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Oehler D, Immohr MB, Böttger C, Bruno RR, Sigetti D, Haschemi J, Aubin H, Horn P, Tudorache I, Westenfeld R, Akhyari P, Kelm M, Lichtenberg A, Boeken U. Donor hypernatremia is associated with increased mortality after heart transplantation: A retrospective study. Clin Transplant 2022; 36:e14803. [PMID: 36004448 DOI: 10.1111/ctr.14803] [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: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation (HTx) and is correlated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium dysregulation on survival. This study aims to investigate the impact of donor sodium levels on early morbidity and short- and midterm survival following HTx. METHODS Between September 2010 and June 2021, a total of n = 218 patients underwent HTx in our center. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut-off levels from 145 to 159 mmol/L were investigated by Kaplan-Meier-analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133-145 mmol/L, n = 73), mild hypernatremia (146-156 mmol/L, n = 105) and severe hypernatremia (>156 mmol/L, n = 35). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival after up to 5 years after transplantation. RESULTS All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90-day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (90% vs. 71%, p = .02), but not in mild hypernatremia (89%, p = .89). One-year survival was comparable in all groups (p > .28). CONCLUSION Severe donor hypernatremia was associated with reduced short-term survival, while the correlation weakens > 1 year after HTx. As our study is limited due to the nature of its retrospective, single-center approach, future prospective studies are needed to evaluate the importance of donor management with regard to hypernatremia.
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Affiliation(s)
- Daniel Oehler
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Charlotte Böttger
- Department of Diagnostic and Interventional Radiology, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Dennis Sigetti
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Jafer Haschemi
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
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Foroutan F, Malik A, Clark KE, Buchan TA, Yang H, Cheong GHL, Pezzutti O, Kim I, Gupta R, Tan C, Samman A, Friesen EL, Akhtar A, Rigobon A, Stein M, Nunez JJY, Sidhu A, Heels-Ansdell D, Guyatt G, Meade MO. Predictors of 1-year Mortality after Adult Lung Transplantation: Systematic Review and Meta-analyses. J Heart Lung Transplant 2022; 41:937-951. [DOI: 10.1016/j.healun.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022] Open
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3
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Wang K, Lu D, Liu Y, Li W, Zhuang L, Ma Z, Xie Q, Pan B, Wu Y, Chen J, Lin L, Feng X, Wei Q, Wei X, Xie H, Wang Z, Zheng S, Xu X. Severity of early allograft dysfunction following donation after circulatory death liver transplantation: a multicentre study. Hepatobiliary Surg Nutr 2021; 10:9-19. [PMID: 33575286 DOI: 10.21037/hbsn.2019.09.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
Background Early allograft dysfunction (EAD) is associated with decreased graft and patient survival rates. This study aimed to identify the severity of EAD and develop a predictive model for EAD after donation after circulatory death (DCD) liver transplantation (LT). Furthermore, the influence of operative time on EAD incidence was also evaluated. Methods In this retrospective, multicentre cohort study, nomograms were established based on a single-centre training cohort (n=321) and validated in a 3-center validation cohort (n=501). Results The incidence rate of EAD was 46.4% (149/321) in the training cohort and 40.5% (203/501) in the validation cohort. Of the 149 EAD patients in the training cohort, 77 patients with either elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) were classified as having EAD type A, and the rest of the EAD patients were classified as having EAD type B. Recipients with EAD type B had lower graft and patient survival rates than recipients with EAD type A (P=0.043 and 0.044, respectively). We further developed a nomogram to predict EAD (graft weight, cold ischemia time, donor age, model for end-stage liver disease (MELD) score) and another nomogram to predict EAD type B (graft weight, cold ischemia time, MELD score). The nomograms for the prediction of EAD and EAD type B had good discrimination [concordance index (C-index) =0.712 (0.666-0.758), 0.707 (0.641-0.773)] and calibration [Hosmer-Lemeshow (HL) P=0.384, P=0.425] in the validation cohort. An increased operative time (>6 h) was associated with increased EAD and EAD type B incidence in the high-risk group (P=0.005, P=0.020, respectively). Conclusions EAD type B was associated with decreased graft and patient survival rates. The novel nomograms effectively predicted the incidence of EAD and EAD type B in DCD LT patients.
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Affiliation(s)
- Kun Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Di Lu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Yuhui Liu
- Department of Surgery, Dezhou People's Hospital, Dezhou, China
| | - Wangyao Li
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Zhenyu Ma
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qinfen Xie
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Binhua Pan
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Yichao Wu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Junli Chen
- China Liver Transplant Registry, Hangzhou, China
| | - Lidan Lin
- China Liver Transplant Registry, Hangzhou, China
| | - Xiaowen Feng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Qiang Wei
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Xuyong Wei
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Haiyang Xie
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - Zhengxin Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China.,Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Xiao Xu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China
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4
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Sharma A, Peltz M, Wait MA, Ring SW, Mathur A, Jessen ME, Murala JS. The conduct of thoracic organ procurement. Asian Cardiovasc Thorac Ann 2020; 28:158-167. [PMID: 32052649 DOI: 10.1177/0218492320906687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transplantation has become the gold-standard treatment for endstage heart and lung failure. A well-executed procurement process is the cornerstone of a successful transplant program and patient outcome after transplantation. The aim of this review was to describe a standardized protocol and guidelines for optimal thoracic organ procurement. Here, we describe all aspects of optimal thoracic organ procurement including the intraoperative conduct of the teams, operative steps, graft preservation, transportation, and pitfalls. We believe that a standardized protocol helps in streamlining and minimizing errors, provides optimal training for junior members of the team, and predetermines graft function postimplantation.
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Affiliation(s)
| | | | | | | | - Alok Mathur
- UT Southwestern Medical Center, Dallas, Texas, USA
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