Navegando por Palavras-chave "Sobrevivência De Enxerto"

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    Perfil Inflamatório Dos Doadores De Órgãos Em Morte Encefálica E Sua Correlação Com A Falência Dos Enxertos Renal, Hepático E Pancreático
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Soutinho, Leonardo Wanderley [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Organ transplantation is an established therapy since it improves survival and quality of life of renal, hepatic and pancreatic terminal patients, but many are not performed due to a shortage of organs for donation. This imbalance between the supply and demand for organs causes a high mortality in the transplant waiting list worldwide. The rationalization of the use of organs is imposed and begins with the best evaluation of potential brain-dead donors and the inclusion of marginal criteria donors. These donors are increasingly used and the decision on the viability of their organs is a difficult task and specific risk scores for each organ are currently applied. In this study, we investigated whether cytokines and chemokines in the blood of multiple organ in brain-dead donors may influence the results of each specific transplanted organ including kidney, liver and pancreas. We also sought to clarify the relationship of these proteins to the routinely collected health data from donors. Methods: A prospective, non-interventional cohort study was conducted between 2013 and 2016. Of the 99 multiple organs donors in encephalic death offered to our institution (mean age 40.2 years), were performed 172 renal transplants, 54 Hepatic and 15 pancreatic. From each donor, serum samples were collected from which the concentrations of 41 cytokines and chemokines were measured through the Luminex® xMAP® technology MILLIPLEX MAP kits #HCYTMAG-60K-X41 (Millipore Corporation). Clinical data from donors and recipients were collected and, through the Mann-Whitney statistical test, their correlations with the cytokine results of the collected plasma samples were investigated. Results: The cytokine eotaxin elevation demonstrated a significant correlation with the loss of twelve transplanted kidneys. Five hepatic and one pancreatic grafts were lost and none of the 41 cytokines evaluated showed a significant correlation with these losses. Significant correlations were detected between the presence of Infection in the Donors and the mean values of the macrophage-derived chemokine (MDC); Serum sodium and interleukin 10; The number of days of Orotracheal Intubation and interleukins 5 and 8; The number of days in intensive care with the concentrations of interleukin 5, and inversely with interferon gamma, interleukin 8 and with interleukin 1 antagonist receptor; leukocytosis in donors and the interleukins: granulocyte colony-stimulating factor (GCSF), granulocyte/macrophage colony-stimulating factor (GM-CSF), macrophagederived chemokine (MDC), IL-6 and IL-8. Conclusions: The elevation in the Eotaxin chemokine concentration in the donors demonstrated a significant correlation with the loss of renal grafts in the recipients. No significant difference was detected between the mean values of any of the cytokines among donors whose recipients lost or not the pancreas or liver grafts. There were important correlations between data from the donor information sheet (serum sodium, leukocytosis, infection, number of days of intubation and hospitalization in ICU) and the inflammatory profile of the donors at the time of organ harvesting.