Letter to the Editor
First renal transplant chain involving an altruistic donor performed in Spain
Primera cadena de trasplantes a partir de un donante altruista realizada en España
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Breda, O. Rodríguez Faba, E. Espejo, J.M. Cozar, H. Villavicencio" "autores" => array:5 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Breda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "O." "apellidos" => "Rodríguez Faba" "email" => array:1 [ 0 => "orodriguez@fundacio-puigvert.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Espejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Cozar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "H." "apellidos" => "Villavicencio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Universidad Autónoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urología, Hospital Virgen de las Nieves, Universidad de Granada, Granada, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primera cadena de trasplantes a partir de un donante altruista realizada en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1253 "Ancho" => 2508 "Tamanyo" => 139684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal transplant chain involving an altruistic donor.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, we have witnessed a progressive decrease in the number of cadaveric donors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This fact, together with the rapid development of laparoscopic surgery in Urology, has enhanced the living donor in kidney transplantation programs now accounting for 12% of all transplants performed in Spain.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Overall, the grafts from living donors have an average life longer than the cadaveric ones; however, up to 30% of the potential pairs have ABO (system of classifying blood groups by a or b antibody) incompatibility or positive cross match, which substantially decreases the potential beneficiaries. In these cases, the alternative is a long waiting list for cadaveric donors, or desensitization protocols with plasmapheresis/immunoabsorption and intravenous immunoglobulins.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Both alternatives have shown an overall graft survival lower than those from negative cross match pairs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this scenario, the possibility of getting a kidney from a negative cross match living donor from a transplant chain program initiated by an altruistic donor, also called ‘Good Samaritan’, represents a very attractive option for these patients. The first chain of transplants was performed in the U.S. in 2006,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and it currently has wide acceptance in countries such as Korea and Holland.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In order to achieve compatibility between the patients, the National Kidney Registry (<a href="http://www.%20kidneyregistry.org/">www. kidneyregistry.org</a>) has the necessary software available to get up to a trillion chance of crossing starting from a small number of pairs entered into the program.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the chain principles consider the performance of donations and transplantations non-simultaneously to create a large number of transplants, our chain began and ended on the same day to avoid the risk that any member reconsidered the donation and abandoned it. Thus, jointly between the Fundació Puigvert (FP) and the Hospital Virgen de las Nieves (HVN), the first chain of transplants performed in Spain was carried out on April 6, 2011. The procedure began at 9<span class="elsevierStyleHsp" style=""></span>AM with the living donor nephrectomies performed simultaneously with the altruistic donor and the other two donors. The kidney from the altruistic donor was transplanted into ‘B’ immediately after the extraction in the PF. The kidney of ‘A’ was sent to HVN in a commercial flight. The trip lasted 2.5<span class="elsevierStyleHsp" style=""></span>h and the kidney was transplanted into ‘D’ after 4<span class="elsevierStyleHsp" style=""></span>h of cold ischemia at the HVN. During this time, the kidney of ‘C’ remained in cold ischemia until the plane that landed in Granada came back to Barcelona and was transplanted in ‘E’ with 5<span class="elsevierStyleHsp" style=""></span>h and 15<span class="elsevierStyleHsp" style=""></span>min of cold ischemia. At 7:30<span class="elsevierStyleHsp" style=""></span>PM, the transplant was completed and the chain was closed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The donors of both hospitals were discharged at 3 and 4 days, respectively. Two of the three recipients were discharged on the seventh day with a creatinine of 1.2 and 1.4<span class="elsevierStyleHsp" style=""></span>mg/dl. The third recipient showed a perirenal hematoma which required surgical revision, being discharged on the tenth day with creatinine of 1.2<span class="elsevierStyleHsp" style=""></span>mg/dl. The experience with the first chain of transplants performed in Spain has been very positive, considering that three receptors have been transplanted thanks to an altruistic donor. This new pathway in renal transplantation opens the door to a large number of patients who could potentially benefit from this possibility.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Breda A, et al. Primera cadena de trasplantes a partir de un donante altruista realizada en España. Actas Urol Esp. 2012;36:196–7.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1253 "Ancho" => 2508 "Tamanyo" => 139684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Renal transplant chain involving an altruistic donor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "United Network for Organ Sharing (UNOS). Available from: <a class="elsevierStyleInterRef" href="http://www.unos.org/">www.unos.org</a> [accessed 03.11.08]." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Present situation of living-donor kidney transplantation in Spain and other countries: past, present and future of an excellent therapeutic option" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Domínguez-Gil" 1 => "M. de la Oliva Valentín" 2 => "E. Martín Escobar" 3 => "J.M. Cruzado" 4 => "J. Pascual" 5 => "G. 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Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Transplantation" "fecha" => "1999" "volumen" => "67" "paginaInicial" => "336" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10075605" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016510708016465" "estado" => "S300" "issn" => "00165107" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003600000003/v1_201304251809/S2173578612000856/v1_201304251809/en/main.assets" "Apartado" => array:4 [ "identificador" => "6306" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003600000003/v1_201304251809/S2173578612000856/v1_201304251809/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000856?idApp=UINPBA00004N" ]
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