This week I worked on a patient database about outcome of kidney transplants. I have to look through the notes written by the doctors after each follow up of the patient. These notes are usually unorganized and difficult to understand (and badly written because the doctors write fast and abbreviate the sentences as much as possible), and each doctor has his own style and each gives varying degrees of information. The number of acronyms is astonishing and I have to work my way through them. Many are simply phone notes, usually to check how the patient is doing at home, and very often the patient is currently being taken care of in another institution which complicates the acquisition of information. Looking through the notes you see interesting things. For example, it was shocking to me to find out that one patient who was undergoing a routine kidney biopsy had his colon pierced by the surgeon which led to a removal of part of the colon and a 4 month hospitalization!
A highlight of the week was to attend grand rounds on an interesting subject: fibrosis as a cause of organ failure. There I learnt that doctors think (but aren´t sure) that collagen produced by fibroblasts that come from endothelial cells through an epithelial-mesenchymal transition cause the fibrosis that damages organs. To me it seems very clear that this is a wound healing response and that stopping it might help the body to regenerate a little bit better but the underlying cause of allograft rejection is still an immune response which is what doctors such focus on controlling.