1
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Motter JD, Jaffe IS, Moazami N, Smith DE, Kon ZN, Piper GL, Sommer PM, Reyentovich A, Chang SH, Aljabban I, Montgomery RA, Segev DL, Massie AB, Lonze BE. Single center utilization and post-transplant outcomes of thoracoabdominal normothermic regional perfusion deceased cardiac donor organs. Clin Transplant 2024; 38:e15269. [PMID: 38445531 DOI: 10.1111/ctr.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Thoracoabdominal normothermic regional perfusion (TA-NRP) following cardiac death is an emerging multivisceral organ procurement technique. Recent national studies on outcomes of presumptive TA-NRP-procured organs are limited by potential misclassification since TA-NRP is not differentiated from donation after cardiac death (DCD) in registry data. METHODS We studied 22 donors whose designees consented to TA-NRP and organ procurement performed at our institution between January 20, 2020 and July 3, 2022. We identified these donors in SRTR to describe organ utilization and recipient outcomes and compared them to recipients of traditional DCD (tDCD) and donation after brain death (DBD) organs during the same timeframe. RESULTS All 22 donors progressed to cardiac arrest and underwent TA-NRP followed by heart, lung, kidney, and/or liver procurement. Median donor age was 41 years, 55% had anoxic brain injury, 45% were hypertensive, 0% were diabetic, and median kidney donor profile index was 40%. TA-NRP utilization was high across all organ types (88%-100%), with a higher percentage of kidneys procured via TA-NRP compared to tDCD (88% vs. 72%, p = .02). Recipient and graft survival ranged from 89% to 100% and were comparable to tDCD and DBD recipients (p ≥ .2). Delayed graft function was lower for kidneys procured from TA-NRP compared to tDCD donors (27% vs. 44%, p = .045). CONCLUSION Procurement from TA-NRP donors yielded high organ utilization, with outcomes comparable to tDCD and DBD recipients across organ types. Further large-scale study of TA-NRP donors, facilitated by its capture in the national registry, will be critical to fully understand its impact as an organ procurement technique.
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Affiliation(s)
- Jennifer D Motter
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Ian S Jaffe
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Greta L Piper
- Department of Cardiothoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Philip M Sommer
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Alex Reyentovich
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Imad Aljabban
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Surgery, Columbia University School of Medicine, New York, New York, USA
| | - Robert A Montgomery
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | - Allan B Massie
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Bonnie E Lonze
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
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2
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Salguero J, Chamorro L, Gómez-Gómez E, Robles JE, Campos JP. Graft survival and delayed graft function with normothermic regional perfusion and rapid recovery after circulatory death in kidney transplantation: a propensity score matching study. Minerva Urol Nephrol 2024; 76:60-67. [PMID: 38015549 DOI: 10.23736/s2724-6051.23.05393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND A shortage of kidney grafts has led to the implementation of various strategies, including donations after circulatory death. The in situ normothermic regional perfusion technique has been introduced to improve graft quality by reducing warm ischemia times. However, there is limited evidence available on its mid- and long-term outcomes. Therefore, this study aimed to compare the incidence of delayed graft function, graft function, and survival at three years among three groups: brain death donors, rapid recovery, and normothermic regional perfusion. METHODS A retrospective analysis of a cohort of kidney transplantations was conducted at a single referral center between January 1, 2015, and December 31, 2019. Univariate and multivariate regression models and propensity score matching analysis were performed to compare recipient-related, transplantation procedure-related, donor-related, and kidney function variables. RESULTS A total of 327 patients were included, with 256 kidneys from brain death donors, 52 kidneys from rapid recovery, and 19 patients from normothermic regional perfusion. After propensity score matching, univariate and multivariate analyses showed a higher incidence of delayed graft function in the rapid recovery group compared to the others (OR: 2.39 CI95%: 1.19, 4.77) with a longer hospital stay (median 11, 15 and 10 days, respectively). However, no differences in 1- and 3-year graft function and survival were found. CONCLUSIONS Normothermic regional perfusion offers advantages over rapid recovery, with a reduced incidence of delayed graft function and a shorter hospital stay. However, no differences in mid-term graft function and survival were found.
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Affiliation(s)
- Joseba Salguero
- Department of Urology, Infanta Margarita Hospital, Cabra, Spain -
| | - Laura Chamorro
- Department of Urology, Reina Sofia University Hospital, IMIBIC, Cordoba, Spain
| | - Enrique Gómez-Gómez
- Department of Urology, Reina Sofia University Hospital IMIBIC UCO, Cordoba, Spain
| | - José E Robles
- Department of Urology, School of Medicine, University of Navarra, Pamplona, Spain
| | - Juan P Campos
- Department of Urology, Reina Sofia University Hospital IMIBIC UCO, Cordoba, Spain
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3
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Elsisy M, Tillman B, Chau L, Go C, Cho SK, Chun Y. In vitro and In vivo assessment of a novel organ perfusion stent for successful flow separation in donation after cardiac death. J Biomater Appl 2022; 37:389-401. [PMID: 35466766 PMCID: PMC9578539 DOI: 10.1177/08853282221093753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shortage of healthy donors' organs has appeared as one of the main challenges for organ transplantation. This study focuses on the novel endovascular device development to increase the number of available organs from cardiac death donors. The primary objective of this study is the design validation of a newly developed stent graft for the abdominal organ perfusion with cardiac blood flow isolation. In this paper, the effectiveness of the device design has been validated via the assessment of the device performance both in vitro and in vivo. The radial force of stent structure was first numerically analyzed using finite element method, then was quantified experimentally. The blood perfusion parameters were investigated to demonstrate their effect on the blood delivered to the abdominal organs, maintaining the organs healthy for donation. In vitro flow leakage was measured using a 3-D printing-based silicone aortic model to evaluate the isolation between cardiac flow and perfusion flow with minimum values. Following the design validation process, a functional prototype stent graft has been successfully fabricated using optimized laser welding conditions and subsequent joining processes. In vivo porcine study results have demonstrated smooth delivery and successful placement of the device showing complete cardiac flow separation isolating abdominal regions only with the oxygenated blood flow.
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Affiliation(s)
- Moataz Elsisy
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryan Tillman
- The Ohio State University Medical Center, Columbus, OH, USA
| | - Lynn Chau
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Go
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sung Kwon Cho
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | - Youngjae Chun
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
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4
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Argani H. Cardiopulmonary death donation. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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5
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Ho AFW, Tan TXZ, Latiff E, Shahidah N, Ng YY, Leong BSH, Lim SL, Pek PP, Gan HN, Mao DR, Chia MYC, Cheah SO, Tham LP, Ong MEH. Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2021; 29:105. [PMID: 34321054 PMCID: PMC8317313 DOI: 10.1186/s13049-021-00924-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study. Methods Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered. Results 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year). Conclusions In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. .,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.
| | | | - Ejaz Latiff
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Han Nee Gan
- Accident & Emergency, Changi General Hospital, Singapore, Singapore
| | - Desmond Renhao Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Si Oon Cheah
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Lai Peng Tham
- Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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6
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Brennan C, Sandoval PR, Husain SA, King KL, Dube GK, Tsapepas D, Mohan S, Ratner LE. Impact of warm ischemia time on outcomes for kidneys donated after cardiac death Post-KAS. Clin Transplant 2020; 34:e14040. [PMID: 32654278 DOI: 10.1111/ctr.14040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 12/22/2022]
Abstract
Prolonged warm (WIT) and cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post-transplant outcomes in the post-KAS era is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death-censored graft failure for DCD kidneys. The 2018 SRTR SAF was utilized to identify post-KAS DCD kidney transplants occurring from 2015 to 2018. Relative risk and Cox regression were used to calculate risk of delayed graft function and hazard of death-censored graft failure, respectively. We identified 4,680 kidneys from DCD donors transplanted from 2015 to 2018 with recorded WIT and CIT times. Median WIT was 21.0 minutes (IQR 14.0-28.0), and CIT was 18.5 hours (IQR 13.9-23.5). The overall incidence of DGF was 42.7%. In a univariable relative risk regression model, extended CIT (24-30 hours:RR 1.37, 95% CI 1.15-1.77; >30 hours:RR 1.47, 95% CI 1.22-1.77) and WIT (20-40 minutes:RR 1.10, 95% CI 1.03-1.17) were associated with increased risk of DGF. When included in a multivariable model, neither prolonged CIT nor WIT were significantly associated with death-censored graft failure. Prolonged WIT and CIT are associated with increased DGF but not death-censored graft failure in recipients of DCD kidney transplants in the post-KAS era. Extended ischemia alone should not be used as a basis for discard or non-utilization of these organs.
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Affiliation(s)
- Corey Brennan
- The Columbia University Renal Epidemiology (CURE) Group, New York City, New York, USA.,New York- Presbyterian Hospital, New York City, New York, USA
| | - Pedro Rodrigo Sandoval
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York City, New York, USA
| | - Syed Ali Husain
- The Columbia University Renal Epidemiology (CURE) Group, New York City, New York, USA.,Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York City, New York, USA
| | - Kristen L King
- The Columbia University Renal Epidemiology (CURE) Group, New York City, New York, USA.,Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York City, New York, USA
| | - Geoffrey K Dube
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York City, New York, USA
| | - Demetra Tsapepas
- The Columbia University Renal Epidemiology (CURE) Group, New York City, New York, USA.,New York- Presbyterian Hospital, New York City, New York, USA
| | - Sumit Mohan
- The Columbia University Renal Epidemiology (CURE) Group, New York City, New York, USA.,Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York City, New York, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York City, New York, USA
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7
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The Use of Donation After Circulatory Death Organs for Simultaneous Liver-kidney Transplant: To DCD or Not to DCD? Transplantation 2019; 103:1159-1167. [DOI: 10.1097/tp.0000000000002434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Introducing of the First DCD Kidney Transplantation Program in Poland. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6302153. [PMID: 31016193 PMCID: PMC6425340 DOI: 10.1155/2019/6302153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022]
Abstract
In many countries, including Poland, the main problem with transplantation is the insufficiency of organ donors in relation to the demand for organs. Hence, the common aim globally is to increase the pool of donors. The prolonged survival of patients after transplantation, with respect to the survival time of patients on dialysis, makes the search much more intense. After the recourse of expanded criteria donors (ECD), the next step was obtaining kidneys from donors after irreversible cardiac death (DCD). Therefore, based on Dutch, British, and Spanish experience, it can be hypothesized that the introduction of DCD procedures in countries that have not launched these programs and the improvement of DCD procedures may shorten the waiting time for organ transplantation globally. The legal basis for the procurement of organs after irreversible cardiac arrest came into existence in Poland in 2010. Previously, such organ procurements were not in practice. Since 1984, when Poland published irreversible cardiac arrest as a criterion of brain death, it became the only way to determine death prior to the procurement of organs. The aim of this report was to evaluate the results of the first 19 transplantation cases involving harvested kidneys from donors after cardiac arrest, which was irreversible and clinically confirmed, without any doubt as per the ethical protocol of DCD. Understanding, support, and public perception are essential for this program's initiation and maintenance.
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9
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Weiss J, Elmer A, Béchir M, Brunner C, Eckert P, Endermann S, Lenherr R, Nebiker M, Tisljar K, Haberthür C, Immer FF. Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges. BMC Health Serv Res 2018; 18:876. [PMID: 30458762 PMCID: PMC6247533 DOI: 10.1186/s12913-018-3691-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Various actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program's efficiency in relation to the situation in the neighboring countries. METHODS This study is an analysis of prospective registry data, covering the period from 1 January 2008 to 31 December 2017. It includes all actual deceased organ donors (ADD) in Switzerland. Donor data were extracted from the Swiss Organ Allocation System. The "donor conversion index" (DCI) methodology and data was used for the comparison of donation program efficiency in Switzerland, Germany, Austria, Italy and France. RESULTS During the study period there were 1116 ADD in Switzerland. The number of ADD per year increased from 91 in 2008 to 145 in 2017 (+ 59%). The reintroduction of the donation after cardiocirculatory death (DCD) program in 2011 resulted in the growth of annual percentages of DCD donors, reaching a maximum of 27% in 2017. The total number of organs transplanted from ADD was 3763 (3.4 ± 1.5 transplants per donor on average). Of these, 48% were kidneys (n = 1814), 24% livers (n = 903), 12% lungs (n = 445), 9% hearts (n = 352) and 7% pancreata or pancreatic islets (n = 249). The donation program efficiency assessment showed an increase of the Swiss DCI from 1.6% in 2008 to 2.7% in 2017 (+ 69%). The most prominent efficiency growth was observed between 2012 and 2017. Even though Swiss donation efficiency increased during the study period, it remained below the DCI of the French and Austrian donation programs. CONCLUSION Swiss donation activity and efficiency grew during the last decade. The increased donation efficiency suggests that measures implemented so far were effective. The lower efficiency of the Swiss donation program, compared to the French and Austrian programs, may likely be explained by the lower consent rate in Switzerland. This issue should be addressed in order to achieve the goal of more organs available for transplantation.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Andreas Elmer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Markus Béchir
- Zentrum für Innere Medizin, Hirslanden Klinik Aarau, Aarau, Switzerland
| | - Christian Brunner
- Zentrum für Intensivmedizin, Luzerner Kantonsspital, Luzern, Switzerland
| | - Philippe Eckert
- Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Susann Endermann
- Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Renato Lenherr
- Chirurgische Intensivmedizin USZ, Universitätsspital Zürich, Zürich, Switzerland
| | - Mathias Nebiker
- Transplantationszentrum, Direktion Medizin und Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Kai Tisljar
- Medizinische Intensivstation, Universitätsspital Basel, Basel, Switzerland
| | - Christoph Haberthür
- Klinik Hirslanden, Institut für Anästhesiologie und Intensivmedizin, Zürich, Switzerland
| | - Franz F Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland.
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10
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Ethische Relevanz und faktische Mängel in der Kommunikation von Spezifika der Organspende nach Kreislaufstillstand. Ethik Med 2018. [DOI: 10.1007/s00481-018-0501-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Mechanisms of Bone Morphogenetic Protein-7 Protective Effects Against Cold Ischemia-Induced Renal Injury in Rats. Transplant Proc 2018; 50:3822-3830. [PMID: 30577274 DOI: 10.1016/j.transproceed.2018.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
Deceased donor kidneys are exposed to cold ischemic insult which makes them particularly susceptible to the effects of cold ischemic injury during hypothermic preservation resulting in high rates of delayed graft function. Bone morphogenetic protein-7 (BMP-7) is a valuable reagent in the field of tissue regeneration and preservation under ischemic conditions. Following these insights, we investigated the effect of recombinant human BMP-7 (rhBMP-7) on graft preservation during cold ischemia. The study was conducted on an experimental model of kidney cold ischemia in rats. Kidneys were perfused with University of Wisconsin (UW) saline solution, rhBMP-7, or rhBMP-7 + UW, and exposed to cold ischemia for 6, 12, and 24 hours. In tubular epithelial cells of kidneys perfused with rhBMP-7 and rhBMP-7+UW solution, the expression of BMP-7 and E-cadherin was observed after 24 hours of cold ischemia. In kidneys not perfused with rhBMP-7, high expression of transforming growth factor-β and α-smooth muscle actin was found. Also, in kidneys perfused with rhBMP-7 solution, statistically higher levels of Smad1, Smad5, and Smad8 messenger RNA expressions were proven. BMP-7 maintains the morphology of kidney tissue better than UW solution during 24 hours of cold ischemia. BMP-7 prevents epithelial to mesenchymal transformation and consequently maintains epithelial phenotype of tubular cells.
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12
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Hodgson R, Young AL, Attia MA, Lodge JPA. Impact of a National Controlled Donation After Circulatory Death (DCD) Program on Organ Donation in the United Kingdom: A 10-Year Study. Am J Transplant 2017; 17:3172-3182. [PMID: 28556608 DOI: 10.1111/ajt.14374] [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: 02/06/2017] [Revised: 04/09/2017] [Accepted: 05/15/2017] [Indexed: 01/25/2023]
Abstract
Organ transplantation is the most successful treatment for some forms of organ failure, yet a lack of organs means many die on the waiting list. In the United Kingdom, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (Organ Donation Taskforce Report; ODTR). This study assesses the success since the ODTR and examines the impact of the United Kingdom's controlled donation after circulatory death (DCD) program and the controversies surrounding it. There were 12 864 intended donation after brain death (DBD) or DCD donors from April 2004 to March 2014. When the 5 years preceding the ODTR was compared to the 5 years following, intended DCD donors increased 292% (1187 to 4652), and intended DBD donors increased 11% (3327 to 3698). Organs retrieved per intended DBD donor remained static (3.30 to 3.26), whereas there was a decrease in DCD (1.54 to 0.99) due to a large rise in donors who did not proceed to donation (325 to 2464). The majority of DCD donors who proceeded did so within 30 min from time of withdrawal. Our study suggests further work on converting eligible referrals to organ donation and exploring methods of converting DCD to DBD donors.
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Affiliation(s)
- R Hodgson
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - A L Young
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - M A Attia
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - J P A Lodge
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
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13
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Peters-Sengers H, Homan van der Heide JJ, Heemskerk MBA, ten Berge IJM, Ultee FCW, Idu MM, Betjes MGH, van Zuilen AD, Christiaans MHL, Hilbrands LH, de Vries APJ, Nurmohamed AS, Berger SP, Bemelman FJ. Similar 5-Year Estimated Glomerular Filtration Rate Between Kidney Transplants From Uncontrolled and Controlled Donors After Circulatory Death-A Dutch Cohort Study. Transplantation 2017; 101:1144-1151. [PMID: 27257998 PMCID: PMC5441890 DOI: 10.1097/tp.0000000000001211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Organ shortage persists despite a high rate of donation after circulatory death (DCD) in the Netherlands. The median waiting time for a deceased donor kidney in 2013 was 3.5 years. Most DCD kidneys are from controlled DCD (cDCD; Maastricht category III). Experience with uncontrolled donors after cardiac death (uDCD), that is, donors with an unexpected and irreversible cardiac arrest (Maastricht categories I and II), is increasing; and its effect on transplant outcomes needs evaluation. METHODS We used the Dutch Organ Transplantation Registry to include recipients (≥18 years old) from all Dutch centers who received transplants from 2002 to 2012 with a first DCD kidney. We compared transplant outcome in uDCD (n = 97) and cDCD (n = 1441). RESULTS Primary nonfunction in uDCD was higher than in the cDCD (19.6% vs 9.6%, P < 0.001, respectively). Delayed graft function was also higher in uDCD than in cDCD, but not significantly (73.7% vs 63.3%, P = .074, respectively). If censored for primary nonfunction, estimated glomerular filtration rates after 1 year and 5 years were comparable between uDCD and cDCD (1 year: uDCD, 44.3 (23.4) mL/min/m and cDCD, 45.8 (24.1) mL/min/m; P = 0.621; 5 years: uDCD, 49.1 (25.6) mL/min/m and cDCD, 47.7 (21.7) mL/min/m; P = 0.686). The differences in primary nonfunction between kidneys from uDCD and cDCD were explained by differences in the first warm ischemic period, cold ischemic time, and donor age. CONCLUSIONS We conclude that uDCD kidneys have potential for excellent function and can constitute a valuable extension of the donor pool. However, further efforts are necessary to address the high rate of primary nonfunction.
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Affiliation(s)
| | | | | | | | - Fred C. W. Ultee
- Department of Nephrology, Academic Medical Center, the Netherlands
| | - Mirza M. Idu
- Department of Surgery, Academic Medical Center, the Netherlands
| | - Michiel G. H. Betjes
- Department of Nephrology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Arjan D. van Zuilen
- Department of Nephrology, University Medical Center Utrecht, the Netherlands
| | | | - Luuk H. Hilbrands
- Department of Nephrology, Radboud University Medical Center, the Netherlands
| | | | | | - Stefan P. Berger
- Department of Nephrology, University Medical Center Groningen, the Netherlands
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Estimación de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche. Med Intensiva 2017; 41:153-161. [DOI: 10.1016/j.medin.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/03/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022]
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15
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Organ Pretreatment With Cytotopic Endothelial Localizing Peptides to Ameliorate Microvascular Thrombosis and Perfusion Deficits in Ex Vivo Renal Hemoreperfusion Models. Transplantation 2016; 100:e128-e139. [DOI: 10.1097/tp.0000000000001437] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Dupriez F, De Pauw L, Darius T, Mourad M, Penaloza A, Van Deynse D, Baltus C, Verschuren F. Fourteen years of experience in uncontrolled organ donation after cardio-circulatory death. Transplant Proc 2015; 46:3134-7. [PMID: 25420843 DOI: 10.1016/j.transproceed.2014.09.164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Since 1999, a protocol for uncontrolled donation after cardio-circulatory death (DCD) has been carried out in our institution. We aimed at evaluating those 14 years of local experience. METHODS We reviewed the charts of uncontrolled donors from 1999 till 2013. Potential donors with a no-flow period less than 30 minutes were considered. Kidneys were perfused by the use of a double balloon triple lumen catheter after at least a 2-minute period of no touch. We analyzed grafts outcome and warm and cold ischemia times. RESULTS Thirty-nine procedures were initiated: 19 were aborted because of family refusal (n = 7), medical reasons (n = 7), or canulation failures (n = 5) and 20 harvesting procedures were completed. Transplantation was considered for 35 kidneys (cold storage [n = 5] and hypothermic preservation system [n = 30]). The causes of withdrawal from transplantation were mostly macroscopic lesions (poor perfusion, macroscopic parenchyma or vascular lesions, or infectious risk). We transplanted 22 kidneys locally and 3 were shipped to another Eurotransplant center. Mean donor age was 40 ± 13 years. Among the 20 donors, 13 came from the emergency unit and 7 from the intensive care unit. Mean no-flow time for out-hospital management was 8.7 ± 3.6 minutes. Mean time of cardiopulmonary resuscitation was 71 ± 46 minutes. Mean cold ischemia time was 19 ± 5 hours. Primary nonfunction and delayed graft function occurred in 1 and 12 cases (4.5% and 54%), respectively. Graft survival was 86% at 1 year. Causes of graft loss during the entire follow-up were graft rejection (n = 3), ischemically damaged kidney (n = 2), and recurrence of focal segmental glomerulosclerosis (n = 1). CONCLUSION In our experience, uncontrolled donors represent a valuable source of kidney grafts, with a prognosis of graft function and survival similar to the literature. To increase the number of available DCD organs, new techniques, such as the use of Normothermic ExtraCorporeal Membrane Oxygenation (NECMO), as well as improvement of recruitment of out of hospital potential donors have to be considered.
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Affiliation(s)
- F Dupriez
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
| | - L De Pauw
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - T Darius
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Mourad
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - A Penaloza
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Van Deynse
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - C Baltus
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - F Verschuren
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
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Ortega-Deballon I, Hornby L, Shemie SD. Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes. Crit Care 2015; 19:268. [PMID: 26104293 PMCID: PMC4495857 DOI: 10.1186/s13054-015-0985-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/12/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation. METHODS We searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258). RESULTS Six guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers. CONCLUSIONS Despite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.
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Affiliation(s)
- Iván Ortega-Deballon
- Canadian National Transplant Research Program, Montréal, Canada.
- Research Institute McGill University Health Centre, Montréal, Canada.
- Centre de Prélèvement d'Organes and Laboratoire de Simulation, Hôpital du Sacré-Cœur, Montréal, Canada.
- Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain.
- Helicopter Emergency Medical Service (SUMMA 112), Madrid, Spain.
- Critical Care Division, Montreal Children's Hospital, Office C-806, 2300, Rue Tupper, Montreal, QC, H3H 1P3, Canada.
| | - Laura Hornby
- DePPaRT Study, Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- Deceased Donation, Canadian Blood Services, Ottawa, Canada.
| | - Sam D Shemie
- Deceased Donation, Canadian Blood Services, Ottawa, Canada.
- Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.
- McGill University, Montreal, Canada.
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Salmeron-Rodriguez M, Navarro-Cabello M, Agüera-Morales M, Lopez-Andreu M, Rodriguez-Benot A, Robles-Arista J, Dueñas-Jurado J, Campos-Hernandez J, Requena-Tapia M, Aljama-Garcia P. Short-Term Evolution of Renal Transplant With Grafts From Donation After Cardiac Death: Type III Maastricht Category. Transplant Proc 2015; 47:23-6. [DOI: 10.1016/j.transproceed.2014.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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19
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Portolés Pérez J, Lafuente O, Sánchez-Sobrino B, Pérez Sáez M, Fernández García A, Llamas F, López-Sánchez P, Rodriguez-Ferrero M, Zarraga S, Ramos A, Pascual J. Kidney Transplantation With Organs From Donors After Circulatory Death Type 3: A Prospective Multicentric Spanish Study (GEODAS 3). Transplant Proc 2015; 47:27-9. [DOI: 10.1016/j.transproceed.2014.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Results from a horizon scan on risks associated with transplantation of human organs, tissues and cells: from donor to patient. Cell Tissue Bank 2014; 16:1-17. [DOI: 10.1007/s10561-014-9450-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 04/16/2014] [Indexed: 12/14/2022]
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21
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Legendre C, Canaud G, Martinez F. Factors influencing long-term outcome after kidney transplantation. Transpl Int 2013; 27:19-27. [DOI: 10.1111/tri.12217] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/27/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Christophe Legendre
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
- Université Paris Descartes; Sorbonne Paris Cité; Paris France
- INSERM U845; Hôpital Necker; Paris France
| | - Guillaume Canaud
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
- Université Paris Descartes; Sorbonne Paris Cité; Paris France
- INSERM U845; Hôpital Necker; Paris France
| | - Frank Martinez
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
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22
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Outcome of Renal Transplantation From Deceased Donors After Cardiac Death: A Single-Center Experience From a Developing Country. Transplant Proc 2013; 45:2147-51. [PMID: 23953524 DOI: 10.1016/j.transproceed.2013.02.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/18/2012] [Accepted: 02/05/2013] [Indexed: 01/14/2023]
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23
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Pieter Hoogland ER, van Smaalen TC, Christiaans MHL, van Heurn LWE. Kidneys from uncontrolled donors after cardiac death: which kidneys do worse? Transpl Int 2013; 26:477-84. [DOI: 10.1111/tri.12067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/23/2012] [Accepted: 01/06/2013] [Indexed: 12/31/2022]
Affiliation(s)
- E. R. Pieter Hoogland
- Department of Surgery; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Tim C. van Smaalen
- Department of Surgery; Maastricht University Medical Center; Maastricht; The Netherlands
| | | | - L. W. Ernest van Heurn
- Department of Surgery; Maastricht University Medical Center; Maastricht; The Netherlands
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24
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Hypothermic machine perfusion in deceased donor kidney transplantation: a systematic review. J Surg Res 2012; 180:176-82. [PMID: 23211958 DOI: 10.1016/j.jss.2012.10.055] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/05/2012] [Accepted: 10/26/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) of kidneys is intended to mitigate the deleterious effects of cold storage on organ quality, particularly when the cold ischemic time is prolonged or the donor is otherwise marginal. The use of HMP has remained controversial; however, a number of randomized controlled trials (RCTs) have recently been conducted to clarify its benefits. METHODS We undertook a systematic search of the Medline and Embase databases and of the Cochrane Central Register of Controlled Trials. We included only RCTs in the meta-analysis. Outcomes analyzed were the incidence of delayed graft function (DGF), primary nonfunction (PNF), graft loss, and patient death at 1 y. RESULTS We identified seven RCT trials and subjected them to meta-analysis, including 1353 kidney transplant recipients. Hypothermic machine perfusion significantly reduced the incidence of DGF (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.72-0.96). There was no difference in the incidence of PNF (RR 0.78, 95% CI 0.36-1.68), graft loss at 1 y (RR 0.87, 95% CI 0.64-1.19), and patient death at 1 y (RR 0.91, 95% CI 0.60-1.37) between HMP and donor kidneys preserved using cold storage. CONCLUSIONS There are few RCT comparing HMP and cold storage of kidneys in deceased donor kidney transplantation. Although these studies are small and heterogeneous in design, HMP appeared to be associated with a reduced incidence of DGF. No difference in the incidence of PNF, graft loss, or patient death at 1 y could be demonstrated.
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Abstract
The vascular endothelium constantly integrates biomechanical and humoral signals and responds by secreting or metabolizing multiple factors that act in an autocrine or paracrine manner on the vasculature and adjacent tissues. Several studies have documented the effects of blood flow on renal endothelial cells and its effects on the pathophysiology of the kidney. In contrast, less is known about the effects of acute flow cessation on renal endothelium and kidney function. Here we review our current knowledge on flow cessation, endothelial function, and kidney dysfunction in the context of two clinically relevant settings, namely, the no-reflow phenomenon, observed during periods of renal warm ischemia, and the cold storage of kidney transplants.
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Affiliation(s)
- Marc-Olivier Timsit
- Laboratory for Systems Biology, Center for Excellence in Vascular Biology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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26
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Mateos Rodriguez AA. Acerca de los abscesos hepáticos tras trasplante de hígado de donante a corazón parado. Med Clin (Barc) 2012; 139:274. [DOI: 10.1016/j.medcli.2012.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 01/26/2012] [Indexed: 11/16/2022]
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Shimizu U, Saito S, Lings Y, Iino N, Kazama JJ, Akazawa K. Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan. J Med Econ 2012; 15:444-53. [PMID: 22250787 DOI: 10.3111/13696998.2011.653512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time. METHODS By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results. RESULTS Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years. LIMITATIONS It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally. CONCLUSIONS Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.
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Affiliation(s)
- Utako Shimizu
- Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan.
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Moers C, van Rijt G, Ploeg RJ, Leuvenink HGD. The effect of normothermic recirculation before cold preservation on post-transplant injury of ischemically damaged donor kidneys. Transpl Int 2011; 25:210-7. [PMID: 22077364 DOI: 10.1111/j.1432-2277.2011.01383.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Kidneys recovered from donation after cardiac death (DCD) are increasingly used to enlarge the deceased donor pool. Such renal grafts, especially those derived from uncontrolled DCD, have inevitably sustained profound warm ischemic injury, which compromises post-transplant function. Normothermic recirculation (NR) of the deceased donor's body before organ cooling could be an interesting approach to mitigate the detrimental effect of warm ischemia. To date, however, there is no evidence coming from preclinical studies to support the principle of NR in kidney transplantation. In this study, we subjected 48 Lewis rat kidneys to 15 or 30 min of warm ischemia, and subsequently 0, 1, or 2 h of NR. After 24 h cold storage, kidneys were transplanted into a recipient animal and 24 h later we measured the percentage of cortical necrosis, and determined gene expression of heme oxigenase-1, heat shock protein-70, transforming growth factor-β, kidney injury molecule-1, interleukin-6, hypoxia inducible factor-1α, monocyte chemoattractant protein-1, and α-smooth muscle actin in kidney tissue. We found that NR had no significant influence on any of these markers. Therefore, we conclude that this animal study by no means supports the presumed beneficial effect of NR on kidneys that have been severely damaged by warm ischemia.
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Affiliation(s)
- Cyril Moers
- Surgery Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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29
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Hoogland ERP, Snoeijs MGJ, Winkens B, Christaans MHL, van Heurn LWE. Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation. Am J Transplant 2011; 11:1427-34. [PMID: 21668628 DOI: 10.1111/j.1600-6143.2011.03562.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney donation after cardiac death has been popularized over the last decade. The majority of these kidneys are from controlled donors. The number of organs for transplantation can be further increased by uncontrolled donors after cardiac death. The outcome of uncontrolled compared to controlled donor kidney transplantation is relatively unknown. We compared the long-term outcome of kidney transplantation from uncontrolled (n = 128) and controlled (n = 208) donor kidneys procured in the Maastricht region from January 1, 1981 until January 1, 2008, and transplanted in the Eurotransplant region. The incidence of primary nonfunction and delayed graft function in both uncontrolled and controlled donor kidneys is relatively high (22% vs. 21%, and 61% vs. 56%, p = 0.43, respectively). Ten-year graft and recipient survival are similar in both groups (50% vs. 46%, p = 0.74 and 61% vs. 60%, p = 0.76, respectively). Estimated glomerular filtration rates 1 year after transplantation are 40 ± 16 versus 42 ± 19 mL/min/1.73 m(2) , p = 0.55, with a yearly decline thereafter of 0.67 ± 3 versus 0.70 ± 7 mL/min/1.73 m(2) /year, p = 0.97. The outcome of kidney transplantation from uncontrolled and controlled donors after cardiac death is equivalent. This justifies the expansion of the donor pool with uncontrolled donors to reduce the still growing waiting list for renal transplantation, and may stimulate the implementation of uncontrolled kidney donation programs.
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Affiliation(s)
- E R P Hoogland
- Department of Surgery, Maastricht University Medical Center, The Netherlands.
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Abstract
PURPOSE OF REVIEW The purpose of the present review is to describe the techniques currently used to preserve kidneys from donors after cardiac death. RECENT FINDINGS Automated chest compression devices may be used to improve organ perfusion between cardiac death and preservation measures. Normothermic extracorporeal membrane oxygenation reduces warm ischemic injury and has the ability to improve organ viability in donors after cardiac death. SUMMARY Kidneys from donors after cardiac death expand the donor pool but are inevitably subjected to a period of warm ischemia. Reduction of warm ischemic injury to the organs improves transplant outcome. To reduce this injury in organs from donors after cardiac death, different preservation techniques are used. Automated chest compression devices improve organ perfusion between cardiac death and the start of organ preservation. In-situ preservation with double-balloon triple-lumen catheter is an easy technique to preserve organs in uncontrolled donors and is used in many centers to cool and flush the organs. In controlled donors, organs can also be flushed after laparotomy and direct cannulation of the aorta. Extracorporeal membrane oxygenation reduces warm ischemic injury and the use of normothermic perfusion seems promising. Optimal preservation is essential to improve the viability of kidneys from donors after cardiac death, to fully utilize this large donor pool.
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Domínguez-Gil B, Haase-Kromwijk B, Van Leiden H, Neuberger J, Coene L, Morel P, Corinne A, Muehlbacher F, Brezovsky P, Costa AN, Rozental R, Matesanz R. Current situation of donation after circulatory death in European countries. Transpl Int 2011; 24:676-86. [PMID: 21504489 DOI: 10.1111/j.1432-2277.2011.01257.x] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000-2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000-2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short-term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short-term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed.
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Kim JM, Kim SJ. The Use of Non-Heart Beating Donors to Expand the Donor Pool. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.3.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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