Is routine sternotomy necessary for organ recovery from deceased donors? A comparative retrospective study

Comparison of Standard and Modified Standard Organ Procurement Techniques for Deceased Donors

OBJECTIVES

This study aimed to compare the impact of deceased-donor organ procurement techniques (standard versus modified standard) on biochemical outcomes after liver transplant.

MATERIALS AND METHODS

From February 2006 to December 2013, organs were recovered from 105 consecutive deceased donors by our transplant team. All organ procurement procedures were performed by a pioneer surgeon experienced in organ recovery from deceased donors. Donors were divided into those who had the abdominothoracic approach, which is referred to as the standard technique, and those who had the abdominal approach, which is referred to as the modified standard technique. Both groups were compared in terms of age, sex, weight, height, body mass index, liver graft weight, cross-clamping time, cold ischemia time, and liver function tests in recipients over the first 3 postoperative days.

RESULTS

Our study group included 66 male and 39 female donors, with an age range of 1 to 93 years (median of 44 y, means ± standard deviation of 43.8 ± 23.7 y). Among the deceased donors, 73 underwent the modified standard technique and 32 underwent the standard technique. There were no statistically significant differences between groups in terms of age, sex, weight, height, body mass index, graft weight, cold ischemia time, and liver function tests in recipients over the first 3 postoperative days. We observed a statistically significant difference between groups in terms of cross-clamping time (P < .001).

CONCLUSIONS

Except for the decreased cross-clamping time, the modified standard technique for deceased organ retrieval had no effect on clinical outcomes in recipients after liver transplant. However, this retrospective study requires additional prospective investigations to more fully understand the differences.

Renal Procurement: Techniques for Optimizing the Quality of the Graft in the Cadaveric Setting

PURPOSE OF REVIEW

Kidney transplantation is the best treatment for end-stage renal disease. However, due to organ shortage, suboptimal grafts are increasingly being used.

RECENT FINDINGS

We carried out a review on the methods and techniques of organ optimization in the cadaveric setting. Donor care is the first link in a chain of care. Right after brain death, there is a set of changes, of which hormonal and hemodynamic changes are the most relevant. Several studies have been conducted to determine which drugs to administer, although in most cases, the results are not definitive. The main goal seems rather achieve a set of biochemical and hemodynamic objectives. The ischemia-reperfusion injury is a critical factor for kidney damage in transplantation. One of the ways found to deal with this type of injury is preconditioning. Local and remote ischemic preconditioning has been studied for various organs, but studies on the kidney are scarce. A new promising area is pharmacological preconditioning, which is taking its first steps. Main surgical techniques were established in the late twentieth century. Some minor new features have been introduced to deal with anatomical variations or the emergence of donation after circulatory death. Finally, after harvesting, it is necessary to ensure the best conditions for the kidneys until the time of transplantation. Much has evolved since static cold preservation, but the best preservation conditions are yet to be determined. Conservation in the cold has come to be questioned, and great results have appeared at temperatures closer to physiological.