1
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Nakajima D, Date H. Ex vivo lung perfusion in lung transplantation. Gen Thorac Cardiovasc Surg 2021; 69:625-630. [PMID: 33683575 PMCID: PMC7938286 DOI: 10.1007/s11748-021-01609-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
Lung transplantation is an established life-saving intervention for patients with end-stage lung diseases. The success of lung transplantation mainly depends on the quality and function of the implanted donor lungs, which are frequently subject to brain-death-induced lung injuries and intensive care unit (ICU)-related complications before transplantation. Recent innovations, particularly the development of ex vivo lung perfusion (EVLP), in which donor lungs are ventilated and perfused under normothermic conditions outside the body, have allowed clinicians to more accurately assess the donor lung function prior to transplantation. Therefore, EVLP has been successfully translated into clinical practice with the expansion of the donor lung pool, leading to favorable post-transplant outcomes in a growing number of transplant centers worldwide. The EVLP system and techniques, following the Toronto protocol, have recently been applied for the assessment of extended criteria brain-death donors in clinical lung transplantation in Japan. The advancement of EVLP from organ assessment to organ treatment will be the next challenging stage not only to expand donor lung pool, but also to improve graft survival and long-term outcomes after transplantation.
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Affiliation(s)
- Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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2
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Arias-Cabrales C, Pérez-Sáez MJ, Redondo-Pachón D, Buxeda A, Burballa C, Bermejo S, Sierra A, Mir M, Burón A, Zapatero A, Crespo M, Pascual J. Usefulness of the KDPI in Spain: A comparison with donor age and definition of standard/expanded criteria donor. Nefrologia 2018; 38:503-513. [PMID: 29884503 DOI: 10.1016/j.nefro.2018.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/01/2018] [Accepted: 03/02/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Kidney donor shortage requires expanding donor selection criteria, as well as use of objective tools to minimize the percentage of discarded organs. Some donor pre-transplant variables such as age, standard/expanded criteria donor (SCD/ECD) definition and calculation of the Kidney Donor Profile Index (KDPI), have demonstrated correlations with patient and graft outcomes. We aimed to establish the accuracy of the three models to determine the prognostic value of kidney transplantation (KT) major outcomes. MATERIAL AND METHODS We performed a retrospective study in deceased donor KTs at our institution. Unadjusted Cox and Kaplan-Meier survival, and multivariate Cox analyses were fitted to analyze the impact of donor age, SCD/ECD and KDPI on outcomes. RESULTS 389 KTs were included. Mean donor age was 53.6±15.2 years; 163 (41.9%) came from ECD; mean KDPI was 69.4±23.4%. Median follow-up was 51.9 months. The unadjusted Cox and Kaplan-Meier showed that the three prognostic variables of interest were related to increased risk of patient death, graft failure and death-censored graft failure. However, in the multivariate analysis only KDPI was related to a higher risk of graft failure (HR 1.03 [95% CI 1.01-1.05]; p=0.014). CONCLUSIONS SCD/ECD classification did not provide significant prognostic information about patient and graft outcomes. KDPI was linearly related to a higher risk of graft failure, providing a better assessment. More studies are needed before using KDPI as a tool to discard or accept kidneys for transplantation.
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Affiliation(s)
- Carlos Arias-Cabrales
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - María José Pérez-Sáez
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Dolores Redondo-Pachón
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Anna Buxeda
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Carla Burballa
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Sheila Bermejo
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Adriana Sierra
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Marisa Mir
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Andrea Burón
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain; REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Ana Zapatero
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Department of Intensive Care Medicine, Transplant Coordination Unit, Hospital del Mar, Barcelona, Spain.
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3
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Abstract
BACKGROUND Organ transplantation, the treatment of choice in organ failure, is penalized by the lack of organs. Because the increase in the number of donors is not proportional throughout the different age groups, there is no increase in lung transplantations. The aim of this work was to analyze the use of available lungs and evaluate strategies that may help increase transplantations. METHODS We analyzed the activity of lung transplantation in 2015, divided into various allocation programs. We also examined the surplus organs, in particular, their origin, their destination, their offer's outcome, the characteristics of the donor and the proposed organ, and the reasons for rejection. RESULTS In 2015, 112 lung transplantations were performed: 66 (68.9%) with regional organs, 46 (41.1%) with extraregional organs; 21 (45.6%) of these were allocated as emergencies/return, and 25 (54.4%) as surplus (19 in the North macroarea, 6 in the South macroarea). The number of surplus lungs was 148: 67 from the North macroarea, 71 from the South macroarea, and 10 from abroad. No organ procured in the North macroarea was transplanted in the South macroarea, whereas 6 lungs coming from the South macroarea were transplanted in the North. CONCLUSIONS The acceptance criteria are not the same in different transplant centers and they include not only clinical parameters, but also ischemia time and composition of the waiting list at the time of the offer, quality and accessibility of the intensive care units where the donor is located, and organizational reasons. Offering organs which can not be transplanted within the region to other centers, without clinical foreclosures is a system that increases transplant activities by maximizing the available resources.
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4
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Croome KP, Lee DD, Keaveny AP, Taner CB. Noneligible Donors as a Strategy to Decrease the Organ Shortage. Am J Transplant 2017; 17:1649-1655. [PMID: 27977900 DOI: 10.1111/ajt.14163] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 01/25/2023]
Abstract
Organ procurement organization (OPO) performance is generally evaluated by the number of organ procurement procedures divided by the number of eligible deaths (donation after brain death [DBD] donors aged <70 years), whereas the number of noneligible deaths (including donation after cardiac death donors and DBD donors aged >70 years) is not tracked. The present study aimed to investigate the variability in the proportion of noneligible liver donors by the 58 donor service areas (DSAs). Patients undergoing liver transplant (LT) between 2011 and 2015 were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research file. LTs from noneligible and eligible donors were compared. The proportion of noneligible liver donors by DSA varied significantly, ranging from 0% to 19.6% of total liver grafts used. In transplant programs, the proportion of noneligible liver donors used ranged from 0% to 35.3%. On linear regression there was no correlation between match Model for End-Stage Liver Disease score for programs in a given DSA and proportion of noneligible donors used from the corresponding DSA (p = 0.14). Noneligible donors remain an underutilized resource in many OPOs. Policy changes to begin tracking noneligible donors and learning from OPOs that have high noneligible donor usage are potential strategies to increase awareness and pursuit of these organs.
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Affiliation(s)
- K P Croome
- Department of Transplant, Mayo Clinic, Jacksonville, FL
| | - D D Lee
- Department of Transplant, Mayo Clinic, Jacksonville, FL
| | - A P Keaveny
- Department of Transplant, Mayo Clinic, Jacksonville, FL
| | - C B Taner
- Department of Transplant, Mayo Clinic, Jacksonville, FL
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5
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Abstract
Zero-time kidney biopsies, obtained at time of transplantation, are performed in many transplant centers worldwide. Decisions on kidney discard, kidney allocation, and choice of peritransplant and posttransplant treatment are sometimes based on the histological information obtained from these biopsies. This comprehensive review evaluates the practical considerations of performing zero-time biopsies, the predictive performance of zero-time histology and composite histological scores, and the clinical utility of these biopsies. The predictive performance of individual histological lesions and of composite scores for posttransplant outcome is at best moderate. No single histological lesion or composite score is sufficiently robust to be included in algorithms for kidney discard. Dual kidney transplantation has been based on histological assessment of zero-time biopsies and improves outcome in individual patients, but the waitlist effects of this strategy remain obscure. Zero-time biopsies are valuable for clinical and translational research purposes, providing insight in risk factors for posttransplant events, and as baseline for comparison with posttransplant histology. The molecular phenotype of zero-time biopsies yields novel therapeutic targets for improvement of donor selection, peritransplant management and kidney preservation. It remains however highly unclear whether the molecular expression variation in zero-time biopsies could become a better predictor for posttransplant outcome than donor/recipient baseline demographic factors.
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6
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Newell KA, Formica RN, Gill JS, Schold JD, Allan JS, Covington SH, Wiseman AC, Chandraker A. Integrating APOL1 Gene Variants Into Renal Transplantation: Considerations Arising From the American Society of Transplantation Expert Conference. Am J Transplant 2017; 17:901-911. [PMID: 27997071 DOI: 10.1111/ajt.14173] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 01/25/2023]
Abstract
Thirteen percent of individuals of African ancestry express two variant copies of the gene encoding apolipoprotein 1 (APOL1) that has been associated with an increased risk of end-stage renal disease (ESRD) in the general population. Limited studies suggest that the survival of transplanted kidneys from donors expressing two APOL1 risk alleles is inferior to that of kidneys from donors with zero or one risk allele. In living kidney donation, two case reports describe donors expressing two APOL1 risk alleles who developed ESRD. Given the potential impact of APOL1 variants on the utility and safety of kidney transplantation and living kidney donation, the American Society of Transplantation convened a meeting with the goals of summarizing the current state of knowledge with respect to transplantation and APOL1, identifying knowledge gaps and studies to address these gaps, and considering approaches to integrating APOL1 into clinical practice. The authors recognize that current data are not sufficient to support traditional evidence-based guidelines but also recognize that it may require several years to generate the necessary data. Thus, approaches as to how APOL1 might currently be integrated into the clinical decision-making process were considered. This report summarizes the group's deliberations.
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Affiliation(s)
- K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - R N Formica
- Department of Medicine, Yale University School of Medicine, New Haven, CN
| | - J S Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - J D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - J S Allan
- Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA
| | | | | | - A Chandraker
- Schuster Family Transplantation Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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7
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Abstract
Major neurologic morbidity, such as seizures and encephalopathy, complicates 20-30% of organ and stem cell transplantation procedures. The majority of these disorders occur in the early posttransplant period, but recipients remain at risk for opportunistic infections and other nervous system disorders for many years. These long-term risks may be increasing as acute survival increases, and a greater number of "sicker" patients are exposed to long-term immunosuppression. Drug neurotoxicity accounts for a significant proportion of complications, with posterior reversible leukoencephalopathy syndrome, primarily associated with calcineurin inhibitors (i.e., cyclosporine and tacrolimus), being prominent as a cause of seizures and neurologic deficits. A thorough evaluation of any patient who develops neurologic symptoms after transplantation is mandatory, since reversible and treatable conditions could be found, and important prognostic information can be obtained.
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Affiliation(s)
- R Dhar
- Division of Neurocritical Care, Department of Neurology, Washington University, St. Louis, MO, USA.
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8
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Abstract
Organ transplantation improves survival and quality of life in patients with end-organ failure. Waiting lists continue to grow across the world despite remarkable advances in the transplantation process, from the creation of public engagement campaigns to the development of critical pathways for the timely identification, referral, approach, and treatment of the potential organ donor. The pathophysiology of dying triggers systemic changes that are intimately related to organ viability. The intensive care management of the potential organ donor optimizes organ function and improves the donation yield, representing a significant step in reducing the mismatch between organ supply and demand. Different beliefs and cultures reflect diverse legislations and donation practices amongst different countries, creating a challenge to standardized practices. Maintaining public trust is necessary for continued progress in organ donation and transplantation, hence the urge for a joint effort in creating uniform protocols that ensure transparent practices within the medical community.
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Affiliation(s)
- C B Maciel
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D Y Hwang
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D M Greer
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
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9
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The Importance and Utility of Hemoglobin A1c Levels in the Assessment of Donor Pancreas Allografts. Transplantation 2016; 101:2508-2519. [PMID: 27984519 DOI: 10.1097/tp.0000000000001612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hemoglobin A1C (HbA1c) levels are often obtained in potential pancreas graft donors to assess the overall long-term functional glycemic control or the possibility of unrecognized diabetes. Although routinely measured, the impact of donor HbA1c levels on pancreas graft outcomes has not been reported. Here, we researched the relationship between donor HbA1c levels and postoperative pancreas graft survival. METHODS Data from 266 pancreas transplant patients including 182 simultaneous kidney-pancreas and 84 pancreas alone transplants were reviewed for the study. The patients were separated into groups according to their HbA1c levels (5 groups: HbA1c < 5.0, 5.0-5.4, 5.5-5.9, ≥6.0 % and not available, or 2 groups: HbA1c <5.7, ≥5.7%). Overall, death-censored and technically successful pancreas graft survival and rejection rates of each group were compared. In the case of technically successful graft survival, graft losses due to technical problems in the first 60 days were excluded. RESULTS All groups were similar with regard to donor variables including age, sex, ABO blood type, ethnicity, donor type and recipient variables including recipient age, sex, induction agents and maintenance treatment. Mean follow-up time was 4.2 ± 1.97 years. The overall graft survivals and death censored graft survivals among groups were not statistically different from one other (P > 0.05). Additionally, excluding early technical losses in 18 patients did not reveal any differences in graft survivals. Patient survival and biopsy-proven acute rejections were statistically similar among HbA1c strata. CONCLUSIONS This univariate retrospective analysis of a single center/organ procurement organization use of HbA1c shows that donor HbA1c levels between 3.5 and 6.2 in otherwise transplantable pancreata are not associated with different short-term outcomes.
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10
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Godown J, McKane M, Wujcik K, Mettler BA, Dodd DA. Expanding the donor pool: regional variation in pediatric organ donation rates. Pediatr Transplant 2016; 20:1093-1097. [PMID: 27507803 DOI: 10.1111/petr.12779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/28/2022]
Abstract
There are limited published data on pediatric organ donation rates. The aim of this study was to describe the trends in pediatric organ donation over time and to assess the regional variation in pediatric deceased organ donation. OPTN data were utilized to assess the trends in pediatric organ donation over time. The number of deceased pediatric organ donors was indexed using regional mortality data obtained from the National Center for Health Statistics and compared across UNOS regions and two different eras. The number of pediatric deceased organ donors has declined in the recent era, largely driven by fewer adolescent donors. For all age groups, there is significant regional variation in organ donation rates, with identifiable high- and low-performing regions. Expansion of the donor pool may be possible by optimizing organ donation in regions demonstrating lower recruitment of pediatric donors. Using the region with the highest donation rate for each age group as the gold standard, we estimate a potential 24% increase in the number of donors if all regions performed comparably, equating to 215 new pediatric donors annually.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Meghann McKane
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kari Wujcik
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Bret A Mettler
- Division of Pediatric Cardiothoracic Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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11
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Hoste P, Vanhaecht K, Ferdinande P, Rogiers X, Eeckloo K, Blot S, Hoste E, Vogelaers D, Vandewoude K. Care pathways for organ donation after brain death: guidance from available literature? J Adv Nurs 2016; 72:2369-80. [PMID: 27328738 DOI: 10.1111/jan.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 01/10/2023]
Abstract
AIMS A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death. BACKGROUND Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes. DESIGN A discussion paper. DATA SOURCES A systematic review of the Medline, CINAHL, EMBASE and The Cochrane Library databases was conducted for articles published until June 2015, using the keywords donation after brain death and care pathways. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted. DISCUSSION Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death. IMPLICATIONS FOR NURSING Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored. CONCLUSION Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway.
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Affiliation(s)
- Pieter Hoste
- Department of General Internal Medicine, Ghent University Hospital, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Intensive Care, General Hospital Sint-Lucas, Ghent, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Belgium.,European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | | | - Xavier Rogiers
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Transplant Surgery, Ghent University Hospital, Belgium
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Stijn Blot
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Eric Hoste
- Department of Intensive Care Medicine, Ghent University Hospital, Belgium.,Research Foundation - Flanders (FWO), Egmontstraat, Brussels, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium
| | - Koenraad Vandewoude
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium
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12
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13
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Fananapazir G, Tse G, Corwin MT, Santhanakrishnan C, Perez RV, McGahan JP, Stewart S, Troppmann C. Pediatric En Bloc Kidney Transplants: Clinical and Immediate Postoperative US Factors Associated with Vascular Thrombosis. Radiology 2016; 279:935-42. [DOI: 10.1148/radiol.2015150430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Is Donor Service Area Market Competition Associated With Organ Procurement Organization Performance? Transplantation 2016; 100:1349-55. [DOI: 10.1097/tp.0000000000000979] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Deceased-Donor Apolipoprotein L1 Renal-Risk Variants Have Minimal Effects on Liver Transplant Outcomes. PLoS One 2016; 11:e0152775. [PMID: 27054572 PMCID: PMC4824450 DOI: 10.1371/journal.pone.0152775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/18/2016] [Indexed: 01/08/2023] Open
Abstract
Background Apolipoprotein L1 gene (APOL1) G1 and G2 renal-risk variants, common in populations with recent African ancestry, are strongly associated with non-diabetic nephropathy, end-stage kidney disease, and shorter allograft survival in deceased-donor kidneys (autosomal recessive inheritance). Circulating APOL1 protein is synthesized primarily in the liver and hydrodynamic gene delivery of APOL1 G1 and G2 risk variants has caused hepatic necrosis in a murine model. Methods To evaluate the impact of these variants in liver transplantation, this multicenter study investigated the association of APOL1 G1 and G2 alleles in deceased African American liver donors with allograft survival. Transplant recipients were followed for liver allograft survival using data from the Scientific Registry of Transplant Recipients. Results Of the 639 liver donors evaluated, 247 had no APOL1 risk allele, 300 had 1 risk allele, and 92 had 2 risk alleles. Graft failure assessed at 15 days, 6 months, 1 year and total was not significantly associated with donor APOL1 genotype (p-values = 0.25, 0.19, 0.67 and 0.89, respectively). Conclusions In contrast to kidney transplantation, deceased-donor APOL1 G1 and G2 risk variants do not significantly impact outcomes in liver transplantation.
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16
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Rodrigue JR, Feng S, Johansson AC, Glazier AK, Abt PL. Deceased Donor Intervention Research: A Survey of Transplant Surgeons, Organ Procurement Professionals, and Institutional Review Board Members. Am J Transplant 2016; 16:278-86. [PMID: 26484950 DOI: 10.1111/ajt.13482] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/09/2015] [Accepted: 08/10/2015] [Indexed: 01/25/2023]
Abstract
Innovative deceased donor intervention strategies have the potential to increase the number and quality of transplantable organs. Yet there is confusion over regulatory and legal requirements, as well as ethical considerations. We surveyed transplant surgeons (n = 294), organ procurement organization (OPO) professionals (n = 83), and institutional review board (IRB) members (n = 317) and found wide variations in their perceptions about research classification, risk assessment for donors and organ transplant recipients, regulatory oversight requirements, and informed consent in the context of deceased donor intervention research. For instance, when presented with different research scenarios, IRB members were more likely than transplant surgeons and OPO professionals to feel that study review and oversight were necessary by the IRBs at the investigator, donor, and transplant center hospitals. Survey findings underscore the need to clarify ethical, legal, and regulatory requirements and their application to deceased donor intervention research to accelerate the pace of scientific discovery and facilitate more transplants.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - S Feng
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A C Johansson
- Harvard Medical School, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - P L Abt
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
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