Análise das prevalências de preservação, desqualificação, disponibilização e dos transplantes de tecido escleral no Brasil

Abstract

Introduction: The scarcity of ocular tissues available for transplantation still represents a challenge for the Brazilian National Transplant System (SNT). The sclera is clinically important in reconstructive surgeries, and its procurement, preservation, and distribution depend on the efficiency of Human Ocular Tissue Banks (BTOH). The analysis of quality indicators allows for the identification of weaknesses and guides strategies for optimizing therapeutic use. Objective: To analyze the prevalences of preservation, disqualification, availability, and transplantation of scleral tissue in Brazil in 2024. Method: Quantitative, descriptive, observational study, based on the Production Report of the BTOH from the National Health Surveillance Agency of 2024. Forty-six BTOH distributed across the five Brazilian regions were included. The values were relativized per million population (pmp) and calculated using five indicators: rate of utilization of preserved scleras, disqualification rate, therapeutic use rate, transplant rate over the total preserved tissue, and overall efficiency index. Regional comparisons were performed using the Kruskal-Wallis test, with a significance level of 0.05. Results: The BTOH preserved 2,748 scleras in 2024, mainly concentrated in the Southeast (33.4%) and South (24.4%) regions. The national disqualification rate was 23.5%, varying from 11.6% in the Central-West to 66.1% in the North (p<0.01). The utilization rate was higher in the South (94.5%) and lower in the North (26.6%), while the therapeutic use rate stood out in the Southeast (61.8%) and South (57.9%). The transplantation rate relative to the total preserved tissue reached 74.9% in the Southeast and 76.5% in the Central-West, in contrast to 32.9% in the Northeast. The overall efficiency index varied from 40.0% (Northeast) to 90.0% (CentralWest), which demonstrates significant regional inequality. Conclusion: Regional inequalities were observed in the production and utilization of scleral tissue, with better performance in the Central-West, Southeast, and South regions. The North and Northeast regions showed operational and structural weaknesses. The findings reinforce the need for standardization of processes, team training, and strengthening of the national network in order to expand the availability and therapeutic use of scleral tissue.