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Gonzalez JM, Villarreal C, Fasci A, Rocco DD, Salazar S, Khalil A, Wearden B, Oseghale J, Garcia M, Portillo DJ, Hood RL. Evaluating the Performance of a Nonelectronic, Versatile Oxygenating Perfusion System across Viscosities Representative of Clinical Perfusion Solutions Used for Organ Preservation. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010002. [PMID: 36671574 PMCID: PMC9854583 DOI: 10.3390/bioengineering10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Introduction: On the United States' Organ Transplantation Waitlist, approximately 17 people die each day waiting for an organ. The situation continues to deteriorate as the discrepancy between harvested organs and the number of patients in need is increasing. Static cold storage is the clinical standard method for preserving a harvested organ but is associated with several drawbacks. Machine perfusion of an organ has been shown to improve preservation quality as well as preservation time over static cold storage. While there are machine perfusion devices clinically available, they are costly and limited to specific organs and preservation solutions. This study presents a versatile oxygenating perfusion system (VOPS) that supplies oxygen and pulsatile perfusion. Materials and Methods: Experiments evaluated the system's performance with a human kidney mimicking hydraulic analog using multiple compressed oxygen supply pressures and aqueous solutions with viscosities ranging from 1 to 6.5 cP, which simulated viscosities of commonly used organ preservation solutions. Results and Conclusions: The VOPS produced mean flow rates ranging from 0.6 to 28.2 mL/min and perfusion pressures from 4.8 to 96.8 mmHg, which successfully achieved the desired perfusion parameters for human kidneys. This work provides evidence that the VOPS described herein has the versatility to perfuse organs using many of the clinically available preservation solutions.
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Affiliation(s)
- Jose M. Gonzalez
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Carorina Villarreal
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Anjelyka Fasci
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - David Di Rocco
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Sophia Salazar
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Anis Khalil
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Brandt Wearden
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Jessica Oseghale
- Department of Biomedical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Mariana Garcia
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
| | - Daniel J. Portillo
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Correspondence: (D.J.P.); (R.L.H.)
| | - R. Lyle Hood
- Department of Mechanical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Department of Biomedical Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA
- Correspondence: (D.J.P.); (R.L.H.)
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Zhang Z, Jin J, Luo C, Chen A. Excavating the social representations and perceived barriers of organ donation in China over the past decade: A hybrid text analysis approach. Front Public Health 2022; 10:998737. [PMID: 36225769 PMCID: PMC9549352 DOI: 10.3389/fpubh.2022.998737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 01/26/2023] Open
Abstract
Background Organ donation has been claimed as a prosocial behavior to prolong the recipient's life and deliver great love. However, the supply-demand ratio of organs in China is highly unbalanced. Being entangled with multiple factors derived from individual and supra-individual levels, organ donation in China is important but sensitive. Previous scholars usually depended on obtrusive approaches to explore the facilitators and hindrances of organ donation, which is hard to discover genuine perceptions toward organ donation. Besides, relatively limited scholarly attention has been paid to what hampers organ donation in China. Objective We intended to excavate the diversified social representations and perceived barriers to organ donation in China over the past decade. Method Two kinds of text analysis methods-semantic network analysis and conventional content analysis, were applied to 120,172 posts from ordinary users on the Sina Weibo platform to address the research questions. Results Regarding social representations, the "hope, understanding, and acceptance" of organ donation was the most pronounced one (34% of the whole semantic network), followed by "family story" (26%), "the procedure of organ donation in NGOs" (15%), "the practical value of organ donation" (14%), and "organ donation in the medical context" (11%). Regarding perceived barriers, a four-layer framework was constructed, including (1) the individual level, mainly about the fear of death and postmortem autopsy; (2) the familial level, which refers to the opposition from family members; (3) the societal level, which alludes to distrust toward medical institutions and the general society; (4) the cultural level, which covers religious-cultural concerns about fatalism. Conclusion In concordance with prior works on social representations regarding organ donation, the current study also uncovered the coexistence of antithetical representations about organ donation-the longing for survival and the fear of death. This representation pair serves as the foundation of Chinese people's ambivalence. Besides, family-related narratives were dispersed over various representations, demonstrating the critical position of family support in organ donation. Moreover, the four-layer framework concerning donation barriers affords a reference for future empirical studies. The practical implications of this work are further discussed.
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Affiliation(s)
- Zizhong Zhang
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Jing Jin
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Chen Luo
- School of Journalism and Communication, Wuhan University, Wuhan, China,*Correspondence: Chen Luo
| | - Anfan Chen
- School of Journalism and Communication, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Alamouti-fard E, Garg P, Wadiwala IJ, Yazji JH, Alomari M, Hussain MWA, Elawady MS, Jacob S. Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation. Cureus 2022; 14:e26437. [PMID: 35800191 PMCID: PMC9246458 DOI: 10.7759/cureus.26437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
In donation after circulatory death (DCD) organ transplantation, normothermic regional perfusion (NRP) restores oxygenated blood flow following cardiac arrest and reverses warm ischemia. Recently, NRP has also been used to help recover DCD hearts in addition to the abdominal organs. While DCD donation has increased the number of abdominal organs and lungs pool, it has not been able to increase the number of heart transplants, despite the fact that it has the potential to increase the number of heart transplants by 15-30%. Thoracoabdominal normothermic regional perfusion makes heart transplantation feasible and permits assessing heart function before an organ procurement without affecting the preservation of abdominal organs. NRP can be used in two ways for DCD donor heart transplants: normothermic regional perfusion followed by machine perfusion (NRP-MP) and normothermic regional perfusion followed by static cold storage (NRP-SCS). Normothermic regional perfusion is an emerging technology, a cost-effective alternative in donation after circulatory death (DCD), and will increase the pool of donors in heart transplantation.
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Campo-Cañaveral de la Cruz JL, Crowley Carrasco S, Tanaka S, Romero Román A, Hoyos Mejía L, Gil Barturen M, Sánchez Calle Á, García Fadul C, Aguilar Pérez M, Pérez Redondo M, Naranjo Gómez JM, Royuela A, Córdoba Peláez M, Varela de Ugarte A, Gómez de Antonio D. Lung transplantation from uncontrolled and controlled donation after circulatory death: similar outcomes to brain death donors. Transpl Int 2021; 34:2609-2619. [PMID: 34570381 DOI: 10.1111/tri.14120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
Controlled donation after circulatory death donors (cDCD) are becoming a frequent source of lungs grafts worldwide. Conversely, lung transplantations (LTx) from uncontrolled donors (uDCD) are sporadically reported. We aimed to review our institutional experience using both uDCD and cDCD and compare to LTx from brain death donors (DBD). This is a retrospective analysis of all LTx performed between January 2013 and December 2019 in our institution. Donor and recipient characteristics were collected and univariate, multivariate and survival analyses were carried out comparing the three cohorts of donors. A total of 239 (84.7%) LTx were performed from DBD, 29 (10.3%) from cDCD and 14 (5%) from uDCD. There were no statistically significant differences in primary graft dysfunction grade 3 at 72 h, 30- and 90-day mortality, need for extracorporeal membrane oxygenation after procedure, ICU and hospital length of stay, airway complications, CLAD incidence or survival at 1 and 3 years after transplant (DBD: 87.1% and 78.1%; cDCD: 89.7% and 89.7%; uDCD: 85.7% and 85.7% respectively; P = 0.42). Short- and mid-term outcomes are comparable between the three types of donors. These findings may encourage and reinforce all types of donation after circulatory death programmes as a valid and growing source of suitable organs for transplantation.
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Affiliation(s)
- Jose Luis Campo-Cañaveral de la Cruz
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Silvana Crowley Carrasco
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Shin Tanaka
- Department of General Thoracic Surgery/Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Alejandra Romero Román
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Lucas Hoyos Mejía
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Mariana Gil Barturen
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Álvaro Sánchez Calle
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Christian García Fadul
- Pneumology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Myriam Aguilar Pérez
- Pneumology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Marina Pérez Redondo
- Intensive Care Unit, Transplant Coordinator, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jose Manuel Naranjo Gómez
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Mar Córdoba Peláez
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - Andrés Varela de Ugarte
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
| | - David Gómez de Antonio
- Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid., Madrid, Spain
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Lysyy T, Finotti M, Maina RM, Morotti R, Munoz-Abraham AS, Bertacco A, Ibarra C, Barahona M, Agarwal R, D'Amico F, Rodriguez-Davalos MI, Mulligan D, Geibel J. Human Small Intestine Transplantation: Segmental Susceptibility to Ischemia Using Different Preservation Solutions and Conditions. Transplant Proc 2020; 52:2934-2940. [PMID: 32768284 DOI: 10.1016/j.transproceed.2020.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Among all transplanted abdominal organs, the small intestine is one of the most ischemia sensitive. Appropriate graft selection, procurement, and preservation are crucial for optimum graft and patient survival. We evaluated ischemic damage in human small intestine grafts under different hypothermic preservation conditions (cold static and continuous perfusion) and solutions: histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW). METHODS Fourteen small intestinal grafts were procured from deceased donors. HTK and UW were used for the vascular perfusion at the cross clamp, and UW, HTK, or Ringer Lactate were used for the luminal flush at the back table. Therefore, part of the same harvested intestine was stored in cold static storage and in continuous perfusion preservation (with intestinal perfusion unit) simultaneously. Histological samples were collected from the jejunum and ileum at different time points and different preservation conditions. The samples were collected before the initiation of cold storage (T0), after 8 hours of cold static (ST8), or after 8 hours of continuous perfusion preservation (PT8) (n = 161 samples). Blinded histological evaluation was conducted and ischemic damage was determined using the Park/Chiu scale. RESULTS The ileum had less ischemic damage than the jejunum, regardless of using static or continuous perfusion preservation. There was no significantly ischemic damage difference between intestinal grafts flushed and perfused with UW or HTK. CONCLUSION The jejunum is more susceptible to ischemic injury than the ileum. UW and HTK are equivalent to preserve intestinal graft. This suggests that selective transplantation of ileum could reduce ischemia-related postoperative complications.
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Affiliation(s)
- Taras Lysyy
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Michele Finotti
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA; University of Padua, Transplantation and Hepatobiliary Surgery, Padua, Padua, Italy
| | - Renee M Maina
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Raffaella Morotti
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | | | - Alessandra Bertacco
- University of Padua, Transplantation and Hepatobiliary Surgery, Padua, Padua, Italy
| | - Christopher Ibarra
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Maria Barahona
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Raghav Agarwal
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Francesco D'Amico
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA; University of Padua, Transplantation and Hepatobiliary Surgery, Padua, Padua, Italy
| | | | - David Mulligan
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - John Geibel
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA.
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Deceased Brain Dead Donor Liver Transplantation and Utilization in the United States: Nighttime and Weekend Effects. Transplantation 2020; 103:1392-1404. [PMID: 30444802 DOI: 10.1097/tp.0000000000002533] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Understanding factors that contribute to liver discards and nonusage is urgently needed to improve organ utilization. METHODS Using Scientific Registry of Transplant Recipient data, we studied a national cohort of all US adult, deceased brain dead donor, isolated livers available for transplantation from 2003 to 2016, including organ-specific and system-wide factors that may affect organ procurement and discard rates. RESULTS Of 73 686 available livers, 65 316 (88.64%) were recovered for transplant, of which 6454 (9.88%) were ultimately discarded. Livers that were not procured or, on recovery, discarded were more frequently from older, heavier, hepatitis B virus (HCV)+, and more comorbid donors (P < 0.001). However, even after adjustment for organ quality, the odds of liver nonusage were 11% higher on the weekend (defined as donor procurements with cross-clamping occurring from 5:00 PM Friday until 11:59 AM Sunday) compared with weekdays (P < 0.001). Nonuse rates were also higher at night (P < 0.001), defined as donor procurements with cross-clamping occurring from 5:00 PM to 5:00 AM; however, weekend nights had significantly higher nonuse rates compared with weekday nights (P = 0.005). After Share 35, weekend nonusage rates decreased from 21.77% to 19.51% but were still higher than weekday nonusage rates (P = 0.065). Weekend liver nonusage was higher in all 11 United Network of Organ Sharing regions, with an absolute average of 2.00% fewer available livers being used on the weekend compared with weekdays. CONCLUSIONS Although unused livers frequently have unfavorable donor characteristics, there are also systemic and operational factors, including time of day and day of the week a liver becomes available, that impact the chance of liver nonprocurement and discard.
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Temirov T, Ben-David B, Mustafin A, Viderman D. Erector Spinae Plane Block in Management of Pain After Kidney Transplantation. PAIN MEDICINE 2020; 20:1053-1054. [PMID: 30412258 DOI: 10.1093/pm/pny221] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Talgat Temirov
- JSC Medical University of Astana, Astana, Kazakhstan, USA
| | - Bruce Ben-David
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan.,Department of Anesthesiology and Critical Care, National Neurosurgery Center
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Hessheimer AJ, Riquelme F, Fundora-Suárez Y, García Pérez R, Fondevila C. Normothermic perfusion and outcomes after liver transplantation. Transplant Rev (Orlando) 2019; 33:200-208. [PMID: 31239189 DOI: 10.1016/j.trre.2019.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 01/04/2023]
Abstract
Ischemia has been a persistent and largely unavoidable element in solid organ transplantation, contributing to graft deterioration and adverse post-transplant outcomes. In liver transplantation, where available organs arise with greater frequency from marginal donors (i.e., ones that are older, obese, and/or declared dead following cardiac arrest through the donation after circulatory death process), there is increasing interest using dynamic perfusion strategies to limit, assess, and even reverse the adverse effects of ischemia in these grafts. Normothermic perfusion, in particular, is used to restore the flow of oxygen and other metabolic substrates at physiological temperatures. It may be used in liver transplantation both in situ following cardiac arrest in donation after circulatory death donors or during part or all of the ex situ preservation phase. This review article addresses issues relevant to use of normothermic perfusion strategies in liver transplantation, including technical and logistical aspects associated with establishing and maintaining normothermic perfusion in its different forms and clinical outcomes that have been reported to date.
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Affiliation(s)
- Amelia J Hessheimer
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Digestive & Metabolic Disease Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain.
| | - Francisco Riquelme
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Digestive & Metabolic Disease Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain
| | - Yiliam Fundora-Suárez
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Digestive & Metabolic Disease Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain
| | - Rocío García Pérez
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Digestive & Metabolic Disease Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain
| | - Constantino Fondevila
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Digestive & Metabolic Disease Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain
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9
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Hsin M, Au T. Ex vivo lung perfusion: a potential platform for molecular diagnosis and ex vivo organ repair. J Thorac Dis 2018; 10:S1871-S1883. [PMID: 30026974 DOI: 10.21037/jtd.2018.04.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lung transplantation is a proven treatment for selected patients with end-stage lung disease. However, the number of patients on the transplant waiting list far exceeds the number of available donor lungs, resulting in waiting list morbidity and mortality. The problem is further exacerbated by the low utilisation rate of available donor lungs, for fear of selecting a damaged lung and the resultant primary graft dysfunction. In the past decade, ex vivo lung perfusion (EVLP) has become part of standard lung transplant clinical practice in Canada and Europe, and it has been shown to improve the usage of available donor lungs by allowing physiological and radiologic evaluation of explanted donor lungs that are considered "marginal". This allows clinicians a second opportunity to decide whether to proceed to transplantation, instead of declining an organ that appears questionable by standard clinical criteria. However there has been much research activity looking at EVLP as a platform for (I) molecular diagnosis, thereby further improving the diagnostic accuracy regarding quality of the donor lung; (II) organ repair, thereby allowing injured donor lungs to become clinically useable. This manuscript summarises some of the preclinical and clinical research from the Toronto group focusing on these promising aspects of EVLP which may further increase the number of useable donor lungs in lung transplantation.
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Affiliation(s)
- Michael Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Tim Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
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10
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Essien EOI, Parimi N, Gutwald-Miller J, Nutter T, Scalea TM, Stein DM. Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation. World J Surg 2018; 41:2933-2939. [PMID: 28620674 DOI: 10.1007/s00268-017-4089-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organ dysfunction is common after neurologic determination of death (NDD) but before organ collection. Reliable markers for graft success following transplant of these organs would be useful. We sought to determine the relationship between the donor after neurologic determination of death (DNDD) pathophysiology and successful organ donation. METHODS Donor information was obtained through the local organ procurement organization. Donor demographics and clinical data points for cardiovascular, renal, respiratory, hepatic, hematological and neuroendocrine systems were reviewed 12 h before and 12 h after neurologic determination of death was declared. The worst values were utilized for analysis and generation of the organ-specific Sequential Organ Failure Assessment (SOFA) scores. SOFA scores were calculated and used to quantify the degree of organ dysfunction. The NDD non-donors for a specific organ were used as a comparison control group. The control group refers to DNDD patients whose specific organs were not transplanted. Lack of use was mostly due to discard by the transplant team as a result of unsuitability of the organ caused by deterioration or possible donor-specific pathology. RESULTS One hundred and five organ donors were analyzed. Mean age was 35.0 (± 13.6), 78.1% male, median GCS 3, interquartile range (IQR) 3-4 and median injury severity score 32 (IQR 25-43). Of the successful donors, organ-specific severe dysfunction (SOFA 3 or 4) occurred in 96, 27.5 and 3.3% of cardiac, lung and liver donors, respectively. There was no significant difference between the levels of organ dysfunction in donors versus non-donors except lung donors, in which the median lowest partial pressure of arterial oxygen-to-fraction of inspired oxygen (P/F) ratio in the non-donor was 194 (IQR 121.8-308.3) compared to the median lowest P/F ratio in the donor which was 287 (IQR 180-383.5), p = 0.02. In the recipients, graft failure 6 months after transplantation was reported in one kidney recipient (0.74%) (peak donor creatinine = 1 mg/dL) and in five pancreas recipients (11.4%). The median peak glucose of the pancreas donors in failed recipients was 178 mg/dL (IQR 157-213), whereas in the functioning recipients, the median glucose of their donors was not different (185 mg/dL, IQR 157-216), p = 0.394. CONCLUSION Current measures of organ failure and dysfunction do not predict the success of organ donation. Successful donor management in the face of severe organ dysfunction and failure can result in lives saved.
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Affiliation(s)
- Eno-Obong I Essien
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA.
| | - Nehu Parimi
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | | | - Tyree Nutter
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
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Nacif LS, Rocha-Santos V, Claro LC, Vintimilla A, Ferreira LA, Arantes RM, Pinheiro RS, Andraus W, Alves VA, D’Albuquerque LC. Liver biopsy may facilitate pancreatic graft evaluation: Positive association between liver steatosis and pancreatic graft adipose infiltration. Clinics (Sao Paulo) 2018; 73:e49. [PMID: 29846412 PMCID: PMC5960076 DOI: 10.6061/clinics/2018/e49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 12/11/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The number of pancreatic transplants has decreased in recent years. Pancreatic grafts have been underutilized compared to other solid grafts. One cause of discard is the macroscopic appearance of the pancreas, especially the presence of fatty infiltration. The current research is aimed at understanding any graft-related association between fatty tissue infiltration of the pancreas and liver steatosis. METHODS From August 2013 to August 2014, a prospective cross-sectional clinical study using data from 54 multiple deceased donor organs was performed. RESULTS Micro- and macroscopic liver steatosis were significantly correlated with the donor body mass index ([BMI]; p=0.029 and p=0.006, respectively). Positive gamma associations between pancreatic and liver macroscopic and microscopic findings (0.98; confidence interval [CI]: 0.95-1 and 0.52; CI 0.04-1, respectively) were observed. Furthermore, comparisons of liver microscopy findings showed significant differences between severe versus absent (p<0.001), severe versus mild (p<0.001), and severe versus moderate classifications (p<0.001). The area under the receiver operating curve was 0.94 for the diagnosis of steatosis by BMI evaluation using a cut-off BMI of 27.5 kg/m2, which yielded 100% sensitivity, 87% specificity, and 100% negative predictive value. CONCLUSIONS We observed a positive association of macroscopic and microscopic histopathological findings in steatotic livers with adipose infiltration of pancreatic grafts.
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Affiliation(s)
- Lucas S. Nacif
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Vinicius Rocha-Santos
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Laura C.L. Claro
- Departamento de Patologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Agustin Vintimilla
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro A. Ferreira
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rubens M. Arantes
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rafael S. Pinheiro
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Wellington Andraus
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Venancio A.F. Alves
- Departamento de Patologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Carneiro D’Albuquerque
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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12
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Choinski K, Rocca JP, Torabi J, Lorenzen K, Yongue C, Herbert ME, Block T, Chokechanachaisakul A, Kamal L, Kinkhabwala M, Graham JA. The Pancreas Can Take the Cold: Lower Waitlist Times Through Importation. Transplant Proc 2017; 49:2305-2309. [PMID: 29198666 DOI: 10.1016/j.transproceed.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Our center has used a strategy of pancreas importation owing to long regional waitlist times. Here we assess the clinical outcomes and financial considerations of this strategy. METHODS This was a retrospective observational cohort study of patients who received a pancreas transplant at Montefiore Medical Center (MMC) from 2014 to 2017 (n = 28). Clinical parameters, including hemoglobin A1c and complications, were analyzed. The cohort was compared with United Network for Organ Sharing (UNOS) Region 9 with the use of the UNOS/Organ Procurement and Transplantation Network database. Cost analysis of length of stay (LOS), standard acquisition (SAC) fees, and transportation was performed with the use of internal financial data. RESULTS Pancreas importation resulted in significantly shorter simultaneous pancreas kidney transplant waitlist times compared with Region 9: 518 days vs 1001 days (P = .038). In addition, postoperative complications and 1-year HbA1c did not differ between groups: local 6.30% vs import 6.17% (P = .87). Patients receiving local pancreata stayed an average of 9.2 days compared with 11 days for the import group (P = .36). As such, pancreas importation was associated with higher mean charges ($445,968) compared with local pancreas recipients ($325,470). CONCLUSIONS Long waitlist times in Region 9 have encouraged our center's adoption of pancreas importation to address the needs of our patient population. This practice has resulted in a reduction of waitlist times by an average of 483 days. Understandably, centers have long been wary of importation owing to perceived risk in clinical outcomes. In our single-center experience, we have demonstrated equivalent postoperative glucose control and graft survival. Importantly, there does appear to be increased costs associated with importation, which are mainly driven by LOS. Curiously, importation from regions with lower SAC fees has the potential to offset costs related to transportation expenses. Notwithstanding these findings, pancreas importation does have the potential to lessen the financial societal burden through reduction in waitlist times.
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Affiliation(s)
- K Choinski
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - J P Rocca
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - J Torabi
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - K Lorenzen
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York
| | - C Yongue
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - M E Herbert
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York
| | - T Block
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York
| | - A Chokechanachaisakul
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - L Kamal
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - M Kinkhabwala
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York
| | - J A Graham
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York.
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13
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Donation After Circulatory Arrest in Pancreas Transplantation: A Report of 10 Cases. Transplant Proc 2017; 49:2310-2314. [DOI: 10.1016/j.transproceed.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Scarpino M, Lanzo G, Lolli F, Moretti M, Carrai R, Migliaccio ML, Spalletti M, Bonizzoli M, Peris A, Amantini A, Grippo A. Is brain computed tomography combined with somatosensory evoked potentials useful in the prediction of brain death after cardiac arrest? Neurophysiol Clin 2017; 47:327-335. [DOI: 10.1016/j.neucli.2017.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 12/12/2022] Open
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15
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Rudolph EN, Dunn TB, Sutherland DER, Kandaswamy R, Finger EB. Optimizing outcomes in pancreas transplantation: Impact of organ preservation time. Clin Transplant 2017. [PMID: 28636074 DOI: 10.1111/ctr.13035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent changes to pancreas graft allocation policy have increased the number of organs available for regional and distant sharing, which results in a corresponding increase in preservation time. We sought to systematically assess the impact of cold ischemia time (CIT) on outcomes post-transplant. A retrospective review of 1253 pancreas transplants performed at a single transplant center was performed to correlate CIT to transplant outcomes. The rate of technical failure (TF) increased with 20+ hours of CIT, with a 2.7-fold to 6.2-fold increased rate of TF for pancreas after kidney (PAK), simultaneous pancreas and kidney (SPK), and pancreas transplants overall. Long-term graft survival was best with <12 hours of CIT; graft failure increased 1.2-fold to 1.4-fold with 12-24 hours of CIT and 2.2-fold with 24+ hours. CIT had less influence on the pancreas transplant alone category than either SPK or PAK and had markedly more influence on grafts from older (age >25 years) and overweight (body mass index >25) donors. In the final analysis, grafts with <12 hours of CIT performed the best overall, and strategies that reduce CIT (such as early allocation, pre-recovery cross-matching, and chartered flights for organs) should be considered whenever possible.
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Affiliation(s)
- Ehren N Rudolph
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ty B Dunn
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - David E R Sutherland
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Raja Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Erik B Finger
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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16
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Abstract
Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration. Three hundred and seventy-three patients were identified. Mean age was 37 years (617.2). Seventy-five per cent were male. Major mechanism of injury was blunt trauma in 66 per cent. Median injury severity score was 34 (IQR 25–43) with a median head abbreviated injury scale score of 5. The most common physiological disturbance was hypotension with 91 per cent of subjects requiring vasopressors. Thrombocytopenia and acidosis both had an incidence of 79 per cent. The next most common disturbances were hypothermia and moderate-to-severe respiratory dysfunction in 62 per cent. Myocardial injury was seen in 91 per cent but only 5.7 per cent of patients manifested severe cardiac dysfunction with an ejection fraction of <35. Diabetes insipidus was diagnosed in 50 per cent of patients. Interestingly, coagulopathy was noted in only 61.3 per cent, and hyperglycemia was seen in 36 per cent despite widespread belief that these occur universally during brain death. This is the first and largest study to characterize the incidence of pathophysiological disturbances following brain death in humans. Appropriate management of these dysfunctions is important for support of potential brain-dead organ donors.
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Affiliation(s)
- Eno-Obong Essien
- Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Kristina Fioretti
- Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Thomas M. Scalea
- Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Deborah M. Stein
- Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center, Baltimore, Maryland
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17
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Martens A, Van Raemdonck DE, Smits J, Verleden SE, Vos R, Vanaudenaerde BM, Verleden GM, Degezelle K, Desschans B, Neyrinck AP. A retrospective database analysis to evaluate the potential of ex vivo lung perfusion to recruit declined lung donors. Transpl Int 2017; 30:1002-1010. [DOI: 10.1111/tri.12990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/15/2017] [Accepted: 05/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- An Martens
- Department of Anesthesiology; University Hospitals Leuven; Leuven Belgium
| | | | | | - Stijn E Verleden
- Lung Transplant Unit; Katholieke Universiteit Leuven; Leuven Belgium
| | - Robin Vos
- Lung Transplant Unit; Katholieke Universiteit Leuven; Leuven Belgium
| | | | - Geert M Verleden
- Lung Transplant Unit; Katholieke Universiteit Leuven; Leuven Belgium
| | - Karlien Degezelle
- Transplant Coordination; University Hospitals Leuven; Leuven Belgium
| | - Bruno Desschans
- Transplant Coordination; University Hospitals Leuven; Leuven Belgium
| | - Arne P Neyrinck
- Department of Anesthesiology; University Hospitals Leuven; Leuven Belgium
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18
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Pateria P, Jeffrey GP, Garas G, Tibballs J, Ferguson J, Delriviere L, Huang Y, Adams LA, MacQuillan G. Transjugular intrahepatic portosystemic shunt: Indications, complications, survival and its use as a bridging therapy to liver transplant in Western Australia. J Med Imaging Radiat Oncol 2017; 61:441-447. [DOI: 10.1111/1754-9485.12563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/28/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Puraskar Pateria
- Department of Gastroenterology and Hepatology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Gary P Jeffrey
- Department of Gastroenterology and Hepatology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
| | - George Garas
- Department of Gastroenterology and Hepatology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
| | - Jonathan Tibballs
- Department of Radiology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - John Ferguson
- Department of Radiology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Luc Delriviere
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
- Department of Surgery; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Yi Huang
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
| | - Leon A Adams
- Department of Gastroenterology and Hepatology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
| | - Gerry MacQuillan
- Department of Gastroenterology and Hepatology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Nedlands Western Australia Australia
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19
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Motallebzadeh R, Aly M, El-Khairi M, Drage M, Olsburgh J, Callaghan CJ. High alcohol intake in deceased donors has no effect on pancreas graft survival: a registry analysis. Transpl Int 2016; 30:170-177. [PMID: 27864893 DOI: 10.1111/tri.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/04/2016] [Accepted: 11/12/2016] [Indexed: 01/18/2023]
Abstract
Outcomes of pancreas transplantation from donors with high alcohol consumption are poorly described. The UK Transplant Registry was used to determine whether donor alcohol intake influenced pancreas survival in simultaneous pancreas-kidney (SPK) transplants performed between 2006 and 2012 (n = 770). Recipients were stratified by donor alcohol intake: group I (n = 122)-high recent alcohol intake (>21 or >14 units of alcohol/week in males or females, respectively) or previous alcohol abuse and group II (n = 648)-low/unknown current intake and no previous alcohol abuse. Median current alcohol intake was higher in group I than group II: 36.3 vs. 10 units/week; P < 0.001. One- and five-year pancreas graft survivals were 88.5% and 73.6% in group I, and 87% and 74.9% in group II. There was no difference in unadjusted graft survival between groups I and II (P = 0.76), and no difference between group II and a subgroup of group I with a donor history of alcohol abuse and high current intake (P = 0.26), or from donors with current alcohol consumption of >50 units/week (P = 0.41). Pancreas donors with past alcohol abuse or current high intake are common, and graft outcomes appear to be acceptable. This analysis suggests that high donor alcohol intake, by itself, should not exclude consideration of pancreas transplantation.
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Affiliation(s)
- Reza Motallebzadeh
- Department of Surgery, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Mohamed Aly
- Department of Surgery, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Muna El-Khairi
- Department of Statistical Science, University College London, London, UK
| | - Martin Drage
- Department of Nephrology and Transplantation, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan Olsburgh
- Department of Nephrology and Transplantation, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Christopher J Callaghan
- Department of Nephrology and Transplantation, Guy's & St Thomas' NHS Foundation Trust, London, UK
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20
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Tian Y, Wang J, Wang W, Ding Y, Sun Z, Zhang Q, Wang Y, Xie H, Yan S, Zheng S. Mesenchymal stem cells improve mouse non-heart-beating liver graft survival by inhibiting Kupffer cell apoptosis via TLR4-ERK1/2-Fas/FasL-caspase3 pathway regulation. Stem Cell Res Ther 2016. [DOI: 2778867410.1186/s13287-016-0416-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Liver transplantation is the optimal treatment option for end-stage liver disease, but organ shortages dramatically restrict its application. Donation after cardiac death (DCD) is an alternative approach that may expand the donor pool, but it faces challenges such as graft dysfunction, early graft loss, and cholangiopathy. Moreover, DCD liver grafts are no longer eligible for transplantation after their warm ischaemic time exceeds 30 min. Mesenchymal stem cells (MSCs) have been proposed as a promising therapy for treatment of certain liver diseases, but the role of MSCs in DCD liver graft function remains elusive.
Methods
In this study, we established an arterialized mouse non-heart-beating (NHB) liver transplantation model, and compared survival rates, cytokine and chemokine expression, histology, and the results of in vitro co-culture experiments in animals with or without MSC infusion.
Results
MSCs markedly ameliorated NHB liver graft injury and improved survival post-transplantation. Additionally, MSCs suppressed Kupffer cell apoptosis, Th1/Th17 immune responses, chemokine expression, and inflammatory cell infiltration. In vitro, PGE2 secreted by MSCs inhibited Kupffer cell apoptosis via TLR4-ERK1/2-caspase3 pathway regulation.
Conclusion
Our study uncovers a protective role for MSCs and elucidates the underlying immunomodulatory mechanism in an NHB liver transplantation model. Our results suggest that MSCs are uniquely positioned for use in future clinical studies owing to their ability to protect DCD liver grafts, particularly in patients for whom DCD organs are not an option according to current criteria.
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21
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Tian Y, Wang J, Wang W, Ding Y, Sun Z, Zhang Q, Wang Y, Xie H, Yan S, Zheng S. Mesenchymal stem cells improve mouse non-heart-beating liver graft survival by inhibiting Kupffer cell apoptosis via TLR4-ERK1/2-Fas/FasL-caspase3 pathway regulation. Stem Cell Res Ther 2016; 7:157. [PMID: 27788674 PMCID: PMC5084468 DOI: 10.1186/s13287-016-0416-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Liver transplantation is the optimal treatment option for end-stage liver disease, but organ shortages dramatically restrict its application. Donation after cardiac death (DCD) is an alternative approach that may expand the donor pool, but it faces challenges such as graft dysfunction, early graft loss, and cholangiopathy. Moreover, DCD liver grafts are no longer eligible for transplantation after their warm ischaemic time exceeds 30 min. Mesenchymal stem cells (MSCs) have been proposed as a promising therapy for treatment of certain liver diseases, but the role of MSCs in DCD liver graft function remains elusive. METHODS In this study, we established an arterialized mouse non-heart-beating (NHB) liver transplantation model, and compared survival rates, cytokine and chemokine expression, histology, and the results of in vitro co-culture experiments in animals with or without MSC infusion. RESULTS MSCs markedly ameliorated NHB liver graft injury and improved survival post-transplantation. Additionally, MSCs suppressed Kupffer cell apoptosis, Th1/Th17 immune responses, chemokine expression, and inflammatory cell infiltration. In vitro, PGE2 secreted by MSCs inhibited Kupffer cell apoptosis via TLR4-ERK1/2-caspase3 pathway regulation. CONCLUSION Our study uncovers a protective role for MSCs and elucidates the underlying immunomodulatory mechanism in an NHB liver transplantation model. Our results suggest that MSCs are uniquely positioned for use in future clinical studies owing to their ability to protect DCD liver grafts, particularly in patients for whom DCD organs are not an option according to current criteria.
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Affiliation(s)
- Yang Tian
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China
| | - Jingcheng Wang
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China
| | - Wei Wang
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China
| | - Yuan Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongquan Sun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiyi Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wang
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China
| | - Haiyang Xie
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.,Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, Zhejiang Province, China
| | - Sheng Yan
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China. .,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. .,Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, Zhejiang Province, China.
| | - Shusen Zheng
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China. .,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. .,Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, Zhejiang Province, China.
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22
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Abdominal regional in-situ perfusion in donation after circulatory determination of death donors. Curr Opin Organ Transplant 2016; 21:322-8. [DOI: 10.1097/mot.0000000000000315] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Whalen H, Shiels P, Littlejohn M, Clancy M. A novel rodent model of severe renal ischemia reperfusion injury. Ren Fail 2016; 38:1694-1701. [PMID: 26887330 DOI: 10.3109/0886022x.2016.1144024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Renal ischemia reperfusion injury (IRI) is a major problem, currently without treatments in clinical use. This reflects the failure of animal models to mimic the severity of IRI observed in clinical practice. Most described models lack both the ability to inflict a permanent reduction in renal function and the sensitivity to demonstrate the protective efficacy of different therapies in vivo. To test novel cell-based therapies, we have developed a model of renal IRI in Fisher 344 rats. Animals were subjected to 120 min of unilateral warm ischemia, during which they underwent an intra-renal artery infusion of therapeutic agents or vehicle. At either 2 or 6 weeks post-surgery, animals underwent terminal glomerular filtration rate (GFR) studies by inulin clearance to most accurately quantify renal function. Harvested kidneys underwent histological analysis. Compared to sham operations, saline treated animals suffered a long-term reduction in GFR of ≈50%. Histology revealed short- and long-term disruption of renal architecture. Despite the injury severity, post-operative animal losses are <5%. This model produces a severe, consistent renal injury that closely replicates the pathological processes encountered in clinical medicine. Renal artery infusion mimics the route likely employed in clinical transplantation, where the renal artery is accessible. Inulin clearance characterizes GFR, allowing full assessment of therapeutic intervention. This model is useful for screening therapeutic agents prior to testing in a transplant model. This reduces animal numbers needed to test drugs for clinical transplantation and allows for refinement of dosing schedules.
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Affiliation(s)
- Henry Whalen
- a College of Medical, Veterinary and Life Sciences Institute of Cancer Sciences, University of Glasgow , Glasgow , UK.,b Department of Renal Transplantation , South Glasgow University Hospital , Glasgow , UK
| | - Paul Shiels
- a College of Medical, Veterinary and Life Sciences Institute of Cancer Sciences, University of Glasgow , Glasgow , UK
| | - Marc Littlejohn
- a College of Medical, Veterinary and Life Sciences Institute of Cancer Sciences, University of Glasgow , Glasgow , UK
| | - Marc Clancy
- b Department of Renal Transplantation , South Glasgow University Hospital , Glasgow , UK
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24
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Donor-Derived Infections: Incidence, Prevention, and Management. TRANSPLANT INFECTIONS 2016. [PMCID: PMC7123109 DOI: 10.1007/978-3-319-28797-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Organ donors reflect the diverse US population, and there are an increasing number of donors born in, who have resided in, or who have traveled to underdeveloped areas of the world or areas with geographically restricted infections. As such, these donors are exposed to pathogens that can potentially be transmitted to recipients of the donor’s organs. Additionally, there are newer techniques to identify many pathogens that may be transmitted from the donor to the transplant recipients. Finally, high-profile reports of several donor-derived infections have heightened awareness of donor-derived infections and have likely contributed to increased recognition. In this chapter, the incidence, methods of identification and prevention, and management of unexpected donor-derived infections will be reviewed.
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25
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Hsin MKY, Iskender I, Nakajima D, Chen M, Kim H, dos Santos PR, Sakamoto J, Lee J, Hashimoto K, Harmantas C, Hwang D, Waddell T, Liu M, Keshavjee S, Cypel M. Extension of donor lung preservation with hypothermic storage after normothermic ex vivo lung perfusion. J Heart Lung Transplant 2016; 35:130-136. [DOI: 10.1016/j.healun.2015.05.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/26/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023] Open
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26
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Dalal A. Intestinal transplantation: The anesthesia perspective. Transplant Rev (Orlando) 2015; 30:100-8. [PMID: 26683875 DOI: 10.1016/j.trre.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 06/30/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis, drug interactions between anesthetic and immunosuppressive agents and venous access are some of the anesthetic considerations for this group.
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Affiliation(s)
- Aparna Dalal
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, United States.
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White CW, Ambrose E, Müller A, Li Y, Le H, Hiebert B, Arora R, Lee TW, Dixon I, Tian G, Nagendran J, Hryshko L, Freed D. Assessment of donor heart viability during ex vivo heart perfusion. Can J Physiol Pharmacol 2015; 93:893-901. [DOI: 10.1139/cjpp-2014-0474] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min–1·g–1). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R2 = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R2 = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R2 = 0.74, sensitivity = 1.00, specificity = 0.54; tau: R2 = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R2 = 0.28; coronary vascular resistance: R2 = 0.20; lactate concentration: R2 = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.
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Affiliation(s)
- Christopher W. White
- Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Emma Ambrose
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Alison Müller
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Yun Li
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Hoa Le
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Brett Hiebert
- Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Rakesh Arora
- Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
- National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
| | - Trevor W. Lee
- Anesthesia and Perioperative Medicine, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Ian Dixon
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Ganghong Tian
- National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
| | - Jayan Nagendran
- Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 2D4.34 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada
| | - Larry Hryshko
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Darren Freed
- Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
- Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
- National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada
- Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 2D4.34 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada
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Aubert O, Kamar N, Vernerey D, Viglietti D, Martinez F, Duong-Van-Huyen JP, Eladari D, Empana JP, Rabant M, Verine J, Rostaing L, Congy N, Guilbeau-Frugier C, Mourad G, Garrigue V, Morelon E, Giral M, Kessler M, Ladrière M, Delahousse M, Glotz D, Legendre C, Jouven X, Lefaucheur C, Loupy A. Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. BMJ 2015; 351:h3557. [PMID: 26232393 PMCID: PMC4521904 DOI: 10.1136/bmj.h3557] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To assess the long term outcomes of transplantation using expanded criteria donors (ECD; donors aged ≥ 60 years or aged 50-59 years with vascular comorbidities) and assess the main determinants of its prognosis. DESIGN Prospective, population based cohort study. SETTING Four French referral centres. PARTICIPANTS Consecutive patients who underwent kidney transplantation between January 2004 and January 2011, and were followed up to May 2014. A validation cohort included patients from another four referral centres in France who underwent kidney transplantation between January 2002 and December 2011. MAIN OUTCOME MEASURES Long term kidney allograft survival, based on systematic assessment of donor, recipient, and transplant clinical characteristics; preimplantation biopsy; and circulating levels of donor specific anti-HLA (human leucocyte antigen) antibody (DSA) at baseline. RESULTS The study included 6891 patients (2763 in the principal cohort, 4128 in the validation cohort). Of 2763 transplantations performed, 916 (33.2%) used ECD kidneys. Overall, patients receiving ECD transplants had lower allograft survival after seven years than patients receiving transplants from standard criteria donors (SCD; 80% v 88%, P<0.001). Patients receiving ECD transplants who presented with circulating DSA at the time of transplantation had worse allograft survival after seven years than patients receiving ECD kidneys without circulating DSA at transplantation (44% v 85%, P < 0.001). After adjusting for donor, recipient, and transplant characteristics, as well as preimplantation biopsy findings and baseline immunological parameters, the main independent determinants of long term allograft loss were identified as allocation of ECDs (hazard ratio 1.84 (95% confidence interval 1.5 to 2.3); P < 0.001), presence of circulating DSA on the day of transplantation (3.00 (2.3 to 3.9); P < 0.001), and longer cold ischaemia time (> 12 h; 1.53 (1.1 to 2.1); P = 0.011). Recipients of ECD kidneys with circulating DSA showed a 5.6-fold increased risk of graft loss compared with all other transplant therapies (P < 0.001). ECD allograft survival at seven years significantly improved with screening and transplantation in the absence of circulating DSA (P < 0.001) and with shorter (<12 h) cold ischaemia time (P=0.030), respectively. This strategy achieved ECD graft survival comparable to that of patients receiving an SCD transplant overall, translating to a 544.6 allograft life years saved during the nine years of study inclusion time. CONCLUSIONS Circulating DSA and cold ischaemia time are the main independent determinants of outcome from ECD transplantation. Allocation policies to avoid DSA and reduction of cold ischaemia time to increase efficacy could promote wider implement of ECD transplantation in the context of organ shortage and improve its prognosis.
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Affiliation(s)
- Olivier Aubert
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Rangueil, Toulouse, France INSERM U1043, Purpan, Toulouse Paul Sabatier University, Toulouse DIVAT (Données Informatiques VAlidées en Transplantation Network), France
| | - Dewi Vernerey
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France
| | - Denis Viglietti
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris
| | - Frank Martinez
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne Paris
| | - Jean-Paul Duong-Van-Huyen
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France Department of Pathology, Necker Hospital, Paris
| | - Dominique Eladari
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France Department of Renal Physiology, Georges Pompidou European Hospital, Paris
| | - Jean-Philippe Empana
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France
| | | | - Jerome Verine
- Department of Pathology, Saint-Louis Hospital, Paris
| | - Lionel Rostaing
- Department of Nephrology and Organ Transplantation, Rangueil, Toulouse, France INSERM U1043, Purpan, Toulouse Paul Sabatier University, Toulouse DIVAT (Données Informatiques VAlidées en Transplantation Network), France
| | - Nicolas Congy
- Paul Sabatier University, Toulouse Molecular Immunogenetics Laboratory, EA 3034, Faculty of Medicine Purpan, IFR150 (INSERM), Toulouse, France Department of Immunology, Rangueil Hospital, Toulouse
| | | | - Georges Mourad
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Nephrology and Kidney Transplantation, Montpellier, France
| | - Valérie Garrigue
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Nephrology and Kidney Transplantation, Montpellier, France
| | - Emmanuel Morelon
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Nephrology and Kidney Transplantation, Groupement Hospitalier, Hôpital Edouard Herriot, Lyon, France Centaure Network, France
| | - Magali Giral
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Centaure Network, France Department of Nephrology and Kidney Transplantation, Nantes, France
| | - Michèle Kessler
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Centaure Network, France Department of Nephrology and Kidney Transplantation, Nancy, France
| | - Marc Ladrière
- DIVAT (Données Informatiques VAlidées en Transplantation Network), France Centaure Network, France Department of Nephrology and Kidney Transplantation, Nancy, France
| | - Michel Delahousse
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France Department of Nephrology and Kidney Transplantation, Foch Hospital, Suresnes, Paris
| | - Denis Glotz
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris
| | - Christophe Legendre
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne Paris Centaure Network, France
| | - Xavier Jouven
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France Department of Cardiology, Georges Pompidou European Hospital, Paris
| | - Carmen Lefaucheur
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris
| | - Alexandre Loupy
- Paris Translational Research Centre for Organ Transplantation, INSERM, UMR-S970, Paris Descartes University, 75015 Paris, France DIVAT (Données Informatiques VAlidées en Transplantation Network), France Department of Kidney Transplantation, Necker Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne Paris
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Perspectives of Transplant Professionals on the Values, Ethics, and Challenges of Living Kidney Donor Evaluation in Asia. Transplantation 2015; 99:1386-95. [DOI: 10.1097/tp.0000000000000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adanir T, Erdogan I, Hunerli G, Unveren G, Dasci H, Cetin H, Ozsan I, Aydin U. The Effect of Psychological Support for the Relatives of Intensive Care Unit Patients on Cadaveric Organ Donation Rate. Transplant Proc 2014; 46:3249-52. [DOI: 10.1016/j.transproceed.2014.05.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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Dirchwolf M, Ruf AE, Biggins SW, Bisigniano L, Hansen Krogh D, Villamil FG. Donor selection criteria for liver transplantation in Argentina: are current standards too rigorous? Transpl Int 2014; 28:206-13. [PMID: 25406336 DOI: 10.1111/tri.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/12/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Abstract
Organ shortage is the major limitation for the growth of deceased donor liver transplant worldwide. One strategy to ameliorate this problem is to maximize the liver utilization rate. To assess predictors of liver utilization in Argentina. The national database was used to analyze transplant activity in 2010. Donor, recipient, and transplant variables were evaluated as predictors of graft utilization of number of rejected donor offers before grafting and with the occurrence of primary nonfunction (PNF) or early post-transplant mortality (EM). Of the 582 deceased donors, 293 (50.3%) were recovered for liver transplant. Variables associated with the nonrecovery of the liver were age ≥46 years, umbilical perimeter ≥92 cm, organ procurement outside Gran Buenos Aires, AST ≥42 U/l and ALT ≥29 U/l. The median number of rejected offers before grafting was 4, and in 71 patients (25%), there were ≥13. The only independent predictor for the occurrence of PNF (3.4%) or EM (5.2%) was the recipient's emergency status. During 2010 in Argentina, the liver was recovered in only half of donors. The low incidence of PNF and EM and the characteristics of the nonrecovered liver donors suggest that organ acceptance criteria should be less rigorous.
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Affiliation(s)
- Melisa Dirchwolf
- FUNDIEH (Fundación para la Docencia e Investigación de las Enfermedades del Hígado), Buenos Aires, Argentina
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32
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Saidi RF, Khaksari S, Ko DSC. Effect of staff migration on kidney transplant activity in United Network for Organ Sharing region 1 transplant centers. Prog Transplant 2014; 24:298-301. [PMID: 25193733 DOI: 10.7182/pit2014644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Organ shortage is unquestionably the greatest challenge facing the field of transplantation today. Transplant centers are constantly competing with one another for limited numbers of organs for their recipients. Recruitment of specialized transplant surgical expertise and leadership is thought to enable a center to grow in volume and thus profitability in the increasingly difficult world of health care reimbursement. In this study, the pattern of kidney transplants at 13 different centers in the United Network for Organ Sharing's region 1 is examined: the comparison is between transplant volume before and after changes in the centers' leadership between 2000 and 2011. Each center's kidney transplant volume showed a significant increase after a leadership change that ultimately regressed to the center's baseline. This study is the first to show that behavioral changes in transplant center competition cause transient increases in transplant volume that quickly regress back to mean levels.
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Affiliation(s)
- Reza F Saidi
- Providence Rhode Island, Alpert Medical School of Brown University
| | | | - Dicken S C Ko
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Boyarsky BJ, Massie AB, Alejo J, Van Arendonk KJ, Wildonger S, Garonzik-Wang JM, Montgomery RA, Deshpande NA, Muzaale AD, Segev DL. Experiences obtaining insurance after live kidney donation. Am J Transplant 2014; 14:2168-72. [PMID: 25041695 PMCID: PMC4194161 DOI: 10.1111/ajt.12819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/29/2014] [Accepted: 05/04/2014] [Indexed: 01/25/2023]
Abstract
The impact of kidney donation on the ability to change or initiate health or life insurance following donation is unknown. To quantify this risk, we surveyed 1046 individuals who donated a kidney at our center between 1970 and 2011. Participants were asked whether they changed or initiated health or life insurance after donation, and if they had any difficulty doing so. Among 395 donors who changed or initiated health insurance after donation, 27 (7%) reported difficulty; among those who reported difficulty, 15 were denied altogether, 12 were charged a higher premium and 8 were told they had a preexisting condition because they were kidney donors. Among 186 donors who changed or initiated life insurance after donation, 46 (25%) reported difficulty; among those who reported difficulty, 23 were denied altogether, 27 were charged a higher premium and 17 were told they had a preexisting condition because they were kidney donors. In this single-center study, a high proportion of kidney donors reported difficulty changing or initiating insurance, particularly life insurance. These practices by insurers create unnecessary burden and stress for those choosing to donate and could negatively impact the likelihood of live kidney donation among those considering donation.
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Affiliation(s)
- Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Jennifer Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle J. Van Arendonk
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Spencer Wildonger
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robert A. Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neha A. Deshpande
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Yi DH, Liu H, Chen Y, Li H, Xu T, Liu YF. Ischemic injury of the liver in a porcine model of cardiac death assessed by in vivo microdialysis. Mol Biol Rep 2014; 41:6611-8. [PMID: 25167853 DOI: 10.1007/s11033-014-3544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 06/20/2014] [Indexed: 01/08/2023]
Abstract
This study aims to evaluate the ischemic injury of the liver in a porcine model of cardiac death assessed by in vivo microdialysis. A porcine model of cardiac death was established by the suffocation method. Metabolic indicators were monitored using the microdialysis technique during warm ischemia time (WIT) and cold ischemia time (CIT). Pathological changes in ischemic-injured livers were observed by haematoxylin-eosin staining. The predictive values of biochemical parameters regarding the liver donor were evaluated by receiver operating characteristic curve analysis. All statistical analyses were conducted using the SPSS 18.0 software (SPSS Inc, Chicago, Illinois, USA). The degree of warm ischemic injury of the livers increased with prolonged WIT. Serum glucose, glycerol, pyruvate, lactic acid levels and lactate-to-pyruvate (L/P) ratio increased gradually during WIT. Results from Pearson correlation analyses indicated that serum lactate level and L/P ratio were positively associated with the degree of warm ischemic injury of the livers. The degree of cold ischemic injury of the livers gradually increased after 12 h CIT. Serum glucose, lactic acid and L/P ratio achieved a peak after 6-8 h of CIT, but gradually decreased with prolonged CIT. The peak of glycerol occurred after 8 h of CIT, while no changes were found with prolonged CIT. Serum pyruvate level exhibited an increasing trend after 12 h CIT. Our results confirmed that serum glucose and lactate levels were negatively correlated with cold ischemic injury of the liver. However, serum glycerol and pyruvate levels showed positive correlations with cold ischemic injury of the liver. The liver donor was unavailable after 30 min WIT and 24 h CIT. The cut-off value of serum lactate level for warm ischemic injury of the livers was 2.374 with a sensitivity (Sen) of 90 % and specificity (Spe) of 95 %; while the L/P radio was 0.026 (Sen = 80 %, Spe = 83 %). In addition, the cut-off values of serum glucose, lactate, glycerol and pyruvate levels for cold ischemic injury of the livers were 0.339 (Sen = 100 %, Spe = 77 %), 1.172 (Sen = 100 %, Spe = 61 %), 56.359 (Sen = 100 %, Spe = 65 %) and 0.020 (Sen = 100 %, Spe = 67 %), respectively. Our findings provide empirical evidences that serum glucose, lactate levels and L/P ratio may be good indicators for the degree of warm ischemic injury of the livers after cardiac death; while serum glucose, lactate, glycerol and pyruvate levels may be important in predicting cold ischemic injury.
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Affiliation(s)
- De-Hui Yi
- Department of Transplantation and Hepatobiliary Surgery, The First Affiliated Hospital of China Medical University, Nanjing Street No. 155, Heping District, Shenyang, 110001, People's Republic of China
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35
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Roskott AMC, van Haaften WT, Leuvenink HG, Ploeg RJ, van Goor H, Blokzijl T, Ottens PJ, Dijkstra G, Nieuwenhuijs VB. Histopathologic and molecular evaluation of the Organ Procurement and Transplantation Network selection criteria for intestinal graft donation. J Surg Res 2014; 189:143-51. [DOI: 10.1016/j.jss.2014.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/03/2014] [Accepted: 02/11/2014] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE There is reluctance to use donation after cardiac death (DCD) organs for fear of worse outcomes due to increased warm ischemia time. Extensive evidence to confirm the quality of DCD pancreas transplants is not manifest. METHODS A united network for organ sharing database review of pancreas transplants performed between 1996 and 2012 was conducted. We compared outcomes and all demographic variables between donors after cardiac death and donors after brain death in pancreas transplantation. RESULTS There were 320 DCD pancreas transplants and 20,448 donation after brain death pancreas transplants performed in the United States between 1996 and 2012. There was no statistically significant difference in graft survival or patient survival in pancreas transplantation in DCD versus donation after brain death donors measured at 1-year, 3-year, 5-year, 10-year, and 15-year intervals. There was no significant difference between donor and recipient age, race, sex, and body mass index (BMI) between the groups. There was no significant difference between the recipient ethnicity or time on wait list between the groups. CONCLUSIONS Pancreata procured by DCD have comparable outcomes to those procured after brain death. Donation after cardiac death pancreas transplant is a viable method of increasing the donor pool, decreasing wait list mortality, and improving the quality of life for type 1 diabetic patients.
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Voigt MR, DeLario GT. Perspectives on abdominal organ preservation solutions: a comparative literature review. Prog Transplant 2014; 23:383-91. [PMID: 24311404 DOI: 10.7182/pit2013100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Various preservation solutions are used for kidney, liver, pancreas, small intestine, and multiorgan recoveries and transplants. The effectiveness of these solutions, primarily measured by ability to preserve the organ and graft survival, was analyzed. The 2 most common solutions used for intra-abdominal organs are University of Wisconsin Solution (UW)/Viaspan and Histidine-tryptophan-ketoglutarate (HTK)/Custodiol solution. Outcomes for liver, pancreas, and kidney allografts preserved with these 2 solutions are similar. Although HTK solution shows conflicting results with respect to pancreatic cellular edema, researchers in several studies have noted that HTK solution may be more protective than UW solution against biliary complications in liver transplant. In kidney recoveries, HTK solution may be associated with higher graft loss and increased delayed graft function in marginal deceased donors but had lower incidence of delayed graft function in living donors when compared with UW. UW remains the reference standard for use during multiorgan recoveries but is experiencing strong competition from HTK and other alternative solutions. Some researchers suggest that Celsior's comparable results in abdominal organs and viability for thoracic organs makes it a strong competitor, especially in multiorgan recoveries. Each solution has benefits accompanied by disadvantages. Although it may not be feasible, when considering single-organ recoveries, consideration of alternative solutions may be warranted.
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IV Reunión de consenso de la Sociedad Española de Trasplante Hepático (SETH) 2012. Trasplante hepático con injertos no convencionales: bipartición hepática (split) y donante en asistolia. Cir Esp 2014; 92:157-67. [DOI: 10.1016/j.ciresp.2013.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/31/2013] [Indexed: 02/07/2023]
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40
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Matsuno N, Kobayashi E. Challenges in machine perfusion preservation for liver grafts from donation after circulatory death. Transplant Res 2013; 2:19. [PMID: 24283383 PMCID: PMC3896750 DOI: 10.1186/2047-1440-2-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022] Open
Abstract
Donation after circulatory death (DCD) is a promising solution to the critical shortage of donor graft tissue. Maintaining organ viability after donation until transplantation is essential for optimal graft function and survival. To date, static cold storage is the most widely used form of preservation in clinical practice. However, ischemic damage present in DCD grafts jeopardizes organ viability during cold storage, and whether static cold storage is the most effective method to prevent deterioration of organ quality in the increasing numbers of organs from DCD is unknown. Here we describe the historical background of DCD liver grafts and a new preservation method for experimental and clinical transplantation. To prevent ischemia-reperfusion injury in DCD liver grafts, a hypothermic machine perfusion (HMP) technique has recently been developed and may be superior to static cold preservation. We present evidence supporting the need for improving liver perfusion performance and discuss how doing so will benefit liver transplantation recipients.
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Affiliation(s)
- Naoto Matsuno
- Department of Innovative and Transplant Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan.
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Finger EB, Radosevich DM, Dunn TB, Chinnakotla S, Sutherland DER, Matas AJ, Pruett TL, Kandaswamy R. A composite risk model for predicting technical failure in pancreas transplantation. Am J Transplant 2013; 13:1840-9. [PMID: 23711225 PMCID: PMC3696030 DOI: 10.1111/ajt.12269] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 01/25/2023]
Abstract
Technical failure (TF) continues to have a significant impact on the success of pancreas transplantation. We assessed risk factors for TF in 1115 pancreas transplants performed at a single center between 1998 and 2011. The overall TF rate was 10.2%. In a multivariable model, donor BMI ≥ 30 (HR 1.87, p = 0.005), donor Cr ≥ 2.5 (HR 3.16, p = 0.007), donor age >50 (HR 1.73, p = 0.082) and preservation time >20 h (HR 2.17, p < 0.001) were associated with TF. Bladder drainage of exocrine secretions was protective (HR 0.54, p = 0.002). We incorporated these factors in a Composite Risk Model. In this model the presence of one risk factor did not significantly increase risk of TF (HR 1.35, p = 0.346). Two risk factors in combination increased risk greater than threefold (HR 3.65, p < 0.001) and three risk factors increased risk greater than sevenfold (HR 7.66, p = <0.001). The analysis also identified many factors that were not predictive of TF, including previous transplants, immunosuppressive agent selection, and almost all recipient demographic parameters. While the model suggests that two or more risk factors predict TF, strategies to reduce preservation time may mitigate some of this risk.
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Affiliation(s)
| | | | | | | | | | | | | | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455
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Akhtar M, Henderson T, Sutherland A, Vogel T, Friend P. Novel Approaches to Preventing Ischemia-Reperfusion Injury During Liver Transplantation. Transplant Proc 2013; 45:2083-92. [DOI: 10.1016/j.transproceed.2013.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 04/23/2013] [Indexed: 12/25/2022]
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Davies RR, Haldeman S, Pizarro C. Regional variation in survival before and after pediatric heart transplantation--an analysis of the UNOS database. Am J Transplant 2013; 13:1817-29. [PMID: 23714390 DOI: 10.1111/ajt.12259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 02/21/2013] [Accepted: 03/14/2013] [Indexed: 01/25/2023]
Abstract
Geographic variation occurs in a variety of health outcomes. Regional influences on outcomes before and after listing for pediatric heart transplantation have not been assessed. Review of the UNOS dataset identified 5398 pediatric (≤ 18 years) patients listed for heart transplantation 2000-2011. Patients were stratified based on the region of listing. Regional-level variables were correlated with individual risk-adjusted outcomes. Mean time spent on the waitlist varied from 91.0 ± 163 days (Region 6 [R6]) to 248.1 ± 493 days (R4, p < 0.0001). Regions with more transplant centers (p < 0.0001) and fewer transplants (p = 0.0015) had higher waitlist mortality. Risk-adjusted individual waitlist mortality varied from 6.9% (R1, CI 6.2-7.8) to 19.2% (R5, CI 18.0-20.6). Waitlist mortality was higher for individuals awaiting transplant in regions with more listings per center (OR 1.04, CI 1.01-1.08) and lower in regions with more donors per center (OR 0.95, CI 0.90-0.99 per donor). Posttransplant risk-adjusted survival varied across regions (R4: 5.4%, CI 4.2-7.4; R7: 18.0%, CI 12.4-32.5), but regional variables were not correlated with outcomes. Outcomes among children undergoing heart transplantation vary by region. Factors leading to increased competition for donor allografts are associated with poorer waitlist survival. Equitable allocation of cardiac allografts requires further investigation of these findings.
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Affiliation(s)
- R R Davies
- Nemours Cardiac Center, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
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Factors affecting graft survival among patients receiving kidneys from live donors: a single-center experience. BIOMED RESEARCH INTERNATIONAL 2013; 2013:912413. [PMID: 23878820 PMCID: PMC3708392 DOI: 10.1155/2013/912413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 02/01/2023]
Abstract
Introduction. The aim of this report is to study the graft and patient survival in a large cohort of recipients with an analysis of factors that may affect the final outcomes.
Methods. Between March 1976 and March 2008, 1967 consecutive live-donor renal transplants were carried out. Various variables that may have an impact on patients and/or graft survival were studied in two steps. Initially, a univariate analysis was carried out. Thereafter, significant variables were embedded in a stepwise regression analysis.
Results. The overall graft survival was 86.7% and 65.5%, at 5 and 10 years, respectively. The projected half-life for grafts was 17.5 years and for patients was 22 years. Five factors had an independent negative impact on graft survival: donor's age, genetic considerations, the type of primary immunosuppression, number of acute rejection episodes, and total steroid dose during the first 3 months after transplantation. Conclusions. Despite refinements in tissue matching techniques and improvements in immunosuppression protocols, an important proportion of grafts is still lost following living donor kidney transplantation, presumably due to chronic allograft nephropathy.
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Irving MJ, Tong A, Jan S, Wong G, Cass A, Allen RD, Craig JC, Chadban S, Rose J, Howard K. Community preferences for the allocation of deceased donor organs for transplantation: a focus group study. Nephrol Dial Transplant 2013; 28:2187-93. [DOI: 10.1093/ndt/gft208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Echenique IA, Ison MG. Update on donor-derived infections in liver transplantation. Liver Transpl 2013; 19:575-85. [PMID: 23526639 DOI: 10.1002/lt.23640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/02/2013] [Indexed: 12/15/2022]
Abstract
Advances in surgical techniques, immunosuppressive medications, and robust infectious disease prophylaxis have resulted in liver transplantation becoming the treatment of choice for patients with end-stage liver disease and unresectable hepatocellular carcinoma. Nonetheless, organ transplantation is not without risk. Unexpected donor-derived disease transmission is a newly recognized risk that complicates approximately 0.2% of all organ transplants. We review the epidemiology of donor-derived infectious diseases and methods of risk mitigation with a focus on liver transplantation.
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Affiliation(s)
- Ignacio A Echenique
- Division of Infectious Diseases, Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Abstract
BACKGROUND Organ shortage is the greatest challenge facing the field of organ transplantation today. Use of more organs of marginal quality has been advocated to address the shortage. METHOD We examined the pattern of donation and organ use in the United States as shown in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database of individuals who were consented for and progressed to organ donation between January 2001 and December 2010. RESULTS There were 66,421 living donors and 73,359 deceased donors, including 67,583 (92.1%) identified as donation after brain death and 5,776 (7.9%) as donation after circulatory death (DCD). Comparing two periods, era 1 (01/2001-12/2005) and era 2 (01/2006-12/2010), the number of deceased donors increased by 20.3% from 33,300 to 40,059 while there was a trend for decreasing living donation. The DCD subgroup increased from 4.9 to 11.7% comparing the two eras. A significant increase in cardiovascular/cerebrovascular disease as a cause of death was also noted, from 38.1% in era 1 to 56.1% in era 2 (p<0.001), as was a corresponding decrease in the number of deaths due to head trauma (48.8 vs. 34.9%). The overall discard rate also increased from 13,411 (11.5%) in era 1 to 19,516 (13.7%) in era 2. This increase in discards was especially prominent in the DCD group [440 (20.9%) in era 1 vs. 2,089 (24.9%) in era 2]. CONCLUSIONS We detect a significant change in pattern of organ donation and use in the last decade in the United States. The transplant community should consider every precaution to prevent the decay of organ quality and to improve the use of marginal organs.
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Donor risk factors, retrieval technique, preservation and ischemia/reperfusion injury in pancreas transplantation. Curr Opin Organ Transplant 2013; 18:83-8. [PMID: 23254698 DOI: 10.1097/mot.0b013e32835c29ef] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Pancreas transplantation is still hampered by a high incidence of early graft loss, and organ quality concerns result in high nonrecovery/discard rates. Demographic donor characteristics, surgical retrieval strategy, preservation fluid and ischemia time are crucial factors in the process of organ selection and are discussed in this review. RECENT FINDINGS The donor shortage is driving an increasing utilization of nonideal organs which would previously have been identified as unsuitable. Recent literature suggests that organs from extended criteria donors - older (>45 years), BMI >30 kg/m(2), and donation after cardiac death (DCD) - can achieve the same graft and patient survival as those from standard criteria donors, with the proviso that the accumulation of risk factors and long ischemic times should be avoided. Visual assessment of the pancreas is advisable before declining/accepting a pancreas. University of Wisconsin represents the gold standard solution; however, histidine-tryptophan-ketoglutarate and Celsior result in equal outcomes if cold ischemia time (CIT) is less than 12 h. Currently in pancreas transplantation, there is no proven effective ischemia/reperfusion injury prophylaxis than trying to keep CIT as short as possible. SUMMARY Demographic risk factors, inspection of the pancreas by an experienced surgeon and predicted CIT are crucial factors in deciding whether to accept a pancreas for transplantation. However, there is a need for an improved evidence base to determine where to set the 'cut-off' for unsuitable pancreatic grafts.
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van der Hilst CS, IJtsma AJ, Bottema JT, van Hoek B, Dubbeld J, Metselaar HJ, Kazemier G, van den Berg AP, Porte RJ, Slooff MJ. The price of donation after cardiac death in liver transplantation: a prospective cost-effectiveness study. Transpl Int 2013; 26:411-8. [DOI: 10.1111/tri.12059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/13/2013] [Accepted: 12/23/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Christian S. van der Hilst
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Alexander J.C. IJtsma
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Jan T. Bottema
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology; Leiden University Medical Center; Leiden; The Netherlands
| | - Jeroen Dubbeld
- Department of Surgery; Leiden University Medical Center; Leiden; The Netherlands
| | - Herold J. Metselaar
- Department of Gastroenterology; Erasmus Medical Center; Rotterdam; The Netherlands
| | - Geert Kazemier
- Department of Surgery; Erasmus Medical Center; Rotterdam; The Netherlands
| | - Aad P. van den Berg
- Department of Gastroenterology; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Robert J. Porte
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | - Maarten J.H. Slooff
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
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Mueller KR, Balamurugan AN, Cline GW, Pongratz RL, Hooper RL, Weegman BP, Kitzmann JP, Taylor MJ, Graham ML, Schuurman HJ, Papas KK. Differences in glucose-stimulated insulin secretion in vitro of islets from human, nonhuman primate, and porcine origin. Xenotransplantation 2013; 20:75-81. [PMID: 23384163 DOI: 10.1111/xen.12022] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/28/2012] [Indexed: 01/15/2023]
Abstract
Porcine islet xenotransplantation is considered a potential cell-based therapy for type 1 diabetes. It is currently being evaluated in diabetic nonhuman primates (NHP) to assess safety and efficacy of the islet product. However, due to a variety of distinct differences between the respective species, including the insulin secretory characteristics of islets, the suitability and predictive value of the preclinical model in the extrapolation to the clinical setting remain a critical issue. Islets isolated from human (n = 3), NHP (n = 2), adult pig (AP, n = 3), and juvenile pig (JP, n = 4) pancreata were perifused with medium at basal glucose (2.5 mm) followed by high glucose (16.7 mm) concentrations. The total glucose-stimulated insulin secretion (GSIS) was calculated from generated insulin secretion profiles. Nonhuman primate islets exhibited GSIS 3-fold higher than AP islets, while AP and JP islets exhibited GSIS 1/3 and 1/30 of human islets, respectively. The insulin content of NHP and AP islets was similar to that of human islets, whereas that of JP islets was 1/5 of human islets. Despite the fact that human, NHP, and AP islets contain similar amounts of insulin, the much higher GSIS for NHP islets than for AP and JP islets suggests the need for increased dosing of islets from JP and AP in pig-to-NHP transplantation. Porcine islet xenotransplantation to humans may require significantly higher dosing given the lower GSIS of AP islets compared to human islets.
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Affiliation(s)
- Kate R Mueller
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
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