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Chotkan KA, Alwayn IPJ, Hemke AC, Baranski A, Nijboer W, Pol RA, Braat AE. Ten Years of Quality Monitoring of Abdominal Organ Procurement in the Netherlands and Its Impact on Transplant Outcome. Transpl Int 2024; 37:12989. [PMID: 38919904 PMCID: PMC11197516 DOI: 10.3389/ti.2024.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
In this study, 10 years of procurement quality monitoring data were analyzed to identify potential risk factors associated with procurement-related injury and their association with long-term graft survival. All deceased kidney, liver, and pancreas donors from 2012 to 2022 and their corresponding recipients in the Netherlands were retrospectively included. The incidence of procurement-related injuries and potential risk factors were analyzed. Of all abdominal organs procured, 23% exhibited procurement-related injuries, with a discard rate of 4.0%. In kidneys and livers, 23% of the grafts had procurement-related injury, with 2.5% and 4% of organs with procurement-related injury being discarded, respectively. In pancreas procurement, this was 27%, with a discard rate of 24%. Male donor gender and donor BMI >25 were significant risk factors for procurement-related injury in all three abdominal organs, whereas aberrant vascularization was significant only for the kidney and liver. In the multivariable Cox regression analyses, procurement-related injury was not a significant predictor for graft failure (kidney; HR 0.99, 95% CI 0.75-1.33, p = 0.99, liver; HR 0.92, 95% CI 0.66-1.28, p = 0.61, pancreas: HR 1.16; 95% CI 0.16-8.68, p = 0.88). The findings of this study suggest that transplant surgeons exhibited good decision-making skills in determining the acceptability and repairability of procurement-related injuries.
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Affiliation(s)
- K. A. Chotkan
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, Netherlands
- Dutch Transplant Foundation, Leiden, Netherlands
| | - I. P. J. Alwayn
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - A. C. Hemke
- Dutch Transplant Foundation, Leiden, Netherlands
| | - A. Baranski
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - W. Nijboer
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - R. A. Pol
- Department of Surgery, Division of Transplantation, University Medical Center Groningen, Groningen, Netherlands
| | - A. E. Braat
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
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2
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Lam HD, Ploeg R, Nijboer WN, Alwayn IPJ, Coenraad M, Hemke AC, Bastiaannet E, Putter H, Baranski A. Certification Training and Liver Transplant Experience Improves Liver Procurement Outcomes: The Dutch Approach. Transplantation 2024:00007890-990000000-00728. [PMID: 38616312 DOI: 10.1097/tp.0000000000005024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND This study investigates the impact of certification training and liver transplant experience on procurement outcomes of deceased donor liver procurement in the Netherlands. METHODS Three groups (trainee, certified, and master) were formed, with further subdivision based on liver transplant experience. Three key outcomes-surgical injury, graft discard after injury, and donor hepatectomy duration-were analyzed. RESULTS There were no significant differences in surgical graft injury in the three groups (trainee, 16.9%; certified, 14.8%; master, 18.2%; P = 0.357; 2011 to 2018). The only predictor for surgical graft injury was donation after cardiac death (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.10-2.02). Of the three groups, the master group had the highest discard rate after surgical injury (trainee, 0%; certified, 1.3%; master, 2.8%; P = 0.013). Master group without liver transplant experience (OR, 3.16; 95% CI, 1.21-8.27) and male donor sex (OR, 3.58; 95% CI, 1.32-9.73) were independent risk factors for discarding livers after surgical injury. Independent predictors for shorter hepatectomy durations included donors older than 50 years (coefficient [Coeff], -7.04; 95% CI, -8.03 to -3.29; P < 0.001), and master group (Coeff, -9.84; 95% CI, -14.37 to -5.31; P < 0.001) and certified group with liver transplant experience (Coeff, -6.54; 95% CI, -10.83 to -2.26; P = 0.003). On the other hand, master group without liver transplant experience (Coeff, 5.00; 95% CI, 1.03-8.96; P = 0.014) and donation after cardiac death (Coeff, 10.81; 95% CI, 8.32-13.3; P < 0.001) were associated with longer hepatectomy durations. CONCLUSIONS Training and certification in abdominal organ procurement surgery were associated with a reduced discard rate for surgical injured livers and shorter hepatectomy times. The contrast between master group with and without liver transplant experience underscores the need for specialized training in this field.
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Affiliation(s)
- Hwai-Ding Lam
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger Ploeg
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Willemijn N Nijboer
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
- Landelijk Overleg Regionale Uitname Teams, Leiden, the Netherlands
| | - Ian P J Alwayn
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Minneke Coenraad
- Department of Gastroenterology and Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Aline C Hemke
- Dutch Transplantation Foundation, Leiden, the Netherlands
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hein Putter
- Section Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrzej Baranski
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
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3
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Dery KJ, Yao S, Cheng B, Kupiec-Weglinski JW. New therapeutic concepts against ischemia-reperfusion injury in organ transplantation. Expert Rev Clin Immunol 2023; 19:1205-1224. [PMID: 37489289 PMCID: PMC10529400 DOI: 10.1080/1744666x.2023.2240516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Ischemia-reperfusion injury (IRI) involves a positive amplification feedback loop that stimulates innate immune-driven tissue damage associated with organ procurement from deceased donors and during transplantation surgery. As our appreciation of its basic immune mechanisms has improved in recent years, translating putative biomarkers into therapeutic interventions in clinical transplantation remains challenging. AREAS COVERED This review presents advances in translational/clinical studies targeting immune responses to reactive oxygen species in IRI-stressed solid organ transplants, especially livers. Here we focus on novel concepts to rejuvenate suboptimal donor organs and improve transplant function using pharmacologic and machine perfusion (MP) strategies. Cellular damage induced by cold ischemia/warm reperfusion and the latest mechanistic insights into the microenvironment's role that leads to reperfusion-induced sterile inflammation is critically discussed. EXPERT OPINION Efforts to improve clinical outcomes and increase the donor organ pool will depend on improving donor management and our better appreciation of the complex mechanisms encompassing organ IRI that govern the innate-adaptive immune interface triggered in the peritransplant period and subsequent allo-Ag challenge. Computational techniques and deep machine learning incorporating the vast cellular and molecular mechanisms will predict which peri-transplant signals and immune interactions are essential for improving access to the long-term function of life-saving transplants.
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Affiliation(s)
- Kenneth J. Dery
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Siyuan Yao
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brian Cheng
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jerzy W. Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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4
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Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation. Transplant Direct 2023; 9:e1450. [PMID: 36845854 PMCID: PMC9945290 DOI: 10.1097/txd.0000000000001450] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 02/22/2023] Open
Abstract
Normothermic regional perfusion (NRP) has gained widespread adoption in multiple European countries. The aim of this study was to examine the influence of thoracoabdominal-NRP (TA-NRP) on the utilization and outcomes of liver, kidney, and pancreas transplantation in the United States. Methods Using the US national registry data between 2020 and 2021, donation after circulatory death (DCD) donors were separated into 2 groups: DCD with TA-NRP and without TA-NRP. There were 5234 DCD donors; among them 34 donors were with TA-NRP. After 1:4 propensity score matching, the utilization rates were compared between DCD with and without TA-NRP. Results Although the utilization rates of kidney and pancreas were comparable (P = 0.71 and P = 0.06, 94.1% versus 95.6% and 8.8% versus 2.2%, respectively), that of liver in DCD with TA-NRP was significantly higher (P < 0.001; 70.6% versus 39.0%). Among 24 liver transplantations, 62 kidney transplantations, and 3 pancreas transplantations from DCD with TA-NRP, there were 2 liver grafts and 1 kidney graft that failed within 1 y after transplantation. Conclusions TA-NRP in the United States significantly increased the utilization rate of abdominal organs from DCD donors with comparable outcomes after transplantation. Increasing use of NRP may expand the donor pool without compromising transplant outcomes.
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Lam HD, Schaapherder AF, Alwayn IP, Nijboer WN, Tushuizen ME, Hemke AC, Baranski A, Pas SLVD. Quality assessment of donor liver procurement surgery using an unadjusted CUSUM prediction model. A practical nationwide evaluation. Clin Transplant 2023; 37:e14940. [PMID: 36796105 DOI: 10.1111/ctr.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The aim of this study was to analyze the value of the unadjusted CUSUM graph of liver surgical injury and discard rates in organ procurement in the Netherlands. METHODS Unadjusted CUSUM graphs were plotted for surgical injury (C event) and discard rate (C2 event) from procured livers accepted for transplantation for each local procurement team compared with the total national cohort. The average incidence for each outcome was used as benchmark based on procurement quality forms (Sep 2010-Oct 2018). The data from the five Dutch procuring teams were blind-coded. RESULTS The C and C2 event rate were 17% and 1.9%, respectively (n = 1265). A total of 12 CUSUM charts were plotted for the national cohort and the five local teams. National CUSUM charts showed an overlapping "alarm signal." This overlapping signal for both C and C2, albeit a different time period, was only found in one local team. The other CUSUM alarm signal went off for two separate local teams, but only for C events or C2 events respectively, and at different points in time. The other remaining CUSUM charts showed no alarm signaling. CONCLUSION The unadjusted CUSUM chart is a simple and effective monitoring tool in following performance quality of organ procurement for liver transplantation. Both national and local recorded CUSUMs are useful to see the implication of national and local effects on organ procurement injury. Both procurement injury and organ discard are equally important in this analysis and need to be separately CUSUM charted.
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Affiliation(s)
- Hwai-Ding Lam
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander F Schaapherder
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian Pj Alwayn
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Willemijn N Nijboer
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.,Landelijk Overleg Regionale Uitname teams, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology & Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Aline C Hemke
- Dutch Transplantation Foundation, Leiden, The Netherlands
| | - Andrzej Baranski
- Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Stéphanie L Van der Pas
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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6
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Silva NA, Waisberg DR, Fernandes MR, Pinheiro RS, Santos JPC, Lima MRD, Alvarez PSE, Ernani L, Lins-Albuquerque MV, Nacif LS, Rocha-Santos V, Martino RB, Ducatti L, Arantes RM, Song AT, Lee AD, Haddad LB, Dala Riva DF, Silva AM, Galvão FH, Andraus W, Carneiro-D'Albuquerque LA. Incidence of Donor Hepatic Artery Thrombosis in Liver Grafts Recognized During Organ Procurement and Backtable: A Rare but Treacherous Pitfall In Liver Transplantation. Transplant Proc 2022; 54:1345-1348. [PMID: 35599202 DOI: 10.1016/j.transproceed.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 02/07/2023]
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7
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Sellers MT, Nassar A, Alebrahim M, Sasaki K, Lee DD, Bohorquez H, Cannon RM, Selvaggi G, Neidlinger N, McMaster WG, Hoffman JRH, Shah AS, Montenovo MI. Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: A multi-institutional observational study. Clin Transplant 2022; 36:e14659. [PMID: 35362152 DOI: 10.1111/ctr.14659] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Mortality on the liver waitlist remains unacceptably high. Donation after circulatory determination of death (DCD) donors are considered marginal but are a potentially underutilized resource. Thoraco-abdominal normothermic perfusion (TA-NRP) in DCD donors might result in higher quality livers and offset waitlist mortality. We retrospectively reviewed outcomes of the first 13 livers transplanted from TA-NRP donors in the US. Nine centers transplanted livers from 8 organ procurement organizations. Median donor age was 25 years; median agonal phase was 13 minutes. Median recipient age was 60 years; median lab MELD score was 21. Three patients (23%) met early allograft dysfunction (EAD) criteria. Three received simultaneous liver-kidney transplants; neither had EAD nor delayed renal allograft function. One recipient died 186 days post-transplant from sepsis but had normal pre-sepsis liver function. One patient developed a biliary anastomotic stricture, managed endoscopically; no recipient developed clinical evidence of ischemic cholangiopathy (IC). Twelve of 13 (92%) patients are alive with good liver function at 439 days median follow-up; 1 patient has extrahepatic recurrent HCC. TA-NRP DCD livers in these recipients all functioned well, particularly with respect to IC, and provide a valuable option to decrease deaths on the waiting list. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marty T Sellers
- Department of Surgery, Emory University, Atlanta, Georgia.,Tennessee Donor Services, Nashville, Tennessee
| | - Ahmed Nassar
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Musab Alebrahim
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Kazunari Sasaki
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Surgery, Stanford University
| | - David D Lee
- Department of Surgery, Loyola University, Chicago, Illinois
| | - Humberto Bohorquez
- Department of Surgery, Ochsner School of Medicine, New Orleans, Louisiana
| | - Robert M Cannon
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - William G McMaster
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee
| | - Jordan R H Hoffman
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee
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8
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Walcott J, Fink M, Ealing I, Christophi C, Muralidharan V. Procurement-related liver injury for transplantation: an analysis of the risk factors and consequences in an Australian transplant centre. ANZ J Surg 2021; 91:2669-2674. [PMID: 34723420 DOI: 10.1111/ans.17285] [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: 05/02/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Liver transplantation is an established treatment for liver failure, and its success relies on the quality of the donated organ amongst other factors. Studies on procurement-related liver injury (PRLI) are few and some may not apply to modern-day practice. This is the first Australian study examining risk factors and consequences of PRLI. METHOD The Victorian Liver Transplant Unit database was examined for deceased liver donors from 2010 to 2017. Information regarding the donor, retrieval and subsequent transplantation was obtained. PRLI details were sought from the 'organ retrieval report form'. PRLI risk factors and their complications were analysed. RESULTS A total of 420 transplants were included, with 45 injuries in 44 livers (10%), and significant injuries were observed in 4%. Variant anatomy was associated with an increased risk of PRLI (11% vs. 2%, p < 0.001). Complication rates were not significantly different between livers with and without PRLI however a reduction in early graft survival was observed. CONCLUSION This study shows that PRLI is common, and that variant anatomy is associated with an increased risk of injury. Appropriate feedback and benchmarking are important to maintain a high quality in donor surgery.
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Affiliation(s)
- James Walcott
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | - Michael Fink
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Isaac Ealing
- Royal Prince Alfred Hospital, UGI, Sydney, New South Wales, Australia
| | - Christopher Christophi
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia.,Hepato-Pancreato-Biliary & Transplant Surgery Unit, Austin Health, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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9
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De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, Kimenai HJAN, Knight SR, Neyrinck AP, Paredes D, Watson CJE, Rega F, Jochmans I. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int 2021; 34:2046-2060. [PMID: 34570380 DOI: 10.1111/tri.14121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
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Affiliation(s)
- Julie De Beule
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Liset H M Pengel
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Heylen L, Pirenne J, Naesens M, Sprangers B, Jochmans I. "Time is tissue"-A minireview on the importance of donor nephrectomy, donor hepatectomy, and implantation times in kidney and liver transplantation. Am J Transplant 2021; 21:2653-2661. [PMID: 33759371 DOI: 10.1111/ajt.16580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 01/25/2023]
Abstract
Donor organs are exposed to sequential temperature changes during the transplantation process. The role of donor warm ischemia and cold ischemia times on post-transplant outcomes has been extensively studied. Much less attention has been paid to the transient ischemia occurring during donor organ removal and implantation. Recently, it has become clear that prolonged donor nephrectomy and implantation time are independently associated with delayed graft function after kidney transplantation. In addition, implantation time correlates with post-transplant kidney graft function, histology, and survival. Similar detrimental associations of donor hepatectomy and implantation time with early allograft dysfunction, ischemic cholangiopathy, and graft and patient survival after liver transplantation have been demonstrated. This review details kidney and liver temperature changes occurring during procurement and transplantation. It summarizes the effects of the ischemia the kidney and liver sustain during these phases on short- and long-term post-transplant outcomes, advocating the standardized reporting of donor hepatectomy, donor nephrectomy, and implantation times in (inter)national registries. The review also explores strategies to protect the graft from this ischemic injury.
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Affiliation(s)
- Line Heylen
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jacques Pirenne
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Naesens
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ben Sprangers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.,Immunity and Inflammation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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11
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Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society. Transplantation 2021; 105:945-951. [PMID: 33675315 DOI: 10.1097/tp.0000000000003729] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Donation after circulatory death (DCD) donors are an increasingly more common source of livers for transplantation in many parts of the world. Events that occur during DCD liver recovery have a significant impact on the success of subsequent transplantation. This working group of the International Liver Transplantation Society evaluated current evidence as well as combined experience and created this guidance on DCD liver procurement. Best practices for the recovery and transplantation of livers arising through DCD after euthanasia and organ procurement with super-rapid cold preservation and recovery as well as postmortem normothermic regional perfusion are described, as are the use of adjuncts during DCD liver procurement.
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12
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Van den Eynde J, Achtergaele J, Fieuws S, Jochmans I, Sainz-Barriga M, Monbaliu D, Pirenne J, Gilbo N. The effect of organ preservation solutions on short-term outcomes after liver transplantation: a single-center retrospective study. Transpl Int 2021; 34:327-338. [PMID: 33280170 DOI: 10.1111/tri.13799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
The effect of preservation solutions on outcomes has been subject of many debates but the relative benefits of the various solutions remain unclear. We retrospectively compared short-term outcomes of 885 liver transplantations performed between 1/2000 and 12/2017 and preserved with either Histidine-Tryptophan-Ketoglutarate (HTK, n = 190), University of Wisconsin (UW, n = 557), or Institute George Lopez 1 preservation solution (IGL-1, n = 139). Inverse probability of treatment weighting (IPTW) was performed to account for baseline differences between groups and analyses were adjusted for confounders. In the IPTW analyses, peak AST within 7 days was 44% higher (95% CI 15-81%, P < 0.001) in HTK than in UW. Mean model of early allograft function (MEAF) score was 0.61 points (95% CI 0.12-1.10, P = 0.01) higher in HTK than in UW. Early allograft dysfunction (EAD) was more likely to occur with HTK compared to IGL-1 (IPTW OR = 2.87, 95% CI = 1.00-8.19, P = 0.049) and UW (IPTW OR = 1.75, 95% CI = 1.06-2.88, P = 0.023). The type of preservation solution had no impact on hospital stay, ICU stay, incidence of biliary strictures, or graft and recipient survival. HTK was the least effective on reducing graft injury and increased the probability of graft dysfunction after transplantation. UW and IGL-1 were equally effective in reducing graft injury and dysfunction.
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Affiliation(s)
- Jef Van den Eynde
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Jannick Achtergaele
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Mauricio Sainz-Barriga
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Nicholas Gilbo
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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13
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Hessheimer AJ, Gastaca M, Miñambres E, Colmenero J, Fondevila C. Donation after circulatory death liver transplantation: consensus statements from the Spanish Liver Transplantation Society. Transpl Int 2020; 33:902-916. [PMID: 32311806 PMCID: PMC7496958 DOI: 10.1111/tri.13619] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
Livers from donation after circulatory death (DCD) donors are an increasingly more common source of organs for transplantation. While there are few high-level studies in the field of DCD liver transplantation, clinical practice has undergone progressive changes during the past decade, in particular due to mounting use of postmortem normothermic regional perfusion (NRP). In Spain, uncontrolled DCD has been performed since the late 1980s/early 1990s, while controlled DCD was implemented nationally in 2012. Since 2012, the rise in DCD liver transplant activity in Spain has been considerable, and the great majority of DCD livers transplanted in Spain today are recovered with NRP. A panel of the Spanish Liver Transplantation Society was convened in 2018 to evaluate current evidence and accumulated experience in DCD liver transplantation, in particular addressing issues related to DCD liver evaluation, acceptance criteria, and recovery as well as recipient selection and postoperative management. This panel has created a series of consensus statements for the standard of practice in Spain and has published these statements with the hope they might help guide other groups interested in implementing new forms of DCD liver transplantation and/or introducing NRP into their clinical practices.
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Affiliation(s)
- Amelia J. Hessheimer
- Liver Transplant UnitCIBERehdIDIBAPSHospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Mikel Gastaca
- Hospital Universitario CrucesBilbaoSpain
- SETH Board of DirectorsSpain
| | - Eduardo Miñambres
- Transplant Coordination Unit & Intensive Care ServiceIDIVALHospital Universitario Marqués de ValdecillaUniversity of CantabriaSantanderSpain
| | - Jordi Colmenero
- Liver Transplant UnitCIBERehdIDIBAPSHospital ClínicUniversity of BarcelonaBarcelonaSpain
- SETH Board of DirectorsSpain
| | - Constantino Fondevila
- Liver Transplant UnitCIBERehdIDIBAPSHospital ClínicUniversity of BarcelonaBarcelonaSpain
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14
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Pérez Redondo M, Alcántara Carmona S, Fernández Simón I, Villanueva Fernández H, Ortega López A, Pardo Rey C, Duerto Álvarez J, Lipperheide Vallhonrat I, González Romero M, Ballesteros Ortega D, Río Gallegos F, Rubio Muñoz JJ. Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results. Clin Transplant 2020; 34:e13899. [DOI: 10.1111/ctr.13899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/11/2020] [Accepted: 05/02/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Marina Pérez Redondo
- Department of Intensive Care MedicineHospital Universitario Puerta de Hierro Majadahonda Madrid Spain
| | - Sara Alcántara Carmona
- Department of Intensive Care MedicineHospital Universitario Puerta de Hierro Majadahonda Madrid Spain
| | | | | | - Alfonso Ortega López
- Department of Intensive Care MedicineHospital Universitario Puerta de Hierro Majadahonda Madrid Spain
| | - Cándido Pardo Rey
- Department of Intensive Care Medicine and Transplant Coordinator. HospitalUniversitario Clínico San Carlos Madrid Spain
| | - Jorge Duerto Álvarez
- Department of Intensive Care Medicine and Transplant Coordinator. HospitalUniversitario Clínico San Carlos Madrid Spain
| | | | - Manuel González Romero
- Department of Intensive Care Medicine and Transplant Coordinator. HospitalUniversitario Clínico San Carlos Madrid Spain
| | - Daniel Ballesteros Ortega
- Department of Intensive Care MedicineHospital Universitario Puerta de Hierro Majadahonda Madrid Spain
| | - Francisco Río Gallegos
- Department of Intensive Care Medicine and Transplant Coordinator. HospitalUniversitario Clínico San Carlos Madrid Spain
| | - Juan José Rubio Muñoz
- Department of Intensive Care MedicineHospital Universitario Puerta de Hierro Majadahonda Madrid Spain
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15
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Palleschi A, Tosi D, Rosso L, Zanella A, De Carlis R, Zanierato M, Benazzi E, Tarsia P, Colledan M, Nosotti M. Successful preservation and transplant of warm ischaemic lungs from controlled donors after circulatory death by prolonged in situ ventilation during normothermic regional perfusion of abdominal organs. Interact Cardiovasc Thorac Surg 2020; 29:699-705. [PMID: 31243436 DOI: 10.1093/icvts/ivz160] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/17/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Donation after circulatory death (DCD) potentially provides transplantable lungs suitable for a transplant, but in Italy, the need for 20 min of a no-touch period after cardiac arrest for legal declaration of death poses real challenges to organ preservation. METHODS This is a single-institution, retrospective study using data collected prospectively between October and December 2017. After the approval of the multidisciplinary DCD study group of Regione Lombardia, Maastricht category III DCD donors became eligible for combined procurement of lungs and abdominal organs. Our group subsequently established a dedicated technical protocol. Our protocol consists of a non-rapid normothermic open-lung procurement process that takes place during abdominal normothermic regional perfusion, namely without pleural topical cooling before the start of pneumoplegia. After the lung is procured according to the technique described in the article, lung function is evaluated by ex vivo lung perfusion, which is run with the low-flow, open atrium, low haematocrit technique. RESULTS During the study, we managed 5 controlled DCDs. In 3 cases, the lungs were successfully transplanted. All 3 patients are alive after 1 year, with good respiratory function. CONCLUSIONS Our approach resulted in adequate lung preservation and successful transplants without detrimental effects on abdominal organ procurement, confirming the possibility of overcoming the obstacle of a long no-touch period in a DCD setting.
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Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zanella
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Marinella Zanierato
- Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Benazzi
- Coordinamento trapianti North Italy Transplantation program (NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Tarsia
- Department of Pathophysiology and Transplantation, Respiratory Unit and Regional Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Colledan
- Division of Liver and Small Bowel Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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16
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The Impact of Hepatectomy Time of the Liver Graft on Post-transplant Outcome: A Eurotransplant Cohort Study. Ann Surg 2020; 269:712-717. [PMID: 29166361 DOI: 10.1097/sla.0000000000002593] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Assessing the effect of donor hepatectomy time on outcome after transplantation. SUMMARY OF BACKGROUND DATA When blood supply in a deceased organ donor stops, ischemic injury starts. Livers are cooled to reduce cellular metabolism and minimize ischemic injury. This cooling is slow and livers are lukewarm during hepatectomy, potentially affecting outcome. METHODS We used the Eurotransplant Registry to investigate the relationship between donor hepatectomy time and post-transplant outcome in 12,974 recipients of deceased-donor livers (January 1, 2004, to December 31, 2013). Cox regression analyses for patient and graft survival (censored and uncensored for death with a functioning graft) were corrected for donor, preservation, and recipient variables. Donor hepatectomy time was defined as time between start of aortic cold flush and placement of the liver in the ice-bowl. RESULTS Median donor hepatectomy time was 41 minutes [interquartile range (IQR) 32 to 52]. Livers donated after circulatory death had longer hepatectomy times than those from brain-dead donors [50 minutes (35 to 68) vs 40 minutes (32 to 51), P < 0.001]. Donor hepatectomy time was independently associated with graft loss [adjusted hazard ratio (HR) 1.03 for every 10-minute increase, 95% confidence interval (95% CI) 1.02-1.05; P < 0.001]. The magnitude of this effect was comparable to the effect of each hour of additional cold ischemia time (adjusted HR 1.04, 95% CI 1.02-1.05; P < 0.001). Donor hepatectomy time had a similar effect on death-censored graft survival and patient survival. Livers donated after circulatory death and those with a higher donor risk index were more susceptible to the effect of donor hepatectomy time on death-censored graft survival. CONCLUSION Donor hepatectomy time impairs liver transplant outcome. Keeping this time short together with efficient cooling during hepatectomy might improve outcome.
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17
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Organ Procurement in the Brain Dead Donors Without In Vivo Cold Perfusion: A Novel Technique. J Clin Exp Hepatol 2020; 10:462-466. [PMID: 33029055 PMCID: PMC7527850 DOI: 10.1016/j.jceh.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION We describe our technique of ex vivo organ perfusion and procurement in donation after deceased brain death (DBD) donors. MATERIAL AND METHODS This technique comprises warm dissection of liver, kidneys, and heart, in hemodynamically stable DBD donors and perfusing them ex vivo. The cardiac and abdominal dissection can take place simultaneously. As a precaution, the iliac arteries and the abdominal aorta are dissected and kept ready for rapid cannulation and perfusion, should the donor become unstable at any stage.The liver dissection is in principle similar to living donor hepatectomy, where portal dissection is combined with supra and infrahepatic caval dissection to completely mobilize liver to allow it to be removed and perfused ex vivo. The renal dissection is done after hepatic dissection is complete. The sequence of recovery of organ was modified where kidneys were procured first followed by hepatic and cardiac procurement simultaneously. RESULTS Twelve multivisceral (liver and kidneys in all and heart in four) procurements have been performed. The average perfusion fluid volume for liver was 3.4 L. All recipients had uneventful postoperative course. CONCLUSION Our technique has not affected recipient outcomes and with benefits of less use of preservation solution, shortening bench surgery time, and decreasing the propensity of procurement injuries by avoiding cold-phase dissection.
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18
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Wang NN, Chen GN, Qu B, Yu F, Sheng GN, Shi Y. Effect of Hypotensive Brain Death on the Donor Liver and Its Mechanism in an Improved Bama Miniature Pig (Sus scrofa domestica) Model. Transplant Proc 2019; 51:951-959. [PMID: 30979488 DOI: 10.1016/j.transproceed.2019.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to observe the effect of hypotensive brain death on the donor liver and understand its pathophysiological mechanism in improved pig model. METHODS The model was induced using the modified intracranial water sac inflation method in 16 Bama miniature pigs. Effects of hypotensive brain death on liver function and tissue morphology were evaluated via changes in liver function enzyme index, liver tissue alkaline phosphatase levels, hourly bile flow, and liver tissue pathology. Its pathophysiological mechanism was examined on the basis of changes in portal vein blood flow, hepatic artery blood flow, portal venous endotoxin level, and liver tissue cytokine levels. RESULTS After model establishment, portal vein blood flow, hepatic arterial blood flow, hourly bile flow, and alkaline phosphatase content in hepatic tissue significantly decreased, and serum aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase levels significantly increased. Hematoxylin-eosin staining of liver tissue showed that after model establishment, hepatic tissue injury was gradually aggravated and hepatic cells were irreversibly damaged at 7 hours. Portal vein endotoxin levels significantly increased after brain death. Tumor necrosis factor α, interleukin 1, and endothelin 1 levels in liver tissues significantly increased at 3, 6, and 12 hours after brain death (P < .05), and hypoxia-inducible factor 1-α and nitric oxide levels significantly decreased (P < .05). CONCLUSIONS Hepatic injury was progressively aggravated under hypotensive brain death. The mechanism of donor liver injury under hypotensive brain death may involve low liver perfusion, release of intestinal endotoxin and inflammatory factors (eg, tumor necrosis factor α and interleukin 1), decreased hypoxia-inducible factor 1-α, and endothelin 1 and nitric oxide imbalance.
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Affiliation(s)
- N-N Wang
- Postgraduate Training Base, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Jinzhou Medical University, Tianjin, China
| | - G-N Chen
- Postgraduate Training Base, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Jinzhou Medical University, Tianjin, China
| | - B Qu
- Postgraduate Training Base, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Jinzhou Medical University, Tianjin, China.
| | - F Yu
- Department of Emergency, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - G-N Sheng
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Y Shi
- Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China.
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19
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Sonnenberg EM, Goldberg DS. Donation After Circulatory Death Liver Procurement: Time to Consider More Options? Liver Transpl 2019; 25:533-534. [PMID: 30807687 PMCID: PMC6759756 DOI: 10.1002/lt.25436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Elizabeth M. Sonnenberg
- Department of Surgery, University of Pennsylvania,
Philadelphia, PA, USA,National Clinician Scholars Program, University of
Pennsylvania, Philadelphia, PA, USA
| | - David S. Goldberg
- Gastroenterology Division, University of Pennsylvania,
Philadelphia, PA, USA,Center for Clinical Epidemiology and Biostatistics,
University of Pennsylvania, Philadelphia, PA, USA
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20
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de Boer J, Van der Bogt K, Putter H, Ooms-de Vries K, Haase-Kromwijk B, Pol R, De Jonge J, Dejong K, Nijboer M, Van der Vliet D, Braat D. Surgical quality in organ procurement during day and night: an analysis of quality forms. BMJ Open 2018; 8:e022182. [PMID: 30478108 PMCID: PMC6254412 DOI: 10.1136/bmjopen-2018-022182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To analyse a potential association between surgical quality and time of day. DESIGN A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors. SETTING Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region. PARTICIPANTS In 18 months' time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003). PRIMARY OUTCOME MEASURE All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00-17:00) or evening/night-time (17:00-8:00). RESULTS Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders. CONCLUSIONS This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.
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Affiliation(s)
- Jacob de Boer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Nederlandse Transplantatie Stichting, Leiden, The Netherlands
| | - Koen Van der Bogt
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Department of Surgery, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Hein Putter
- Leids Universitair Medisch Centrum, Statistical Department, Leiden, Netherlands
| | | | | | - Robert Pol
- Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Jeroen De Jonge
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Kees Dejong
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Mijntje Nijboer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | | | - Dries Braat
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
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21
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Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Ayllón-Terán MD, Gómez-Luque I, Ciria-Bru R, Luque-Molina A, López-Cillero P, Rufián-Peña S, Briceño-Delgado J. "Super-rapid" Technique in Donation After Circulatory Death Liver Donors: Advantages and Disadvantages. Transplant Proc 2018; 51:25-27. [PMID: 30655137 DOI: 10.1016/j.transproceed.2018.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/28/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
In recent years, donation after circulatory death (DCD) has increased as an option to overcome the organ donor shortage crisis and to decrease the large number of patients on liver transplant waiting lists. The "super-rapid" technique is now the "gold standard" procurement method because of its availability, reproducibility, low cost, and extensive experience. Recently, extracorporeal support has been implemented, with encouraging results. Strict donor acceptance criteria have proven to be essential to optimize the DCD liver graft outcomes and minimize biliary complication rates. In this study we assessed the state of the art of DCD liver transplantation with regard to its development and the actual strategies to prevent graft complications, with aim of expanding the pool of marginal liver donors.
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Affiliation(s)
| | - L Rodríguez-Ortiz
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - Á Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - M D Ayllón-Terán
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - I Gómez-Luque
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - R Ciria-Bru
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - A Luque-Molina
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - P López-Cillero
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - S Rufián-Peña
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
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22
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Extending normothermic regional perfusion to the thorax in donors after circulatory death. Curr Opin Organ Transplant 2017; 22:245-250. [DOI: 10.1097/mot.0000000000000413] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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23
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de Boer JD, Kopp WH, Ooms K, Haase-Kromwijk BJ, Krikke C, de Jonge J, van Heurn LWE, Baranski AG, van der Vliet JA, Braat AE. Abdominal organ procurement in the Netherlands - an analysis of quality and clinical impact. Transpl Int 2017; 30:288-294. [PMID: 27992973 DOI: 10.1111/tri.12906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/01/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume is associated with fewer injuries.
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Affiliation(s)
- Jacob D de Boer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | - Wouter H Kopp
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kirsten Ooms
- Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Christina Krikke
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L W Ernst van Heurn
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andre G Baranski
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Adam van der Vliet
- Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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24
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Lam HD, Schaapherder AF, Kopp WH, Putter H, Braat AE, Baranski AG. Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis. Transpl Int 2016; 30:117-123. [PMID: 27874968 DOI: 10.1111/tri.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/14/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
Abstract
Professional abdominal organ recovery with certification has been mandatory in the Netherlands since 2010. This study analyses the effects of certification (January 2010-September 2015) on pancreas transplantation and compares it to an era before certification (February 2002-May 2008) for surgical injuries and the number of pancreases transplanted. A total of 264 cases were analysed. Eighty-four recovered pancreases (31.8%) with surgically injuries were encountered. Forty-six of those were surgically salvaged for transplantation, resulting in a total of 226 (85.6%) being transplanted. It was found that certified surgeons recovered grafts from older donors (36.8 vs. 33.3; P = 0.021), more often from donation after circulatory death (DCD) donors (18% vs. 0%; P < 0.001) and had less surgical injuries (21.6% vs. 41.0%; P < 0.001). Certification (OR: 0.285; P < 0.001) and surgeons from a pancreas transplant centre (OR: 0.420; P = 0.002) were independent risk factors for surgical organ injury. Predictors for proceeding to the actual pancreas transplantation were a recovering surgeon from a pancreas transplantation centre (OR: 3.230; P = 0.003), certification (OR: 3.750; P = 0.004), donation after brain death (DBD) (OR: 8.313; P = 0.002) and donor body mass index (BMI) (OR: 0.851; P = 0.023). It is concluded that certification in abdominal organ recovery will limit the number of surgical injuries in pancreas grafts which will translate in more pancreases available for transplantation.
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Affiliation(s)
- Hwai-Ding Lam
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
| | | | - Wouter H Kopp
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
| | - Hein Putter
- Department of Statistics, LUMC, Leiden, The Netherlands
| | - Andries E Braat
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
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25
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Messer SJ, Axell RG, Colah S, White PA, Ryan M, Page AA, Parizkova B, Valchanov K, White CW, Freed DH, Ashley E, Dunning J, Goddard M, Parameshwar J, Watson CJ, Krieg T, Ali A, Tsui S, Large SR. Functional assessment and transplantation of the donor heart after circulatory death. J Heart Lung Transplant 2016; 35:1443-1452. [PMID: 27916176 DOI: 10.1016/j.healun.2016.07.004] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/06/2016] [Accepted: 07/13/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND After a severe shortage of brain-dead donors, the demand for heart transplantation has never been greater. In an attempt to increase organ supply, abdominal and lung transplant programs have turned to the donation after circulatory-determined death (DCD) donor. However, because heart function cannot be assessed after circulatory death, DCD heart transplantation was deemed high risk and never adopted routinely. We report a novel method of functional assessment of the DCD heart resulting in a successful clinical program. METHODS Normothermic regional perfusion (NRP) was used to restore function to the arrested DCD heart within the donor after exclusion of the cerebral circulation. After weaning from support, DCD hearts underwent functional assessment with cardiac-output studies, echocardiography, and pressure-volume loops. In the feasibility phase, hearts were transported perfused before evaluation of function in modified working mode extracorporeally. After the establishment of a reliable assessment technique, hearts with demonstrable good function were then selected for clinical transplantation. RESULTS NRP was instituted in 13 adult DCD donors, median age of 33 years (interquartile range [IQR], 28-38 years), after a median ischemic time from withdrawal to perfusion of 24 minutes (IQR, 21-29; range, 17-146 minutes). Two of 4 hearts in the feasibility phase were unsuitable for transplantation after functional assessment. Nine DCD hearts were transplanted in the clinical phase, with 100% survival. The median intensive care duration was 5 days (IQR, 4-5 days), with 2 patients requiring mechanical support. There were no episodes of rejection (total, 1,436 patient-days; range, 48-297). During the same period, we performed 20 standard heart transplants using brain-dead donors. CONCLUSIONS NRP allows rapid reperfusion and functional assessment of the DCD donor heart, ensuring only viable hearts are selected for transplantation. This technique minimizes the risk of primary graft dysfunction and maximizes confidence in DCD heart transplantation, realizing a 45% increase in our heart transplant activity.
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Affiliation(s)
- Simon J Messer
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Richard G Axell
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Simon Colah
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Paul A White
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Marian Ryan
- Eastern Region Specialist Nurses in Organ Donation, NHS Blood and Transplant, Cambridge, United Kingdom
| | - Aravinda A Page
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Barbora Parizkova
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Kamen Valchanov
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Christopher W White
- Division of Cardiac Surgery, University of Alberta Hospital, Manankowiski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, University of Alberta Hospital, Manankowiski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Euan Ashley
- Falk Cardiovascular Research Center, Stanford University School of Medicine, Palo Alto, California
| | - John Dunning
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Martin Goddard
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Jayan Parameshwar
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Christopher J Watson
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Thomas Krieg
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ayyaz Ali
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Steven Tsui
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom
| | - Stephen R Large
- Department of Transplantation, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire, United Kingdom.
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26
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Ausania F, Drage M, Manas D, Callaghan CJ. A registry analysis of damage to the deceased donor pancreas during procurement. Am J Transplant 2015; 15:2955-62. [PMID: 26484838 DOI: 10.1111/ajt.13419] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 01/25/2023]
Abstract
Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p = 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p = 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p = 0.04) and in those with parenchymal damage (p = 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.
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Affiliation(s)
- F Ausania
- HPB Surgery, Hospital Xeral, Vigo, Spain
| | - M Drage
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
| | - D Manas
- HPB and Transplant Surgery, Freeman Hospital, Newcastle, UK
| | - C J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
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27
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Jung DH, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Park GC, Lee SG. Safety and usefulness of warm dissection technique during liver graft retrieval from deceased donors. Transplant Proc 2015; 47:576-9. [PMID: 25891689 DOI: 10.1016/j.transproceed.2014.12.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/31/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND For deceased-donor liver graft retrieval, the warm dissection technique of hilar dissection before perfusion had been the standard procedure in the early period of liver transplantation. Thereafter, the cold dissection technique of in situ flushing and hilar dissection after perfusion has been preferred in many transplantation centers for rapid procurement of multiple organs. This study intended to assess the safety and usefulness of the warm dissection technique used in deceased-donor liver transplantation. METHODS This study analyzed a single surgeon's experience of the warm dissection technique for 165 cases of liver graft retrieval, regarding the prolongation of retrieval operation time, retrieval-associated graft injury, and recipient outcomes. RESULTS An additional 20 to 40 minutes was required for warm dissection. The incidence of retrieval-associated graft injury was 13 (7.9%), in which hepatic parenchymal injury was detected in 7 (capsular tear in 6 and subcapsular hematoma in 1) and vascular injury in 6 (celiac axis injury in 5 and common hepatic artery injury in 1). There was no other episode of injury at the branch artery, vena cava, portal vein, and bile duct. There was no significant difference of 1-year graft survival rates between liver grafts with and without graft injury (83% vs 83.3%, P = .73). CONCLUSIONS When the vital signs of deceased donor are stable, the warm dissection technique may be helpful to decrease the cold ischemic preservation time because the risk of graft injury is acceptably low and it provides more time for recipient preparation, thus giving potential advantages for marginal liver grafts.
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Affiliation(s)
- D-H Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C-S Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - K-H Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D-B Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - T-Y Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G-W Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G C Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S-G Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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28
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Scalera I, Perera MTPR, Muiesan P. Donor Hepatic Artery Thrombosis Recognized During Organ Procurement for Liver Transplant. EXP CLIN TRANSPLANT 2014; 13:287-9. [PMID: 25247466 DOI: 10.6002/ect.2013.0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arterial injuries in graft organs may be recognized during procurement and may contribute to organ waste. These injuries may be more likely in the presence of abnormal anatomy. We observed 2 liver grafts that had hepatic artery thrombosis in the donor vessels. The graft from a 64-year-old woman who had circulatory death was discarded because of potential decreased perfusion of the lobe and risk of thrombosis extending to the main hepatic artery after transplant. The graft from a 68-year-old woman donor who had brain death was used successfully as a reduced-size liver graft that included the caudate lobe. In summary, donor grafts that have hepatic artery thrombosis may or may not be used in transplant, depending on the cause of donor death, graft quality, and anatomic location of donor hepatic artery thrombosis.
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Affiliation(s)
- Irene Scalera
- From the Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
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29
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Allain G, Kerforne T, Thuret R, Delpech PO, Saint-Yves T, Pinsard M, Hauet T, Giraud S, Jayle C, Barrou B. Development of a preclinical model of donation after circulatory determination of death for translational application. Transplant Res 2014; 3:13. [PMID: 24999383 PMCID: PMC4082279 DOI: 10.1186/2047-1440-3-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background Extracorporeal membranous oxygenation is proposed for abdominal organ procurement from donation after circulatory determination of death (DCD). In France, the national Agency of Biomedicine supervises the procurement of kidneys from DCD, specifying the durations of tolerated warm and cold ischemia. However, no study has determined the optimal conditions of this technique. The aim of this work was to develop a preclinical model of DCD using abdominal normothermic oxygenated recirculation (ANOR). In short, our objectives are to characterize the mechanisms involved during ANOR and its impact on abdominal organs. Methods We used Large White pigs weighing between 45 and 55 kg. After 30 minutes of potassium-induced cardiac arrest, the descending thoracic aorta was clamped and ANOR set up between the inferior vena cava and the abdominal aorta for 4 hours. Hemodynamic, respiratory and biochemical parameters were collected. Blood gasometry and biochemistry analysis were performed during the ANOR procedure. Results Six ANOR procedures were performed. The surgical procedure is described and intraoperative parameters and biological data are presented. Pump flow rates were between 2.5 and 3 l/min. Hemodynamic, respiratory, and biochemical objectives were achieved under reproducible conditions. Interestingly, animals remained hemodynamically stable following the targeted protocol. Arterial pH was controlled, and natremia and renal function remained stable 4 hours after the procedure was started. Decreased hemoglobin and serum proteins levels, concomitant with increased lactate dehydrogenase activity, were observed as a consequence of the surgery. The serum potassium level was increased, owing to the extracorporeal circulation circuit. Conclusions Our ANOR model is the closest to clinical conditions reported in the literature and will allow the study of the systemic and abdominal organ impact of this technique. The translational relevance of the pig will permit the determination of new biomarkers and protocols to improve DCD donor management.
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Affiliation(s)
- Géraldine Allain
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Chirurgie cardio-thoracique, Poitiers F-86000, France
| | - Thomas Kerforne
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Réanimation chirurgicale, Poitiers F-86000, France
| | - Rodolphe Thuret
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Montpellier, Service d'Urologie et de transplantation rénale, Montpellier F-34295, France
| | - Pierre-Olivier Delpech
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service d'Urologie, Poitiers F-86000, France
| | - Thibaut Saint-Yves
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service d'Urologie, Poitiers F-86000, France
| | - Michel Pinsard
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Réanimation chirurgicale, Poitiers F-86000, France ; CHU de Montpellier, Service d'Urologie et de transplantation rénale, Montpellier F-34295, France
| | - Thierry Hauet
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers F-86000, France ; CHU Poitiers, Service de Biochimie, Poitiers F-86000, France ; IBISA Platform 'Experimental Surgery and Transplantation', INRA, Domaine expérimental du Magneraud, Surgères F-17700, France
| | - Sébastien Giraud
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU Poitiers, Service de Biochimie, Poitiers F-86000, France
| | - Christophe Jayle
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Chirurgie cardio-thoracique, Poitiers F-86000, France ; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers F-86000, France ; IBISA Platform 'Experimental Surgery and Transplantation', INRA, Domaine expérimental du Magneraud, Surgères F-17700, France
| | - Benoît Barrou
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; GH Pitié-Salpêtrière, AP-HP, Service d'Urologie et de transplantation rénale, Paris F-75013, France ; UPMC Université Paris VI, Paris F-75013, France
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