Clinical and technological advances related to organ transplants in Spain have translated, as is already known historically, that our country continues to be undisputed world leader in this area. Donation records even indicate that in 2023 the transplant rate will exceed 8% pre-pandemic data, specifically from 2019, which even then offered historic numbers. However, despite the achievements, there are still aspects that must be improved to continue increasing the survival and quality of life of transplant patients.
According to Domingo Hernandez, president of the Spanish Transplant Society (SET), there is still a pending issue in Spain: the transplant of living donors. “Although this last year it grew by 24%, comparatively with the total donations, is stagnant“, he noted in the presentation of the 8th Congress of the Spanish Transplant Society (SET) that is being held in Bilbao.
Based on your data, we present worst figures than other European countries, so its promotion must be precisely one of the great future challengessince “the living transplant “exponentially improves survival and kidney function outcomes.”
In his opinion, an important aspect to maintain donation, especially living donation, “is to carry out periodic information campaigns directed at professionals, patients and the general population led by experts in this field, those responsible for the institutions and the patients themselves who have been protagonists of this altruistic activity, expressing its benefits.”
In this sense, in recent years, coordinated actions have been carried out by the National Transplant Organization (ONT) and scientific societies, developing guides, recommendations and consensus that “improve this clinical practice, not only from the point of view doctor but also from the epidemiological and social perspectivehe added.
GOOD NUMBERS
In this congress, which has brought together more than 400 experts, it has been revealed that in 2023, Spain will reach the rate of 48.9 donors per million population (pmp) and of 122.1 transplants pmp; the latter breaking the record of 2019. A total of 3,688 kidney transplants, 1,262 liver, 479 lung, 325 heart, 100 pancreas and 7 intestine transplants were registered.
The 2,346 deceased donors and the 435 living donors represented a increase of 7% and 24%, compared to the previous year. In addition, 314 transplants were performed in patients with zero urgency and 190 transplants in children. As well as 153 hyperimmunized kidney patients were transplanted.
“These data, after overcoming a pandemic, with how hard it was for transplants, is a great satisfaction for the effort made by all health and non-health professionals involved in this work and a motivation to continue innovating and expanding knowledge to later transfer it to clinical practice”, according to the president of the SET.
Javier Bustamante, from Euskadi Liver Transplantation; Domingo Hernndez, president of the SET; Sofa Zarraga, president of the Local Committee and Head of Transplantation at HU Cruces; and Mikel Gastaca, from Liver Transplant of the Basque Country
Breaking down the data, Hernndez has highlighted the growing weight of transplants from donation in asystole, which in 2023 increased by 15% and now represents 45% of total donations. “This type of donation generates excellent transplant results and that is why for the SET it is key to promote donation in asystole. “That donation in asystole is already so close to half of the total donations is very striking and great news.”
Compared to donation after brain death, the growth of the donation in asystole It is also very important because brain death is increasingly being reduced thanks to Road Safety Law and people’s awareness. Thanks to the growth in non-asystole donations, the rate of deceased donors per million population in Spain now stands at 48.9, very close to the goal of 50 that the ONT proposed in its 50×22 Strategic Plan. According to Hernández, “this success belongs to everyone, in deceased cases we have a very good donation rate and one of the great people responsible is the families, because the donor does it while alive but the last decision belongs to the family. It is a success of the society”.
Spain advantage in deceased donor rate pmp to countries with the most advanced health systems in the world. Its rate of 48.9 is ahead of that of the United States (44.5), neighboring countries such as France (25.8), Italy (25), the United Kingdom (20.6), Germany (10, 4), the average of the European Union itself (20.9), Canada (21.4) or Australia (10.4).
NEW STRATEGIES
Another of the striking data presented at this congress is the related to increasing donor age. According to analyzes presented at the congress, 56.8% of donors are over 60 years old, 30% over 70 and 5% more than 80. Even in 2023 there was a donor who was 92 years old. “Longevity is growing, our life expectancy is longer, people take better care of themselves, they play sports and eat better. Living and environmental conditions have changed. 40 years ago a 50-year-old donor was older. Today it is very normal. And that is very good news,” says the president of the SET.
In addition to increasing the activity of transplantespecially the kidney transplant with a living donor, for the SET it is essential in the coming years to improve the survival rates and quality of life of patients with everyone’s efforts based on care excellence and promoting training and research in the field of transplantation.
“This implies the search for more strategiessuch as new markers of immunological dysfunction, optimizing immunosuppression, developing new therapeutic strategies for the prevention of post-transplant complications (infectious, tumor or metabolic), implementing the tools of artificial intelligence or the application of biomedical genetic engineering techniques to increase transplant activity and improve survival, among others.
In this sense, in this scientific event a consensus document on management of kidney disease in heart transplant recipients and heart disease in kidney transplant recipients, prepared by the Spanish Transplant Society, the Spanish Society of Cardiology and the Spanish Society of Nephrology.
In Euskadi, and according to Zrraga Sofa, president of the Local Organizing Committee of this scientific meetingDuring 2023, 157 kidney transplants and 76 liver transplants were performed. Of the kidneys, 19 came from a living donor, 7 were pediatric and 3 were combined hepatorenal transplants. “Are highlights in the whole of the transplant activity in Spain”, has also indicated the head of the Nephrology Service at the Cruces Hospital in Bilbaowhere, since the beginning of the transplant activity, 4,891 kidney transplants have been performed (296 from living donors) and 1,810 liver transplants.
According to ONT data, Euskadi is at the head in rate of deceased donors pmp among the Spanish autonomous communities, specifically occupying fifth place, with 57 donors pmp, just over eight points above the Spanish average, which stands at 48.9 donors pmp, although significantly below the three communities that manage to place this average above 70 pmp donors: Cantabria, Murcia and Navarra.
At this congress, professionals will also present the current and future problems in solid organ transplantation, the application of artificial intelligence tools or innovations in the field of pancreas transplants.
Aspects related to the transplant will also be analyzed after donation after cardiorespiratory arrest, the proper management of cardiological and kidney problems in patients with kidney or heart transplants, updates in the management of sensitized patients or current tools to detect and treat the immune response against the graft.
There will also be no shortage of new features in the detection of adherence to immunosuppressive treatmentthe management of infections, optimization in organ distribution or developments in heart and lung transplantation.
THE TRANSPLANTED TRANSPLANTER
Robert Montgomery, head of the Department of Surgery and director of the Langone Transplant Institute, New York University, United Statesone of the greatest experts in kidney transplantationworld-class and heart transplant patient, has been one of the guests at the Congress of the Spanish Transplant Society.
The case of this specialist is very curious not only because he was already a renowned expert in kidney transplantation when his heart, affected by congenital cardiomyopathyhe said enough after several episodes in which he was on the verge of dying.
It is also because he received the organ of a person infected with hepatitis C and that was precisely one of the main lines of research of his team, which was working on how to make the greatest number of organs usable for transplants.
Although at that time very few transplant programs in the United States adopted these organs and the potential recipients themselves refused to accept them, causing 40% of donated organs with hepatitis C to be discarded, Montgomery did not hesitate and Today he is a heart transplant patient and cured of hepatitis C. thanks to the treatments antivirals which in more than 95% of cases cure the disease.