xxxxxxx

xxxxx

xxxxxxx

E-Poster NumberTHE SHORTAGE OF DONOR FOR INTESTINAL AND

MULTIVISCERAL TRANSPLANTATION IN BRAZILGuilherme M. Andrade1 , Igor L. Calil1, Andre ZA Leite1, Luis Marcelo S. Malbouisson1, Gustavo Saliba1, Liliana Ducatti1, Rafael Pinheiro1, Vinicius Rocha1, Rodrigo Bronze1, Wellington Andraus1, Wangles Soler1, Luciana Haddad1, Lucas Nacif1, Carlos Pantanali1, Rafael Pecora1, Andre David1, Flávio Galvão1, Luiz Augusto D'Albuquerque1.1Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

INTRODUCTION In 2013 the Intestinal and multivisceral transplantation (IMT) program was started in Hospital das Clinicas-USP, São Paulo - Brazil. Since then, only two multivisceral transplants were effectively performed, specially due to donor shortage, a common problem faced worldwide. Furthermore, IMT candidates compete with recipients from liver and pancreas transplantation. São Paulo state has an estimated population of 44 million people, 15 million of those living in the capital, São Paulo city. The state encloses two transplantation centers and 9 OPOs. Despite the almost doubling in the annual liver transplant numbers in the last 10 years and improvement in notification, donor care and organ procurement, indicators regarding donor profile and IMT viability (such as donor-recipient size and blood group match, ICU stay, etc) are still lacking.

OBJECTIVES We aimed to analyze the epidemiological profile of potential donors based on the organs offered by the regional Organ Procurement Organization from Hospital das Clinicas-USP (OPO/HC-USP), and try to estimate possible matches and program viability.

E-poster Number  225

MATERIALS AND METHODS Retrospectively analyzed information from the OPO/HC-FMUSP database regarding organs offered between january-2007 and december-2014, as well as from listed patients in the IMT program. Data regarding donor description profile (sex, age, race, BMI, blood type, cause of death), along with medical care details (ICU stay, use of vasopressors, antibiotics) and lab values were extracted and plotted for analyzes in Microsoft Excel.

RESULTSIn this time period there were 18.103 brain death notifications in the state of São Paulo, 5.202 (35%) becoming viable donors, resulting in 5.201(99%) effectively used livers. From the OPO/HC-FMUSP the numbers were 2.918, 1.063(36,4%) and 991(93%), respectively. Most potential donors were males, on their forties, from Caucasian origin, and had blood type O. Based on size criteria (<20% of body weight), there would´ve been potentially 11,8 donors/year for the smallest IMT patient and 6,2 donors/year for the heaviest one from OPO/HC-USP.However, only three potential donors would have reached the established minimum combined criteria for IMT donation during these 7 years.

CONCLUSIONS Despite public efforts to increase organ donation in Brazil, the characteristics of donors are unsatisfactory for the IMT demand. Meanwhile, one should concentrate efforts on overcoming difficulties in obtaining convenient donors as well as improving intestinal rehabilitation, and possibly consider surgical alternatives, such as bowel-graft shortening techniques.

REFERENCES

DONOR CHARACTERISTICS  Age - min-max (median) - years 0,2-83 (46)Male gender - no (%) 627 (59)Race – no (%)

CaucasianPardo

African-AmericanYellow

 555 (52)360 (34)134 (13)

14 (1)

Weight min-max (median) - Kg 7 – 180 (75)Height - min-max (median) - cm 50 – 195 (168)BMI – median – kg/m2 26Blood type – no (%)

OAB

AB

 508 (48)384 (37)125 (12)

34 (3)

Plasma sodium – min-max (median) - mEq/dL

111-219 (153)

Use of pressors – no (%)Norepinephrine – median dose*

Dobutamine – median dose* Dopamine – median dose‡

909 (94)880 (95) – 0,28

26 (3) – 569 (7) – 5,19

ICU length stay – median - days 4

Table 1 – general characteristics and epidemiological profile of potential donors from 2007 to 2014.

* mcg/Kg/min

EXCLUSION CRITERIA OPO/HC-USP Mazariegos3

Age > 50 years - % 38 32Anti-HCV (+) - % 0,12 27Anti-HBc (+) - % 8 1,0AST or ALT>500 - % 2,6 1,4Sodium > 170mEq/dL – % 13,4 0,2More than 2 vasopressors - % 4 1,2Creatinine >2mg/dL - % 27,2 5,2

Table 2 – comparison between the OPO/HC-FMUSP potential donor population and those from Mazariegos et al3, according to traditional exclusion criteria for IMT

SIZE-MATCH DONOR RECIPIENTWeight mean ± SD - Kg 73 ± 18,1 59,8 ± 6,19Height - mean ± SD – cm

170 ± 20 166 ± 11

IMC – mean ± SD – kg/m2

26,1 ± 4,7 21,7 ± 3,8

Table 3 – comparison of possible matches between patients listed in tje IMT program and potential donors from 2007 to 2014.

1. Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). IBGE. www.ibge.gov.br. Accessed May 2, 2015.2. Associação Brasileira de Transplante de Órgãos (Brazilian Organ Transplant Association). 2014. www.abto.org.br. Accessed May 2, 2015.3. Mazariegos G V, Steffick DE, Horslen S, et al. Intestine transplantation in the United States, 1999-2008. Am J Transplant. 2010;10(4 Pt 2):1020-1034. 4. Fischer-Fröhlich C-L, Königsrainer A, Schaffer R, et al. Organ donation: when should we consider intestinal donation. Transpl Int. 2012;25(12):1229-1240.