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Meier RPH, Kelly Y, Braun H, Maluf D, Freise C, Ascher N, Roberts J, Roll G. Comparison of Biliary Complications Rates After Brain Death, Donation After Circulatory Death, and Living-Donor Liver Transplantation: A Single-Center Cohort Study. Transpl Int 2022; 35:10855. [PMID: 36568142 PMCID: PMC9780276 DOI: 10.3389/ti.2022.10855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
Donation-after-circulatory-death (DCD), donation-after-brain-death (DBD), and living-donation (LD) are the three possible options for liver transplantation (LT), each with unique benefits and complication rates. We aimed to compare DCD-, DBD-, and LD-LT-specific graft survival and biliary complications (BC). We collected data on 138 DCD-, 3,027 DBD- and 318 LD-LTs adult recipients from a single center and analyzed patient/graft survival. BC (leak and anastomotic/non-anastomotic stricture (AS/NAS)) were analyzed in a subset of 414 patients. One-/five-year graft survival were 88.6%/70.0% for DCD-LT, 92.6%/79.9% for DBD-LT, and, 91.7%/82.9% for LD-LT. DCD-LTs had a 1.7-/1.3-fold adjusted risk of losing their graft compared to DBD-LT and LD-LT, respectively (p < 0.010/0.403). Bile leaks were present in 10.1% (DCD-LTs), 7.2% (DBD-LTs), and 36.2% (LD-LTs) (ORs, DBD/LD vs. DCD: 0.7/4.2, p = 0.402/<0.001). AS developed in 28.3% DCD-LTs, 18.1% DBD-LTs, and 43.5% LD-LTs (ORs, DBD/LD vs. DCD: 0.5/1.8, p = 0.018/0.006). NAS was present in 15.2% DCD-LTs, 1.4% DBDs-LT, and 4.3% LD-LTs (ORs, DBD/LD vs. DCD: 0.1/0.3, p = 0.001/0.005). LTs w/o BC had better liver graft survival compared to any other groups with BC. DCD-LT and LD-LT had excellent graft survival despite significantly higher BC rates compared to DBD-LT. DCD-LT represents a valid alternative whose importance should increase further with machine/perfusion systems.
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Affiliation(s)
- Raphael Pascal Henri Meier
- University of California, San Francisco, San Francisco, CA, United States,University of Maryland, Baltimore, Baltimore, MD, United States,*Correspondence: Raphael Pascal Henri Meier,
| | - Yvonne Kelly
- University of California, San Francisco, San Francisco, CA, United States
| | - Hillary Braun
- University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Maluf
- University of Maryland, Baltimore, Baltimore, MD, United States
| | - Chris Freise
- University of California, San Francisco, San Francisco, CA, United States
| | - Nancy Ascher
- University of California, San Francisco, San Francisco, CA, United States
| | - John Roberts
- University of California, San Francisco, San Francisco, CA, United States
| | - Garrett Roll
- University of California, San Francisco, San Francisco, CA, United States
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Agius T, Songeon J, Klauser A, Longchamp G, Allagnat F, Nastasi A, Ruttiman R, Meier RPH, Toso C, Bühler L, Corpataux JM, Lazeyras F, Longchamp A. Analysis of DCD porcine kidney graft viability during sub-normothermic perfusion using magnetic resonance imaging and spectroscopy. Br J Surg 2022. [DOI: 10.1093/bjs/znac186.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Better preservation strategies for the storage of donation after circulatory death grafts could increase the number of kidneys available and improve patient survival. Warm (22°C and 37°C) ex-vivo perfusion has emerged as an alternative to hypothermia and a feasible strategy to recover/repair organs, but the underlying mechanism remains elusive. Here, using magnetic resonance imaging spectroscopy (MRIs), we evaluated kidney viability, and adenosine triphosphate (ATP) production during sub-normothermic ex-vivo kidney perfusion (22°C + O2) versus hypothermic machine perfusion (4°C and 4°C + O2) in a porcine kidney autotransplantation model.
Methods
To mimic donation after circulatory death (DCD), kidneys from 8-month-old pigs underwent 60 minutes of warm ischemia, prior to procurement. Kidneys were then perfused ex-vivo at 4°C with (4°C + O2), and without oxygen (4°C) or at 22°C (22°C + O2) before autotransplantation. During the ex-vivo perfusion, and after transplantation we assessed energy metabolites using MRIs. In addition, we performed Gadolinum (Gd) perfusion sequences. Each sample underwent histopathological analyzing and scoring. mRNA expression was analyzed on renal biopsies at various time points.
Results
Using MRI, we found that in pig kidney, total ATP content was 4 times higher during ex-vivo perfusion at sub-normothermic temperature compared to cold perfusion, with or without oxygen. At 22°C, ATP levels gradually increased up to 10 hrs of perfusion, then progressively declined. Similarly, AMP content was increased in SNOP perfused organs, then slowly consumed. over time. In addition, 22°C + O2 improved cortical and medullary perfusion (Gd elimination). Finally, sub-normothermic ex-vivo perfused graft had lower grade of histological damages 1 hour after transplantation compared to cold perfused organs (injury score 22°C + O2 : 8.8–12.2, 4°C : 13.5–18.8, 4°C + O2 : 17.5–18.5).
Conclusion
In kidneys, sub-normothermic perfusion improved graft viability when compared with hypothermic perfusions. These results suggest that sub-normothermic ex-vivo kidney perfusion might dampen the negative effect of warm ischemia and promote kidney metabolism such as ATP production. Future clinical studies will define the benefits of sub-normothermic ex-vivo kidney perfusion in improving kidney graft function, and patient's survival.
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Affiliation(s)
- T Agius
- Department of Vascular Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Songeon
- Department of Radiology and Medical Informatics, Geneva University Hospital , Geneva, Switzerland
| | - A Klauser
- Department of Radiology and Medical Informatics, Geneva University Hospital , Geneva, Switzerland
- Center for Biomedical Imaging, Geneva University Hospital , Geneva, Switzerland
| | - G Longchamp
- Hirslanden Hospital Zurich , Zurich, Switzerland
| | - F Allagnat
- Department of Vascular Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - A Nastasi
- Center for Biomedical Imaging, Geneva University Hospital , Geneva, Switzerland
| | - R Ruttiman
- Center for Biomedical Imaging, Geneva University Hospital , Geneva, Switzerland
| | - R P H Meier
- Department of Surgery, University of Maryland School of Medecine , Baltimore, USA
| | - C Toso
- Department of Visceral and Transplant Surgery, Geneva University Hospital , Geneva, Switzerland
| | - L Bühler
- Faculty of science and medicine, University of Fribourg , Fribourg, Switzerland
| | - J-M Corpataux
- Department of Vascular Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - F Lazeyras
- Department of Radiology and Medical Informatics, Geneva University Hospital , Geneva, Switzerland
- Center for Biomedical Imaging, Geneva University Hospital , Geneva, Switzerland
| | - A Longchamp
- Department of Vascular Surgery, Lausanne University Hospital , Lausanne, Switzerland
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Longchamp A, Klauser A, Agius T, Songeon J, Nastasi A, Ruttiman R, Meier RPH, Buhler L, Allagnat F, Corpataux JM, Lazeyras F. Ex vivo analysis of graft viability using 31P magnetic resonance imaging spectroscopy. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Expansion in organ supply has been proposed through the use of organs after circulatory death (donation after circulatory death [DCD]) in order to face the chronic shortage of kidneys for transplantation. However, many DCD grafts are discarded because of long warm ischemia times, and the absence of reliable non-invasive means to determine kidney viability. P magnetic resonance imaging (pMRI) spectroscopy is a noninvasive method to detect high-energy phosphate metabolites, such as ATP. However, the reliability of pMRI to predict kidney energy state, and its viability before transplantation remain also unknown.
Methods
To mimic DCD, pig kidneys underwent 0, 30 min or 60 min of warm ischemia, before oxygenated hypothermic machine perfusion (HMP). During the ex vivo perfusion, we assessed energy metabolites and Gadolinium elimination using pMRI. Each sample underwent histopathological scoring.
Results
Using pMRI, we found that in pig kidney, ATP was rapidly generated in presence of oxygen (100 kPa), which remained stable up to 22 h. Warm ischemia (60 min) induced significant histological damages, delayed cortical and medullary Gadolinium elimination (perfusion), and reduced ATP levels, but not its precursors (AMP). Finally, ATP levels and kidney perfusion both inversely correlated with the severity of kidney histological injury.
Conclusion
ATP levels, and kidney perfusion measurements using pMRI, are biomarkers of kidney injury after warm ischemia. Future work will define the role of pMRI in predicting kidney graft viability and patient's survival.
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Affiliation(s)
- A Longchamp
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Sciences, University of Lausanne, Lausanne, Switzerland
| | - A Klauser
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- CIBM, Center for Biomedical Imaging, Geneva, Switzerland
| | - T Agius
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Sciences, University of Lausanne, Lausanne, Switzerland
| | - J Songeon
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - A Nastasi
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Ruttiman
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R P H Meier
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - L Buhler
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - F Allagnat
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Sciences, University of Lausanne, Lausanne, Switzerland
| | - J -M Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Lazeyras
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- CIBM, Center for Biomedical Imaging, Geneva, Switzerland
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Agius T, Songeon J, Klauser A, Nastasi A, Ruttiman R, Meier RPH, Buhler L, Allagnat F, Corpataux JM, Lazeyras F, Longchamp A. Hydrogen sulfide (H2S) reduces oxygen and ATP consumption in the isolated perfused pig kidney. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Organ donation after circulatory death [DCD] has the potential to reduce the shortage of kidneys available for transplantation. However, many DCD grafts are discarded because of long warm ischemia times. Strategies reducing oxygen demand may minimize damages caused by ischemia/reperfusion injury. Ex-vivo, Hydrogen sulfide (H2S) reduces oxygen and ATP consumption of the isolated perfused kidney, reduces inflammation and improves renal function following ischemia reperfusion injury in rodents. However, the benefits and applicability of H2S in clinically relevant model remain unknown.
Methods
To mimic DCD, pig kidneys underwent 0 or 60 min of warm ischemia, before oxygenated hypothermic machine perfusion (HMP). NaHS (100µM), an H2S donor, was added to the perfusion media or injected as an intra-arterial bolus before warm ischemia. After 2 hours of HMP, kidneys were transplanted and reperfused for 1 hour before harvest. Kidney function was assesses before, after and during ex vivo perfusion by measuring energy metabolites, Gadolinium elimination by pMRI and histopathological scoring.
Results
Warm ischemia (60 min) induced significant histological damages, delayed cortical and medullary Gadolinium elimination (perfusion), and reduced ATP levels, but not its precursors (AMP). As expected, ATP levels and kidney perfusion both inversely correlated with the severity of kidney histological injury. NaHS reduced metabolism during warm ischemia, and seemed to increase kidney ATP levels and viability after reperfusion.
Conclusion
Our preliminary data suggest that the H2S donor NaHS reduces kidney metabolism and protects from warm ischemia. Further experiments will identify the best administration protocol and the clinical relevance of H2S supplementation in the context of organ preservation.
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Affiliation(s)
- T Agius
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Xciences, University of Lausanne, Lausanne, Switzerland
| | - J Songeon
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - A Klauser
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- CIBM, Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - A Nastasi
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Ruttiman
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R P H Meier
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - L Buhler
- Faculty of Science and Medicine, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - F Allagnat
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Xciences, University of Lausanne, Lausanne, Switzerland
| | - J -M Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Lazeyras
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- CIBM, Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - A Longchamp
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedicals Xciences, University of Lausanne, Lausanne, Switzerland
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Meier RPH, Muller YD, Gutzwiller EM, Spahr L, Negro F, Krause KH, Schaller K, Wandrey C, Sgroi A, Morel P, Bühler LH. [Cell transplantation: current treatments and future prospects]. Rev Med Suisse 2014; 10:1350-1355. [PMID: 25051598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Regenerative medicine aims to replace a body function or specific cell loss. It includes therapies at the forefront of modem medicine, issuing from translational biomedical research. Transplantation of organs and cells has revolutionized the management of patients for whom medical treatment is a failure. Unfortunately, organ shortage is limiting treatment possibility. As an example, among the 15,000 patients with type I diabetes in Switzerland, only approximately 30 can receive a pancreas or an islet transplant per year. Second example, 500 patients die each year in Switzerland from alcoholic cirrhosis because no treatment is available. Transplantation of islet cells, hepatocytes, mesenchymal stem cells or dopaminergic neurons represents hope fora therapy available for large populations of patients.
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Orci LA, Meier RPH, Morel P, Staszewicz W, Toso C. Systematic review and meta-analysis of percutaneous subclavian vein puncture versus surgical venous cutdown for the insertion of a totally implantable venous access device. Br J Surg 2013; 101:8-16. [DOI: 10.1002/bjs.9276] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 01/04/2023]
Abstract
Abstract
Background
Totally implantable venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical venous cutdown.
Methods
MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched by two independent authors. No time limits were applied. A systematic review and meta-analysis was carried out according to the recommendations of the Cochrane Collaboration, including randomized clinical trials comparing primary percutaneous subclavian vein puncture with surgical venous cutdown.
Results
Six trials were included, with 772 patients overall. The primary implantation failure rate was significantly lower for the percutaneous approach compared with surgical cutdown (odds ratio (OR) 0·26, 95 per cent confidence interval (c.i.) 0·07 to 0·94; P = 0·039). There was no evidence supporting a significant difference in terms of risk of pneumothorax, haematoma, venous thrombosis, infectious events or catheter migration. After taking between-study heterogeneity into account by using a random-effects model, procedure duration was not significantly longer for surgical cutdown: weighted mean difference +4 (95 per cent c.i. –12 to 20) min (P = 0·625).
Conclusion
Percutaneous subclavian vein puncture is associated with a higher TIVAD implantation success rate and a procedure duration similar to that of surgical cutdown. Pneumothorax develops exclusively after percutaneous puncture and requires special attention from clinicians dealing with TIVAD insertion.
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Affiliation(s)
- L A Orci
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland
| | - R P H Meier
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland
| | - P Morel
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland
| | - W Staszewicz
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland
| | - C Toso
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland
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