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Antifungal prophylaxis is recommended for hematopoietic stem cell transplantation (HSCT) to decrease the incidence of invasive fungal infections (IFI). This study aimed to compare the two groups of antifungal prophylaxis in pediatric patients undergoing allogeneic HSCT.This observational, analytic, retrospective cohort study compared the incidence of IFI with antifungal prophylaxis with voriconazole vs. other antifungals in the first 100 days after allogeneic HSCT in patients aged18 years between 2012 and 2018. The statistical analysis included univariate and multivariate analyses and determination of the cumulative incidence of invasive fungal infection by the Kaplan‒Meier method using STATA 14 statistical software.A total of 139 allogeneic HSCT were performed. The principal diagnosis was acute leukemia (63%). The 75% had haploidentical donors, and 50% used an antifungal in the month before transplantation. Voriconazole (69%) was the most frequently administered antifungal prophylaxis. The cumulative incidence of IFI was 5% (7 cases). Of the patients with IFIs, four began prophylaxis with voriconazole, one with caspofungin, and one with fluconazole. Additionally, six were possible cases, one was proven (There were no differences in the incidence of IFI between patients who received prophylaxis with voriconazole and other antifungal agents.

Background Haploidentical stem cell transplantation (haplo‐SCT) is an option for patients without human leukocyte antigen‐matched related or unrelated donor. Post-transplantation cyclophosphamide (PTCy) is an effective method of graft versus host disease (GVHD) prophylaxis and permits the use of T‐cell replete grafts in settings were ex vivo manipulation is not feasible. Methods A retrospective study among patients younger than 18 years, with a history of hematologic malignancies who underwent haplo-SCT between 2012 and 2016. All patients received a preparative regimen of fludarabine, busulfan, and 400 cGy total body irradiation or melphalan. Post-transplant GvHD prophylaxis consisted either of PTCy (50 mg/kg on Days + 3 and + 4) and cyclosporine (CSA) plus mycophenolate (MMF) (15 mg/kg/dose, thrice daily, per os), or mini-dose methotrexate (MTX; 5 mg/m2 dose) on Days + 5, +7, +10, and + 15. Results A total of 52 children were included, whose median age was 9 years (interquartile range, 4.9–14; range, 1.2–17 years), and 63% were males. The most common complications were cytomegalovirus reactivation (57%) and hemorrhagic cystitis (36%). The acute GVHD prophylaxis was PTCy, CSA, and mini-dose MTX in 42 (81%) patients, and 10 (19%) patients received PTCy, CSA, and MMF. The cumulative incidence of acute GvHD II–IV, acute GvHD III–IV, and chronic GvHD were 42%, 8.5%, and 19%, respectively. Grades I–IV acute GvHD occurred in 100% of the patients who received prophylaxis with CSA and MMF, and 62% who received CSA and mini-dose MTX (p = .055). The transplant-related mortality at 100 days was 18%. The 5-year overall and event-free survival were 59% and 57%, respectively. Conclusions Haplo‐SCT with PT/Cy can be an available, safe, and feasible option for children with hematologic malignancies; meanwhile, the use of mini-dose of MTX was associated with lower rates of acute GVHD. However, our results require further support from prospective randomized studies to improve the efficacy of this prophylactic strategy.

To characterize the pediatric population with inborn errors of immunity (IEI) that was treated with hematopoietic stem cell transplantation (HSCT) in three reference centers in Colombia. What have been the characteristics and outcomes of hematopoietic stem cell transplantation in pediatric patients with inborn errors of immunity in three reference care centers in Colombia between 2007 and 2018? We conducted an observational, retrospective cohort study in children with a diagnosis of IEI who underwent HSCT between 2007 and 2018. Forty-seven patients were identified, and 5 were re-transplanted. Sixty-eight percent were male. The median age at diagnosis was 0.6 years, and for HSCT was 1.4 years. The most common diseases were chronic granulomatous disease (38%) followed by severe combined immune deficiencies (19%) and hemophagocytic lymphohistiocytosis (15%). Cord blood donors were the most used source of HSCT (44%). T cell–replete grafts from haploidentical donors using post-transplantation cyclophosphamide represent 37% of the cohort. All patients received conditioning, 62% with a non-myeloablative regimen. Calcineurin inhibitors were the main graft-versus-host disease prophylaxis (63.8%). Acute graft-versus-host disease developed in 35% of the total patients. The most frequent post-transplant infections were viral and fungal infections. The 1-year overall survival rates for the patients who received HSCT from identical, haploidentical, and cord sources were 80%, 72%, and 63%, respectively. The 5-year overall survival was 63%. HSCT is a curative treatment option for some IEI and can be performed with any donor type. Early and timely treatment in referral centers can improve survival.

Resumen: Introducción: en el trasplante cardiaco la sobrevida es del 81 al 85% en el primer año; las infecciones y la falla del injerto son las principales causas de mortalidad. Objetivo: determinar los factores de riesgo asociados a mortalidad al año postrasplante cardiaco en un hospital de alta complejidad del suroccidente colombiano. Métodos: cohorte retrospectiva de pacientes con trasplante de corazón llevado a cabo entre 1996 a 2015. Se obtuvo la información de las características del donante, receptor y procedimiento quirúrgico. Se realizó una regresión de Cox; el evento de interés fue la mortalidad al primer año de seguimiento. En el análisis multivariable se incluyeron variables con p ≤ 0,20 y significancia clínica. Resultados: se incluyeron 158 pacientes, con mediana de edad de 50 años (RIC: 39-57), 76% hombres. La principal etiología de falla cardiaca fue idiopática (45%). La mediana de tiempo de isquemia fue 187 minutos (RIC: 142-300). La mortalidad fue 24%, y se atribuyó principalmente a infecciones (29%). Fueron factores asociados a mortalidad la cardiopatía congénita como etiología de falla cardíaca (p 0,048), antecedente de diabetes mellitus (p 0,001), cirugía cardiaca previa (p 0,023) tiempo de isquemia mayor a 150 minutos (p 0,038) y relación receptor hombre/donante mujer (p 0,022). Conclusiones: los factores asociados a mayor mortalidad en el primer año postrasplante cardiaco fueron: etiología de la falla cardíaca por cardiopatía congénita, antecedente de diabetes mellitus, cirugía cardiaca previa, relación receptor hombre con donante mujer, tiempo de isquemia mayor a 150 minutos. Abstract: Introduction: The survival rate in the first year after heart transplant is between 81% and 85%. The main causes of mortality are infections and failure of the graft. Objective: To determine the risk factors associated with mortality at one year post- cardiac transplant in a high complexity hospital in south-west Colombia. Methods: A retrospective cohort study was performed on patients with a heart transplant carried out between 1996 and 2015. Information was obtained on the characteristics of the donor, recipient, and surgical procedure. A Cox regression was performed, with the event of interest being mortality in the first year of follow-up. In the multivariate analysis, variables were included that had a P≤ .20 and clinical significance. Results: The study included a total of 158 patients, with a median age of 50 years (IQR: 39-57), of whom 76% were males. The most common origin was idiopathic heart failure (45%). The median time of ischaemia was 187 minutes (IQR: 142-300). The mortality was 24% and was mainly due to infections (29%). There were factors associated with the congenital heart failure mortality such as origin of heart failure (P = .048), history of diabetes mellitus (P = .001), previous cardiac surgery (P = .023), ischaemia time greater than 150 minutes (P = .038), and the male recipient / female donor ratio (P = .022). Conclusions: The factors associated with higher mortality in the first year post-cardiac transplant were: origin of heart failure due to congenital heart disease, history of diabetes mellitus, previous cardiac surgery, the male recipient / female donor ratio, and an ischaemia time greater than 150 minutes.

Cytomegalovirus infection represents a significant cause of morbidity and mortality after hematopoietic stem cell transplantation. This study aimed to evaluate the incidence of viremia and disease due to cytomegalovirus and the risk factors in pediatric patients with hematopoietic stem cell transplantation in our institution.This was a retrospective cohort of patients under 19 years of age who underwent allogeneic hematopoietic stem cell transplantation due to any indication between 2012 and 2019. The analysis included the diagnosis of cytomegalovirus viremia or disease during post-transplant follow-up, evaluation of risk factors, and outcomes. The statistical analysis included univariate and multivariate analyses, and the cumulative incidence of cytomegalovirus viremia was determined by the Kaplan-Meier method using STATA 14 statistical software.A total of 182 transplants were included. At 100 days, the cumulative incidence of cytomegalovirus viremia was 70.5%, and that of cytomegalovirus disease was 4.7%. Overall survival at 2 years was 74%, and event-free survival was 64%. The remaining demographic characteristics were not predictors of infection. There was no association between viremia and relapse or survival of the patients. Higher mortality was noted in cytomegalovirus disease.During the study period, the incidence of cytomegalovirus disease was similar to that of other pediatric reports, but the incidence of viremia was higher. Pre-emptive therapy has diminished disease rates and death due to infection. Viral load cutoff points should be standardized to guide treatment and avoid myelotoxicity.

Introduction: Hematopoietic stem cell transplantation is the curative option for some diseases and is increasing patient survival. The health-related quality of life in these patients is not systematically evaluated. Objectives: The present study sought to describe the health-related quality of life and complications in children who underwent hematopoietic stem cell transplantation. Materials and methods: A cross-sectional study was conducted on pediatric transplanted survivors. Health-related quality of life was measured using the KIDSCREEN-27 scale and Short Form-12 (SF-12) in patients between 8 and 14 years of age and those over 14 years, respectively. Statistical analysis was performed using STATA 12 software. We used the Rasch model person parameter estimates translated into T-values to score the questionnaire. Results: A total of 42 children answered the questionnaires. The most frequent adverse events were chronic graft Vs. host disease and endocrine complications. According to European norm data in the KIDSCREEN-12 scale, scores for the school dimension and social and peer support were below the 50th. percentile. The group administered immunosuppressants had lower scores on the physical component of the SF-12™ scale. Conclusions: In general, the KIDSCREEN-27 does appear to suggest some quality-of-life deficit in younger children. The scales showed reliability in this population.Introducción. El trasplante de células madre hematopoyéticas es la opción curativa para algunas enfermedades y está aumentando el tiempo de supervivencia de los pacientes. La calidad de vida relacionada con la salud en estos pacientes no se evalúa de manera sistemática. Objetivos. Describir la calidad de vida relacionada con la salud y las complicaciones en niños con trasplante de células madre hematopoyéticas. Materiales y métodos. Es un estudio transversal en pacientes pediátricos sobrevivientes al trasplante. Se midió la calidad de vida relacionada con la salud, utilizando el cuestionario KIDSCREEN-27 en pacientes entre 8 y 14 años y la SF-12™ (Short Form-12) en pacientes mayores de 14 años. El análisis estadístico se realizó en el software Stata 12. Utilizamos el modelo de Rasch, trasladando estimación de parámetros a valores t para obtener el resultado de los cuestionarios. Resultados. En total, 42 pacientes respondieron alguno de los cuestionarios. Los eventos adversos más frecuentes fueron “enfermedad crónica de injerto Vs. contra huésped” y “complicaciones endocrinas”. De acuerdo con la normalidad de datos del KIDSCREEN-27, los puntajes de las dimensiones “ambiente escolar” y “soporte social y pares” fueron inferiores al percentil 50. En el cuestionario SF-12™, el grupo que utilizaba inmunosupresores tuvo un menor puntaje en el componente físico. Conclusiones. En general, los resultados del KIDSCREEN-27 sugieren un cierto déficit de calidad de vida en pacientes entre 8 y 14 años. Los cuestionarios mostraron confiabilidad en la muestra.

Introduction. Autoimmune hepatitis is a progressive inflammatory liver disease that is rare in children, characterized by inflammation in liver histology, the presence of autoantibodies and high levels of immunoglobulin G. There are few data in children and in some studies performed in Latin America, but limited in Colombia. The aim of this study is to describe the demographic, clinical, paraclinical and therapeutic data as well as, the outcome of paediatric patients diagnosed with autoimmune hepatitis in a tertiary care centre in south-western Colombia. Methods. This is a descriptive study of a retrospective cohort of paediatric patients (≤ 18 years) with a diagnosis of autoimmune hepatitis, attended in a third-level hospital in Colombia between 2011 and 2019. Statistical analyses were performed using the program Stata 14.0. Results. A total of 40 patients were included, 57.5% were female, with a median age of 10.5 years (IQR 4-13). The 62.5% presented with acute hepatitis, 20% had liver failure, a 27.5% with cirrhosis at diagnosis; 75% presented compatible liver biopsy, and 82.5% were classified as type 1 autoimmune hepatitis. All patients received a steroid plus immunomodulator; presenting biochemical remission in 75% relapse in the 22.5%. Four of the patients required liver transplantation. Conclusions. Autoimmune hepatitis is an infrequent entity, although not negligible, in children in our environment. A higher prevalence of type I autoimmune hepatitis was found. Most patients were female and presented with symptoms of acute hepatitis at the initial diagnosis. The characteristics and clinical responses, in this cohort, are similar to those described in different series in the world population.

Background: Up to 60% of pediatric renal transplant recipients with end-stage renal disease due to primary focal and segmental glomerulosclerosis (FSGS) may develop recurrent disease. Such recurrence is associated with poor prognosis if no remission is achieved. We report a single center experience with a protocol based on plasmaphereis and increased immunosuppression that resulted in a high long-lived remission rates.Methods: This retrospective cohort study included consecutive pediatric renal transplant patients with recurrent FSGS treated with a standardized protocol using plasmapheresis and cyclophosphamide to supplement usual post-transplant immunosuppression with calcineurin inhibitors and steroids. Relapse was defined as urinary protein/creatinine ratio >1.0g/g and remission as Results: 15 patients with FSGS recurrence post-transplant were treated. All had therapy-resistant FSGS in native kidneys and had been on dialysis from 4-10 years. Of the 15, one died perioperatively from a pulmonary thromboembolism. 13 others achieved a complete remission within 3 months of treatment for FSGS recurrence. After a median follow-up period of 4 years, there were no recurrences of significant proteinuria. Conclusion: The addition of plasmapheresis and cyclophosphamide to a calcineurin- and steroid-based immunosuppression regime was highy successful in inducing high remission rates with recurrent FSGS. Prospective trials are needed to evaluate further the efficacy of increased immunosuppression along with plasmapheresis in this setting.

Resumen: Introducción: Los síndromes de falla medular (SFM) son trastornos infrecuentes, con una incidencia anual de 2-4 casos por millón. Las opciones de tratamiento incluyen terapia de inmunosupresión (TIS) y restaura ción de la hematopoyesis con trasplante de progenitores hematopoyéticas (TPH). Objetivo: Analizar los desenlaces de pacientes pediátricos diagnosticados con SFM tratados en una institución de alta complejidad. Pacientes y Método: Estudio retrospectivo de pacientes pediátricos con diagnóstico de SFM que consultaron a la Fundación Valle del Lili, Cali. Se realizo análisis estadístico descriptivo según SFM adquirida (SFMA) y SFM congénita (SFMC). Los desenlaces incluyeron: tratamiento, complicaciones, supervivencia global (SG) en los trasplantados, calculada con el método Kaplan Meier. Resultados: Se incluyeron 24 pacientes con SFM, edad 6,5 ± 4 años, 50% mujeres. El 58% fue ron SFMC, 9 con anemia de Fanconi, 2 disqueratosis congénita, 2 trombocitopenia amegacariocítica congénita, uno anemia Diamond-Blackfan. Doce pacientes con TPH tuvieron SG a 5 años de 83%. SFMA correspondió al 42%, 6 recibieron TIS-TPH, 3 TIS y 1 TPH, la SG del grupo con TIS-TPH fue 86%. Seis pacientes fallecieron, 4/6 relacionadas con infección. Conclusiones: En esta serie fue mayor el número de casos con SFMC. La SG de los pacientes llevados a TPH es comparable con la reportada en estudios recientes. La causa de muerte predominante fue infecciosa que también se ha reportado previamente. El tratamiento instaurado en los pacientes de esta serie mostró resultados favorables en un centro de alta complejidad en un país latinoamericano.

Background: This study aimed to describe the incidence, microbiological profile, and risk factors associated with bacteremia in pediatric patients with hematopoietic stem cell transplantation (HSCT). Methods: A retrospective cohort study was performed on patients under 18 years old who underwent HSCT due to any indication, between January 2012 and January 2017. The patient data were collected from the first 100 days post-HSCT. Bacteremia was defined as the isolation of bacteria from at least one blood culture. The relation between bacteremia and associated risk factors was evaluated using univariate and multivariate analysis. Results: We enrolled a total of 111 pediatric patients who received HSCT during the period of study. The total number of patients who developed at least one episode of bacteremia was 46 (41.4%), and the total number of bacteremia episodes was 62. Rectal swabs were performed in 44 patients to detect prior colonization and this showed that 25% of them were positive, the main pathogen isolated being carbapenem-resistant enterobacteriaceae. The Gram-negative bacteria cases accounted for 60% of 62 events. The main Gram-negative bacteria isolated were Klebsiella pneumoniae and Escherichia coli and the majority were resistant strains. The mortality rate on day +100 for the whole cohort was 18% (n = 20). Regarding the patients with bacteremia, the mortality rate on day +100 was 30% (n = 14), and the cause of death was related to infection in 10 of them. We did not find any statistically significant risk factor for the development of bacteremia. Conclusion: Bacteremia is common after HSCT, and there is a high frequency of resistant Gram-negative infections which is related to high mortality. Keywords: Stem cell transplantation, Bacteraemia, Fluoroquinolone prophylaxis, Carbapenemase-producing Klebsiella pneumoniae

Objective: Cytomegalovirus infection and disease are significant causes of morbidity and mortality among patients with hematopoietic stem cell transplantation. The aim of this study was to assess the frequency of cytomegalovirus infection and characterize the patients who developed the disease. Methods: A retrospective cohort study was performed among adult patients, recipients of allogeneic HSTC between 2008 and 2015. Taking into account the institutional protocol of prophylaxis infections in hematopoietic stem cell transplantation, patients received either preemptive therapy or prophylaxis with valganciclovir. Infection was defined as a positive pp65 antigenemia assay or PCR higher than 500 copies/mL. Disease was defined as viremia with evidence of end organ damage. Results: Seventy patients were included, the median age was 36 years old (IQR 17–62). A total of 93% of the recipients had a positive serology. The Cytomegalovirus infection occurred in 59% of the patients. Eleven patients developed disease (16%), the most frequent manifestation being colitis, followed by pneumonitis and a single case of retinitis. There were no differences between the preemptive therapy or prophylaxis groups. The mean time of onset of the disease was day 94 post-transplant. Three patients developed disease with a viral load lower than 1000 copies/mL. Conclusion: The incidence of cytomegalovirus infection after transplantation at our institution is high. It was found that the disease can occur with any level of viral load and is associated with high mortality. Keywords: Cytomegalovirus infection, Hematopoietic stem cell transplantation, Viral load

Resumen Objetivo Describir la experiencia en terminos de supervivencia y complicaciones de los pacientes llevados a trasplante de celulas madre hematopoyeticos (TCMH) en los ultimos 15 anos. Materiales y metodos Se realizo un estudio descriptivo, tipo cohorte retrospectiva en el que se incluyeron pacientes menores de 18 anos con diagnostico de leucemia mieloide aguda (LMA), leucemia mieloide cronica (LMC) y sindrome mielodisplasico (SMD) llevados a TCMH entre enero de 2001 y diciembre de 2015. Los desenlaces fueron supervivencia global, supervivencia libre de evento y las complicaciones relacionadas con el trasplante. Resultados Durante el periodo de estudio se trasplantaron: 43 pacientes con diagnostico de neoplasias mieloides; 31 con LMA (72%); 4 con LMC (9%) y 8 con SMD (19%). Se realizaron 11 trasplantes de donante identico, 11 haploidenticos, 11 autologos y 10 de sangre de cordon umbilical. De los pacientes con LMA (31 casos), el 58% fueron sometidos a trasplante en primera remision completa y el 39% en segunda o subsecuente remision completa. La supervivencia global y libre de evento a 5 anos fue 56% y 38% respectivamente. La mortalidad relacionada al trasplante en el dia 100 fue del 15%, la incidencia acumulada de enfermedad injerto contra huesped 59%, la infeccion por citomegalovirus 39%, las infecciones bacterianas 54% y la cistitis hemorragica 14%. Conclusion La baja tasa de mortalidad y complicaciones relacionadas al trasplante sugiere que el trasplante de celulas madre hematopoyeticas es una alternativa factible como tratamiento para pacientes con neoplasias mieloides en nuestro medio.

Background Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor, with the Milan criteria considered to be the gold standard for patient selection for liver transplantation (LT). Materials and Methods We performed a descriptive observational study, reviewing 20 years of experience of LT in patients with HCC in the Fundacion Valle del Lili in Cali, Colombia. Subgroup analysis was undertaken for periods 1999 to 2007 and 2008 to 2015. Results Fifty-seven cases with a pretransplant HCC diagnosis were reviewed. In the first period patients within the Milan criteria had a recurrence-free survival at 5 years of 66.6%, and in those who exceeded the Milan criteria, recurrence-free survival was 75%. In the second period, patients within the Milan criteria, recurrence-free survival at 5 years was 93.5%, and in those who exceeded the Milan criteria, recurrence-free survival was 75.7%. No statistically significant difference was found in either period. For patients with mild and moderate tumor differentiation, the relapse survival rate at 5 years was 69.4% (95% confidence interval [CI] 35.8–87.8) and 74.7% (95% CI 44.5–90), respectively. All patients with poor tumor differentiation relapsed and died within 3 years. Conclusion Global and recurrence-free survival among patients who met and patients who exceeded the Milan criteria was not significantly different, suggesting an expansion of the Milan criteria to include potential recipients who were previously excluded. Obtaining histologic differentiation and identifying vascular invasion will provide a more worthwhile contribution to LT decision making.

Introduction. New-onset diabetes after transplantation (NODAT) is associated with immunosuppression. Its complications can negatively influence patients’ quality of life, which is why it is important to study the associated risk factors and expand the possible therapies in this particular group of patients. Materials and methods. Case-control study nested in a retrospective cohort. It included patients who received kidney transplantation at the high complexity University Hospital Fundación Valle del Lili in Cali, Colombia, between 1995 and 2014. Two controls were assigned for each case, depending on the type of donor and the date of the surgery. Information was collected from clinical records and the institutional TRENAL registry. We carried out a descriptive analysis of the selected variables and identified the risk factors with conditional logistic regression. Results. 122 cases were identified to which 224 controls were assigned. The median age was 44 years (IQR: 34–55), and 54% were men. Having >50 years of age at the time of transplantation (OR: 3.18, 95% CI: 1.6−6.3, p = 0.001), body mass index >30 kg/m2 (OR: 3.6, 95% CI: 1.3−9.7, p = 0.010) and being afro-descendant (OR: 2.74, 95% CI: 1.1−6.5, p = 0.023) were identified as risk factors for the development of NODAT. Pretransplant fasting plasma glucose >100 mg/dl (OR: 2.9, 95% CI: 1.4−6.4, p = 0.005) and serum triglycerides >200 mg/dl (OR: 2.5, 95% CI: 1.4−4.4, p = 0.002) were also reported as independent risk factors. Conclusion. We ratify some risk factors for the development of this important disease, which include certain modifiable characteristics. Interventions aimed at changes in lifestyle could be established in a timely manner before transplant surgery.

Bone marrow failure (BMF) syndromes are rare disorders with an annual incidence of 2-4 cases per million. Treatment options include immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT).To analyze the outcomes of pediatric patients diagnosed with BMF treated in a tertiary care center.Retrospective study of pediatric patients diagnosed with BMF who consulted at Fundación Valle de Lili, Cali. Descriptive statistical analysis was performed according to Acquired BMF (ABMF) and Inherited BMF (IBMF). The outcomes include treatment, complications, overall survival (OS) in transplant patients, calculated using the Kaplan Meier method.We included 24 patients with BMF, average age 6.5 ± 4 years, and 50% were women. 58% presented IBMF, 9 with Fanconi anemia (FA), 2 dyskeratosis congenita, 2 congenital amegakaryocytic thrombocytopenia, and 1 presented Diamond-Blackfan anemia. 12 patients treated with HSCT had a 5-year OS of 83%. ABMF represented 42%. 6 patients received IST-HSCT, 3 received IST, and 1 received HSCT. The OS of the IST-HSCT group was 86%. Six patients died, four of them related to infection.In this series, there was a higher number of cases with IBMF. The OS of patients treated with HSCT is similar to that reported in recent studies. The most frequent cause of death was of infectious origin which has also been previously reported. The treatment esta blished in the patients showed favorable results in a Latin American tertiary care center.

Antecedentes y objetivo. Los pacientes con muerte encefálica por trauma craneoencefálico secundario a herida por proyectil de arma de fuego ayudan a mitigar la necesidad de donantes de órganos y tejidos. En Colombia, el 78 % de los homicidios son por arma de fuego. Se buscaba describir la experiencia con donantes de órganos y tejidos con muerte encefálica secundaria a trauma craneoencefálico por herida por proyectil de arma de fuego en un centro colombiano de trasplantes. Materiales y métodos. Se trató de un estudio de cohorte histórica retrospectiva. Se caracterizaron 169 donantes con diagnóstico de muerte encefálica secundaria a trauma craneoencefálico por herida con proyectil de arma de fuego en la institución, entre 2010 y 2016. Las variables cualitativas se evaluaron mediante proporciones, las variables cuantitativas continuas, con medidas de tendencia central, y la supervivencia, con el método de Kaplan-Meier. Resultados. La mayoría de los pacientes eran de sexo masculino (93 %), con una mediana de edad de 21 años (rango intercuartílico, RIQ=17-27) y el 32 % tenía antecedentes de consumo de sustancias psicoactivas. El 12 % de los pacientes necesitó manejo con hemoderivados y el 62 % requirió dosis altas de vasopresores. Se trasplantaron 338 órganos sólidos. La supervivencia del injerto renal y hepático a un año fue de 90 % y 85 %, respectivamente, y a 5 años, de 87 % y 76 %. Conclusiones. Según este estudio, la mayoría de estos pacientes eran hombres jóvenes con órganos potencialmente trasplantables que mostraron excelentes resultados en la supervivencia de los injertos. Consideramos que estos donantes son una buena alternativa para aumentar el número de donantes de órganos y tejidos.

Resumen Objetivo Describir la experiencia en el manejo de los pacientes con diagnostico de neuroblastoma de alto riesgo manejados con trasplante autologo de celulas madre hematopoyeticas en la Fundacion Valle de Lili. Pacientes y metodos Estudio descriptivo, tipo serie de casos de pacientes con diagnostico de neuroblastoma de alto riesgo que recibieron trasplante autologo de celulas madre hematopoyeticas entre 2001 y 2015. Los desenlaces de este estudio fueron: supervivencia global; supervivencia libre de evento; tiempo de injerto de plaquetas y neutrofilos, e incidencia acumulada de enfermedad venooclusiva. Se realizo un analisis estadistico descriptivo para todas las variables consideradas en el analisis y para subgrupos seleccionados. El analisis de supervivencia se hizo con el metodo Kaplan-Meier. Resultados Entre 2001 y 2015 quince pacientes con diagnostico de neuroblastoma recibieron trasplante autologo de celulas madre hematopoyeticas. La supervivencia global a 3 y 5 anos fue del 55% y la supervivencia libre de evento fue del 47%, donde 14 pacientes injertaron neutrofilos entre el dia 8 y 19 postrasplante e injerto de plaquetas entre los 9 y 91 dias y 2 pacientes desarrollaron enfermedad venooclusiva hepatica como toxicidad a los farmacos quimioterapeuticos de acondicionamiento. Al momento del ultimo seguimiento 10 pacientes permanecen vivos, de los cuales 8 no presentan evidencia clinica y/o paraclinica de la enfermedad. De los 5 pacientes que fallecieron, 2 fue por toxicidad al trasplante en los primeros 100 dias y 3 por progresion de la enfermedad. Conclusion El trasplante autologo de celulas madre hematopoyeticas es una alternativa factible como tratamiento en nuestro medio para pacientes con diagnostico de neuroblastoma de alto riesgo, el cual ha contribuido a mejorar la supervivencia en este grupo de pacientes.

Introduction. In Colombia, the genetic background of the populations was shaped by different levels of admixture between Natives, European, and Africans. Approximately 35.363 patients have diagnosed chronic kidney disease and according to population studies, 10.4% of these patients are Afro-descendant. We aim to assess the frequency of APOL1 variants G1 and G2 in Afro-descendant patients with ESRD treated at la Fundacion Valle del Lili University Hospital in Cali, Colombia. Methods. This is an observational cross-sectional study. Afro-descendant patients with ESRD in waitlist or recipients of kidney transplant were evaluated. Clinical data were collected from the electronic medical records. Genotyping was carried out by amplification of the exon 7 of the APOL1 gene. For the identification of risk genotypes, the bioinformatics tool BLAST was used. Results. We enrolled 102 participants. The frequency of APOL1 risk variants was 67.2%, in which 24.5% (n = 25) were G1 heterozygous and 5.8% (n = 6) were G2 heterozygous and 37% of the patients had high-risk status with two alleles in homozygous (G1/G1 = 21 and G2/G2 = 3) or compound heterozygote (G1/G2 = 14) form.

Resumen Objetivo: El mieloma múltiple representa la primera causa de trasplante autólogo de células madre hematopoyéticas (TCMH). El objetivo del presente trabajo es describir los resultados del TCMH en pacientes con diagnóstico de mieloma múltiple en la Fundación Valle del Lili. Materiales y métodos: Se realizó un estudio observacional, descriptivo de una cohorte retrospectiva, se incluyeron pacientes mayores de 18 años con TCMH autólogo tratados entre 2008 y 2016. Los desenlaces fueron: supervivencia global, supervivencia libre de progresión y la respuesta de la enfermedad postrasplante. Se realizó un análisis estadístico descriptivo y el análisis de supervivencia se hizo con el método Kaplan-Meier. Resultados: Durante el periodo de estudio se trasplantaron 103 pacientes. La mediana de la edad fue 57 años. El subtipo de inmunoglobulina secretada fue: 75% de IgG, 18% de IgA, 5% no secretor y 2% oligosecretor. El estadio Durie Salmon en la mayoría fue IIIA (43,7%). Previo al trasplante la mayoría de los pacientes estaba en muy buena respuesta parcial (31%), seguido por respuesta completa (25,2%) y respuesta parcial (19,4%). La supervivencia global y libre de progresión a 5 años fue de 71% y de 40%, respectivamente. Posterior al trasplante: el 33% de los pacientes estaba en muy buena respuesta parcial, el 25% en respuesta completa estricta, el 22% en respuesta completa, el 12% en respuesta parcial y el 8% en enfermedad progresiva o recaída. Conclusión: El TCMH autólogo es una estrategia que se asocia a buenas tasas de supervivencia, baja toxicidad y adecuada respuesta de la enfermedad postrasplante. Abstract Objective: Multiple myeloma in Colombia is the one of the main reasons for autologous hematopoietic stem cell transplantation (HSCT). The aim of this study is to describe the results of the HSCT in adult patients diagnosed with multiple myeloma in the Fundación Valle del Lili. Materials and methods: An observational, descriptive study of a retrospective cohort was carried out. Patients older than 18 years with a diagnosis of multiple myeloma with autologous HSCT between 2008 and 2016 were included. The outcomes were overall survival, progression-free survival, and post-transplant disease response. A descriptive statistical analysis was carried out for all the variables considered in the analysis. The survival analysis was performed using the Kaplan-Meier method. Results: During the study period, transplants were performed on 103 patients with a diagnosis of multiple myeloma. The median age was 57 years. The subtype of secreted immunoglobulin was 75% IgG, 18% IgA, 5% non-secretor, and 2% oligo-secretor. The majority of patients were in Durie Salmon stage was IIIA (43.7%). Prior to transplantation 31% had a very good partial response, 25.2% complete response, 19.4% partial response, 10.7% progressive disease, 6.8% stable disease, 2.9% complete strict response, and in 3.9% of the patients the report of the disease status was not found. The 5-year overall survival was 71% (95% CI: 53-83) and progression-free survival was 40% (95% CI 25-54). After transplantation 33% of the patients were in very good partial response, 25% in strict complete response, 22% in complete response, 12% partial response, and 8% progressive disease or relapse. Conclusion: Autologous HSCT is a strategy that is associated with good survival rates, low toxicity, and an adequate post-transplant disease response.

Introduction: mTOR inhibitors Sirolimus and Everolimus are an alternative for inmunosuppression in renal transplant recipients. The aim of the study was to describe the experience of patients with switch to mTOR inhibitors, followed up for more than five years. Materials and methods: Patients with renal transplantation from 1995 to 2013, who had indication of calcineurin inhibitor (CNI) withdrawl after the third month post-transplant were included. All patients underwent renal biopsy prior to conversion. No patient had a diagnosis of chronic nephtopathy, IFTA>40 % or proteinuria >350mg/24h. A descriptive analysis for all variables was devoloped. Kaplan-Meier method was used for the patient's and graft survival and graft rejection incidence. Results: From 1273 renal transplants, the switch from CNI to mTOR inhibitors was performed in 166 (13 %), 78 % (n=129) were switched to Sirolimus. 12,6 % of the patients lost graft function and 4,2 % (n=7) died. 37% had mTOR inhibitors withdrawal, and the major cause was pathologic proteinuria. The incidence of graft rejection after switching to mTOR inhibitors was 9,6 %. The one and five year graf survival was 96,6 % and 83,5 %. The patient survival at one and five years was 98 % and 97 %. Conclusions: The use of mTOR inhibitors drugs appears to be safe in the managgement of specific renal transplant recipients, with a low rejection rate and good survival. Resumen Introducción: los ImTOR, sirolimus y everolimus son una alternativa de inmunosupresión en personas que han recibido transplantes renales. En este artículo, se describe la experiencia de pacientes que han experimentado una conversión a ImTOR, y a los que se les ha hecho un seguimiento por más de cinco años. Materiales y métodos: se incluyeron pacientes con transplantes renales desde 1995 hasta 2013, quienes tuvieron indicación de suspensión del inhibidor de calcineurina (ICN) después del tercer mes posterior al trasplante. Todos los pacientes fueron sometidos a biopsia renal antes de la administración de ImTOR. Ningún paciente tuvo diagnóstico de nefropatía crónica, IFTA >40 % o proteinuria >350 mg/24h. Se elaboró un análisis descriptivo para todas las variables. Para estudiar la supervivencia del paciente y del injerto, y la incidencia de rechazo agudo, se usó el método de Kaplan-Meier. Resultados: de 1273 trasplantes renales, la conversión de ICN a ImTOR se realizó en 166 casos (13 %). Al 78 % (n=129) se le administró sirolimus. El 13 % de los pacientes perdió la función del injerto y 7 pacientes (4,2 %) fallecieron. En el 37 % de los casos, se retiró el ImTOR. La principal causa de retiro fue el hallazgo de proteinuria patológica. La incidencia de rechazo agudo después del cambio a ImTOR fue de 9,6 %. La supervivencia del injerto tras uno y cinco años fue de 96,6 % y 83,5 %, respectivamente; y la supervivencia del paciente a uno y cinco años fue de 98 % y 97 %, respectivamente. Conclusiones: el uso de inhibidores ImTOR parece ser seguro en este grupo de pacientes trasplantados, pues hubo una baja tasa de rechazo y buena supervivencia del injerto.

BACKGROUND Hepatoblastoma is the most common primary malignant liver tumor in children and is usually diagnosed during the first 3 years of life. Overall survival has increased 50% due to chemotherapeutic schemes, expertise surgery centers, and liver transplantation. METHODS A retrospective collection of data was performed from pediatric patients with diagnosis of hepatoblastoma. Variables included demographic, diagnostic tools and histological classification; chemotherapy and surgical treatment; and outcomes and patient survival. The PRETEXT classification was applied, which included the risk evaluation, and according to the medical criterion in an individualized way, underwent resection or transplant. The morbidity of patients was evaluated by the Clavien-Dindo classification. Statistical analysis was performed according to the distribution of data and the survival analysis was carried out using the Kaplan-Meier method. RESULTS The patients (n = 16) were divided in a resection group (n = 8) and a transplant group (n = 8). The median age at the time of diagnosis was 13.5 months. The motive for the initial consultation was the discovery of a mass; all patients had high levels of α-fetoprotein and an imaging study. Ten of 16 patients required chemotherapy before the surgical procedure. In the resection group, 5 of 8 patients were classified as Clavien I and 4 of 8 patients of the transplant group were classified as Clavien II. Patient survival at 30 months was 100% in the resection group and 65% in the liver transplantation group. CONCLUSIONS To our knowledge, this is the first case report of pediatric patients with hepatoblastoma and liver resection or transplant in Colombia and Latin America. Our results are comparable with the series worldwide, showing that resection and transplant increase the survival of the pediatric patients with hepatoblastoma. It is important to advocate for an increase of reporting in the scientific literature in Latin America.

Case series Patient: Male, 38 • Male, 48 Final Diagnosis: En-bloc transplantation (liver, kidney, pancreas) Symptoms: Encephalopathy • adynamia • ascites • asthenia Medication: — Clinical Procedure: En-bloc transplantation Specialty: Transplantology Objective: Unusual setting of medical care Background: En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages. This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique. Case Report: The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent. Conclusions: En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control.

Introduction: There is controversy in medical literature regarding the use of electromagnetic fields to promote bone healing. Methods: After designing and building devices capable of generating an electromagnetic field for this study, their safety was confirmed and the electromagnetic therapy was randomly allocated and compared to placebo in patients with fracture of the femoral diaphysis. Treatment began six weeks after the fracture and it was administered once a day, during 1 h, for eight consecutive weeks. Twenty devices were built, 10 of which were placebo-devices. Between June 2008 and October 2009, 64 patients were randomized in two different hospitals and were followed for 24 weeks. The mean age was 30 years (18-59) and 81% were males. Results: Healing observed at week 12 was 75% vs. 58% (p= 0.1); at week 18, it was 94% vs. 80% (p= 0.15); and at week 24, it was 94% vs. 87% (p= 0.43) for the device group and the placebo group, respectively. Discussion: This study suggests that an electromagnetic field stimulus can promote earlier bone healing compared to placebo in femoral diaphyseal fractures. Faster bone healing translates into sooner weight bearing, which – in turn – permits quicker return to normal daily activities.