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Phillips B, Asgari E, Berry M, Callaghan C, Cerisuelo MC, Johnson P, Karydis N, Nasralla D, Nutu A, Oniscu G, Perera T, Sinha S, Sutherland A, Van Dellen D, Watson C, White S, O'Neill S. British Transplantation Society guidelines on abdominal organ transplantation from deceased donors after circulatory death. Transplant Rev (Orlando) 2024; 38:100801. [PMID: 37840003 DOI: 10.1016/j.trre.2023.100801] [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: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The British Transplantation Society (BTS) 'Guideline on transplantation from deceased donors after circulatory death' has recently been updated and this manuscript summarises the relevant recommendations in abdominal organ transplantation from Donation after Circulatory Death (DCD) donors, encompassing the chapters on liver, kidney, pancreas and islet cell transplantation.
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Affiliation(s)
- Benedict Phillips
- Specialty Registrar in Transplant Surgery, Guy's Hospital, London, United Kingdom
| | - Ellie Asgari
- Consultant Nephrologist, Guy's Hospital, London, United Kingdom
| | - Miriam Berry
- Consultant Nephrologist, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Chris Callaghan
- Consultant Transplant Surgeon, Guy's Hospital, London, United Kingdom
| | | | - Paul Johnson
- Consultant Paediatric Surgeon, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nikolaos Karydis
- Consultant Transplant Surgeon, Guy's Hospital, London, United Kingdom
| | - David Nasralla
- Consultant Transplant Surgeon, Royal Free Hospital, London, United Kingdom
| | - Anisa Nutu
- Transplant Fellow, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Gabi Oniscu
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, United Kingdom
| | - Thamara Perera
- Consultant Transplant Surgeon, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sanjay Sinha
- Consultant Transplant Surgeon, Churchill Hospital, Oxford, United Kingdom
| | - Andrew Sutherland
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, United Kingdom
| | - David Van Dellen
- Consultant Transplant Surgeon, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Chris Watson
- Consultant Transplanxt Surgeon, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Steve White
- Consultant Transplant Surgeon, Freeman Hospital, Newcastle, United Kingdom
| | - Stephen O'Neill
- Consultant Transplant Surgeon, Belfast City Hospital, Belfast, United Kingdom.
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Sharma S, Saner FH, Bezinover D. A brief history of liver transplantation and transplant anesthesia. BMC Anesthesiol 2022; 22:363. [PMID: 36435747 PMCID: PMC9701388 DOI: 10.1186/s12871-022-01904-1] [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: 09/06/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022] Open
Abstract
In this review, we describe the major milestones in the development of organ transplantation with a specific focus on hepatic transplantation. For many years, the barriers preventing successful organ transplantation in humans seemed insurmountable. Although advances in surgical technique provided the technical ability to perform organ transplantation, limited understanding of immunology prevented successful organ transplantation. The breakthrough to success was the result of several significant discoveries between 1950 and 1980 involving improved surgical techniques, the development of effective preservative solutions, and the suppression of cellular immunity to prevent graft rejection. After that, technical innovations and laboratory and clinical research developed rapidly. However, these advances alone could not have led to improved transplant outcomes without parallel advances in anesthesia and critical care. With increasing organ demand, it proved necessary to expand the donor pool, which has been achieved with the use of living donors, split grafts, extended criteria organs, and organs obtained through donation after cardiac death. Given this increased access to organs and organ resources, the number of transplantations performed every year has increased dramatically. New regulatory organizations and transplant societies provide critical oversight to ensure equitable organ distribution and a high standard of care and also perform outcome analyses. Establishing dedicated transplant anesthesia teams results in improved organ transplantation outcomes and provides a foundation for developing new standards for other subspecialties in anesthesiology, critical care, and medicine overall. Through a century of discovery, the success we enjoy at the present time is the result of the work of well-organized multidisciplinary teams following standardized protocols and thereby saving thousands of lives worldwide each year. With continuing innovation, the future is bright.
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Affiliation(s)
- Sonal Sharma
- Department of Anesthesiology and Perioperative Medicine, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, USA
| | - Fuat H Saner
- Department of General, Visceral, and Transplant Surgery, Medical Center University Essen, Hufeland 55, 45147, Essen, Germany
| | - Dmitri Bezinover
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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Isenberg JS, Roberts DD. The role of CD47 in pathogenesis and treatment of renal ischemia reperfusion injury. Pediatr Nephrol 2019; 34:2479-2494. [PMID: 30392076 PMCID: PMC6677644 DOI: 10.1007/s00467-018-4123-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/01/2018] [Accepted: 10/18/2018] [Indexed: 01/05/2023]
Abstract
Ischemia reperfusion (IR) injury is a process defined by the temporary loss of blood flow and tissue perfusion followed later by restoration of the same. Brief periods of IR can be tolerated with little permanent deficit, but sensitivity varies for different target cells and tissues. Ischemia reperfusion injuries have multiple causes including peripheral vascular disease and surgical interventions that disrupt soft tissue and organ perfusion as occurs in general and reconstructive surgery. Ischemia reperfusion injury is especially prominent in organ transplantation where substantial effort has been focused on protecting the transplanted organ from the consequences of IR. A number of factors mediate IR injury including the production of reactive oxygen species and inflammatory cell infiltration and activation. In the kidney, IR injury is a major cause of acute injury and secondary loss of renal function. Transplant-initiated renal IR is also a stimulus for innate and adaptive immune-mediated transplant dysfunction. The cell surface molecule CD47 negatively modulates cell and tissue responses to stress through limitation of specific homeostatic pathways and initiation of cell death pathways. Herein, a summary of the maladaptive activities of renal CD47 will be considered as well as the possible therapeutic benefit of interfering with CD47 to limit renal IR.
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Affiliation(s)
- Jeffrey S. Isenberg
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - David D. Roberts
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, Corresponding author: David D. Roberts, , 301-480-4368
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Chen Y, Shi J, Xia TC, Xu R, He X, Xia Y. Preservation Solutions for Kidney Transplantation: History, Advances and Mechanisms. Cell Transplant 2019; 28:1472-1489. [PMID: 31450971 PMCID: PMC6923544 DOI: 10.1177/0963689719872699] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Solid organ transplantation was one of the greatest medical advances during the past few
decades. Organ preservation solutions have been applied to diminish ischemic/hypoxic
injury during cold storage and improve graft survival. In this article, we provide a
general review of the history and advances of preservation solutions for kidney
transplantation. Key components of commonly used solutions are listed, and effective
supplementations for current available preservation solutions are discussed. At cellular
and molecular levels, further insights were provided into the pathophysiological
mechanisms of effective ingredients against ischemic/hypoxic renal injury during cold
storage. We pay special attention to the cellular and molecular events during
transplantation, including ATP depletion, acidosis, mitochondrial dysfunction, oxidative
stress, inflammation, and other intracellular mechanisms.
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Affiliation(s)
- Yimeng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jian Shi
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Terry C Xia
- The University of Connecticut, Storrs, CT, USA
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Ying Xia
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
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A Comparative Study of Single and Dual Perfusion During End-ischemic Subnormothermic Liver Machine Preservation. Transplant Direct 2018; 4:e400. [PMID: 30534591 PMCID: PMC6233661 DOI: 10.1097/txd.0000000000000840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
Background It remains controversial if arterial perfusion in addition to portal vein perfusion during machine preservation improves liver graft quality. Comparative studies using both techniques are lacking. We studied the impact of using single or dual machine perfusion of donation after circulatory death rat livers. In addition, we analyzed the effect of pulsatile versus continuous arterial flow. Methods Donation after circulatory death rat livers (n = 18) were preserved by 6 hours cold storage, followed by 1 hour subnormothermic machine perfusion (20°C, pressure of 40/5 mm Hg) and 2 hours ex vivo warm reperfusion (37°C, pressure of 80/11 mm Hg, 9% whole blood). Machine preservation was either through single portal vein perfusion (SP), dual pulsatile (DPP), or dual continuous perfusion (DCP) of the portal vein and hepatic artery. Hydrodynamics, liver function tests, histopathology, and expression of endothelial specific genes were assessed during 2 hours warm reperfusion. Results At the end of reperfusion, arterial flow in DPP livers tended to be higher compared to DCP and SP grafts. However, this difference was not significant nor was better flow associated with better outcome. No differences in bile production or alanine aminotransferase levels were observed. SP livers had significantly lower lactate compared to DCP, but not DPP livers. Levels of Caspase-3 and tumor necrosis factor-α were similar between the groups. Expression of endothelial genes Krüppel-like-factor 2 and endothelial nitric oxide synthase tended to be higher in dual perfused livers, but no histological evidence of better preservation of the biliary endothelium or vasculature of the hepatic artery was observed. Conclusions This study shows comparable outcomes after using a dual or single perfusion approach during end-ischemic subnormothermic liver machine preservation.
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von Horn C, Minor T. Isolated kidney perfusion: the influence of pulsatile flow. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:131-135. [DOI: 10.1080/00365513.2017.1422539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Charlotte von Horn
- Department of Surgical Research General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Minor
- Department of Surgical Research General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Abstract
OBJECTIVES To perform a state of the art about the history of kidney transplantation. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): kidney transplantation, history, vascular anastomosis. RESULTS From the first vascular ligations to the discovery of ciclosporin, the history of organ transplantation was made of surgical bets and medical discoveries, such as blood group, HLA-system, immunity, etc. The audacity of some surgeons led to the onset of renal transplantation as the treatment of choice for end stage renal disease. CONCLUSION This article aims to describe the first surgical methods for vascular anastomosis and renal transplantation. Through a comprehensive search within the archives of the French National Library, the authors provide a precise description of the first renal transplantations performed, the technique that have been used and their authors.
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Oberhuber R, Liu G, Heinbokel T, Tullius SG. Emerging issues in transplantation. Transpl Immunol 2015. [DOI: 10.1002/9781119072997.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Minor T, Paul A, Efferz P, Wohlschlaeger J, Rauen U, Gallinat A. Kidney transplantation after oxygenated machine perfusion preservation with Custodiol-N solution. Transpl Int 2015; 28:1102-8. [PMID: 25882869 DOI: 10.1111/tri.12593] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
Custodiol-N, a new preservation solution, has been shown particularly suitable for hypothermic machine perfusion preservation (HMP) in isolated porcine kidneys. These preliminary results should be confirmed in an actual transplant model in vivo. Kidney function after 21 h of HMP was studied in an autotransplant model using Landrace pigs (25-30 kg; n = 6 per group). Perfusion was performed with oxygenated perfusate, using either Custodiol-N solution including 50 g/l dextran 40 (CND) or kidney perfusion solution 1 (KPS-1) as gold standard. Viability of the grafts was followed for 1 week after bilateral nephrectomy in the recipient pigs. HMP with CND resulted in less acute tubular injury, evaluated by levels of fatty acid-binding protein and better clearance function during the first 24 h after Tx than with KPS-1 (P < 0.05, resp.). Serum creatinine tended to be lower in the CND group during the whole observation period. Histological tissue scores one week after Tx were similar in both groups. Expression of endothelin-1 as well as of Toll-like receptor 4 15 min after reperfusion was lower in the CND group (P < 0.05), suggesting less endothelial stress response. The data provide first in vivo evidence for the suitability of Custodiol-N as an effective perfusate for renal machine perfusion.
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Affiliation(s)
- Thomas Minor
- Surgical Research Division, University Clinic of Surgery, Bonn, Germany
| | - Andreas Paul
- Clinic of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany
| | - Patrik Efferz
- Surgical Research Division, University Clinic of Surgery, Bonn, Germany
| | | | - Ursula Rauen
- Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
| | - Anja Gallinat
- Clinic of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany
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Gallinat A, Efferz P, Paul A, Minor T. One or 4 h of "in-house" reconditioning by machine perfusion after cold storage improve reperfusion parameters in porcine kidneys. Transpl Int 2014; 27:1214-9. [PMID: 24977654 DOI: 10.1111/tri.12393] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 04/22/2014] [Accepted: 06/26/2014] [Indexed: 12/01/2022]
Abstract
In-house machine perfusion after cold storage (hypothermic reconditioning) has been proposed as convenient tool to improve kidney graft function. This study investigated the role of machine perfusion duration for early reperfusion parameters in porcine kidneys. Kidney function after cold preservation (4 °C, 18 h) and subsequent reconditioning by one or 4 h of pulsatile, nonoxygenated hypothermic machine perfusion (HMP) was studied in an isolated kidney perfusion model in pigs (n = 6, respectively) and compared with simply cold-stored grafts (CS). Compared with CS alone, one or 4 h of subsequent HMP similarly and significantly improved renal flow and kidney function (clearance and sodium reabsorption) upon warm reperfusion, along with reduced perfusate concentrations of endothelin-1 and increased vascular release of nitric oxide. Molecular effects of HMP comprised a significant (vs CS) mRNA increase in the endothelial transcription factor KLF2 and lower expression of endothelin that were observed already at the end of one-hour HMP after CS. Reconditioning of cold-stored kidneys is possible, even if clinical logistics only permit one hour of therapy, while limited extension of the overall storage time by in-house machine perfusion might also allow for postponing of transplantation from night to early day work.
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Affiliation(s)
- Anja Gallinat
- Clinic of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany
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Edtinger K, Yang X, Uehara H, Tullius SG. Current status of vascularized composite tissue allotransplantation. BURNS & TRAUMA 2014; 2:53-60. [PMID: 27602363 PMCID: PMC5012023 DOI: 10.4103/2321-3868.130184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/09/2014] [Indexed: 01/01/2023]
Abstract
Vascularized composite tissue allotransplantation (VCA) offers treatment options of complex functional deficiencies that cannot be repaired with conventional reconstructive methods. VCAs consist of blocks of functional units comprising different tissue types such as skin, bone, muscle, nerves, blood vessels, tendons, ligaments and others, and are thus substantially different from the composition of organ transplants. The field of VCA has made fascinating progresses in the recent past. Among other VCAs, numerous successful hand, face and limb transplants have been performed in the world. At the same time, specific questions in regard to innate and adaptive immunity, consequences of ischemia/reperfusion injury, immunosuppression, preservation, and regenerative capacity remain. In spite of this, the field is poised to make significant advances in the near future.
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Affiliation(s)
- Karoline Edtinger
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Department of Surgery, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Xiaoyong Yang
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Division of Urology, Bejing Chao-Yang Hospital, Capital Medical University, Bejing, China
| | - Hanae Uehara
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Department of Plastic and Reconstructive Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Stefan G Tullius
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA
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Lüer B, Fox M, Efferz P, Minor T. Adding pulsatile vascular stimulation to venous systemic oxygen persufflation of liver grafts. Artif Organs 2013; 38:404-10. [PMID: 24117496 DOI: 10.1111/aor.12184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The effect of adding pulsatility to gaseous oxygen persufflation during liver preservation was studied in an isolated rat liver model. Livers from male Wistar rats were retrieved 30 min after cardiac arrest of the donor and subjected to 18 h of cold storage. Some grafts were subjected to nonpulsatile or pulsatile gaseous oxygen persufflation. Graft viability was assessed thereafter upon warm reperfusion in vitro (n = 5 per group). Pulsatile persufflation significantly improved parenchymal integrity (enzyme release, bile flow) upon reperfusion, with respect to nonpulsatile persufflation or cold storage (CS) (e.g., max. release of alanine aminotransferase: 44 ± 10 vs. 178 ± 29 vs. 345 ± 100 U/L; pulsatile vs. nonpulsatile persufflation vs. CS).The effect was associated with the prevention of the ischemic decline in gene and protein expression of the vasoprotective Krüppel-like factor 2, increased perfusate levels of the endogenous vasodilator nitric oxide, and reduced portal vascular resistance upon reperfusion, while nonpulsatile persufflation was less effective (e.g., vascular resistance: 1235 ± 108 vs. 1607 ± 155 vs. 2215 ± 208 Pa s/mL; pulsatile vs. nonpulsatile persufflation vs. CS). In conclusion, pulsatile mechanostimulation of the hepatovasculature seems a genuine protective mechanism, affecting early graft recovery upon reperfusion.
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Affiliation(s)
- Bastian Lüer
- Surgical Research Division, University Clinic of Surgery, Bonn, Germany
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van Egmond A, van der Keur C, Swings GMJS, van Beelen E, van Zijl L, Scherjon SA, Claas FHJ. Preservation of human placenta facilitates multicenter studies on the local immune response in normal and aberrant pregnancies. J Reprod Immunol 2013; 98:29-38. [PMID: 23623053 DOI: 10.1016/j.jri.2013.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 01/03/2023]
Abstract
Our standard procedure for phenotypic and functional analysis of immune cells present in the placenta is to isolate leukocytes from the decidua within five hours of the delivery. However, this results in logistical problems with deliveries at night, weekends or in other medical centers. Collecting placentas after complicated pregnancies is even more difficult owing to the low prevalence and the often unscheduled delivery. The aim was to investigate the possibility of preserving the human placenta before phenotypic and functional analysis of decidual lymphocytes. Placentas were obtained after uncomplicated pregnancy. The tissue was divided into two equal parts: decidual lymphocytes from one part were isolated within five hours according to our standard procedure, whereas the other part was preserved in either Celsior(®), a storage solution for solid organ preservation, or phosphate-buffered saline (PBS) for 24h at 4°C before isolation. Overall, the phenotype and functional capacity of decidual lymphocytes isolated within five hours was comparable to decidual lymphocytes isolated after 24-h preservation in Celsior(®) or PBS. Minor differences were found between decidual lymphocytes isolated within five hours and decidual lymphocytes isolated after 24-h preservation in Celsior(®). The results indicate that PBS is sufficient to preserve the placenta for 24h for phenotypical and functional studies. The ability to preserve the placenta will simplify the procedure for the isolation of decidual lymphocytes and makes it easier to analyze tissue from women who deliver during the night, at weekends or in other hospitals, and possibly even women with complicated pregnancies.
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Affiliation(s)
- A van Egmond
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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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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Optimal flow and pressure management in machine perfusion systems for organ preservation. Ann Biomed Eng 2012; 40:2698-707. [PMID: 22669502 PMCID: PMC3508271 DOI: 10.1007/s10439-012-0601-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/19/2012] [Indexed: 01/03/2023]
Abstract
Intra-organ flow is the most critical parameter in machine-perfused organ preservation systems (MPS). Ultrasonic flow sensors (UFS) are commonly employed in MPS. However, UFS are sensitive to changes in fluid composition and temperature and require recalibration. Novel Coriolis-type mass flow sensors (CFS) may be more suitable for MPS because the measurement technique is not amenable to these factors. The effect of viscosity, colloids, temperature, pressure, and preservation solution on flow measurement accuracy of UFS and CFS was therefore investigated. A CFS-based MPS was built and validated for setpoint stability using porcine kidneys and the ability to reproduce different pressure and flow waveforms. The UFS exhibited a temperature- and preservation solution-dependent overestimation of flow rate compared to the CFS. The CFS deviated minimally from the actual flow rate and did not require recalibration. The CFS-based MPS conformed to the preprogrammed temperature, flow, pressure, and vascular resistance settings during 6-h kidney preservation. The system was also able to accurately reproduce different pressure and flow waveforms. Conclusively, CFS-based MPS are more suitable for organ preservation than UFS-based MPS. Our CFS-based MPS provides a versatile yet robust experimental platform for testing and validating different types of clinical and experimental MPS.
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Solini S, Aiello S, Cassis P, Scudeletti P, Azzollini N, Mister M, Rocchetta F, Abbate M, Pereira RL, Noris M. Prolonged cold ischemia accelerates cellular and humoral chronic rejection in a rat model of kidney allotransplantation. Transpl Int 2012; 25:347-56. [DOI: 10.1111/j.1432-2277.2011.01425.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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