with complex congenital heart disease and have been leading the world in staged repair strategies for hypoplastic left heart syndrome.

The Heart Transplant Program at Children's Hospital draws on this wealth of knowledge and experience. Children's Hospital of Wisconsin was ranked as the fourth busiest hospital in the nation for pediatric heart transplantations (UNOS 2006). Over the past few years, our pediatric heart transplant program has seen rapid growth in volume with tremendous success. Since Jan 2004, the pediatric heart transplant program has:

Performed 32 cardiac transplants with 95 percent overall survival. Performed five ABO incompatible transplants. Bridged eight recipients to transplant with use of The Berlin Heart ventricular assist

device. Performed one multi-organ and one cardiac retransplant. Pioneered the use of the Virtual Crossmatch to decrease wait times in highly sensitized

patients. Developed a comprehensive program in pediatric heart failure.

A team of pediatric cardiology and transplant experts

Everyone involved in the care of transplant patients, from pharmacy to consultants, is experienced in managing complex heart cases. This experienced team approach optimizes outcomes.

The heart transplant team members include specialists in: Cardiothoracic Surgeons. Cardiology. Critical Care Intensivists. Infectious Disease. Pathology. Immunology. Anesthesiology. Pulmonary Medicine. Nephrology. Pharmacy. Dialysis. Nursing. Child Life specialists. Psychology. Social Work.

The team is dedicated to ensuring open lines of communication as well as consistent and compassionate care. Referring physicians and family members have easy access to the entire transplant team.

Surgeons affiliated with the Medical College of Wisconsin collaborate closely on treatment and follow-up with Infectious Disease and the Herma Heart Center playing major roles. Herma Heart Center's eight board-certified pediatric cardiologists have more experience with congenital heart defects and heart disease in children than any other pediatric group in the region.

Quality Reports - Solid Organ Transplant

Volume - overallWhy we measure it - Research shows that

physicians and hospitals that treat a large number of patients tend to provide‚better care and have improved outcomes for treatments and procedures. This is especially true of transplants.

What this means - Children's Hospital of Wisconsin has had steady numbers of solid organtransplants from 2004 through 2008.About the data - These data reflects the number of pediatric kidney transplants and pediatricheart transplants performed between 2004 and 2008.

Transplant by age Why we measure it - Pediatric transplant

programs should be able to care for children of all ages from the smallest infants to full-grown young adults.

What this means - Our talents and resources allow us to take care of any age child, which shows the breadth and depth of our program.About the data - These data show the breakdown of pediatric kidney transplant and pediatric heart transplant patients by age from 2001 through 2008.

Median time on wait list


Generally, shorter wait times to transplant result

in better outcomes. Shorter wait times mean patients generally are healthier, have fewer complications and experience fewer deaths while waiting.

What this means - Children's Hospital has shorter median wait times to transplant for heart and kidney transplants than the national median.About the data - These data reflect the number of months patients waited for pediatric kidney transplants and pediatric heart transplants compared to the national median. The national comparison data include all adult and pediatric transplant centers.


We realize the importance of not having a child

stay in the hospital any longer than necessary. The time a child is in the hospital depends on many factors including how serious the illness or injury. Medical therapies can have a significant impact on recovery and length of hospital stay.

What this means - Patients receiving a heart transplant typically stay in the hospital less than one month post-transplant. Patients receiving a kidney transplant stay one week or less.About the data - These data represent the median number of inpatient days post transplant stratified by organ type. National standards for length of stay do not currently exist for pediatric solid organ transplants.

Survival - heart transplant

Why we measure it - Overwhelmingly, survival is the first and most important statistic parents and others ask about. In general, centers that have high survival rates for the most complex cases, including transplants, generally have high survival rates for all types of

heart procedures.

What this means - Children's Hospital's Herma Heart Center has a consistently high early survival rate for all children undergoing heart surgery.About the data - These data reflect survival rates for pediatric heart transplant patients from 2002 through 2009 for the first 1,200 days after transplant. These data are publicly reported to the Scientific Registry of Transplant Recipients for benchmarking purposes.

What we're doing to provide the best care:

Our 72-bed Pediatric Intensive Care Unit is staffed by board-certified and pediatric-trained critical care specialists and anesthesiologists.

We have a core team of specialists and a dedicated cardiac critical care unit to care for children undergoing heart transplants.

Each patient has a transplant coordinator who closely manages the care before and after surgery Children's Hospital's Solid Organ Transplant Program ranks in the top 25 percent of pediatric

transplant programs for volume.

Heart and kidney transplant patients have access to pediatric PT/OT, speech and rehabilitation specialists to enhance and speed recovery. A dedicated pediatric psychologist, pharmacist, social worker and child life specialist consistently are involved to help children and families through the transplant process and facilitate the transition to home, school and work.

Pre-transplant care management is provided by the transplant team and may be coordinated with the referring physician and treatment program in the child's home community or at Children's Hospital of Wisconsin depending on the needs and health status of the child. An interdisciplinary review committee meets regularly to evaluate all transplant candidates.

Before and after transplant, the hospital's premier pediatric intensive care unit (PICU) provides 24-hour critical care coverage. The PICU is staffed by Pediatric Critical Care Intensivists with consultation available in all pediatric specialties. Not all transplant patients need this level of intensive care post transplant.

Post-transplant care management is essential for good outcomes. Comprehensive specialty support well equips Children's Hospital of Wisconsin to meet the long-term challenges of managing transplant patients. Over the years, our team members have gained invaluable experience in minimizing rejection issues while maximizing quality of life.

Family Accommodations Program

Children's Hospital of Wisconsin understands that traveling with a sick child to a new city can be stressful. In order to make your stay at Children's Hospital as easy as possible, we have developed a program that helps out-of-town families coordinate their lodging arrangements in Milwaukee.

Lodging Hotels Ronald McDonald House information Transportation Local attractions

Patients/Families:

Take a virtual tour of Children's Hospital, which will help prepare you and your child for a hospital stay.

Be an advocate for your child. Participate in daily bedside clinical discussions, and provide any information about your child that may be helpful to staff.

Follow medical instructions fully and carefully before and after surgery.

Ask questions if you don't understand the plan of care or if you are not sure how to care for your child at home.

Attend any and all follow-up appointments.

Children's Hospital and Health System Foundation Gifts to the foundation support the many programs and services for

children and families provided through Children's Hospital and Health System member organizations. Your donation can support patient care programs, professional and community education, advocacy for the health and safety of children, and pediatric research.

Your gifts support: Children's Hospital of Wisconsin. Children's Hospital of Wisconsin-Fox Valley. Children's Health Education Center. Children's Service Society of Wisconsin.Special fundraising initiatives: Child Abuse Prevention Fund. Max McGee National Research Center for Juvenile Diabetes.

Children's Hospital of Wisconsin offers the following transplant programs:

Pediatric Liver Transplant Program. Pediatric Heart Transplant Program. Pediatric Kidney Transplant Program. Pediatric Blood and Marrow Transplant Program.

The solid organ transplant programs at Children's Hospital of Wisconsin are certified by the United Network for Organ Sharing.

The Blood and Marrow Transplant Program is accredited by the Foundation for the Accreditation of Cellular Therapy.

Curr Cardiol Rev. 2010 February; 6(1): 46–53.

Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation

Avihu Z Gazit,1,3* Sanjiv K Gandhi,2 and Charles C Canter31Division of Pediatric Critical Care, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA

2Division of Pediatric Cardiothoracic Surgery, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA3Division of Pediatric Cardiology, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA

Most pediatric patients listed for heart transplantation eventually require a high level of cardiac support before transplantation.

Unfortunately, due to the limited availability of donors, only 500 children worldwide undergo cardiac transplantation yearly, and mortality while awaiting a suitable organ exceeds 20% .

This situation has led to increased interest in mechanical circulatory support (MCS) as a bridge to transplantation or recovery in the pediatric age group

An artificial heart

mechanical device that replaces the heart. Artificial hearts are typically used to bridge

the time to heart transplantation, or to permanently replace the heart in case transplantation is impossible.

Although other similar inventions preceded it going back to the late 1940's, some used successfully on dogs, the first artificial heart to be successfully implanted in a human, was the Jarvik-7, designed by Robert Jarvik and implemented in 1982. The first two patients to receive these hearts, Barney Clark and William Schroeder, survived 112 and 620 days beyond their surgeries...respectively.

An artificial heart displayed at the London science museum

Mechanical heart patient on 'revolutionary' treatment

2 AUGUST 2011 LAST UPDATED AT 12:13 GMTA 40-YEAR-OLD MAN HAS BECOME THE FIRST BRITISH PATIENT TO RECEIVE A COMPLETELY ARTIFICIAL HEART. MATTHEW GREEN WILL BE ABLE TO TO LEAD A MORE NORMAL LIFE WHILE HE WAITS FOR A LIVE TRANSPLANT. WHOLE ARTIFICIAL HEARTS HAVE BEEN IMPLANTED IN SEVERAL HUNDRED PEOPLE IN THE UNITED STATES, BUT THE OPERATION HAS ONLY JUST BEEN LICENSED IN THE UK.

Mechanical Circulatory Support

MCS is utilized in children with acute congestive heart failure associated with congenital heart disease, cardiomyopathy, and myocarditis, both as a bridge to transplantation and as a bridge to myocardial recovery.

The current arsenal of mechanical assist devices available for children is limited to:

ECMO, intra-aortic balloon counterpulsation, centrifugal pump ventricular assist devices, the DeBakey ventricular assist device Child; the Thoratec ventricular assist device; Berlin Heart VAD (Berlin Heart AG, Berlin, Germany)

Mechanical Circulatory Support

Pediatric MCS in the United States has been limited until recently to: ECMO, Bio-pump (Medtronic Bio-Medicus, Minneapolis, Minnesota), adult systems adapted for pediatric support.

New devices in the United States available for children are the -implantable MicroMed DeBakey VAD Child (MicroMed Cardiovascular, Inc., Houston, Texas)

-Berlin Heart VAD (Berlin Heart AG, Berlin, Germany)

In the spring of 2004, five contracts were awarded by the National Heart, Lung and Blood Institute to support preclinical development for a range of pediatric ventricular assist devices and similar circulatory support systems.

These 5-years programs were awarded on March 30, 2004 and include the: PediaFlow VAD (University of Pittsburgh), PediPump (The Cleveland Clinic Foundation), Pediatric Cardiopulmonary Assist System (Ension, Inc), Pediatric Jarvik 2000 (Jarvik Heart), and the Pediatric Ventricular Assist Device (Penn State).

Proc Inst Mech Eng H. 2011 Jul;225(7):648-56.A simple, economical, and effective portable paediatric mock circulatory system.

Vandenberghe S, Shu F, Arnold DK, Antaki JF.Source Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.

[email protected] Ventricular assist devices (VADs) and total artificial hearts have been in development for the last 50 years. Since

their inception, simulators of the circulation with different degrees of complexity have been produced to test these devices in vitro. Currently, a new path has been taken with the extensive efforts to develop paediatric VADs, which require totally different design constraints. This paper presents the manufacturing details of an economical simulator of the systemic paediatric circulation. This simulator allows the insertion of a paediatric VAD, includes a pumping ventricle, and is adjustable within the paediatric range. Rather than focusing on complexity and physiological simulation, this simulator is designed to be simple and practical for rapid device testing. The simulator was instrumented with medical sensors and data were acquired under different conditions with and without the new PediaFlowTM paediatric VAD. The VAD was run at different impeller speeds while simulator settings such as vascular resistance and stroke volume were varied. The hydraulic performance of the VAD under pulsatile conditions could be characterized and the magnetic suspension could be tested via manipulations such as cannula clamping. This compact mock loop has proven to be valuable throughout the PediaFlow development process and has the advantage that it is uncomplicated and can be manufactured cheaply. It can be produced by several research groups and the results of different VADs can then be compared easily

SHORT-TERM MCS1. ECMO

ECMO is an effective rescue device, it is generally limited to short-term use (less than a month), requires the patient’s immobilization, precludes rehabilitation, and is associated with multiple potential complications including major bleeding and neurological sequelae.

Based on the 2006 ECLS registry report, the mortality rate in pediatric patients supported by ECMO was approximately 60%. This rate has been consistent over the last two decades.

2. BioMedicus Centrifugal Pump (BCP)

The BCP (Medtronic BioMedicus, Eden Prairie, MN, USA) is a constant speed, nonpulsatile device which can be used in children of all ages.

Compared with roller pumps, there is less hemolysis and less significant inflammatory response

ECMO or biventricular BCP are required if right sided failure is observed during this assessment. Advantages of left BCP over ECMO in those children with pure LV failure is its relative ease of use, fast set-up time, low priming volume, and low-level anticoagulation

3. Intra-Aortic Balloon Counterpulsation (IABP)

Its clinical efficacy in adults with left ventricular failure was established Its use in children remains limited due to technical considerations related to small patient and blood vessel size Biventricular support which cannot be achieved with IABP, leads to its limited use in pediatric patients

LONG TERM MCS

1. Adult Systems Used for Pediatric Support Heartmate VAD Thoratec VAD (Thoratec Corp., Pleasanton, CA)

These adult FDA approved extracorporeal MCS devices have been used successfully in older children whose body surface area is greater than 1.4 m2

A retrospective multicenter study conducted by Reinhartz and colleagues in children and adolescents supported with the Thoratec VAD (November 1982 until December 1999) revealed overall favorable outcomes. 58 patients in 27 centers worldwide were studied. Their mean age was 13.8 years (range, 7-17 years), and mean weight and body surface area were 51.6 kg

(range, 17 to 93 kg) and 1.5 m2 (range, 0.7-2.1 m2), respectively. Overall survival in this cohort (71%) was similar to survival in adults supported by this device (58%-

71.6%) with a comparable average duration of support. Statistical analysis exposed congenital heart disease as a strong independent risk factor for death. Another concerning finding was that 27% of the subjects had neurologic complications, substantially

higher than the 5-12% neurological complications in adults supported by the Thoratec VAD.

LONG TERM MCS

2.The Micromed DeBakey VAD Child (Micromed Technology Inc., Houston TX, USA)

The DeBakey VAD Child system consists of four subsystems: implantable pump system, external controller system, external Clinical Data Acquisition System and external Patient Home Support System. The blood pump, intended to provide mechanical assistance to the failing left ventricle,

DeBakey VAD Child was authorized by the U.S. FDA (February 2004) for use in providing temporary left side mechanical circulatory support as a bridge to heart transplantation for

pediatric patients (5-16 yeas old, with BSA > 0.7 m2 and < 1.5 m2) who are in NYHA Class IV end stage heart failure, are refractory to medical therapy, and who are listed for heart transplantation.

Its use in children has been limited to date. A recent report by Fraser et al. summarized a single center experience of 6 patients with the DeBakey

VAD Child. The average age of the patients was 11 years (range, 6 to 15 years) with a BSA of 0.8 to 1.7 m2. The average duration of support was 39 days, with 84 days being the longest duration of support. Three of these patients were successfully transplanted, whereas three died during support before transplantation.

3. Pneumatic Pulsatile Pediatric VADs-The Berlin Heart EXCOR and Medos HIA

These extracorporeal systems have provided successful MCS in children of all ages. They provide a long term bridge to heart transplantation while allowing extubation, ambulation, and active physical

therapy, unlike ECMO or centrifugal pump VADs. The Berlin Heart VAD (Berlin Heart AG, Berlin, Germany) consists of a paracorporeal, pneumatically driven pump. The

available biventricular operating modes are synchronous, where both ventricles are filled and emptied in concert, asynchronous, where one ventricle is filled while the other is emptied, and separate, where each ventricle is cycling independently.

While the Berlin Heart EXCOR system has been used successfully in Europe since 1991, the U.S. FDA has only recently approved the use of the Berlin Heart EXCOR Pediatric VAD under a limited investigational device exemption in the USA.

This picture illustrates the RVAD and LVAD cannulae. The order of the cannulae, from right to left, is right atrial outflow, pulmonary artery inflow, aortic inflow and left ventricular outflow

The Berlin Heart VAD (Berlin Heart AG, Berlin, Germany) consists of a paracorporeal, pneumatically driven pump. The pump is made of a translucent, semirigid housing of polyurethane divided into a blood chamber and an air chamber by a three layer flexible

Pneumatic Pulsatile Pediatric VADs-The Berlin Heart EXCOR

Over 160 childre have now been supported by this device in North America through September 2008. The device has been used in over 30 US medical centers.

According to the Berlin Heart Institute’s results for the Berlin Heart Excor, between January 1990 and June 2006, 11 children out of 74 were weaned off the device. In the era between October 2000 and June 2006, 8 out of 34 children were weaned and 18 underwent heart transplantation. No child died after weaning

Liver support systems

Due to the scarcity of donor organs, liver support technologies are being developed to support patients with severe liver failure until either an organ becomes available for transplantation or their livers recover from injury.

Early devices including hemodialysis, hemoperfusion, exchange transfusion, cross-hemodialysis, cross-circulation and plasmapheresis

appeared inefficient.

Liver support systems today

Bioartificial liver support systems

use either porcine hepatocytes or human hepatoma cell lines housed within a hollow-fiber bioreactor.

The system perfuses the patient's whole blood or separated plasma through the luminal space in the bioreactor.

Theoretically, these methods should optimally resemble normal hepatic tissue structure and function.

However, the existing bioartificial systems are far from ideal solution in terms of immunological, infectological, oncological and financial problems and must still be thought of as experimental.

The artificial systems are already available for the clinicians in limited quantities.

Liver support systems today

non-cell-based devices

These systems include the hemodiabsorption (Liver Dialysis Unit) which is commercially available in the United

States,

the albumin dialysis which is available in Europe The simple method of albumin dialysis is "single pass albumin dialysis" (SPAD),

which evolved into the so-called "molecular adsorbent recirculating system"(MARS).

and the newly developed fractionated plasma separation and adsorption (FPSA) system. Prometheus system combines the FPSA method with high-flux hemodialysis.

These non-cell-based devices are intended to remove protein-bound and water-soluble toxins without providing synthetic function, which can be partially replaced with substitution of the failing substances (plasma proteins, coagulation factors).

MARS: Molecular adsorbent recirculating system; FPSA: Fractionated plasma separation and adsorption; SPAD: Single-pass albumin dialysis. HepaWash: hemodiabsorption

Regenerative therapy

Cell-based regenerative therapy currently emerges as one of the most promising methods for treating cardiac disease.

Regenerative therapy by the direct injection of dissociated cells has been clinically performed, and the modest therapeutic efficacies are confirmed.

tissue engineering is viewed as a new generational cell therapy for cardiac disease

Tissue engineering is currently based on concepts that three-dimensional (3D) scaffolds are used as an alternative for extracellular matrix (ECM), and cells are seeded into the scaffolds.

Cell sheet-based tissue engineering has been applied for the regenerative medicine of several tissues including myocardial, corneal epithelial, esophageal, lung, liver, pancreatic, thyroidal, and periodontal tissue . In some tissues, clinical trials have been started.

The transplantation of engineered myocardial tissue grafts improves damaged heart functions in animal models, and clinical trials have already started.

The transplantation of myocardial tissue fabricated by cell sheet-based tissue engineering is a quite different cell delivery method from cell injection, and previous studies show promising and powerful potentials for curing damaged heart in several animal models

Scaffold-free cell sheet-based tissue engineering is realized to be very useful for fabricating electrically communicative and pulsatile 3D myocardial tissue both in vitro and in vivo.

Cell sheet-based tissue engineering has promising and enormous potentials to cure many patients suffering from severe cardiac disease

Cardiol Res Pract. 2011; 2011: 845170. Published online 2011 October 6. doi: 10.4061/2011/845170

November 15, 2011 Stem cells give new hope to heart attack

survivors "There is promising news for people at risk of heart

failure after US researchers found stem cell herapy in humans has been surprisingly successful in replacing damaged muscle and getting the heart t pump better.“

Active Research We are actively enrolling patients in studies

using stem cells for the treatment of: Heart Failure Heart Attacks Peripheral Vascular Disease

The Stem Cell Center of the Texas Heart Institute at St. Luke’s Episcopal Hospital in Houston, Texas is actively recruiting patients for FDA-approved clinical studies investigating the use of adult stem cells in treating heart failure

Chronic liver disease (CLD) is increasing worldwide yet there has been no major advance in effective therapies for almost five decades.

At present orthotopic liver transplantation is the only therapeutic option for patients with acute and chronic ESLDs.

Liver transplantation, however, has the disadvantage of requiring lifelong immunosuppression and followup,

10–15% of patients dying whilst on the waiting list due to the shortage of donated organs.

In 2005, only one-third of patients waiting for a liver transplant were transplanted.

With the number of donor organs likely to decrease over the coming decades, research into the alternative methods of treatment of whole-organ transplant is essential.

Hepatocyte transplantation (HT) has been performed in patients with liver-based metabolic disease and acute liver failure as a potential alternative to liver transplantation.

The results are encouraging in genetic liver conditions where HT can replace the missing enzyme or protein.

However, there are limitations to the technique, which need to be overcome. Encapsulation of hepatocytes allows cells to be transplanted intraperitoneally in

acute liver failure with the advantage of avoiding immunosuppression. Alternative sources of hepatocytes, which could be derived from stem cells,

are needed. Mesenchymal stem cells are currently being investigated particularly for their hepatotropic effects.

Transplantation. 2011 Nov 11. Current Status of Hepatocyte Transplantation.Hughes RD, Mitry RR, Dhawan A.SourceInstitute of Liver Studies, King's College London School of Medicine at King's College Hospital, London, United Kingdom.

Transplantation. 2009 Mar 15;87(5):636-41.One liver for four children: first clinical series of liver cell transplantation for severe neonatal urea cycle defects.Meyburg J, Das AM, Hoerster F, Lindner M, Kriegbaum H, Engelmann G, Schmidt J, Ott M, Pettenazzo A, Luecke T, Bertram H, Hoffmann GF, Burlina A.Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany. [email protected]

Abstract BACKGROUND: Urea cycle disorders (UCD) have a poor prognosis despite dietary and pharmacologic therapy, especially if the

onset of the disease is within the neonatal period. They are promising target diseases for liver cell transplantation (LCT), which may be a less invasive alternative or supplementation to orthotopic liver transplantation.

METHODS: Cryopreserved hepatocytes were isolated under good manufacturing practice conditions. Four children with

severe neonatal UCD (age 1 day-3 years) received multiple intraportal infusions of cryopreserved hepatocytes from that same donor, a 9-day old neonate. Portal vein access was achieved surgically in two children, whereas the umbilical vein was suitable for interventional catheter placement in two neonates. Cell applications were carefully monitored by means of Doppler ultrasound and portal vein pressure.

RESULTS: LCT was feasible in all children. No signs of portal vein thrombosis or extrahepatic shunting were observed. All

children showed metabolic stabilization during observation periods of 4 to 13 months. One child with prenatally diagnosed ornithine transcarbamylase deficiency died after 4 months from a fatal metabolic decompensation.

CONCLUSIONS: Given the poor prognosis of UCD with conservative therapy, LCT caused considerable beneficial effects. Periods of

hyperammonemia and clinically relevant crises could be reduced during an observation period of up to 13 months. Though cell therapy is not a permanent therapeutic option, bridging to liver transplantation may be substantially improved.

Recently, induced pluripotent stem (iPS) cells, derived from the reprogramming of somatic fibroblasts, have been shown to resemble embryonic stem (ES) cells in that they have pluripotent properties and the potential to differentiate into all cell lineages in vitro, including hepatocytes.

rapid and efficient differentiation protocol that is able to generate functional hepatocyte-like cells from human iPS cells. This may offer an alternative option for treatment of liver diseases.

Hepatology. 2011 Nov 16. doi: 10.1002/hep.24790. [Epub ahead of print]Rapid generation of mature hepatocyte-like cells from human induced pluripotent stem cells by an efficient three-step protocol.Chen YF, Tseng CY, Wang HW, Kuo HC, Yang VW, Lee OK.Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan; Stem Cell Research Center, National Yang-Ming University, Taiwan.

This study demonstrated the safety and short-term efficacy of autologous bone marrow-derived mesenchymal stem cell injection in liver cell failure. Further study is necessary to standardize the cell dose, determine the life span of the injected cells, and detect the appearance of long-term complications

Eur J Gastroenterol Hepatol. 2011 Oct;23(10):936-41.Clinical and laboratory evaluation of patients with end-stage liver cell failure injected with bone marrow-derived hepatocyte-like cells.Amer ME, El-Sayed SZ, El-Kheir WA, Gabr H, Gomaa AA, El-Noomani N, Hegazy M.Department of Tropical Medicine, Al-Azhar University, Domeat, Eygpt.

Handchir Mikrochir Plast Chir. 2010 Dec;42(6):337-41. Epub 2010 Apr 19.[Hepatic tissue engineering].Fiegel HC, Kneser U, Kluth D, Rolle U.Source-Goethe Universität Frankfurt, Kinderchirurgie, Theodor-Stern-Kai

7, Frankfurt.

tissue engineering based cell transplantation is currently under investigation with the aim to replace liver tissue and function.

The principle of tissue engineering is the notion of an interaction between a cell and a three-dimensional matrix.

system for heterotopic hepatocyte transplantation on polymeric matrices was developed in an animal model.

In this transplantation model a long-term proliferation and function of transplanted hepatocytes was shown.

The major limitation of matrix-based transplantation systems is the high initial cell loss, most probably due to an insufficient vascularisation.

regenerative therapy

present study was designed to develop a cell sheet-based hepatocyte co-culture system that enables cultured hepatocytes to preserve their functions for a longer period of time. To achieve this goal, a monolayer cell sheet composed of endothelial cells (EC) was placed on top

of a monolayer of hepatocytes (Hep). In this hybrid cell sheet format, histological examination revealed that bile canaliculi networks were formed and well developed among the hepatocytes in the layered Hep-EC sheet group.

this culture system provides a valuable technology to prolong hepatocyte functionality and enable more efficient development of liver tissue engineering approaches to create liver-targeted regenerative therapies.

Biomaterials. 2011 Nov 23. [Epub ahead of print]Preserved liver-specific functions of hepatocytes in 3D co-culture

with endothelial cell sheets.Kim K, Ohashi K, Utoh R, Kano K, Okano T.Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Japan.

cell-based liver directed therapies, e.g. liver tissue engineering should permit (i) expansion of cells in an in vitro phase, (ii) genetic or immunological manipulation of cells for transplantation, (iii) tissue typing and cryopreservation in a cell bank, and (iv) the ex vivo genetic modification of patient's own cells prior re-implantation.

Function and differentiation of liver cells are influenced by the three-dimensional organ architecture.

Based on bioreactor technology, bioartificial liver devices (BAL) are developed for extracorporeal liver support.

J Cell Mol Med. 2008 Jan-Feb;12(1):56-66. Epub 2007 Nov 16.Hepatic tissue engineering: from transplantation to customized cell-based liver directed therapies from the laboratory.Fiegel HC, Kaufmann PM, Bruns H, Kluth D, Horch RE, Vacanti JP, Kneser U.Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

Curr Opin Biotechnol. 2009 Oct;20(5):575-92. Epub 2009 Nov 5.

Engineering organs.Atala A.SourceWake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27157, USA. [email protected]

Abstract Applications of regenerative medicine technology may offer novel therapies for patients with injuries,

end-stage organ failure, or other clinical problems. Currently, patients suffering from diseased and injured organs can be treated with transplanted organs.

However, there is a severe shortage of donor organs that is worsening yearly as the population ages and new cases of organ failure increase.

Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that will restore and maintain normal function in diseased and injured tissues.

The stem cell field is also advancing rapidly, opening new avenues for this type of therapy. For example, therapeutic cloning and cellular reprogramming may one day provide a potentially limitless source of cells for tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors have already entered the clinical setting successfully, indicating the promise regenerative medicine holds for the future.

Transpl Int. 2011 Mar;24(3):223-32. doi: 10.1111/j.1432-2277.2010.01182.x. Epub 2010 Nov 10.

Regenerative medicine as applied to solid organ transplantation: current status and future challenges.

Orlando G, Baptista P, Birchall M, De Coppi P, Farney A, Guimaraes-Souza NK, Opara E, Rogers J, Seliktar D, Shapira-Schweitzer K, Stratta RJ, Atala A, Wood KJ, Soker S.

Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. [email protected]

Abstract

In the last two decades, regenerative medicine has shown the potential for "bench-to-bedside" translational research in specific clinical settings. Progress made in cell and stem cell biology, material sciences and tissue engineering enabled researchers to develop cutting-edge technology which has lead to the creation of monocular tissue constructs such as skin, bladders, vessels and upper airways. In all cases, autologous cells were seeded on either artificial or natural supporting scaffolds. However, such constructs were implanted without the reconstruction of the vascular supply, and the nutrients and oxygen were supplied by diffusion from adjacent tissues. Engineering of modular organs (namely, organs organized in functioning units referred to as modules and requiring the reconstruction of the vascular supply) is more complex and challenging. Models of functioning hearts and livers have been engineered using "natural tissue" scaffolds and efforts are underway to produce kidneys, pancreata and small intestine. Creation of custom-made bioengineered organs, where the cellular component is exquisitely autologous and have an internal vascular network, will theoretically overcome the two major hurdles in transplantation, namely the shortage of organs and the toxicity deriving from lifelong immunosuppression. This review describes recent advances in the engineering of several key tissues and organs

Tissue Eng Part A. 2010 August; 16(8): 2441–2455. Published online 2010 April 27. doi: 10.1089/ten.tea.2009.0548PMCID: PMC2947461Copyright 2010, Mary Ann Liebert, Inc.

Constructing Kidney-like Tissues from Cells Based on Programs for Organ Development: Toward a Method of In

Vitro Tissue Engineering of the Kidney

Eran Rosines, Ph.D.,1,* Kohei Johkura, M.D.,2,* Xing Zhang, Ph.D.,2 Heidi J. Schmidt, M.S.,1 Marvalyn DeCambre, M.D.,2 Kevin T. Bush, Ph.D.,2 and Sanjay K. Nigam, M.D.2,3,4,5

1Department of Bioengineering, University of California, San Diego, La Jolla, California.

2Department of Medicine, University of California, San Diego, La Jolla, California.

3Department of Pediatrics, University of California, San Diego, La Jolla, California.

4Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, California.

5Department of John and Rebecca Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California.

Taken together with prior work (Rosines et al., 2007; Steer et al., 2002), these results support the plausibility of a developmental strategy for constructing

and propagating vascularized 3D kidney-like tissues from recombinations of cultured renal progenitor cells and/or primordial tissue.

3D structure important for renal function. E13 rat embryonic kidney could undergo 3D growth

and branching morphogenesis when suspended within an ECM gel. Type I collagen, type IV collagen,

and Matrigel all supported 3D kidney growth and development

Examination of engineered kidney tissue 37 days

after implantation under the renal capsule of a kidney

in a nude mouse. (a, b). Hematoxylin and eosin

stained section through the host kidney and implanted

kidney tissue. (c–i) Confocal fluorescent

"national registry andmechanism for allocating organs to ensure

equity of access."

Waiting for their own miracles In 2008, 4,380 Canadians were waiting for a transplant of some kind. Of those, 215 died before donor organs could be procured.

In May 2007, the Canadian Medical Association Journal called for a "national registry andmechanism for allocating organs to ensure equity of access." It cited a study that showed thatpeople under the age of 40 who lived in Ontario waited a median of eight years for a new kidney,while for those in Alberta, the median wait was three years.

Canada's rate of organ donation seriously lagged that of several countries.In 2005, the donation rate for deceased donors was 12.8 per million. That's just over a third therate in Spain (35.1 per million) and around half that of Estonia (26.5 per million), Belgium (22.8per million), the United States (21.5 per million), and Italy (20.9 per million).

Pediatr Transplant. 2011 Jun;15(4):376-83. doi: 10.1111/j.1399-3046.2011.01495.x. Epub 2011 Apr 5. Wait list status of pediatric dialysis patients in North America. Nguyen S, Martz K, Stablein D, Neu A. Source University of California, Davis, Sacramento, CA 95817, USA. [email protected] Abstract Kidney transplantation is the treatment of choice for the majority of pediatric patients with end-stage kidney

disease. Previous studies demonstrating racial or gender disparities in access to the deceased donor transplant list could not evaluate the impact of medical concerns or patient preference on waitlist status. We undertook a retrospective cohort study using the NAPRTCS registry to begin to determine barriers to wait list registration for kidney transplantation among pediatric dialysis patients. Clinical and demographic factors were compared in listed vs. non-listed patients. Reasons cited for not listing patients were examined by clinical and demographic factors. At dialysis initiation, 88.7% of pediatric dialysis patients were not on the renal transplant wait list. Twelve months after dialysis initiation, 67.1% of pediatric dialysis patients were not on the wait list. The groups least likely to be on the wait list were infants (adjusted OR 0.23, 95% CI 0.16, 0.32) and girls (adjusted OR 0.78, 95% CI 0.67, 0.90) after adjusting for multiple confounders. The reason most often cited for not listing was medical reason for young infants and that the transplant workup was pending for girls. Further study is needed to identify barriers to wait list registration

More patients/less organs The right organ for the right recipient

need to utilize organs from as many donors as possible.

selection criteria have become less stringent to accommodate increasing demand, transplant outcomes are more strongly influenced by recipient and donor factors;

finding the right organ for the right recipient is more important than ever.

Representative dilemmas in the matching of donor organs with recipients were discussed. These included the following: matching by donor and recipient risk characteristics; use of organs with risk for disease transmission; biologic incompatibility; use of organs from donors after cardiac death; the justification for combined organ transplants like liver-kidney and kidney-pancreas; and the role of allocation in facilitating the matching of donors and recipients.

Clin Transplant. 2011 Sep 9. doi: 10.1111/j.1399-0012.2011.01513.x. [Epub ahead of print]The right organ for the right recipient: the Ninth Annual American Society of Transplant

Surgeons' State-of-the-Art Winter Symposium.Sung RS, Abt PL, Desai DM, Garvey CA, Segev DL, Kaufman DB.

Department of Surgery, University of Michigan, Ann Arbor, MI Department of Surgery, University of Pennsylvania, Philadelphia, PA Department of Surgery, University of Texas Southwestern, Dallas, TX The

Transplant Center, University of Minnesota Medical Center-Fairview, Minneapolis, MN Department of Surgery, Johns Hopkins University, Baltimore, MD Department of Surgery, University of Wisconsin,

Madison, WI, USA.

DCD- donation after cardiac death

In February 2005, a national forum was convened to discuss and develop recommendations on the principles, procedures and practice related to DCD- donation after cardiac death, including ethical and legal considerations.

There was a consensus that Canada should resume harvesting organs under DCD-donation after cardiac death in addition to NDD- neurological determination of death.

It was estimated that procuring organs this way would increase the number of available organs by 20 per cent.

published in the Canadian Medical Association Journal

DCD- donation after cardiac death

A year-and-a-half later, a paper published in the Canadian Medical Association Journal outlined

national recommendations for donation after cardiocirculatory death.

considering DCD donation, the patient should be judged to have:

A non-recoverable injury or illness. Dependence on life-sustaining therapy. Anticipation of imminent death after withdrawal of life-sustaining therapy.

HEALTHTransplantsOrgan donation: the gift of lifeLast Updated: Thursday, June 25, 2009 | 11:51 AM ETCBC News

The drama that unfolded in a Toronto hospital as the lives of two infants hung in the balance in thesecond week of April 2009 gripped the nation.

Kaylee's parents, Jason Wallace and Crystal Vitelli, understood that without a machine to help herbreathe, Kaylee's heart would eventually stop and she would die. They decided that Kaylee's heart should live on and give Lily a chance to live a healthy life.

Lily O'Connor, born March 9, 2009,with a congenital heart defect lay seriously ill at Toronto's Hospital for Sick Children. Her only option for survival is aheart transplant.

"Thirty to 40 per cent of people with living willing donors don't match their living donor.

We've been basically not utilizing these kidneys,"

Kidney Chains"When you see those people who have come out of these swaps

and they've got the transplant, it's a miracle,"

On Feb. 12, 2009, Canada Blood Services announced the Living Donor Paired Exchange Registry, which is designed to facilitate kidney donations among live donors

Become a Kidney DonorNational Kidney RegistryDonate Life America

Participating Kidney Chain CentersNew York-Presbyterian/Weill-CornellNew York Presbyterian TransplantPinnacle Health SystemsUCSF Medical CenterUCLA Medical CenterStanford University Medical Center

"good Samaritan" donor

It all started with Max Zapata, from Clovis, Calif., who kicked off this chain as the "good Samaritan" donor. He gave a kidney and expected nothing in return.

"I just really felt that it was something that I needed to do in my heart," Zapata said. "I didn't know where it would go, but that I knew that it would be something that would help someone out."

Zapata gave his kidney to 25-year-old Laura Amador

"domino surgery"

The first "domino surgery" occurred in late 2008 at the Ottawa Hospital, when Ottawa resident Gene Borys intended to donate a kidney to his wife, Kelly Shannon. She was not a compatible match, but an anonymous live kidney donor set off a chain reaction that saved several lives.

The blood agency forecasts that the paired exchange registry for living donors will increase donations by 20 per cent or more.

Pilot transplant programs through the registry are being conducted in Ontario, Alberta and British Columbia, with other provinces to be added shortly.

Guidelines needed to stem 'transplant tourism': WHOMarch 30, 2007

The UN agency is concerned about increasing cases of commercial exploitation of human materials such as organs for transplant.

We believe five to 10 per cent of all kidneys transplanted were in 2005 transplanted in this setting," said Luc Noel, the head of WHO's unit, told a news conference at the agency's headquarters in Geneva.

In Pakistan, from 40 per cent to half of residents in some villages have only one kidney each because their other was sold to a wealthy person, likely from another country, said Dr. Farhat Moazam of the Sindh Institute of Urology and Transplantation in Karachi, Pakistan, and one of the participants at the meeting.

Donors may be offered $2,500 US for a kidney but may receive only half because of the broker's cut.

Guidelines : WHOMarch 30, 2007

The principles put forward by WHO underscore that the person – whether recipient of an organ or a donor - must be the main concern both as patient and as human being;

that commercial exploitation of organs denies equitable access and can be harmful to both donors and recipients;

That organ donation from live donors poses numerous health risks which can be avoided by promoting donation from deceased donors;

and that quality, safety, efficacy and transparency are essential if society is to reap

the benefits transplantation can offer as a therapy.

The Canadian Council for Donation and Transplantation was set up in 2001 to improve Canada's organ donation system.

In August 2008, federal, provincial and territorial ministries of health announced funding of $35 million over five years to merge the council's activities with Canada Blood Services in a bid to improve organ donation and transplantation across the country.

organ donations-deceased donors

"The most important step is to have a discussion with your immediate family," Marcello told CBCNews. "They're the ones that are going to be approached, and it will probably be during a tragictime, and they have to be as prepared as possible to say yes [to donating your organs] … and ifthey're not prepared, they're probably going to say no.“

registries are helpful but you still need to have that discussion with your immediatefamily. 23 European countries use an "opt-out system" for organ donation. Theyassume you want to donate your organs unless you've expressly said you don't. 90 per cent of Canadians want to donate their organs, but the system is too complicated. some people believe that age or illness may prevent them from becoming anorgan donor.

"Everybody is an eligible donor. There was a case of a 102-year-old great grandmother whodonated three of her organs.

"The most important step is to have a discussion with your immediate family,"

Enferm Infecc Microbiol Clin. 2007 Jan;25(1):54-62. [Epidemiology of transplantation in Spain]. [Article in Spanish] Garrido-Cantarero G, Matesanz-Acedos R. Source Organización Nacional de Trasplantes, Madrid, Spain. [email protected] Abstract During 2005, 1546 true solid organ donors were registered in Spain, yielding a rate of 35.1 per

million population (pmp), which places our country at the head of word-wide donation rates. A total of 2200 kidney transplantations were performed in Spain during 2005, 72 of them in infants and children. The cadaveric kidney transplantation rate was 47.9 pmp, the highest in the world for this type of transplant. The 2005 Spanish Renal Transplant Registry showed that patient mortality associated with these transplants is 1.6%. Graft survival is 90% to 84% at the first year and 76% to 66% at 5 years. Furthermore, in 2005, 1070 liver transplantations (24.1 pmp) were carried out. Patient survival in this group is 81.3% the first year, 73.3% at 3 years, 56.7% at 10 years and 26.8% at 20 years. A total of 287 heart transplantations were undertaken (6.5 pmp). Patient survival is 86% to 81% the first year, and around 70% at 5 years. There were 167 lung transplantations, 112 double and 55 single lung transplants. Patient survival in this population is 79.3% the first year and 45.2% at 5 years. Lastly, pancreas transplant activity has increased considerably in recent years, with 96 transplants during 2005

During 2005, 1546 true solid organ donors were registered in Spain, yielding a rate of 35.1 per million

population (pmp), which places our country at the head of word-wide donation rates

Número de donantes y tasa de donación.

Tasa de donación por millón de población en diferentes países del mundo.

Grupos de edad de los donantes.

Trasplante renal Durante el año 2005 se han realizado en nuestro

país 2.200 trasplantes renales de los que 72 eran trasplantes infantiles.

La tasa de trasplante renal de cadáver pmp se sitúa en 47,9 lo que nos coloca a la cabeza mundial de este tipo de trasplantes.

Trasplante renal. Actividad en España.

Trasplante hepático. Actividad en España Trasplante cardíaco. Actividad en España

Patient survival is 86% to 81% the first year, and around 70% at 5 years

Documents

TRANSPLANTACIJA BUBREGA KOD DECE. Cenatr za hemodijalizu i transplantaciju “Prof. Dr Milana Popović-Rolović” 31 godina hemodijalize 25 godina transplantacije