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Manuel Torres-Gutiérrez,1 Nicolás Lozano-Suárez,2 Viviana A Burgos-Camacho,1 Jessica Caamaño-Jaraba,1 Julia Andrea Gómez-Montero,2 Andrea García-López,2 Fernando Girón-Luque2,3 1Department of Mental Health, Colombiana de Trasplantes, Bogotá, Colombia; 2Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia; 3Department of Transplant Surgery, Colombiana de Trasplantes, Bogotá, ColombiaCorrespondence: Andrea García-López, Transplant Research, Colombiana de Trasplantes, Av Carrera, 30 No. 47 A-74, Bogota, 111311, Colombia, Email aegarcia@colombianadetrasplantes.comIntroduction: Non-adherence in kidney transplants is diversely defined. Immunosuppression non-adherence (INA) is the most used definition and has been associated with graft loss and acute rejection. But INA assesses only one fraction of adherence. Therefore, we analyzed the association of a holistic non-adherence definition with transplant outcomes and compared its prediction performance with other definitions.Methods: We retrospectively included 739 kidney recipients between 2019 and 2021. We evaluated holistic non-adherence (HNA), suboptimal-immunosuppressor levels (SIL), appointment non-adherence (ANA), procedure non-adherence (PNA) and INA. The main outcomes were graft loss, graft rejection, and mortality. A backward logistic regression was performed estimating adjusted and un-adjusted odds ratio (OR) for each outcome. Finally, we compared the non-adherence definitions’ prediction for the main outcomes using the area under the curve.Results: HNA was present in 28.7% of patients. Non-adherent patients had an adjusted OR of 2.66 (1.37– 5.15) for mortality, 6.44 for graft loss (2.71– 16.6), and 2.28 (1.15– 4.47) for graft rejection. INA and PNA presented a moderate discrimination for graft loss and HNA and ANA mild-to-moderate discrimination for graft loss and death.Conclusion: Holistic non-adherence was associated with worst outcomes in kidney recipients and had a significant prediction performance for graft loss and mortality.Keywords: kidney transplantation, patient adherence, mortality, graft survival, patient outcome assessment

Manuel Torres-Gutiérrez,1 Viviana Burgos-Camacho,1 Jessica Paola Caamaño-Jaraba,1 Nicolás Lozano-Suárez,2 Andrea García-López,2 Fernando Girón-Luque2,3 1Department of Mental Health, Colombiana de Trasplantes, Bogotá, Colombia; 2Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia; 3Department of Transplant Surgery, Colombiana de Trasplantes, Bogotá, ColombiaCorrespondence: Andrea García-López, Transplant Research, Colombiana de Trasplantes, Av Carrera, 30 No. 47 A-74, Bogota, 111311, Colombia, Email aegarcia@colombianadetrasplantes.comIntroduction: In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence.Methods: This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence.Results: Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors.Conclusion: Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.Keywords: treatment adherence and compliance, kidney transplantation, patient compliance, social support, patient education, mental health, psychopathology

Laura Nino-Torres,1 Andrea Garcia-Lopez,2 Nasly Patino-Jaramillo,2 Fernando Giron-Luque,1 Alejandro Nino-Murcia1 1Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia; 2Department of Transplantation Research, Colombiana de Trasplantes, Bogotá, ColombiaCorrespondence: Alejandro Nino-Murcia, Transplant Surgeon, Colombiana de Trasplantes, Av Carrera, 30 No. 47 A-74, Bogota, 111311, Colombia, Tel +57 3112499999, Email anino@colombianadetrasplantes.comBackground and Purpose: Kidney transplantation (KT) is the best therapy for chronic kidney disease (CKD). Major urologic complications (MUCs) are the second etiology associated to morbidity and graft loss following KT, after rejection episodes. The objective of this study was to estimate the incidence, risk factors and impact on graft survival associated to urological complications in KT patients.Patients and Methods: A retrospective cohort based on electronic patient files of kidney transplant recipients from Colombiana de Trasplantes was created for the period August 2008 to September 2019. Initiation of follow-up was defined as the date of transplantation up to 3 years post-transplantation. Incidence of ureteral stenosis, ureteral obstruction, and ureteral leak was measured. A logistic regression multivariate model was adjusted to determine the associated factors to MUCs (yes/no). Patient and graft survival time were analyzed using a Kaplan-Meier method.Results: A total of 1584 KT patients were included in the cohort. MUCs were present in 195 (12.6%) KT patients. We found that dialysis duration (OR: 1.004; p = 0.02) remained significant for the incidence of MUCs in KT patients of deceased donors. Probability of graft and patient survival at 3 years of follow-up was 90.5% and 85.5%, respectively. No significant difference was found on graft and patient survival in KT patients with or without MUCs.Conclusion: MUCs are frequent complications for KT. We did not observe significant differences in graft or patient survival according to the presence of MUCs. The identification of MUCs and risk factors may guide transplant teams for future surgical and clinical decisions.Keywords: major urologic complications, kidney transplantation, graft survival, patient survival

Fernando Giron-Luque,1 Yenny Baez-Suarez,1 Andrea Garcia-Lopez,2 Nasly Patino-Jaramillo2 1Surgery Department, Colombiana de Trasplantes, Bogotá, Colombia; 2Research Department, Colombiana de Trasplantes, Bogotá, ColombiaCorrespondence: Andrea Garcia-LopezResearch Department, Colombiana de Trasplantes, Av Carrera 30, No. 47A-74, Bogotá, ColombiaTel +57 300 502 4618Email aegarcia@colombianadetrasplantes.comBackground and Purpose: Vascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN).Patients and Methods: Data from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations.Results: MRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively.Conclusion: HALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.Keywords: kidney transplant, vascular multiplicity, living kidney donors, laparoscopic nephrectomy, anatomic variation

Background: BK virus nephropathy (BKVN) is a significant complication in kidney transplant recipients, resulting in graft dysfunction and potentially leading to graft loss. This study aims to investigate the incidence and outcomes of BKVN in kidney transplant recipients receiving steroid-free maintenance immunosuppression in a Latin -American cohort., Methods: Case series study of BKVN among kidney transplant recipients who underwent transplantation between 2008 and 2023. The primary outcome was graft loss caused by BKVN, excluding death with function. Secondary outcomes included graft function and acute rejection episodes. The statistical analysis involved descriptive statistics and the Kaplan-Meier (K-M) method to plot the overall probabilities of not initiating dialysis., Results: During the 15-year period, 2236 kidney transplants were performed, BKVN was histologically diagnosed in 38 kidney recipients and 33 cases were analyzed. Median age was 50 years and men were 48.5% of patients. A total of 45.4% of BKVN occurred within the first 12 months of transplant. The incidence of BKVN was 1.6% but it varied by era. The rate of graft loss was 75.7% (25 cases). The K-M graft survival probability at 6 months and 12 months after diagnosis of BKVN was 38.3% (95% CI 24.7-59.4) and 22.3% (95% CI 11.7-42.8), respectively., Conclusion: BKVN affected 1.6% of transplant recipients and it was associated with high-rate of graft loss. We observed that significant graft disfunction at the time of diagnosis resulted in worse outcomes with a reduced probability of graft survival., Competing Interests: Declaration of competing interest All the other authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The relevance of training medical students in surgical specialty services has been a matter of debate in contexts where the health care system focuses on primary health care. Some educators argue that medical students should be trained in primary care settings. Other educators assert that rotating in highly complex hospitals strengthens the competencies of future general practitioners. Nonetheless, little attention has been paid to the added value that rotations in surgical specialties have brought to newly graduated doctors' lives. In this study, we explored the perceptions of a group of graduates by focusing on the relevant experiences they had during their surgical specialty rotations in undergraduate medical training and how this training influenced their personal and professional life., Methods: We conducted a qualitative study using a convenience sampling strategy to recruit a total of seven junior doctors. Data were collected through semi-structured interviews in 2022. Thematic analysis was used to analyse the data until code saturation was reached., Results: The recurring themes were (1) perception of rotations, (2) valuable learning for medical practice and (3) defining their professional future. Participants felt that their experiences in surgical specialty rotations were beneficial, as they gained confidence to perform professionally and decide on future employment and strengthened their research and primary healthcare competencies., Conclusion: Although training in primary healthcare centres is crucial in undergraduate medical education, these results suggest that including rotations in surgical specialties may be valuable in enhancing the future careers of junior doctors., (© 2023 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objective: To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia., Methods: A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described., Results: Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential dono r pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%., Conclusions: About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia., Competing Interests: Conflict of interest. None declared.

Background: Although tacrolimus is an effective immunosuppressive drug used for preventing biopsy proven acute rejection (BPAR) in kidney transplanted patients, its nephrotoxicity may compromise renal function and lead to delayed initiation because of its side effects. This study aimed to evaluate the safety of early initiation of tacrolimus in the occurrence of BPAR during the first 90 days post transplant., Methods: We conducted a retrospective cohort study involving 315 patients who underwent kidney transplantation from 2015 to 2017. Comparisons were performed between 2 groups according to whether the start time of tacrolimus therapy was delayed or not delayed. Cox proportional hazards models were used to examine the association between variables and the occurrence of BPAR., Results: The incidence of BPAR was 14.9% (n = 47) and it was significantly higher in the delayed group (19.4% vs 6.4%; P = .002). Delayed initiation tacrolimus group was significantly associated with the risk of BPAR (hazard ratio: 2.95; P < .036). The overall mortality rate was 2.5% (n = 8) and there was no association between delayed initiation therapy and death (P = .56)., Conclusion: Our study confirmed that delayed initiation of tacrolimus in patients with delayed graft function is associated with a high risk of BPAR., (Copyright © 2019 Elsevier Inc. All rights reserved.)