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Fallani G, Comai G, Serenari M, Del Gaudio M, La Manna G, Ravaioli M. Technical and Immunological Challenges in Early Kidney Regrafting. EXP CLIN TRANSPLANT 2021; 19:613-616. [PMID: 34085607 DOI: 10.6002/ect.2018.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Few reports concerning early organ regrafting are available in the literature, and those dedicated to kidney regrafting do not focus on allocation policies or retrieval surgical strategies. This report describes an unsuccessful living donor kidney transplant, where a 12-year-old female recipient who had received a kidney from her mother died on postoperative day 2 due to cerebral ischemia and became a brain-dead donor. The family agreed to a multiorgan donation since the previously transplanted kidney was highly performing. The organ had initially been allocated according to the blood group of the recipient (AB), although the donor's (her mother) blood group was B; however, human leukocyte antigen matching was performed considering the donor's human leukocyte antigen typing. The new recipient of the kidney was a 53-year-old man. Organ procurement was performed with adjunctive cannulation of the iliac vessels, to flush the transplanted kidney with preservation solution; the graft was then procured, including the previous vascular anastomoses. Implantation of the graft was performed on the iliac vessels of the recipient, which were anastomosed to the iliac vessels of the donor, leaving the previous vascular anastomoses untouched.Two years afterthe transplant, the patientis alive with a functioning graft. Early kidney regrafting is a safeand feasible procedure, on both the surgical and immunological sides. Although kidney recipients who experience brain death in the early postoperative period are few, they should be considered as viable organ donors. Also, allocating and retrieving such organs require few precautions compared with standard allocation and retrieval processes.
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Affiliation(s)
- Guido Fallani
- From the Division of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
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Hu XG, Kim IG, Wang HJ, Kim BW, Hong SY, Kim YB, Shen XY. Reuse of Living-Donor Liver Graft in Second Recipient with Long-Term Survival. Transplant Proc 2019; 50:3984-3987. [PMID: 30577301 DOI: 10.1016/j.transproceed.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 03/01/2018] [Indexed: 01/01/2023]
Abstract
Brain death is a rare situation after living-donor liver transplantation. However, the recipient who suffers from brain death and has functional liver graft is a potential liver donor. We report the 1st case of successful reuse of extended right living-donor liver graft after brain death of the first recipient. The first recipient, who had acute liver failure caused by hepatitis A virus, experienced brain death on the 2nd day after the transplantation. The allograft had a favorable regeneration and functional recovery. On the 7th day, the allograft was procured with a patent hepatic artery, bile duct, portal vein, and reconstructed outflow (right hepatic vein and middle hepatic vein) and successfully implanted into the second recipient. The second recipient has experienced a long-term survival without any complications.
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Affiliation(s)
- X-G Hu
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - I-G Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - H-J Wang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
| | - B-W Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - S Y Hong
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Y B Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
| | - X-Y Shen
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
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Lee GS, Goldberg DS, Levine MH, Abt PL. Outcomes of organ transplants when the donor is a prior recipient. Am J Transplant 2018; 18:492-503. [PMID: 28992380 DOI: 10.1111/ajt.14536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/12/2017] [Accepted: 09/30/2017] [Indexed: 01/25/2023]
Abstract
Organ shortage continues to challenge the field of transplantation. One potential group of donors are those who have been transplant recipients themselves, or Organ Donation After Transplant (ODAT) donors. We conducted a retrospective cohort study to describe ODAT donors and to compare outcomes of ODAT grafts versus conventional grafts. From October 1, 1987 to June 30, 2015, 517 former recipients successfully donated 803 organs for transplant. Former kidney recipients generally survived a median of approximately 4 years before becoming an ODAT donor whereas liver, lung, and heart recipients generally survived less than a month prior to donation. In the period June 1, 2005 to December 31, 2014, liver grafts from ODAT donors had a significantly higher risk of graft failure compared to non-ODAT liver transplants (P = .008). Kidney grafts donated by ODAT donors whose initial transplant occurred >1 year prior were associated with significantly increased graft failure (P = .012). Despite increased risk of graft failure amongst certain ODAT grafts, 5-year survival was still high. ODAT donors should be considered another form of expanded criteria donor under these circumstances.
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Affiliation(s)
- G S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D S Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - P L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Tanaka H, McAlister VC, Levstik MA, Ghent CN, Marotta PJ, Quan D, Wall WJ. Reuse of liver grafts following the brain death of the initial recipient. World J Hepatol 2014; 6:443-447. [PMID: 25018855 PMCID: PMC4081619 DOI: 10.4254/wjh.v6.i6.443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine if there is a reasonable prospect of success of a re-use liver transplantation.
METHODS: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts.
RESULTS: A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of cerebral edema. The second transplantation was performed after a median interval of 5 d (one day-13 years). Viral hepatitis was present in 3 (11%) of the initial recipients and in 8 (29%) of final recipients. Hepatocellular carcinoma was present in 6 (21%) of the final recipients. Early survival after the final transplantation was 93%, whereas long-term survival was 78% with a mean follow-up of 23.3 (3-120) mo.
CONCLUSION: Outcomes of transplantation using previously transplanted grafts in this select population are similar to those seen with conventional grafts.
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Desai CS, Khan KM, Fishbein TM. Reuse of liver allografts from brain-dead liver transplant recipients. Transpl Int 2013; 26:e43-5. [PMID: 23442019 DOI: 10.1111/tri.12079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reuse of a pediatric liver graft: a case report. Case Rep Transplant 2012; 2012:350817. [PMID: 23227415 PMCID: PMC3513722 DOI: 10.1155/2012/350817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/05/2012] [Indexed: 02/05/2023] Open
Abstract
We report the reuse of a liver graft after brain death of the first recipient. The liver donor was an 8-year-old male who died as a result of head injury. The graft was implanted first to a 4-year-old girl for fulminant hepatic failure. Unfortunately she developed progressive coma and brain death on fifth day of transplantation. The graft functions were normal, and reuse of the liver graft was planned. After informed consent, the graft was transplanted to a 31-year-old female recipient who has hepatocellular carcinoma with an underlying cryptogenic liver cirrhosis. The patient was discharged to home on 9th day after an uneventful postoperative period. However, she was readmitted to hospital with an acute abdominal pain 30 days after the operation. Hepatic artery thrombosis was diagnosed, and the attempt to open the artery by interventional radiology was unsuccessful. She died of sepsis and multiorgan failure on 37th posttransplant day.
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Nguyen JH. Blood-brain barrier in acute liver failure. Neurochem Int 2011; 60:676-83. [PMID: 22100566 DOI: 10.1016/j.neuint.2011.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 10/20/2011] [Accepted: 10/26/2011] [Indexed: 12/16/2022]
Abstract
Brain edema remains a challenging obstacle in the management of acute liver failure (ALF). Cytotoxic mechanisms associated with brain edema have been well recognized, but evidence for vasogenic mechanisms in the pathogenesis of brain edema in ALF has been lacking. Recent reports have not only shown a role of matrix metalloproteinase-9 in the pathogenesis of brain edema in experimental ALF but have also found significant alterations in the tight junction elements including occludin and claudin-5, suggesting a vasogenic injury in the blood-brain barrier (BBB) integrity. This article reviews and explores the role of the paracellular tight junction proteins in the increased selective BBB permeability that leads to brain edema in ALF.
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Affiliation(s)
- Justin H Nguyen
- Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States.
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Nafidi O, Letourneau R, Willems BE, Lapointe RW. Reuse of liver graft from a brain dead recipient. Clin Transplant 2007; 21:773-6. [DOI: 10.1111/j.1399-0012.2007.00724.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Celik A, Saglam F, Cavdar C, Sifil A, Gungor O, Bora S, Gulay H, Camsari T. Successful Reuse of a Transplanted Kidney: 3-Year Follow-Up. Am J Kidney Dis 2007; 50:143-5. [PMID: 17591534 DOI: 10.1053/j.ajkd.2007.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Accepted: 04/09/2007] [Indexed: 11/11/2022]
Abstract
The number of new transplantations has not kept pace with the ever-growing number of patients waiting for a kidney transplant, and there has been a growing shortage of deceased donor kidneys. Previously transplanted organs have been used to increase the donor pool. There is very little data about the reuse of a transplanted kidney. We report a case of successful reuse of a kidney graft after the death of the first recipient with a 3-year follow-up.
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Affiliation(s)
- Ali Celik
- Department of Medicine, Division of Nephrology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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