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Biomedical subjects

E A Santiago-Delpin

Publications and source records attributed to E A Santiago-Delpin.

At least 19 recordsLinked to original sources
PubMed2005

A marked increase in organ donation in Puerto Rico.

During its first years of existence, the Puerto Rico Transplant Program barely reached 18 to 20 renal transplants per year. A brain death amendment to the law improved the numbers but only to a stable thirty/year. Polls and studies showed that, although people knew about transplantation and expressed willingness to donate, the powerful emotional grief reaction, as well as a peculiar decision-making process, all militated against effective donation. In 1995, LifeLink of Puerto Rico was created as part of the very successful LifeLink Foundation of Tampa, staffed by local professionals. Cadaveric donation increased exponentially by 1227% and in 2004, 22.4 donors per million population were recovered, up from 1.5, one of the steepest growth curves in the United States. As a result, kidney transplantation increased, a cardiac transplant program was inaugurated, a pancreas transplant program has started, and liver will follow. The success is the result of well-trained, culturally sensitive coordinators and requestors; continuous education to the public, hospitals, administrators, neurospecialists, and critical care units; hospital development; implementation of federal law; and a sensitive approach the deceased donor family, and not only to the waiting list patients. The results demonstrate that organizational and educational factors can override cultural obstacles.

Brain Death↗
PubMed2003

Organ transplants in Latin America.

Latin America has carried out kidney transplantation for 45 years. Twenty-four countries perform kidney transplantations, 14 perform heart transplantations, 12 perform liver transplantations, 9 perform pancreas transplantations, and, 2 perform small bowel transplantations. Seventeen countries have nephrology societies, 10 have transplantation societies, and 10 have national transplant organizations. The potential donor rate, 40 to 100 per million population per year (pmp/y), is similar to that observed in developed countries, but the rate of potential notified donors is 5 to 25 pmp/y, and the rate of effective donors is lower, 2 to 12 pmp/y. Approximately 77,000 transplantations were performed in the region until 2001, 70,000 kidney transplantations, 4000 liver transplantations, and 2500 heart transplantations. The annual number of kidney transplantations in Latin America increased from less than 3000 in 1991 to almost 7000 in 2001. Latin America, with only 8.5% of the world population, performed 12.7% of the kidney transplantations. Future strategies to improve the transplantation situation in Latin America include the following: obtain financial coverage for all the population, establish a National Transplant Organization and registries with transplantation results, and improve cadaveric and living donation to 10 pmp/y each.

Animals↗
PubMed1999

Correlates of support for organ donation among three ethnic groups.

Telephone interviews about organ donation were conducted with 4880 white respondents, 634 African-American respondents and 566 Hispanic respondents. Forty-three percent (42.9%) of whites, 31.2% of Hispanics and 22.6% of African-Americans reported that they were willing to donate their organs after their death (p < 0.001). Logistic regression analysis revealed three significant correlates of willingness to donate across all ethnic groups: having had a family discussion about end-of-life issues; the belief that a doctor does all he or she can to save a life before pursuing donation; and concerns about surgical 'disfigurement' of a relative's body after donation. Concerns in relation to body disfigurement were more prevalent among African-American and Hispanic respondents (p < 0.001) than among white respondents. Public education should: a) stress the need for family communication about end-of-life issues including organ donation; b) underline the fact that donation is considered only after all efforts to save the life of the patient are exhausted; and c) reassure minorities that the body of the donor is treated respectfully and not disfigured.

Adult↗
PubMed1995

Cold ischemia and outcome in 17,937 cadaveric kidney transplants.

To determine if cold preservation time continues to affect renal transplant outcome, prospectively collected data from 17,937 cadaveric renal transplants performed between 1982 and 1991 were analyzed. Cold preservation intervals of 1-16, 16-32, 32-48, and greater than 48 hr were studied by multi- and univariate methods for two time periods: 1982-1989 (n = 13,800) and 1990-1991 (n = 4137). The functional one-year graft survival for kidneys stored over different intervals was significantly different (P < 0.001) only for the 1982-1989 epoch: one-year allograft survival ranged from 76% (1-16), to 72% (16-32 and 32-48) to 74% (> 48) hr. One-year graft survival ranged from 81 to 83% for the four preservation times in 1990 through 1991 (P = NS). Overall actuarial graft survival was 76% (74% prior to 1990, and 82% after 1990). Factors significantly (P < 0.0001) affecting kidney transplant outcome before and after 1990 were delayed graft function (DGF): n = 4232, 65% one-year graft survival; retransplant status: n = 3029, 67% one-year graft survival; and HLA match at three or more loci: n = 6067, 79% one-year graft survival. While DGF occurred more often with prolonged preservation, kidneys with DGF had similar survival regardless of preservation duration. Before 1990, pretransplant transfusion was associated with better and black recipient race with worse outcome; neither transfusion nor recipient race had any effect after 1990. Patients receiving kidneys preserved for longer periods demonstrate one-year graft survival comparable to kidneys preserved for shorter periods. Prolonged cold ischemic time should no longer be a principal reason for considering organ discard.

Analysis of Variance↗
PubMed1986

HLA and tropical sprue.

In 27 Puerto Rican patients with tropical sprue proven by intestinal biopsy and clinical response to folic acid, HLA type was determined with a microcytotoxicity assay. 25 of these patients had at least one antigen of the Aw-19 series (p = 10(-10)). The strongest association was with Aw-31, for which the relative risk was 10.6 (p = 1.2 X 10(-6)). The absence of a B-locus or haplotype effect suggests a marker association only, rather than an immune association.

Disease Susceptibility↗
PubMed1986

Low incidence of urologic complications after renal transplantation.

The incidence of urologic complications after renal transplantation has been reported to range from less than 1 to 10 percent. They are still a significant source of morbidity and mortality. We report on 111 kidney transplants performed at the San Juan Veterans Administration Hospital in 85 of whom urinary continuity was restored with a Politano-Lead-better ureteroneocystostomy, 23 with the Lich-Grégoir operation, and 3 with extravesical urinary, diversions. Important factors included meticulous attention to details during ureter manipulation, the use of prophylactic antibiotics, unabsorbable sutures in the closure of the muscular part of the bladder wall and infrequent use of drains. This resulted in a low rate of complications which included early ureteral obstruction (3.6 percent), late ureteral obstruction (1.8 percent), lithiasis (1.8 percent), urinary extravasation (0.9 percent), and ureteropelvic necrosis. No kidneys or patients were lost to technical complications, and no deep wound infections were observed. Our experience demonstrates the beneficial effects of a low complication rate on patient and graft loss.

Adolescent↗
PubMed1983

Pretransplant predictors in renal transplantation.

We have prospectively studied the predictive value of three tests commonly used in transplant units (mixed lymphocyte culture, phytohemagglutinin-induced transformation, and skin testing with recall antigens), and their correlation with rejection and kidney loss. Thirty-five transplant recipients provided complete data for analysis. The results of mixed lymphocyte culture reactivity, phytohemagglutinin-induced transformation, and skin reactivity to recall antigens were similar and did not predict or discriminate between the patients that had few or many rejections, nor between those that kept or lost their allografts. Nonetheless, patients with a very high mixed lymphocyte culture stimulation index (above 3) had higher morbidity and mortality than those with a nonreactive mixed lymphocyte culture. Pretransplant mixed lymphocyte culture may give more important information than nonspecific immunologic tests regarding allograft outcome.

Evaluation Studies as Topic↗