Trasplante renal de donante vivo. Análisis de situación y hoja de ruta
- María de la Oliva Valentín 1
- Domingo Hernández 2
- Marta Crespo 3
- Beatriz Mahillo 1
- Isabel Beneyto 4
- Itziar Martínez 1
- Julia Kanter 4
- Elena Calderari 1
- Salvador Gil-Vernet 6
- Sara Sánchez 1
- Maria Luisa Agüera 7
- Gabriel Bernal 8
- Carlos de Santiago 9
- Carmen Díaz-Corte 10
- Cándido Díaz 11
- Laura Espinosa 12
- Carme Facundo 13
- Milagros Fernández-Lucas 14
- Tamara Ferreiro 15
- Gorka García-Erauzkin 16
- Teresa García-Alvarez 17
- Pilar Fraile 18
- Ana González-Rinne 19
- María José González-Soriano 20
- Esther González 21
- Alex Gutiérrez-Dalmau 22
- Carlos Jiménez 23
- Ricardo Lauzurica 24
- Inmaculada Lorenzo 25
- Paloma L. Martín-Moreno 26
- Francesc Moreso 27
- María Carmen de Gracia 28
- Isabel Pérez-Flores 29
- Ana Ramos-Verde 30
- Ignacio Revuelta 31
- María Luisa Rodríguez-Ferrero 32
- Juan Carlos Ruiz 33
- Beatriz Domínguez-Gil
- Beatriz Sánchez-Sobrino 134
- Show all authors +
- 1 Organización Nacional de Trasplantes, Madrid, España
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2
Hospital Regional Universitario de Málaga
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Hospital del Mar
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Hospital Universitario La Fe
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Hospital Universitario Doctor Peset
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Hospital Universitari de Bellvitge
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Hospital Universitario Reina Sofia
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- 8 H.U. Virgen del Rocío, Valencia, España
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Hospital General Universitario de Alicante
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Hospital Universitario Central de Asturias
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- 11 H. Clínico U. de Santiago, Santiago de Compostela, España
- 12 H.U. La Paz infantil, Madrid, España
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Fundacio Puigvert
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Hospital Ramón y Cajal
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Complexo Hospitalario Universitario da Coruña
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Hospital de Cruces
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Hospital Universitario Puerta del Mar
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Hospital Universitario de Salamanca
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- 19 H.U. de Canarias, La Laguna (Tenerife), España
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Hospital Virgen de la Arrixaca
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Hospital Universitario 12 de Octubre
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Hospital Miguel Servet
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Hospital Universitario La Paz
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Hospital Universitari Germans Trias i Pujol
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- 25 H. General U. de Albacete, Albacete, España
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Clínica Universitaria de Navarra
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Hospital Vall d'Hebron
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Hospital Universitario Virgen de las Nieves
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Hospital Clínico San Carlos de Madrid
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Fundación Jiménez Díaz
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Hospital Clinic Barcelona
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Hospital General Universitario Gregorio Marañón
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Hospital Universitario Marqués de Valdecilla
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Hospital Universitario Puerta de Hierro
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ISSN: 0211-6995, 1989-2284
Year of publication: 2021
Type: Article
More publications in: Nefrología
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years.One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams.Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors.Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT).A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire.The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level.The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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