Transplantation Process Research Articles

Primary Preventive Care of Hematopoietic Stem Cell Transplantation Survivors: Time to Educate and Empower Recipients and Providers

Increasing use of hematopoietic stem cell transplantation (HCT) and improvements in recipient outcomes have led to a steady increase in the number of allogeneic HCT survivors. In addition to complications specific to the transplantation process, HCT recipients are at increased risk of developing cardiovascular disease (CVD) and subsequent neoplasm (SN). Strict surveillance of risk factors for CVD and cancer in the general population is recommended as an essential component of long-term follow-up (LTFU) care of HCT survivors, but implementation of this has been suboptimal. Various models for improving the provision of survivorship care have been proposed, including a hybrid/combined care approach wherein the HCT provider manages transplantation-specific complications and the primary care physician (PCP) provides general medical care, including surveillance and aggressive management of CVD risk factors and screening for SN. This model also offers a practical approach to LTFU care for HCT survivors who live at a distance from the HCT center, which is a reality for many recipients of HCT at The Ottawa Hospital (TOH). As the success of such a hybrid approach to survivorship care depends on the engagement of HCT recipients with their PCP and compliance with recommended general population surveillance, the aim of the present study was to assess the rates of PCP attendance and adherence to recommended preventive medicine interventions in the years immediately before and after HCT. We hypothesized that rates would be suboptimal and planned to use these results as a baseline for an educational initiative aimed at increasing awareness of HCT recipients and their PCPs about embracing preventive survivorship care. This was a single-center cohort study of allogeneic HCT recipients who underwent transplantation at TOH with linkage to population-based health administrative data. Published clinical practice guidelines were used to define recommended screening for CVD risk factors and cancer. The rates of annual PCP visits and utilization of recommended preventive care interventions in the 5 years before and after HCT were calculated for all eligible patients. Between 2014 and 2020, 409 patients with provincial health care coverage underwent allogeneic HCT at TOH. The median patient age was 51 years (range, 15 to 73 years), with a male predominance (60.9%). Approximately one-quarter of recipients did not attend a PCP visit in the 5 years before and after transplantation, and this proportion increased to one- third in the fifth year post-HCT. Among those recipients who were eligible, only 20% to 25% underwent recommended screening for dyslipidemia and diabetes. Cancer screening rates were also low, at 16% to 18% for cervical cancer, 18% to 22% for colon cancer, and 30% to 31% for breast cancer. These results highlight the need to increase awareness of HCT recipients and their PCPs about the risk of developing CVD and SN post-transplantation and to emphasize the potential to mitigate this risk by adhering to recommendations for surveillance to enable prompt intervention. Patient education should incorporate this information and empower HCT survivors to actively engage in their follow-up care and optimize their long-term outcomes.

Complement-targeting therapeutics for ischemia-reperfusion injury in transplantation and the potential for ex vivo delivery.

Organ shortages and an expanding waitlist have led to increased utilization of marginal organs. All donor organs are subject to varying degrees of IRI during the transplant process. Extended criteria organs, including those from older donors and organs donated after circulatory death are especially vulnerable to ischemia-reperfusion injury (IRI). Involvement of the complement cascade in mediating IRI has been studied extensively. Complement plays a vital role in the propagation of IRI and subsequent recruitment of the adaptive immune elements. Complement inhibition at various points of the pathway has been shown to mitigate IRI and minimize future immune-mediated injury in preclinical models. The recent introduction of ex vivo machine perfusion platforms provides an ideal window for therapeutic interventions. Here we review the role of complement in IRI by organ system and highlight potential therapeutic targets for intervention during ex vivo machine preservation of donor organs.

Usefulness of Indocyanine Green Plasma Disappearance Rate in Liver Donors and Recipients: A Prospective Observational Study

Determination of indocyanine green (ICG) plasma disappearance rate (PDR) is a simple, inexpensive, and noninvasive tool to assess liver perfusion, absorption, and elimination. Its application in the liver transplant process has not been widely incorporated in clinical practice. This study aims to assess the usefulness of ICG PDR in the donor selection setting and in the early post-transplant phase and to analyze its variation between these 2 time points. We performed a single-center prospective observational study. ICG clearance test was performed in 50 brain-dead donors (T0-PDR) to assess concordance with graft suitability. Rejected grafts biopsy specimens were analyzed to correlate histology with T0-PDR. In the recipients, ICG PDR was performed before wound closure (T1-PDR). The association of T0, T1, and T0-T1 variation with the development of early allograft dysfunction (EAD) was investigated. A total of 23 of 50 grafts were discarded because of poor macroscopic quality. A T0-PDR below 15.5%/min could predict graft rejection with 100% specificity and 69.6% sensitivity. All the biopsy specimens from donors with PDR < 10 %/min showed liver fibrosis. A total of 25 of the remaining 27 grafts were implanted; 5 patients (20%) developed EAD. T1-PDR performed better than T0-T1 variation to predict dysfunction. ICG PDR could be used in the donors as a filter to discard poor-quality grafts before procurement and, in the early post-transplant phase, to predict EAD.

Effect of COVID-19 Pandemic on Hematopoietic Stem Cell Transplant Activity: Experience of a JACIE-Accredited Center.

The adoption of international quality and accreditation standards is important for the success of transplant centers. Guidelines from the Joint Accreditation Committee ISCT-Europe and EBMT (JACIE) have enabled quality management of the operations of clinical units of cellular therapy centers, including cell collection and processing, thus minimizing errors and adverse events. COVID-19 has had significant implications for immunocompromised patients, particularly hematopoietic stem cell transplant recipients, as well as their donors and caregivers. Here, we retrospectively examined measures, taken in our transplant center in Turkey during the pandemic period between March 2020 and October 2021, to investigate how JACIE accreditation has affected patient, donor, product, and employee safety. We analyzed data on transplant activity, as well as donor, patient, product, and employee safety, during the pandemic in 3 separate 6- month periods. The measures were analyzed starting from March 2020, when the first COVID-19 case was seen in Turkey. Since the beginning of the pandemic, 140 patients have undergone stem cell transplant in our center. Stem cell transplant was delayed in 22 patients because of the pandemic. Transplant was also postponed due to COVID-19 positivity in 6 patients, and 2 patients died due to COVID-19 infection during the transplant process. Unrelated donor activity continued to be performed safely throughout this period. COVID- 19 infection developed in 12 of the 52 personnel working in the bone marrow transplant unit, one of whom needed intensive care due to severe pneumonia. In terms of quality management activities, the impact of the pandemic was greatest during the first month. Results from our retrospective study examining the impact of JACIE accreditation in a stem cell transplant center during the COVID-19 pandemic showed that, when national and international guidelines are followed, JACIE accreditation can facilitate adaptation to changing conditions in transplant centers.

Advocating for in-center hemodialysis patients via anonymous survey.

We conducted an anonymous survey in 9 of our university affiliated outpatient dialysis units to address the concern that many in-center hemodialysis patients may not feel comfortable sharing their experiences. Major goals of this study: Investigating level of patient satisfaction with their care; Evaluating the subjective perception of the level of understanding of patients regarding pertinent issues of their disease and its management; Identifying potential avenues for care improvement. Survey was conducted in English, paper-based, with answer choices to individual questions for patient satisfaction and education graded using a 5-point Likert scale. Regarding potential areas of improvement, patients were asked to choose as many areas as deemed appropriate. To ensure anonymity, the completed surveys were folded and dropped into a box. Overall, 253 out of 516 (49%) screened patients were eligible and completed the survey. Patients expressed favorable responses regarding satisfaction (mean rating > 4 in each of 14 questions) and education (mean rating > 4 in 8 questions, > 3.5 in 2 questions) regarding hemodialysis. About 62% of overall study participants identified at least one area where they felt additional information would result in improvement of care. Our results indicate that patients undergoing outpatient hemodialysis were overall satisfied and had a good perceptive understanding about their health. Based on the patients’ input, strategies focused on addressing pain and discomfort, privacy, providing information about palliative care/hospice, mental health resources, and the process of kidney transplantation may promote improvement in overall quality of care.

Is ABO Compatibility Important in Islet Transplantation?

One of the current criteria for clinical islet allotransplantation is ABO blood group compatibility between donor and recipient.1 The distribution of ABH antigens in human pancreata was first examined >40 y ago, revealing expression in acinar and vascular cells but not in islets.2 This underlined the importance of ABO matching in whole pancreas transplantation, but the situation in islet transplantation is more complicated. Although islets in situ appear to be ABH-negative,2 islets prepared for transplant are invariably contaminated with exocrine tissue including acinar cells. Furthermore, it is not known whether the islet isolation and transplantation process itself influence ABH expression. It is therefore somewhat surprising that ABH expression in islet preparations before and after transplant has not been characterized until now. In this issue of Transplantation, Verhoeff et al3 present a detailed immunohistochemical and flow cytometric survey of ABH antigen levels in human pancreatic tissue, isolated human clinical-grade islets, and islets derived from human embryonic stem cells (hESCs). After confirming that ABH antigens are present on acinar cells but not on endocrine and ductal cells in the pancreas, the authors demonstrate that islet preparations consist primarily of ABH-negative endocrine cells but are significantly contaminated with ABH-positive acinar cells. When islets were transplanted into immunodeficient rats, the endocrine component was ABH-negative at 24 wk, whereas remnant acinar tissue stained positive. Pancreatic endocrine progenitors derived from hESCs were ABH-negative and remained so after in vivo maturation following transplantation into rats, although this was not unexpected given that the hESC donor was blood group O. The human-to-immunodeficient rat islet xenograft model used in the latter part of the study does have some limitations. First, the kidney subcapsular site does not accurately reflect the clinical scenario, in which islets are transplanted intraportally.1 Subcapsular delivery co-localizes the islets with acinar tissue fragments and potentially exposes the islets to “bystander” injury and inflammation when anti-ABH antibodies attack the acinar cells. In contrast, intraportal delivery disperses islets and acinar fragments widely throughout the liver microvasculature, which probably minimizes co-localization and thus reduces the likelihood of bystander effects. Furthermore, subcapsular but not intraportal delivery shields the graft from exposure to anti-ABH IgM antibodies. Although these differences are not relevant in the immunodeficient rat model, they may well be relevant in the clinical setting. Second, the immunodeficient rat model does not allow investigation of the importance of the in vivo anti-ABH immune response to islet grafts. I have worked with one of the authors (L.J.W.) to develop a mouse model of anti-A antibody-mediated rejection of transgenic blood group A-expressing cardiac grafts.4 However, these A-transgenic donor mice are unsuitable for examining anti-A–mediated islet graft rejection because expression of the antigen is endothelial cell-restricted and absent on islets. Humanized mouse models may be more appropriate, as suggested by the authors. The take-home message of this interesting paper is that ABO matching is indeed likely to be important in islet allotransplantation—as is the case for HLA matching5—but may become less so if islet purification efficiency improves sufficiently or if hESC-derived islets are used. On the former point, the authors speculate that the restriction of surface expression of ABH antigens to acinar tissue (starkly illustrated by Figure 6A in the paper) provides an opportunity to enrich the purity of A, B, or AB islets by some form of negative selection. Although practicality at scale may be an issue, this is an intriguing proposition that is worthy of further consideration.

Processing Method of Gearbox with Non-Circular Gear Train and Its Application in Rice Potted Seedling Transplanting Mechanism

A non-circular gear train has the advantages of compact structure, easy to achieve dynamic balance, and is often used to drive an end-effector to achieve complex trajectory and attitude. The gearbox is the key component of non-circular gear train, which has complex structure, and requires high precision of each wheel shaft hole and its relative position. Conventional methods often use numerical control process tools to process the gearbox with non-circular gear train. The processing cost is too high, and there are some problems, such as shaft hole deflection and it can be difficult to ensure the phase position. This research has proposed a processing method of the gearbox with non-circular gear train and developed the corresponding combination tool. Taking the gearbox of a rice potted seedling transplanting mechanism as an example, a special cutting tool with five boring tools was designed which can process five holes at one clamping, and greatly improve the efficiency and accuracy of gearbox processing. The processed gearbox and other parts were assembled into a rice potted seedling transplanting mechanism and assembled into a rice potted seedling transplanting process to conduct a seedling transplanting performance experiment. The results show that the processing of the gearbox with non-circular gear train satisfies the requirement of processing accuracy, and the transplanting mechanism can accurately complete seedling picking, transporting, planting, and other series of actions. The processing method is suitable for the large-scale manufacturing of transplanting mechanism. In this research, aiming at the double arm transplanting mechanism of high-speed rice potted seedling transplanting, the gearbox was analyzed, and a processing method of the gearbox was proposed.

Generalist in allogeneic hematopoietic stem cell transplantation for MDS or AML: Epigenetic therapy.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment for patients with myeloid malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). However, relapse and graft-versus-host disease (GvHD) still affect the survival of patients who receive allo-HSCT, and more appropriate therapeutic strategies should be applied at all stages of transplantation to prevent these adverse events. The use of epigenetics agents, such as hypomethylating agents (HMAs), has been explored to decrease the risk of relapse by epigenetic modulation, which is especially effective among AML patients with poor mutations in epigenetic regulators. Furthermore, epigenetic agents have also been regarded as prophylactic methods for GvHD management without abrogating graft versus leukemia (GvL) effects. Therefore, the combination of epigenetic therapy and HSCT may optimize the transplantation process and prevent treatment failure. Existing studies have investigated the feasibility and effectiveness of using HMAs in the pretransplant, transplant and posttransplant stages among MDS and AML patients. This review examines the application of HMAs as a bridge treatment to reduce the tumor burden and the determine appropriate dose during allo-HSCT. Within this review, we also examine the efficacy and safety of HMAs alone or HMA-based strategies in posttransplant settings for MDS and AML. Finally, we provide an overview of other epigenetic candidates, which have been discussed in the nontransplant setting.

Competences of the Nurse Member of the Intrahospital Commission for Organ and Tissue Donation for Transplantation

Abstract:Introduction: Among the members that compose the Brazilian Intrahospital Commission for Organ and Tissue Donation for Transplantation (Cihdott), the nurse is the professional who has the greatest contact with potential donors and their families because of the care provided to patients in intensive care units, thus becoming a reference for the family. The nurse’s performance as a member of Cihdott has been recognized and related to the success of organ donation. Objective: To identify the competences of the nurse member of Cihdott. Methods: Descriptive study, with a qualitative approach. Nurses who had been members of Cihdott for at least six months and agreed to participate in the research were included, selected by means of the snowball technique. Semistructured interviews were conducted, and data analysis was done by thematic grouping, using Minayo’s referential. Results: Ten nurses, aged between 32 and 50 years and working at a Cihdott for 4 to 11 years, participated in the study. From the data analysis, four categories emerged: “The role of the nurse from the beginning to the end of the donation process”; “Competences and attributions of the Cihdott nurse”; “Personal qualities that influence the professional ambit”; and “Limiting factors for the nurse’s performance.” Final considerations: The nurse member of the Cihdott acts in several activities in the donation and transplantation process, among them: active search, family interview, donor maintenance, follow-up of the organ and tissue removal and transplantation process, organ packaging for transplantation, body reconstitution follow-up, and body return to the donor family, and training with the teams. Besides this, administrative and bureaucratic attributions are part of the Cihdott nurse’s routine.

Organ transplantation in Nepal: Ethical, legal, and practical issues.

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a racket of human traffickers who lure rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies.

Dynamic Parameters of Hypothermic Machine Perfusion-An Image of Initial Graft Function in Adult Kidney Transplantation?

Kidney allografts are subjected to ischemia reperfusion injury during the process of transplantation. Hypothermic machine perfusion (HMP) of deceased donor kidneys from organ procurement until transplantation is associated with a superior outcome when compared to static cold storage (SCS). Nevertheless, cold ischemia time (CIT) remains an independent risk factor for delayed graft function (DGF) in HMP-preserved kidney allografts as well. We performed a retrospective single-center study including all adult recipients who underwent deceased donor kidney-only transplantation at our center between January 2019 and December 2020. Beside the clinicopathological donor and recipient data, flow and resistance data during HMP were assessed. Short- and long-term kidney allograft outcome after end-ischemic HMP and SCS were analyzed and compared. Organ preservation consisted of either SCS (n = 88) or HMP (n = 45). There were no differences in recipient demographics and donor details between groups. CIT was significantly longer in the HMP group (16.5 [8.5–28.5] vs. 11.3 [5.4–24.1], p < 0.0001). The incidence of DGF as well as serum creatinine at discharge and at 1 year post transplant were comparable between groups. Duration of SCS prior to HMP was comparable among grafts with and without DGF. Flow rate and organ resistance at the start of HMP were significantly worse in DGF-kidney grafts (arterial flow 22.50 [18.00–48.00] vs. 51.83 [25.50–92.67] ml/min, p = 0.0256; organ resistance 123.33 [57.67–165.50] vs. 51.33 [28.17–111.50] mmHg/mL/min, p = 0.0050). Recipients with DGF had significantly worse creatinine levels at discharge (2.54 [1.08–7.64] vs. 1.67 [0.90–6.56], p < 0.0001) and at 1 year post transplant (1.80 [1.09–7.95] vs. 1.59 [0.87–7.40], p = 0.0105). In conclusion, baseline HMP parameters could be applied as a predictive tool for initial graft function, which in turn determines long-term outcome.

Locality from Hybridization to Integration: Cultural Politics and Space Production of Taiwan Mazu Temples in Mainland China

An upsurge in Taiwan-based Mazu temple buildings has been observed in China (Tianjin, Kunshan, and Xiamen, etc.) recently. This paper applies qualitative research methods, including participatory observation and semi-structured interviews, to explore the development of Mazu temples in Tianjin, Kunshan, and Xiamen, China in terms of cross-regional connectivity, materiality, and cross-regional locality, to explore the process of transplantation and construction in the mainland. This paper finds that Mazu culture is a reproduction of the vision of “one race one culture” in the cultural space, and this spatial reproduction is realized through cross-strait religious and cultural exchanges. Informed by the perspective of the political and cultural context, three interconnected dimensions—cross-regional connectivity, materiality, and cross-regional locality—have influenced why, where, and how Taiwan Mazu temples have been transplanted and constructed. This kind of hybrid locality is an integration of urban space and religion, as well as an organic, complex process that integrates religious functions, local politics, and the cultural economy. With the ingenious localization efforts of Taiwanese businessmen, these new Mazu temples promote homogenization in the sacred space and create a unique mixed locality—a more-than-state.

Using team science in vascularized composite allotransplantation to improve team and patient outcomes.

Reconstructive allografts using Vascularized Composite Allotransplantation (VCA) are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment (e.g., local culture and team values; investment of resources) influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented (e.g., communication, leadership), strategic (e.g., planning, training) and interpersonal (e.g., conflict management, trust building). Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA.

Aquaporin-1 inhibition exacerbates ischemia-reperfusion-induced lung injury in mouse

BackgroundIschemia-reperfusion injury (IRI), which involves severe inflammation and edema, is an inevitable feature of the lung transplantation process and leads to primary graft dysfunction (PGD). The activation of aquaporin 1 (AQP1) modulates fluid transport in the alveolar space. The current study investigated the role of AQP1 in ischemia-reperfusion (IR)-induced lung injury. MethodsA mouse model of lung IR was established by clamping the left lung hilar for 1 h and released for reperfusion for 24 h. The AQP1 inhibitor acetazolamide (AZA) was administered 3 days before lung ischemia with a dose of 100 mg/kg per day via gavage. Lung injury was evaluated using the ratio of wet-to-dry weight, peripheral bronchial epithelial thickness, degree of angioedema, acute lung injury score, neutrophil infiltration, and cytokine concentrations in bronchoalveolar lavage fluid. ResultsCompared with sham treatment, ischemia with no reperfusion (IR 0h) and ischemia with reperfusion for 24 h (IR 24 h) significantly upregulated AQP1 expression, increased the wet/dry weight ratio, angioedema, neutrophil infiltration and cytokine production (interleukin -6 and tumor necrosis factor -α) and thickened the peripheral bronchial epithelium. AZA exacerbated inflammation and pulmonary edema. ConclusionAQP1 may exert a protective effect against IR-induced lung injury, which could be attributed to alleviating pulmonary edema and inflammation. AQP1 upregulation might be a potential application to alleviate lung IRI and decrease the incidence of PGD.

Pediatric kidney transplant recipients with and without underlying structural kidney disease have a comparable risk of hospitalization associated with urinary tract infections

IntroductionUrinary tract infections (UTIs) are a common and potentially serious kidney transplant complication. Pediatric kidney transplants are potentially at increased risk for UTIs when structural kidney disease is the underlying end-stage kidney disease (ESKD) etiology. The objective of this manuscript is to determine if children with structural kidney disorders are more prone to UTIs post kidney transplant.Materials and methodsHospitalizations for pediatric kidney transplant recipients were retrospectively reviewed over a 4-year period for UTIs in the diagnostic codes. The patient’s age, sex, graft age, underlying diagnosis for cause of ESKD, symptoms at presentation, urinalysis results, and urine culture results were recorded. UTI rates, febrile UTI rates, and UTI rates in the 1st year post-transplant were compared between children with ESKD due to structural vs. non-structural kidney disease.ResultsOverall, 62 of 145 pediatric patients with kidney transplants accounted for 182 hospitalizations for kidney transplant complications over the 4-year study period. UTIs were components of 34% of the hospitalizations. Overall, UTI rates, febrile UTI rates, and UTI rates for the 1st year post kidney transplant were comparable for children with vs. without structural ESKD etiologies.ConclusionUrinary tract infections are frequent components of hospitalizations for pediatric kidney transplant recipients. Children with and without structural kidney disease as an ESKD etiology have similar UTI rates indicating that UTI susceptibility is primarily due to the transplant process and/or medication regimens. UTIs represent a potentially modifiable risk factor for pediatric kidney transplant complications.

422.11: Instant Post-reperfusion Thromboinflammation in Clinical Kidney Transplantation and Its Possible Impact on Outcome

Introduction: During the process of transplantation, detrimental events such as ischemia inflict harm to, and change the cell phenotype of organs, which increases the susceptibility to an early innate immune attack post-reperfusion. Here, we present data on a detailed systematic characterization of this early response post-reperfusion and its possible impact on outcome after kidney transplantation. Method: Sixty-three consecutive kidney transplant recipients were included. Twenty-six (41%) and 37 (59%) patients received kidneys from living (LD) and deceased donors (DD), respectively. Fifteen DD-kidneys (41%) were preserved with hypothermic machine perfusion (DDmp) and 22 (59%) were preserved in cold storage (DDcs). Four venous EDTA blood samples were collected intra-operatively at baseline (pre-reperfusion from the external iliac vein) and at 1-, 10- and 30-minutes post-reperfusion from the proximal portion of the transplant vein. Samples were handled according to a meticulous and standardized routine including immediate and sustained cooling with subsequent storage of plasma samples at -80 °C. Biomarkers for the complement, coagulation and contact cascade systems were measured. Clinical outcome data for a total of 24 months were collected. Non-parametric analysis of variances on aligned rank transformed data and receiver operating characteristics (ROC) analyses were used. Results: Patient and graft survival did not differ between DD and LD by 24 months. There were no differences in donor age/BMI between LD and DD recipients. The median kidney-donor-risk-index did not differ between DDcs and DDmp (1.56 vs 1.5). Median cold ischemic times in DDcs and DDmp were 11.4 and 13 hours, respectively. Overall, 6 patients (9.5%, all DD-recipients) experienced delayed graft function (DGF). Thromboinflammation, defined as co-activation of complement (sC5b-9), coagulation (FXIa, thrombin) and contact (FXIIa, KK) cascade systems, was detected instantly post-reperfusion in DD-kidneys (predominantly in DDcs), while being largely absent in LD-kidneys. Analyzing the slopes for serum-creatinine and eGFR between 3 to 24 months post-transplant, the release of sC5b-9 at 30 min post-reperfusion correlated with a higher serum-creatinine and lower GFR slope in DDcs, but not in LD and DDmp. Thrombin, sC5b-9, FXIa and FXIIa were predictive for DGF, de novo DSA and rejection. Conclusion: Instant post-reperfusion thromboinflammation (IPRT) occurs in DD-kidneys exposed to ischemia, while being largely absent in LD-kidneys. This early innate immune response may be associated with impaired mid-term graft function, even in the current population with a low burden of ischemia. Furthermore, markers of IPRT were predictive for outcome measures such as DGF and rejection. Lastly, hypothermic machine perfusion seems to reduce IPRT.

235.3: Allograft Vasculopathy in Kidney Transplant Patients: Clinical and Histological Associated Factors

Introduction: Allograft vasculopathy (AV) defined by arterial intimal fibrosis with mononuclear cell inflammation in fibrosis and formation of neointima is one of the main limiting factors in renal graft survival. The etiopathogenesis is multifactorial, including immune mediated mechanism (chronic active or chronic ABMR or mixed ABMR/TCMR), inmune independent factors (e.g.,donnor age) and the endothelial to mesenchymal transition (ETM).The aim of this study is to evaluate the presence of transplant vasculopathy in kidney transplant biopsies, and the risk factors associated. Methods: This retrospective study included 400 allograft biopsies for cause in 294 kidney transplant recipient from 2014 to 2018. All biopsies, with and without transplant vasculopathy, donor, recipient and transplant variables were analyzed. We classified the biopsies in Early (< 3 months) and late(> 3 months).Clinical variables of the recipient were analyzed: age, antiHLA sensitization; from the donor: age, alive -deceased; optimal-marginal and transplant process: TIF, mismatch, delayed graft function (DGF); histological features: rejections, microcirculation injury, C4d. Statistical analysis: Categorical variables are reported as percentages and continuous variables as mean ± standard deviation, median or interquartile range, according to distribution. Chi square test was used to compare categorical variables and T test for continuous variables. Logistic regression models were applied to determine the association of clinical and histological factors with vasculopathy. Odds ratios (OR) with 95% CI were estimated. A p <0.05 was considered significant. The statistical package Medcalc 3.0 was used. Results: Transplant vasculopathy was found in 51,7 % (207/400) sample biopsies, 40% in the early and 60 % in the late transplant biopsies. Recipient age 46(18-76) years, 57 % men, 11,1 % sensitized and 12,2 % hypersensitized. 19,3 % had unacceptable antigens and 16,6%(49/294) developed DSA. All patients received induction and triple immunosuppression therapy. Donor age was 46 (10-73) years, 51 % males, 54,4 % deceased donors and 16, 6%(49) met expanded criteria. Mean Ischemic time was 16,7 ± hours, MM 3.5(1.4), DGF 62,3 %. Vasculopathy in early biopsies was associated with ABMR in patients with DSA. In univariate analysis transplant vasculopathy was correlated with male recipient gender (p=0,0354), staining c4d +(p=0,029) and chronic glomerulopathy (p=0,0116). Late vasculopathy was associated with c4d + p=0,0048; MVI p=0,0018; late rejection p<0.0001 and cellular rejection p=0.03. In multivariate analysis recipient gender (p=0,04) and time of rejection(p=0,03) were statistically significant. Conclusion: Transplant vasculopathy was correlated with male recipient gender, staining c4d +, and chronic glomerulopathy. Late vasculopathy was associated with c4d +, MVI, late and cellular rejection.

P11.26: Serological Profile of Donors in Argentina

Introduction: The infectological profile of donors is the beginning of the infectological traceability of the donation and transplant process. Complementary studies are positioned as a transcendent source of information, along with clinical examination, especially when the history of donors is unknown. The knowledge of these data allows us to implement various strategies aimed at the quality of care of the recipients and on the other hand allows us to carry out an epidemiological surveillance of the microorganisms prevalent in the different regions of our country. We present the serological profile of donors in Argentina during the period 2017-2021 Methodology: Descriptive and retrospective study. The donation processes initiated during the period 2017-2021, registered in SINTRA, were selected. The presence of complete serological studies was considered as an inclusion criterion. The serological memory variables for viruses (HIV, HTLV, CMV, HBV, HCV), bacteria (Treponema pallidum, genus Brucella) and parasites (Trypanosoma cruzi, Toxoplasma gondii) of donors in Argentina during the period were analyzed. Results: The processes initiated in the period 2017-2021 were 18242. The processes that documented complete serological studies were 5889. 85.3% of the donors, during the period analyzed, were from 9 jurisdictions (Buenos Aires, CABA, Santa Fe, Córdoba, Mendoza, Tucumán, Misiones, Entre Ríos and Santiago del Estero). 14.7% corresponds to the rest of the country. From the serological analysis of the donors of the 9 jurisdictions mentioned, cytomegalovirus (89.7%) and Toxoplasma gondii (45.15%) were observed as prevalent serology. We identified 0.31% of reactive serologies for HIV, 0.23% for HTLV, 0.95% for HCV and 2.74% for Treponema pallidum. In reference to hepatitis B markers, 1.47% of donors presented isolated Ac HBc, the Ac HBc + Ag HBs association was observed in 0.13% and the Ac HBc + Ac HBs association in 2.2%. 1.07% of donors were reactive for Huddleson reaction. 2.94% presented at least 2 reactive serologies for Chagas disease. Conclusions: The epidemiological surveillance of donors makes it possible to consider possible modifications in the infectological recommendations of the selection of the donor and the follow-up of the recipient.

348.4: An Analysis of Institutional Communication Strategy To the Increased Social Media Demands in Transplantation in Argentina

Introduction: For more than a decade, the Central National Institute for Ablation and Implant (INCUCAI, Argentina) has been using social networks to communicate with the community. The availability of affordable communication devices such as smartphones connected to the internet favored the use of social networks. Regarding donation and transplantation, social networks are used to share information but also to consult issues related to the demands of transplant recipients, people on the waiting list and their relatives, family members of donors and members of the community to connect with each other, collect news and information, but also create and share content. Among the social networks used by the INCUCAI, Instagram is the one that has experienced the greatest growth in recent years. The aim of this study was to analyze the inquiries and comments of Instagram users to our Institution and the performance of our Institution in meeting the demands of social network users. Methods: We carried out a quantitative and qualitative analysis of the comments made by Instagram users to our publications, as well as the private messages sent and the responses made by our institution between January 1st and December 31st, 2021. The analyzed parameters included the total number of comments; the comments that required some type of official responses from our Institution; the type of inquiries, i.e., requests for information or complaints. Results: During the year 2021, a total of 3,877 comments (in publications and private messages) were registered on the INCUCAI institutional Instagram network. Of the total comments, 871 (22%) required some type of institutional response. The qualitative analysis of the comments that required an institutional response showed that 679 comments (78%) requested information, while the remaining 192 (22%) corresponded to complaints. The analysis of the requested information was as follows: 423 (48.5%) were queries from patients in the transplant registration process, on the transplant waiting list, as well as transplant patients or their relatives; 163 (18.7%) were inquiries about organ and tissue donation and information about the donor registration process; 267 (30.6%) were queries about hematopoietic stem cell transplantation and queries about the registration process in the bone marrow registry; 18 (2%) corresponded to contacts made by relatives of donors. It is important to mention that of the total number of comments that required an institutional response, 687 (81.9%) were answered in less than 48 hours. Conclusion: The analysis of the data confirms that a significant number of people use social networks to demand an institutional response. Most of the consultations correspond to the needs of the patients (transplanted and on the waiting list). Proper use of social networks by institutions linked to the donation and transplantation process probably requires quick responses to queries, this being a priority for INCUCAI.

P8.129: Description of the Process of Inclusion and Kidney Transplantation Waiting List - Uruguay

Introduction: In Uruguay with 3,286,314 inhabitants (2011 census), renal transplantation is performed in 3 transplant centers, is regulated by the Instituto Nacional de Donación y Trasplante (INDT) and financed by the Fondo Nacional de Recursos. The allocation is made on a national algorithm and it is an INDT´s responsibity. In the last 5 years, including the Health Emergency, an average of 139 kidney transplants were performed per year. The average rate for these 5 years of renal transplantation is 42.33 pmp. Objective: Describe the renal waiting list (WL) admission process and the recipient population. Methods: The study algorithm for admission to the WL include: □ABO and Rh blood group typing. □HLA typing by PCR-SSO (Luminex) for A, B, C, DRB1, DQA1 and DQB1 locus. □HLA antibody screening (Luminex), class I and/or II. If positive, a specificity search is performed. □Search for autoantibodies by microlymphocytotoxicity technique (MLCT). □Patient’s serum is preserved (serum collection). □PRA (wall reactive antibodies) by MLCT, defining hyperimmunized PRA>80%. During the period in WL the following procedures are performed: □serum collection update every 3 months or after sensitizing events. Failure to comply with this requirement excludes recipients from the allocation. □HLA antibody screening and specificity analysis are performed annually and PRA every six months. Results: There are currently 434 patients in the WL, including one vascular emergency. Distribution - by age: 1.8% <18 years old, 85% 18-64 years old and 13.2%>65 years old; by sex: 43.8% female, 56.2% male. Blood group distribution: 54% are 0.35% A, 8% B and 2% AB. The highest immunological risk group: 18%, who aspire to be retransplanted, 1.4% hyperimmunized. There are 26.5% with positive HLA antibody screening, see table and distribution in graphs. Conclusions: A single national protocol is applied at the inclusion on the WL. In the renal WL, the adult population (18 to 65 years old), blood group 0, with a male/female ratio of 1.3 prevails. The immune risk group does not present significant changes with respect to previous evaluations. The prevalence of sensitized to both classes and hyperimmunized is maintained.