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Malik AK, Tingle SJ, Chung N, Owen R, Mahendran B, Counter C, Sinha S, Muthasamy A, Sutherland A, Casey J, Drage M, van Dellen D, Callaghan CJ, Elker D, Manas DM, Pettigrew GJ, Wilson CH, White SA. The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation. Am J Transplant 2024; 24:1247-1256. [PMID: 38360185 DOI: 10.1016/j.ajt.2024.02.008] [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: 11/27/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
The time to arrest donors after circulatory death is unpredictable and can vary. This leads to variable periods of warm ischemic damage prior to pancreas transplantation. There is little evidence supporting procurement team stand-down times based on donor time to death (TTD). We examined what impact TTD had on pancreas graft outcomes following donors after circulatory death (DCD) simultaneous pancreas-kidney transplantation. Data were extracted from the UK transplant registry from 2014 to 2022. Predictors of graft loss were evaluated using a Cox proportional hazards model. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome. Three-hundred-and-seventy-five DCD simultaneous kidney-pancreas transplant recipients were included. Increasing TTD was not associated with graft survival (adjusted hazard ratio HR 0.98, 95% confidence interval 0.68-1.41, P = .901). Increasing asystolic time worsened graft survival (adjusted hazard ratio 2.51, 95% confidence interval 1.16-5.43, P = .020). Restricted cubic spline modeling revealed a nonlinear relationship between asystolic time and graft survival and no relationship between TTD and graft survival. We found no evidence that TTD impacts pancreas graft survival after DCD simultaneous pancreas-kidney transplantation; however, increasing asystolic time was a significant predictor of graft loss. Procurement teams should attempt to minimize asystolic time to optimize pancreas graft survival rather than focus on the duration of TTD.
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Affiliation(s)
- Abdullah K Malik
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK.
| | - Samuel J Tingle
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | - Nicholas Chung
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Ruth Owen
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Balaji Mahendran
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | | | - Sanjay Sinha
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - John Casey
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Martin Drage
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Chris J Callaghan
- NHS Blood and Transplant, Bristol, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Doruk Elker
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Derek M Manas
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; NHS Blood and Transplant, Bristol, UK
| | - Gavin J Pettigrew
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Colin H Wilson
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | - Steven A White
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; NHS Blood and Transplant, Bristol, UK
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Hau HM, Jahn N, Vlachos C, Eichler T, Lederer A, Geisler A, Scheuermann U, Seehofer D, Köppen S, Laudi S, Sucher R, Rademacher S. Does Timepoint of Surgical Procedure Affect the Outcome in Simultaneous Pancreas-Kidney Transplantation? A Retrospective Single-Center Analysis over 20 Years. J Clin Med 2024; 13:3688. [PMID: 38999254 PMCID: PMC11242423 DOI: 10.3390/jcm13133688] [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: 05/03/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Sleep deprivation and disturbances in circadian rhythms may hinder surgical performance and decision-making capabilities. Solid organ transplantations, which are technically demanding and often begin at uncertain times, frequently during nighttime hours, are particularly susceptible to these effects. This study aimed to assess how transplant operations conducted during daytime versus nighttime influence both patient and graft outcomes and function. Methods: simultaneous pancreas-kidney transplants (SPKTs) conducted at the University Hospital of Leipzig from 1998 to 2018 were reviewed retrospectively. The transplants were categorized based on whether they began during daytime hours (8 a.m. to 6 p.m.) or nighttime hours (6 p.m. to 8 a.m.). We analyzed the demographics of both donors and recipients, as well as primary outcomes, which included surgical complications, patient survival, and graft longevity. Results: In this research involving 105 patients, 43 SPKTs, accounting for 41%, took place in the daytime, while 62 transplants (59%) occurred at night. The characteristics of both donors and recipients were similar across the two groups. Further, the rate of (surgical) pancreas graft-related complications and reoperations (daytime 39.5% versus nighttime 33.9%; p = 0.552) were also not statistically significant between both groups. In this study, the five-year survival rate for patients was comparable for both daytime and nighttime surgeries, with 85.2% for daytime and 86% for nighttime procedures (p = 0.816). Similarly, the survival rates for pancreas grafts were 75% for daytime and 77% for nighttime operations (p = 0.912), and for kidney grafts, 76% during the day compared to 80% at night (p = 0.740), indicating no significant statistical difference between the two time periods. In a multivariable model, recipient BMI > 30 kg/m2, donor age, donor BMI, and cold ischemia time > 15 h were independent predictors for increased risk of (surgical) pancreas graft-related complications, whereas the timepoint of SPKT (daytime versus nighttime) did not have an impact. Conclusions: The findings from our retrospective analysis at a big single German transplant center indicate that SPKT is a reliable procedure, regardless of the start time. Additionally, our data revealed that patients undergoing nighttime transplants have no greater risk of surgical complications or inferior results concerning long-term survival of the patient and graft. However, due to the small number of cases evaluated, further studies are required to confirm these results.
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Affiliation(s)
- Hans Michael Hau
- Department of General-, Visceral- and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Nora Jahn
- Department for Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8010 Graz, Austria
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Christos Vlachos
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Tim Eichler
- Department of General-, Visceral- and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria
| | - Andri Lederer
- Department of General-, Visceral- and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Antonia Geisler
- Department of General-, Visceral- and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Sylvia Köppen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Robert Sucher
- Department of General-, Visceral- and Transplant Surgery, Medical University of Graz, 8010 Graz, Austria
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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Mesnard B, De Vergie S, Branchereau J, Prudhomme T. Exploring the correlation between arterial clamping duration during kidney surgeries and kidney partial oxygen pressure levels. World J Urol 2024; 42:363. [PMID: 38814367 DOI: 10.1007/s00345-024-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Affiliation(s)
- Benoit Mesnard
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France.
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France.
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France
| | - Thomas Prudhomme
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
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Bostancı H, Erel S, Küçük A, Kip G, Sezen ŞC, Gokgoz S, Atlı M, Aktepe F, Dikmen K, Arslan M, Kavutçu M. Dexmedetomidine's Effects on the Livers and Kidneys of Rats with Pancreatic Ischemia-Reperfusion Injury. Drug Des Devel Ther 2024; 18:1785-1797. [PMID: 38828020 PMCID: PMC11141764 DOI: 10.2147/dddt.s441773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Pancreatic surgeries inherently cause ischemia-reperfusion (IR) injury, affecting not only the pancreas but also distant organs. This study was conducted to explore the potential use of dexmedetomidine, a sedative with antiapoptotic, anti-inflammatory, and antioxidant properties, in mitigating the impacts of pancreatic IR on kidney and liver tissues. Methods A total of 24 rats were randomly divided into four groups: control (C), dexmedetomidine (D), ischemia reperfusion (IR), and dexmedetomidine ischemia reperfusion (D-IR). Pancreatic ischemia was induced in the IR and D-IR groups. Dexmedetomidine was administered intraperitoneally to the D and D-IR groups. Liver and kidney tissue samples were subjected to microscopic examinations after hematoxylin and eosin staining. The levels of thiobarbituric acid reactive substances (TBARS), aryllesterase (AES), catalase (CAT), and glutathione S-transferase (GST) enzyme activity were assessed in liver and kidney tissues. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine were measured. Results A comparison of the groups revealed that the IR group exhibited significantly elevated TBARS (p < 0.0001), AES (p = 0.004), and CAT enzyme activity (p < 0.0001) levels in the liver and kidney compared to groups C and D. Group D-IR demonstrated notably reduced histopathological damage (p < 0.05) and low TBARS (p < 0.0001), AES (p = 0.004), and CAT enzyme activity (p < 0.0001) in the liver and kidney as well as low AST and ALT activity levels (p < 0.0001) in the serum compared to the IR group. Conclusion The preemptive administration of dexmedetomidine before pancreatic IR provides significant protection to kidney and liver tissues, as evidenced by the histopathological and biochemical parameters in this study. The findings underscored the potential therapeutic role of dexmedetomidine in mitigating the multiorgan damage associated with pancreatic surgeries.
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Affiliation(s)
- Hasan Bostancı
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Selin Erel
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Ayşegül Küçük
- Kutahya Health Sciences University Faculty of Medicine, Department of Physiology, Kutahya, Turkey
| | - Gülay Kip
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Şaban Cem Sezen
- Kırıkkale University Faculty of Medicine, Department of Histology and Embryology, Kırıkkale, Turkey
| | - Seda Gokgoz
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Muharrem Atlı
- Kırıkkale University Faculty of Medicine, Department of Histology and Embryology, Kırıkkale, Turkey
| | - Feyza Aktepe
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Kursat Dikmen
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Mustafa Arslan
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
- Gazi University, Life Sciences Application and Research Center, Ankara, Turkey
- Gazi University, Laboratory Animal Breeding and Experimental Research Center (GUDAM), Ankara, Turkey
| | - Mustafa Kavutçu
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
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5
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Ray S, Parmentier C, Kawamura M, Ganesh S, Nogueira E, Novoa FC, Hobeika C, Chu T, Kalimuthu SN, Selzner M, Reichman TW. Reanimating Pancreatic Grafts Subjected to Prolonged Cold Ischemic Injury Using Normothermic Ex Vivo Perfusion. Transplant Direct 2024; 10:e1620. [PMID: 38617463 PMCID: PMC11013695 DOI: 10.1097/txd.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 04/16/2024] Open
Abstract
Background Pancreas transplant volumes are limited because of poor utilization of "extended criteria grafts." Prolonged cold ischemia is a risk factor associated with poor allograft survival. We aimed to establish the feasibility of transplantation using grafts subjected to prolonged cold ischemia and determine whether these grafts could be optimized using normothermic ex vivo perfusion (NEVP) in a porcine model. Methods The study population consisted of 35 to 40 kg male Yorkshire pigs in an allotransplantation model with a 3-d survival plan for recipients. Control grafts were subjected to cold storage (CS) in a University of Wisconsin solution for 21 to 24 h (n = 6), whereas the test group received an additional 3 h NEVP after CS of 21 h (n = 5). Results The 3-d survival was 60% in the NEVP arm versus 0% in the control arm (P = 0.008; log rank). Graft parenchyma was 60% to 70% preserved in the NEVP arm at necropsy on gross appearance. In addition, the islet function was well preserved, and both the pancreas (including the islets) and the duodenal morphology were maintained histologically. The intravenous glucose tolerance test on the day of euthanasia was in the normoglycemic range for 80% of cases in the NEVP arm. Conclusions Optimization of pancreas grafts exposed to extended CS with NEVP seems promising at rescuing and reanimating these grafts for transplantation, resulting in significantly improved survival in a porcine pancreas transplant model.
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Affiliation(s)
- Samrat Ray
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Catherine Parmentier
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Masataka Kawamura
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sujani Ganesh
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Emmanuel Nogueira
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Francisco Calderon Novoa
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christian Hobeika
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Tunpang Chu
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sangeetha N. Kalimuthu
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON, Canada
| | - Markus Selzner
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor W. Reichman
- Department of Multiorgan Transplantation, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Buemi A, Mourad NI, Ambroise J, Hoton D, Devresse A, Darius T, Kanaan N, Gianello P, Mourad M. Donor- and isolation-related predictive factors of in vitro secretory function of cultured human islets. Front Endocrinol (Lausanne) 2024; 15:1345351. [PMID: 38444584 PMCID: PMC10913008 DOI: 10.3389/fendo.2024.1345351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Background and aims Human islet preparations designated for research exhibit diverse insulin-secretory profiles. This study aims to assess the impact of donor- and isolation-related factors on in vitro islet secretory function. Methods A retrospective analysis of 46 isolations from 23 pancreata discarded for clinical transplantation was conducted. In vitro islet secretory function tests were performed on Day 1 and Day 7 of culture. Linear mixed-effects models (LMMs) were employed to investigate the relationships between various predictors characterizing the patient and donor characteristics as well as the isolation effectiveness and two functional outcomes including the islet stimulation index (SI) and area under the insulin curve (AUC). Fixed effects were introduced to represent the main effects of each predictor, and backward elimination was utilized to select the most significant fixed effects for the final model. Interaction effects between the timepoint (Day 7 vs. Day 1) and the predictors were also evaluated to assess whether predictors were associated with the temporal evolution of SI and AUC. Fold-change (Fc) values associated with each predictor were obtained by exponentiating the corresponding coefficients of the models, which were built on log-transformed outcomes. Results Analysis using LMMs revealed that donor body mass index (BMI) (Fc = 0.961, 95% CI = 0.927-0.996, p = 0.05), donor gender (female vs. male, Fc = 0.702, 95% CI = 0.524-0.942, p = 0.04), and donor hypertension (Fc = 0.623, 95% CI = 0.466-0.832, p= <0.01) were significantly and independently associated with SI. Moreover, donor gender (Fc = 0.512, 95% CI = 0.302-0.864, p = 0.02), donor cause of death (cerebrovascular accident vs. cardiac arrest, Fc = 2.129, 95% CI = 0.915-4.946, p = 0.09; trauma vs. cardiac arrest, Fc = 2.129, 95% CI = 1.112-7.106, p = 0.04), pancreas weight (Fc = 1.01, 95% CI = 1.001-1.019, p = 0.03), and islet equivalent (IEQ)/mg (Fc = 1.277, 95% CI = 1.088-1.510, p ≤ 0.01) were significantly and independently associated with AUC. There was no predictor significantly associated with the temporal evolution between Day 1 and Day 7 for both SI and AUC outcomes. Conclusion This study identified donor- and isolation-related factors influencing in vitro islet secretory function. Further investigations are essential to validate the applicability of these results in clinical practice.
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Affiliation(s)
- Antoine Buemi
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nizar I. Mourad
- IREC, Pôle de Chirurgie Expérimentale et Transplantation, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Jérôme Ambroise
- Institute of Experimental and Clinical Research (IREC), Centre de Technologies Moléculaires Appliquées, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Delphine Hoton
- Department of Anatomical Pathology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Arnaud Devresse
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Tom Darius
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nada Kanaan
- Department of Internal Medicine, Nephrology Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Gianello
- IREC, Pôle de Chirurgie Expérimentale et Transplantation, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Mourad
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Sage AT, Donahoe LL, Shamandy AA, Mousavi SH, Chao BT, Zhou X, Valero J, Balachandran S, Ali A, Martinu T, Tomlinson G, Del Sorbo L, Yeung JC, Liu M, Cypel M, Wang B, Keshavjee S. A machine-learning approach to human ex vivo lung perfusion predicts transplantation outcomes and promotes organ utilization. Nat Commun 2023; 14:4810. [PMID: 37558674 PMCID: PMC10412608 DOI: 10.1038/s41467-023-40468-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Ex vivo lung perfusion (EVLP) is a data-intensive platform used for the assessment of isolated lungs outside the body for transplantation; however, the integration of artificial intelligence to rapidly interpret the large constellation of clinical data generated during ex vivo assessment remains an unmet need. We developed a machine-learning model, termed InsighTx, to predict post-transplant outcomes using n = 725 EVLP cases. InsighTx model AUROC (area under the receiver operating characteristic curve) was 79 ± 3%, 75 ± 4%, and 85 ± 3% in training and independent test datasets, respectively. Excellent performance was observed in predicting unsuitable lungs for transplantation (AUROC: 90 ± 4%) and transplants with good outcomes (AUROC: 80 ± 4%). In a retrospective and blinded implementation study by EVLP specialists at our institution, InsighTx increased the likelihood of transplanting suitable donor lungs [odds ratio=13; 95% CI:4-45] and decreased the likelihood of transplanting unsuitable donor lungs [odds ratio=0.4; 95%CI:0.16-0.98]. Herein, we provide strong rationale for the adoption of machine-learning algorithms to optimize EVLP assessments and show that InsighTx could potentially lead to a safe increase in transplantation rates.
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Affiliation(s)
- Andrew T Sage
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Laura L Donahoe
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alaa A Shamandy
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - S Hossein Mousavi
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Bonnie T Chao
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Xuanzi Zhou
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Jerome Valero
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Sharaniyaa Balachandran
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Aadil Ali
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Tereza Martinu
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Medical and Surgical Intensive Care Unit, University Health Network, Toronto, ON, Canada
| | - Jonathan C Yeung
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mingyao Liu
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Marcelo Cypel
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Bo Wang
- Department of Computer Science, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Vector Institute, Toronto, ON, Canada.
| | - Shaf Keshavjee
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
- Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Ferrer-Fàbrega J, Mesnard B, Messner F, Doppenberg JB, Drachenberg C, Engelse MA, Johnson PRV, Leuvenink HGD, Oniscu GC, Papalois V, Ploeg RJ, Reichman TW, Scott WE, Vistoli F, Berney T, Jacobs-Tulleneers-Thevissen D, Kessaris N, Weissenbacher A, Ogbemudia AE, White S, Branchereau J. European Society for Organ Transplantation (ESOT) Consensus Statement on the Role of Pancreas Machine Perfusion to Increase the Donor Pool for Beta Cell Replacement Therapy. Transpl Int 2023; 36:11374. [PMID: 37547751 PMCID: PMC10402633 DOI: 10.3389/ti.2023.11374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
The advent of Machine Perfusion (MP) as a superior form of preservation and assessment for cold storage of both high-risk kidney's and the liver presents opportunities in the field of beta-cell replacement. It is yet unknown whether such techniques, when applied to the pancreas, can increase the pool of suitable donor organs as well as ameliorating the effects of ischemia incurred during the retrieval process. Recent experimental models of pancreatic MP appear promising. Applications of MP to the pancreas, needs refinement regarding perfusion protocols and organ viability assessment criteria. To address the "Role of pancreas machine perfusion to increase the donor pool for beta cell replacement," the European Society for Organ Transplantation (ESOT) assembled a dedicated working group comprising of experts to review literature pertaining to the role of MP as a method of improving donor pancreas quality as well as quantity available for transplant, and to develop guidelines founded on evidence-based reviews in experimental and clinical settings. These were subsequently refined during the Consensus Conference when this took place in Prague.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
- Hepatic Oncology Unit, Barcelona Clínic Liver Cancer Group (BCLC), Hospital Clínic, Barcelona, Spain
- August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
- Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - Benoît Mesnard
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
- Centre for Research in Transplantation and Translational Immunology, INSERM UMR 1064, ITUN5, Nantes, France
| | - Franka Messner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jason B. Doppenberg
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
| | - Cinthia Drachenberg
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marten A. Engelse
- Transplantation Center, Leiden University Medical Center, Leiden, Netherlands
| | - Paul R. V. Johnson
- Research Group for Islet Transplantation, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Gabriel C. Oniscu
- Transplant Division, Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Vassilios Papalois
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rutger J. Ploeg
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Trevor W. Reichman
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - William E Scott
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fabio Vistoli
- Division of General Surgery and Transplantation, University of Pisa, Pisa, Italy
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland
| | - Daniel Jacobs-Tulleneers-Thevissen
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy’s Hospital, London, United Kingdom
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ann Etohan Ogbemudia
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Steve White
- Department of HPB and Transplant Surgery, NIHR BTRU in Organ Donation and Transplantation, The Freeman Hospital, The University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
- Centre for Research in Transplantation and Translational Immunology, INSERM UMR 1064, ITUN5, Nantes, France
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Gopal JP, Vaz O, Varley R, Spiers H, Goldsworthy MA, Siddagangaiah V, Lock B, Sharma V, Summers A, Moinuddin Z, van Dellen D, Augustine T. Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study. Transplant Direct 2023; 9:e1472. [PMID: 37090123 PMCID: PMC10118345 DOI: 10.1097/txd.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 04/25/2023] Open
Abstract
The accuracy of intraoperative graft perfusion assessment still remains subjective, with doppler examination being the only objective adjunct. Laser speckle contrast imaging (LSCI) has been used to assess intraoperative blood flow in neurosurgery and in various surgical specialties. Despite its ability to accurately quantify perfusion at the microvascular level, it has not been clinically evaluated in kidney/kidney-pancreas transplantation for perfusion characterization. We aimed to evaluate the utility of LSCI and identify objective parameters that can be quantified at reperfusion. Methods This study was registered in ClinicalTrials.gov (NCT04202237). The Moor FLPI-2 blood flow imager was used in 4 patients (1 Simultaneous Pancreas and Kidney, 2 deceased, and 1 living donor kidney transplants) during reperfusion to capture reperfusion data. The following parameters were measured: flux (average speed × concentration of moving red blood cells in the sample volume), doppler centroid, total and valid pixels, valid rate, and total and valid area. Flux data were analyzed with Moor FLPI analysis software. Results The perfusion characteristics and flux images correlated with initial graft function. Conclusions LSCI is a safe, noncontact imaging modality that provides real-time, accurate, high-resolution, full field blood flow images and a wide range of flux data to objectively quantify organ reperfusion intraoperatively in kidney/kidney-pancreas transplantation. This modality could be used to develop a robust numerical quantification system for the evaluation and reporting of intraoperative organ perfusion, and aid intraoperative decision-making. Perfusion data could be combined with biomarkers and immunological parameters to more accurately predict graft outcomes.
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Affiliation(s)
- Jeevan Prakash Gopal
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Department of General Surgery, The Queen Elizabeth Hospital King’s Lynn NHS Trust, King’s Lynn, United Kingdom
| | - Osborne Vaz
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Rebecca Varley
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Harry Spiers
- Department of Transplantation, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Matthew A. Goldsworthy
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Vishwanath Siddagangaiah
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Brian Lock
- Moor Instruments Ltd, Axminster, United Kingdom
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Angela Summers
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- University of Manchester-Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- University of Manchester-Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, United Kingdom
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10
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The ischaemic preconditioning paradox and its implications for islet isolation from heart-beating and non heart-beating donors. Sci Rep 2022; 12:19321. [PMID: 36369239 PMCID: PMC9652462 DOI: 10.1038/s41598-022-23862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
The impact of ischaemia can severely damage procured donor organs for transplantation. The pancreas, and pancreatic islets in particular, is one of the most sensitive tissues towards hypoxia. The present study was aimed to assess the effect of hypoxic preconditioning (HP) performed ex-vivo in islets isolated from heart-beating donor (HBD) and non heart-beating donor (NHBD) rats. After HP purified islets were cultured for 24 h in hypoxia followed by islet characterisation. Post-culture islet yields were significantly lower in sham-treated NHBD than in HBD. This difference was reduced when NHBD islets were preconditioned. Similar results were observed regarding viability, apoptosis and in vitro function. Reactive oxygen species generation after hypoxic culture was significantly enhanced in sham-treated NHBD than in HBD islets. Again, this difference could be diminished through HP. qRT-PCR revealed that HP decreases pro-apoptotic genes but increases HIF-1 and VEGF. However, the extent of reduction and augmentation was always substantially higher in preconditioned NHBD than in HBD islets. Our findings indicate a lower benefit of HBD islets from HP than NHBD islets. The ischaemic preconditioning paradox suggests that HP should be primarily applied to islets from marginal donors. This observation needs evaluation in human islets.
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Ferrer-Fàbrega J, Folch-Puy E, Llaves-López A, García-Pérez R, Fuster J. Breaking the limits of experimental pancreas transplantation: Working toward the clinical ideal graft. FRONTIERS IN TRANSPLANTATION 2022; 1:1035480. [PMID: 38994386 PMCID: PMC11235275 DOI: 10.3389/frtra.2022.1035480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 07/13/2024]
Abstract
Pancreas transplantation is, at present, the only curative treatment for type-1 diabetes that maintains normoglycemia thus avoiding complications arising from poor glycemic control. Despite its great benefits, the number of pancreas transplants has decreased significantly since its inception in the late 1960s, largely due to demographic changes and the consequent suboptimal quality of donors. The selection criteria for pancreas donors mainly depend on morphological variables such as fatty infiltration, fibrosis, or edema, as well as both functional (amylase and lipase) and clinical variables of the donor. However, the final criterion in the decision-making process is the somewhat subjective assessment of a trained surgeon. That being said, the recent incorporation of graft perfusion machines into clinical practice seems to be changing the work dynamics of the donor organ retrieval team, facilitating decision-making based on objective morphological and functional criteria. Normothermic perfusion using perfusate with supplemental oxygen replicates near physiological parameters thus being a promising strategy for organ preservation. Nevertheless, optimum perfusion parameters are difficult to establish in pancreas transplantation given its complex vascular anatomy combined with an intrinsically low blood flow. The objective of this work is to analyze the results published in the recent literature relating to the considerations of ex-vivo normothermic graft perfusion machines and their usefulness in the field of pancreas transplantation.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - Emma Folch-Puy
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, Spain
| | - Andrea Llaves-López
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), Barcelona, Spain
| | - Rocío García-Pérez
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
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12
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Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas-Kidney Transplantation. J Clin Med 2022; 11:jcm11123385. [PMID: 35743457 PMCID: PMC9225086 DOI: 10.3390/jcm11123385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite recent advances in surgical procedures and immunosuppressive regimes, early pancreatic graft dysfunction, mainly specified as ischemia-reperfusion injury (IRI)-Remains a common cause of pancreas graft failure with potentially worse outcomes in simultaneous pancreas-kidney transplantation (SPKT). Anesthetic conditioning is a widely described strategy to attenuate IRI and facilitate graft protection. Here, we investigate the effects of different volatile anesthetics (VAs) on early IRI-associated posttransplant clinical outcomes as well as graft function and outcome in SPKT recipients. METHODS Medical data of 105 patients undergoing SPKT between 1998-2018 were retrospectively analyzed and stratified according to the used VAs. The primary study endpoint was the association and effect of VAs on pancreas allograft failure following SPKT; secondary endpoint analyses included "IRI- associated posttransplant clinical outcome" as well as long-term graft function and outcome. Additionally, peak serum levels of C-reactive protein (CRP) and lipase during the first 72 h after SPKT were determined and used as further markers for "pancreatic IRI" and graft injury. Typical clinicopathological characteristics and postoperative outcomes such as early graft outcome and long-term function were analyzed. RESULTS Of the 105 included patients in this study three VAs were used: isoflurane (n = 58 patients; 55%), sevoflurane (n = 22 patients; 21%), and desflurane (n = 25 patients, 24%). Donor and recipient characteristics were comparable between both groups. Early graft loss within 3 months (24% versus 5% versus 8%, p = 0.04) as well as IRI-associated postoperative clinical complications (pancreatitis: 21% versus 5% versus 5%, p = 0.04; vascular thrombosis: 13% versus 0% versus 5%; p = 0.09) occurred more frequently in the Isoflurane group compared with the sevoflurane and desflurane groups. Anesthesia with sevoflurane resulted in the lowest serum peak levels of lipase and CRP during the first 3 days after transplantation, followed by desflurane and isoflurane (p = 0.039 and p = 0.001, respectively). There was no difference with regard to 10-year pancreas graft survival as well as endocrine/metabolic function among all three VA groups. Multivariate analysis revealed the choice of VAs as an independent prognostic factor for graft failure three months after SPKT (HR 0.38, 95%CI: 0.17-0.84; p = 0.029). CONCLUSIONS In our study, sevoflurane and desflurane were associated with significantly increased early graft survival as well as decreased IRI-associated post-transplant clinical outcomes when compared with the isoflurane group and should be the focus of future clinical studies evaluating the positive effects of different VA agents in patients receiving SPKT.
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13
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Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation. J Clin Med 2022; 11:jcm11092563. [PMID: 35566689 PMCID: PMC9103915 DOI: 10.3390/jcm11092563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Despite recent advances and refinements in perioperative management of simultaneous pancreas−kidney transplantation (SPKT) early pancreatic graft dysfunction (ePGD) remains a critical problem with serious impairment of early and long-term graft function and outcome. Hence, we evaluated a panel of classical blood serum markers for their value in predicting early graft dysfunction in patients undergoing SPKT. Methods: From a prospectively collected database medical data of 105 patients undergoing SPKT between 1998 and 2018 at our center were retrospectively analyzed. The primary study outcome was the detection of occurrence of early pancreatic graft dysfunction (ePGD), the secondary study outcome was early renal graft dysfunction (eRGD) as well as all other outcome parameters associated with the graft function. In this context, ePGD was defined as pancreas graft-related complications including graft pancreatitis, pancreatic abscess/peritonitis, delayed graft function, graft thrombosis, bleeding, rejection and the consecutive need for re-laparotomy due to graft-related complications within 3 months. With regard to analyzing ePGD, serum levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), pancreatic lipase as well as neutrophil−lymphocyte ratio (NLR) and platelet−lymphocyte ratio (PLR) were measured preoperatively and at postoperative days (POD) 1, 2, 3 and 5. Further, peak serum levels of CRP and lipase during the first 72 h were evaluated. Receiver operating characteristics (ROC) curves were performed to assess their predictive value for ePGD and eRGD. Cut-off levels were calculated with the Youden index. Significant diagnostic biochemical cut-offs as well as other prognostic clinical factors were tested in a multivariate logistic regression model. Results: Of the 105 patients included, 43 patients (41%) and 28 patients (27%) developed ePGD and eRGD following SPKT, respectively. The mean WBC, PCT, NLR, PLR, CRP and lipase levels were significantly higher on most PODs in the ePGD group compared to the non-ePGD group. ROC analysis indicated that peak lipase (AUC: 0.82) and peak CRP levels (AUC: 0.89) were highly predictive for ePGD after SPKT. The combination of both achieved the highest AUC (0.92; p < 0.01) in predicting ePGD. Concerning eRGD, predictive accuracy of all analyzed serological markers was moderate (all AUC < 0.8). Additionally, multivariable analysis identified previous dialysis/no preemptive transplantation (OR 2.4 (95% CI: 1.41−4.01), p = 0.021), donor age (OR 1.07 (95% CI: 1.03−1.14), p < 0.010), donor body mass index (OR 1.32 (95% CI: 1.01−1.072), p = 0.04), donors cerebrovascular cause of death (OR 7.8 (95% CI: 2.21−26.9), p < 0.010), donor length of ICU stay (OR 1.27 (95% CI: 1.08−1.49), p < 0.010), as well as CIT pancreas (OR 1.07 (95% CI: 1.03−1.14), p < 0.010) as clinical relevant prognostic predictors for ePGD. Further, a peak of lipase (OR 1.04 (95% CI: 1.02−1.07), p < 0.010), peak of CRP levels (OR 1.12 (95% CI: 1.02−1.23), p < 0.010), pancreatic serum lipase concentration on POD 2 > 150 IU/L (OR 2.9 (95% CI: 1.2−7.13), p = 0.021) and CRP levels of ≥ 180 ng/mL on POD 2 (OR 3.6 (95% CI: 1.54−8.34), p < 0.01) and CRP levels > 150 ng/mL on POD 3 (OR 4.5 (95% CI: 1.7−11.4), p < 0.01) were revealed as independent biochemical predictive variables for ePGD after transplantation. Conclusions: In the current study, the combination of peak lipase and CRP levels were highly effective in predicting early pancreatic graft dysfunction development following SPKT. In contrast, for early renal graft dysfunction the predictive value of this parameter was less sensitive. Intensified monitoring of these parameters may be helpful for identifying patients at a higher risk of pancreatic ischemia reperfusion injury and various IRI- associated postoperative complications leading to ePGD and thus deteriorated outcome.
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14
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Aida N, Ito T, Kurihara K, Hiratsuka I, Shibata M, Suzuki A, Kenmochi T. Evaluation of the Efficacy and Effects of Common Hepatic Artery Reconstruction in Pancreas Transplantation: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11082258. [PMID: 35456349 PMCID: PMC9024615 DOI: 10.3390/jcm11082258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 02/07/2023] Open
Abstract
Maintenance of postoperative graft flow is important in pancreas transplantation. In Japan, reconstruction of the common hepatic artery is performed primarily to increase perfusion in the pancreatic head. We investigated the effects of common hepatic artery reconstruction on patient and graft survival and endocrine functions. Twenty-nine cases of pancreas transplantation were registered in the clinical trial. Of the 29 cases, four were excluded because of the risk of ischemia without reconstruction or complicated reconstruction due to a narrow artery. A total of 25 cases were randomized into two groups: 13 in the non-reconstructed group and 12 in the reconstructed group. The 1-year patient survival and graft survival rates of the non-reconstructed and reconstructed groups were 92.3% and 83.3%, and 91.7% and 82.5%, respectively. The incidence of complications in the two groups was comparable, with 38.5% (5/13 cases) in the non-reconstructed group and 33.3% (4/12 cases) in the reconstructed group. The results of the glucagon stimulation test and oral glucose tolerance test at 1 month and 1 year post-transplantation were comparable. Common hepatic artery reconstruction is not essential unless there is risk of ischemia. This study was registered at the University Hospital Medical Information Network Clinical Trials Registry under UMIN000027213.
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Affiliation(s)
- Naohiro Aida
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (T.I.); (K.K.); (T.K.)
- Correspondence: ; Tel.: +81-0562-93-2111; Fax: +81-0562-93-5125
| | - Taihei Ito
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (T.I.); (K.K.); (T.K.)
| | - Kei Kurihara
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (T.I.); (K.K.); (T.K.)
| | - Izumi Hiratsuka
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (I.H.); (M.S.); (A.S.)
| | - Megumi Shibata
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (I.H.); (M.S.); (A.S.)
| | - Atsushi Suzuki
- Department of Endocrinology, Diabetes and Metabolism, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (I.H.); (M.S.); (A.S.)
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; (T.I.); (K.K.); (T.K.)
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