1
|
Hellemans R, Kramer A, De Meester J, Collart F, Kuypers D, Jadoul M, Van Laecke S, Le Moine A, Krzesinski JM, Wissing KM, Luyckx K, van Meel M, de Vries E, Tieken I, Vogelaar S, Samuel U, Abramowicz D, Stel VS, Jager KJ. Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort. Nephrol Dial Transplant 2021; 36:918-926. [PMID: 33650633 PMCID: PMC8075371 DOI: 10.1093/ndt/gfab024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis. METHODS We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20-44, 45-64 and ≥65 years), sex and diabetes as the primary renal disease. RESULTS Among patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2-19.9] with SCD transplantation, 20.5% (95% CI 16.1-24.6) with ECD transplantation and 24.6% (95% CI 19.4-29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. CONCLUSIONS The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.
Collapse
Affiliation(s)
- Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johan De Meester
- Nederlandstalige Belgische Vereniging voor Nefrologie, Sint-Niklaas, Belgium
| | - Frederic Collart
- Groupement des Néphrologues Francophones de Belgique, Liège, Belgium
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Michel Jadoul
- Département de Néphrologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Steven Van Laecke
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Alain Le Moine
- Département de Néphrologie, Hôpital Erasme-Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Kim Luyckx
- Department of Informatics, Antwerp University Hospital, Edegem, Belgium
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Erwin de Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Hellemans R, Kramer A, De Meester J, Kuypers D, Jadoul M, Van Biesen W, Le Moine A, Krzesinski JM, Wissing KM, Luyckx K, Van Meel M, De Vries E, Tieken I, Vogelaar S, Samuel U, Abramowicz D, Stel V, Jager KJ. P1630IS THERE ALWAYS A SURVIVAL BENEFIT WITH KIDNEY TRANSPLANTATION? RESULTS FROM A BELGIAN COHORT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1630] [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] Open
Abstract
Abstract
Background and Aims
Older studies have shown a survival benefit with kidney transplantation compared to dialysis, even for patients older than 60 years. However, due to important evolutions such as older recipient age and the use of less-than-optimal quality donors, it is unclear if the survival benefit with transplantation still holds true nowadays.
Method
Patient survival was analyzed for 3808 Belgian patients waitlisted for a first deceased donor kidney transplant between 2000 to 2012. Patients were divided into age categories (20-44y, 45-64y, ≥65y). Primary outcome was the comparison of mortality during median waiting time plus 3 years follow-up, either after transplantation or when remaining on dialysis. Outcomes were analyzed separately for those receiving a standard criteria donor (SCD) or an expanded criteria donor (ECD) transplant. The survival analyses were adjusted for age, sex and primary renal disease.
Results
Among patients ≥ 65 years old, only SCD transplantation provided a significant survival benefit compared to dialysis: mortality was 16.3 % (95 % CI: 13.2–19.9 %) with SCD transplantation, 20.5 % (16.1–24.6 %) with ECD transplantation, and 24.6 % (19.5–29.5 %) when remaining on dialysis. Relative mortality risk was increased in the first months after transplantation compared to dialysis, with equal risk levels being reached earlier for SCD than ECD transplantations in all age groups.
Conclusion
This study suggests that older patients have a survival benefit with SCD transplantation versus dialysis, but the survival benefit with ECD transplantation versus dialysis may be small or non-existent.
Collapse
Affiliation(s)
| | - Anneke Kramer
- Amsterdam UMC, locatie AMC, ERA-EDTA Registry, Amsterdam, Netherlands
| | | | | | - Michel Jadoul
- UCLouvain, Nephrology, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Alain Le Moine
- Université Libre De Bruxelles / Campus Érasme, Nephrology, Anderlecht, Belgium
| | | | | | - Kim Luyckx
- University Hospital Antwerp, Nephrology, Edegem, Belgium
| | - Marieke Van Meel
- Foundation Eurotransplant International Foundation, Leiden, Netherlands
| | - Erwin De Vries
- Foundation Eurotransplant International Foundation, Leiden, Netherlands
| | - Ineke Tieken
- Foundation Eurotransplant International Foundation, Leiden, Netherlands
| | - Serge Vogelaar
- Foundation Eurotransplant International Foundation, Leiden, Netherlands
| | - Undine Samuel
- Foundation Eurotransplant International Foundation, Leiden, Netherlands
| | | | - Vianda Stel
- Amsterdam UMC, locatie AMC, ERA-EDTA Registry, Amsterdam, Netherlands
| | - Kitty J Jager
- Amsterdam UMC, locatie AMC, ERA-EDTA Registry, Amsterdam, Netherlands
| |
Collapse
|
3
|
Heylen L, Pirenne J, Samuel U, Tieken I, Coemans M, Naesens M, Sprangers B, Jochmans I. Effect of donor nephrectomy time during circulatory-dead donor kidney retrieval on transplant graft failure. Br J Surg 2019; 107:87-95. [DOI: 10.1002/bjs.11316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/05/2019] [Accepted: 06/27/2019] [Indexed: 01/12/2023]
Abstract
Abstract
Background
When the blood supply ceases in a deceased organ donor, ischaemic injury starts. Kidneys are cooled to reduce cellular metabolism and minimize ischaemic injury. This cooling is slow and kidneys are lukewarm during nephrectomy. Smaller single-centre studies have shown that prolonged donor nephrectomy time decreases early kidney transplant function, but the effect on long-term outcome has never been investigated in large multicentre cohort studies.
Methods
The relationship between donor nephrectomy time and death-censored graft survival was evaluated in recipients of single adult-to-adult, first-time deceased-donor kidneys transplanted in the Eurotransplant region between 2004 and 2013.
Results
A total of 13 914 recipients were included. Median donor nephrectomy time was 51 (i.q.r. 39–65) min. Kidneys donated after circulatory death had longer nephrectomy times than those from brain-dead donors: median 57 (43–78) versus 50 (39–64) min respectively (P < 0·001). Donor nephrectomy time was independently associated with graft loss when kidneys were donated after circulatory death: adjusted hazard ratio (HR) 1·05 (95 per cent c.i. 1·01 to 1·09) per 10-min increase (P = 0·026). The magnitude of this effect was comparable to the effect of each hour of additional cold ischaemia: HR 1·04 (1·01 to 1·07) per h (P = 0·004). For kidneys donated after brain death, there was no effect of nephrectomy time on graft survival: adjusted HR 1·01 (0·98 to 1·04) per 10 min (P = 0·464).
Conclusion
Prolonged donor nephrectomy time impairs graft outcome in kidneys donated after circulatory death. Keeping this short, together with efficient cooling during nephrectomy, might improve outcome.
Collapse
Affiliation(s)
- L Heylen
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplantation, Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - U Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - I Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - M Coemans
- Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - M Naesens
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - B Sprangers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Molecular Immunology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Abdominal Transplantation, Transplantation Research Group, KU Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Heylen L, Pirenne J, Samuel U, Tieken I, Maarten C, Naesens M, Sprangers B, Jochmans I. FP787DONOR NEPHRECTOMY TIME DURING CIRCULATORY-DEAD DONOR KIDNEY RETRIEVAL ASSOCIATES WITH GRAFT FAILURE AFTER TRANSPLANTATION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Line Heylen
- University hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Shaw D, Lewis P, Jansen N, Samuel U, Wind T, Georgieva D, Haase B, Ploeg R, Gardiner D. Family overrule of registered refusal to donate organs. J Intensive Care Soc 2019; 21:179-182. [PMID: 32489415 DOI: 10.1177/1751143719846416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is well known that families frequently overrule the wishes of dying patients who had previously expressed a wish to donate their organs. Various strategies have been suggested to reduce the frequency of these 'family overrules'. However, the possibility of families overruling a patient's registered decision not to donate has not been discussed in the medical literature, although it is legally possible in some countries. In this article, we provide an ethical analysis of family overrule of a relative's refusal to donate, using the different jurisdictions of the UK, Switzerland, Germany and the Netherlands to provide some context. Despite some asymmetries between overruling consent and overruling refusal, there are some cases in which donation should proceed despite a recorded refusal to do so.
Collapse
Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,CAPHRI Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Penney Lewis
- Dickson Poon School of Law, Kings College London, London, UK
| | | | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Tineke Wind
- Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
6
|
de Boer JD, Blok JJ, Putter H, Koopman JJE, van Hoek B, Samuel U, van Rosmalen M, Metselaar HJ, Alwayn IPJ, Guba M, Braat AE. Optimizing the Use of Geriatric Livers for Transplantation in the Eurotransplant Region. Liver Transpl 2019; 25:260-274. [PMID: 30317683 PMCID: PMC6590373 DOI: 10.1002/lt.25353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
Abstract
Acceptance criteria for liver allografts are ever more expanding because of a persisting wait-list mortality. Older livers are therefore offered and used more frequently for transplantation. This study aims to analyze the use and longterm outcome of these transplantations. Data were included on 17,811 first liver transplantations (LTs) and information on livers that were reported for allocation but not transplanted from 2000 to 2015 in the Eurotransplant (ET) region. Graft survival was defined as the period between transplantation and date of retransplantation or date of recipient death. In the study period, 2394 (13%) transplantations were performed with livers ≥70 years old. Graft survival was 74%, 57%, and 41% at 1-, 5-, and 10-year follow-up, respectively. A history of diabetes mellitus in the donor (hazard ratio [HR], 1.3; P = 0.01) and positive hepatitis C virus antibody in the recipient (HR, 1.5; P < 0.001) are specific risk factors for transplantations with livers ≥70 years old. Although donor age is associated with a linearly increasing risk of graft loss between 25 and 80 years old, no difference in graft survival could be observed when "preferred" recipients were transplanted with a liver <70 or ≥70 years old (HR 1.1; CI 0.92-1.23, P = 0.40) or with a donor <40 or ≥70 years old (HR 1.2; CI 0.96-1.37, P = 0.13). Utilization of reported livers ≥70 years old increased from 42% in 2000-2003 to 76% in 2013-2015 without a decrease in graft survival (P = 0.45). In conclusion, an important proportion of LTs in the ET region are performed with livers ≥70 years old. The risk of donor age on graft loss increases linearly between 25 and 80 years old. Livers ≥70 years old can, however, be transplanted safely in preferred patients and are to be used more frequently to further reduce wait-list mortality.
Collapse
Affiliation(s)
- Jacob D. de Boer
- Departments of Surgery, Division of TransplantationLeiden University Medical CenterLeidenthe Netherlands,Eurotransplant International FoundationLeidenthe Netherlands
| | - Joris J. Blok
- Departments of Surgery, Division of TransplantationLeiden University Medical CenterLeidenthe Netherlands
| | - Hein Putter
- Medical StatisticsLeiden University Medical CenterLeidenthe Netherlands
| | | | - Bart van Hoek
- Gastroenterology and HepatologyLeiden University Medical CenterLeidenthe Netherlands
| | - Undine Samuel
- Eurotransplant International FoundationLeidenthe Netherlands
| | | | - Herold J. Metselaar
- Department of Hepatology, Division of Transplantation, Erasmus Medical CenterRotterdam UniversityRotterdamthe Netherlands
| | - Ian P. J. Alwayn
- Departments of Surgery, Division of TransplantationLeiden University Medical CenterLeidenthe Netherlands
| | - Markus Guba
- Department of General, Visceral, Transplantation, Vascular and Thoracic SurgeryUniversity of Munich HospitalMunichGermany
| | - Andries E. Braat
- Departments of Surgery, Division of TransplantationLeiden University Medical CenterLeidenthe Netherlands
| | | |
Collapse
|
7
|
Raevens S, Rogiers X, Geerts A, Verhelst X, Samuel U, van Rosmalen M, Berlakovich G, Delwaide J, Detry O, Lehner F, Mittler J, Nadalin S, Nevens F, Pirenne J, Saner F, Schneeberger S, Stippel D, Turk JM, Zoltan M, Troisi RI, Van Vlierberghe H, Colle I. Outcome of liver transplantation for hepatopulmonary syndrome: a Eurotransplant experience. Eur Respir J 2019; 53:13993003.01096-2018. [PMID: 30487203 DOI: 10.1183/13993003.01096-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Sarah Raevens
- Dept of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Xavier Rogiers
- Dept of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium.,Eurotransplant, Leiden, The Netherlands
| | - Anja Geerts
- Dept of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Xavier Verhelst
- Dept of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | | | - Gabriela Berlakovich
- Division of Transplantation, Dept of Surgery, Medical University of Vienna, Vienna, Austria
| | - Jean Delwaide
- Dept of Gastroenterology and Hepatology, CHU Liège, University of Liège, Liège, Belgium
| | - Olivier Detry
- Dept of Abdominal Surgery and Transplantation, CHU Liège, University of Liège, Liège, Belgium
| | - Frank Lehner
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Mittler
- Dept of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Silvio Nadalin
- Dept of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Frederik Nevens
- Dept of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Abdominal Transplant Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Fuat Saner
- Dept of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Stefan Schneeberger
- Dept of Visceral Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Dirk Stippel
- Division of Transplantation Surgery, Dept of General, Visceral and Cancer Surgery, Transplant Center Cologne, University of Cologne, Cologne, Germany
| | - Jerovšek Marjana Turk
- Dept of Gastroenterology and Hepatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mathe Zoltan
- Dept of Transplantation and Surgery, Semmelweis University Budapest, Budapest, Hungary
| | - Roberto Ivan Troisi
- Dept of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium.,Dept of Clinical Medicine and Surgery, Federico II University Naples, Naples, Italy
| | - Hans Van Vlierberghe
- Dept of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Isabelle Colle
- Dept of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Shaw D, Gardiner D, Lewis P, Jansen N, Wind T, Samuel U, Georgieva D, Ploeg R, Broderick A. Conscientious objection to organ donation: Authors' reply. J Intensive Care Soc 2018; 19:NP5-NP6. [PMID: 30515248 PMCID: PMC6262268 DOI: 10.1177/1751143718777168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Switzerland
- Department of Health, Ethics and Society, CAPHRI Research Institute, Maastricht University, the Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals Trust, Nottingham, UK
| | - Penney Lewis
- Dickson Poon School of Law, Kings College London, UK
| | - Nichon Jansen
- Dutch Transplant Foundation, Leiden, the Netherlands
| | - Tineke Wind
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | | | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, UK
| | | |
Collapse
|
9
|
Pratschke S, Bender A, Boesch F, Andrassy J, van Rosmalen M, Samuel U, Rogiers X, Meiser B, Küchenhoff H, Driesslein D, Werner J, Guba M, Angele MK. Association between donor age and risk of graft failure after liver transplantation: an analysis of the Eurotransplant database. Transpl Int 2018; 32:270-279. [PMID: 30260509 DOI: 10.1111/tri.13357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/05/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
Grafts from elderly donors are increasingly used for liver transplantation. As of yet there is no published systematic data to guide the use of specific age cutoffs the effect of elderly donors on patient outcomes must be clarified. This study analyzed the Eurotransplant database (01/01/2000-31/07/2014; N = 26 294) out of whom 8341 liver transplantations were filtered to identify for this analysis. 2162 of the grafts came from donors >60 including 203 from octogenarians ≥80 years. Primary outcome was the risk of graft failure according to donor age using a confounder adjusted Cox-Regression model with frailty terms (or random effects). The proportion of elderly grafts increased during the study period [i.e., octogenarians 0.1% (n = 1) in 2000 to 3.4% (n = 45) in 2013]. Kaplan-Meier and Cox-analyses revealed a reduced survival and a higher risk for graft failure with increasing donor age. Although the age effect was allowed to vary non-linearly, a linear association hazard ratio (HR = 1.1 for a 10 year increase in donor age) was evident. The linearity of the association suggests that there is no particular age at which the effect increases more rapidly, providing no evidence for a cutoff age. In clinical practice, the combination of high donor age with HU-transplantations, hepatitis C, high MELD-scores and long cold ischemic time should be avoided.
Collapse
Affiliation(s)
- Sebastian Pratschke
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | - Andreas Bender
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians University, Munich, Germany
| | - Florian Boesch
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | - Joachim Andrassy
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | | | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Xavier Rogiers
- Transplantatiecentrum, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Bruno Meiser
- Transplant Center, Hospital of the LMU Munich, Munich, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians University, Munich, Germany
| | - David Driesslein
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians University, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | - Markus Guba
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the LMU Munich, Munich, Germany
| | | |
Collapse
|
10
|
Smits JM, De Pauw M, Schulz U, Van Cleemput J, Raake P, Knezevic I, Caliskan K, Sutlic Z, Knosalla C, Schoenrath F, Szabolcs Z, Gottlieb J, Hagl C, Doesch A, Baric D, Rudez I, Strelniece A, De Vries E, Green D, Samuel U, Milicic D, Hartyanszky I, Berchtold-Herz M, Schulze PC, Mohr F, Meiser B, Haverich A, Reichenspurner H, Gummert J, Laufer G, Zuckermann A. Heart re-transplantation in Eurotransplant. Transpl Int 2018; 31:1223-1232. [PMID: 29885002 DOI: 10.1111/tri.13289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/23/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.
Collapse
Affiliation(s)
| | - Michel De Pauw
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Uwe Schulz
- Department of Thoracic and Cardiavascular Surgery, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Johan Van Cleemput
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Philip Raake
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivan Knezevic
- Department of Cardiothoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zeljko Sutlic
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, German Center for Cardiovascular Research, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, German Center for Cardiovascular Research, Berlin, Germany
| | - Zoltan Szabolcs
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Transplant Center Munich, Munich, Germany
| | - Andreas Doesch
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Davor Baric
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Igor Rudez
- Department of Cardiac Surgery, University Hospital, Zagreb, Croatia
| | - Agita Strelniece
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Erwin De Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Dave Green
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Istvan Hartyanszky
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine, University Hospital Jena, Jena, Germany
| | - Friedrich Mohr
- Department of Cardiothoracic Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Bruno Meiser
- Department of Cardiac Surgery, Transplant Center Munich, Munich, Germany
| | - Axel Haverich
- Department of Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Jan Gummert
- Department of Thoracic and Cardiavascular Surgery, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Guenter Laufer
- Department of Cardiac Surgery, University Hospital Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, University Hospital Vienna, Vienna, Austria
| |
Collapse
|
11
|
Smits JM, Nossent G, Evrard P, Lang G, Knoop C, Kwakkel-van Erp JM, Langer F, Schramm R, van de Graaf E, Vos R, Verleden G, Rondelet B, Hoefer D, Hoek R, Hoetzenecker K, Deuse T, Strelniece A, Green D, de Vries E, Samuel U, Laufer G, Buhl R, Witt C, Gottlieb J. Lung allocation score: the Eurotransplant model versus the revised US model - a cross-sectional study. Transpl Int 2018; 31:930-937. [DOI: 10.1111/tri.13262] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/19/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - George Nossent
- Department of Respiratory Medicine; University Medical Center Groningen; Groningen The Netherlands
| | - Patrick Evrard
- Department of Intensive Care; Centre Hospitalier Universitaire Université Catholique de Louvain; Namur Godinne Belgium
| | - György Lang
- Department of Thoracic Surgery; University Hospital; Vienna Austria
| | - Christiane Knoop
- Department of Respiratory Medicine; Hôpital Erasme; Brussels Belgium
| | | | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery; University Hospital Saarland; Homburg Germany
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery; University Hospital Munich; Munich Germany
| | - Ed van de Graaf
- Department of Respiratory Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Robin Vos
- Department of Respiratory Medicine; UZ Leuven; Leuven Belgium
| | - Geert Verleden
- Department of Respiratory Medicine; UZ Leuven; Leuven Belgium
| | - Benoit Rondelet
- Department of Thoracic Surgery; Centre Hospitalier Universitaire Université Catholique de Louvain; Namur Godinne Belgium
| | - Daniel Hoefer
- Department of Thoracic and Cardiovascular Surgery; University Hospital Innsbruck; Innsbruck Austria
| | - Rogier Hoek
- Department of Pulmonary Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
| | | | - Tobias Deuse
- Department of Thoracic and Cardiovascular Surgery; University Hospital Eppendorf; Hamburg Germany
| | | | - Dave Green
- Eurotransplant International Foundation; Leiden The Netherlands
| | - Erwin de Vries
- Eurotransplant International Foundation; Leiden The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation; Leiden The Netherlands
| | - Guenther Laufer
- Department of Cardiac Surgery; University Hospital; Vienna Austria
| | - Roland Buhl
- Department of Respiratory Medicine; University Hospital Mainz; Mainz Germany
| | - Christian Witt
- Department of Respiratory Medicine; University Hospital Charité; Berlin Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Biomedical Research in End-stage and Obstructive Disease (Breath); German Centre for Lung Research (DZL); Hannover Germany
| |
Collapse
|
12
|
Heylen L, Jochmans I, Samuel U, Tieken I, Naesens M, Pirenne J, Sprangers B. The duration of asystolic ischemia determines the risk of graft failure after circulatory-dead donor kidney transplantation: A Eurotransplant cohort study. Am J Transplant 2018; 18:881-889. [PMID: 28980391 DOI: 10.1111/ajt.14526] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/20/2017] [Accepted: 09/16/2017] [Indexed: 01/25/2023]
Abstract
Circulatory death donor (DCD) kidney transplantations are steadily increasing. Consensus reports recommend limiting donor warm ischemia time (DWIT) in DCD donation, although an independent effect on graft outcome has not been demonstrated. We investigated death-censored graft survival in 18 065 recipients of deceased-donor kidney transplants in the Eurotransplant region: 1059 DCD and 17 006 brain-dead donor (DBD) kidney recipients. DWIT was defined as time from circulatory arrest until cold flush. DCD donation was an independent risk factor for graft failure (adjusted hazard ratio [HR] 1.28, 95% CI 1.10-1.46), due to an increased risk of primary nonfunction (62/1059 vs 560/17 006; P < .0001). With DWIT in the model, DCD donation was no longer a risk factor, demonstrating that DWIT explains the inferior graft survival of DCD kidneys. Indeed, DCD transplants with short DWIT have graft survival comparable to that of standard-criteria DBD transplants (P = .59). DWIT also associated with graft failure in DCDs (adjusted HR 1.20 per 10-minute increase, 95% CI 1.03-1.42). At 5 years after transplantation, graft failure occurred in 14 of 133 recipients (10.5%) with DWIT <10 minutes, 139 of 555 recipients (25.0%) with DWIT between 10 and 19 minutes, and 117 of 371 recipients (31.5%) with DWIT ≥20 minutes. These findings support the expert opinion-based guidelines to limit DWIT.
Collapse
Affiliation(s)
- L Heylen
- Laboratory of Experimental Transplantation, Department of Immunology and Microbiology, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - I Jochmans
- Abdominal Transplant Surgery, Department of Immunology and Microbiology, K.U. Leuven, Leuven, Belgium.,Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - U Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - I Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - M Naesens
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.,Nephrology, Department of Immunology and Microbiology, K.U. Leuven, Leuven, Belgium
| | - J Pirenne
- Abdominal Transplant Surgery, Department of Immunology and Microbiology, K.U. Leuven, Leuven, Belgium.,Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - B Sprangers
- Laboratory of Experimental Transplantation, Department of Immunology and Microbiology, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Blok JJ, de Boer JD, Putter H, Rogiers X, Guba MO, Strassburg CP, Samuel U, van Hoek B, Hamming JF, Braat AE. The center effect in liver transplantation in the Eurotransplant region: a retrospective database analysis. Transpl Int 2018; 31:610-619. [DOI: 10.1111/tri.13129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/10/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Joris J. Blok
- Division of Transplantation; Department of Surgery; Leiden University Medical Center; Leiden University; Leiden The Netherlands
| | - Jacob D. de Boer
- Division of Transplantation; Department of Surgery; Leiden University Medical Center; Leiden University; Leiden The Netherlands
- Eurotransplant International Foundation; Leiden The Netherlands
| | - Hein Putter
- Department of Medical Statistics; Leiden University Medical Center; Leiden University; Leiden The Netherlands
| | - Xavier Rogiers
- Department of Surgery; Ghent University Hospital Medical School; Ghent Belgium
| | - Markus O. Guba
- Department of General, Visceral and Transplant Surgery; Hospital of the University of Munich; Munich Germany
| | | | - Undine Samuel
- Eurotransplant International Foundation; Leiden The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology; Leiden University Medical Center; Leiden University; Leiden The Netherlands
| | - Jaap F. Hamming
- Division of Transplantation; Department of Surgery; Leiden University Medical Center; Leiden University; Leiden The Netherlands
| | - Andries E. Braat
- Division of Transplantation; Department of Surgery; Leiden University Medical Center; Leiden University; Leiden The Netherlands
| | | |
Collapse
|
14
|
Gallinat A, Amrillaeva V, Hoyer DP, Kocabayoglu P, Benko T, Treckmann JW, van Meel M, Samuel U, Minor T, Paul A. Reconditioning by end-ischemic hypothermic in-house machine perfusion: A promising strategy to improve outcome in expanded criteria donors kidney transplantation. Clin Transplant 2018; 31. [PMID: 28035688 DOI: 10.1111/ctr.12904] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 12/01/2022]
Abstract
This clinical study evaluates end-ischemic hypothermic machine perfusion (eHMP) in expanded criteria donors (ECD) kidneys. eHMP was initiated upon arrival of the kidney in our center and continued until transplantation. Between 11/2011 and 8/2014 eHMP was performed in 66 ECD kidneys for 369 (98-912) minutes after 863 (364-1567) minutes of cold storage (CS). In 49 of 66 cases, the contralateral kidney from the same donor was preserved by static CS only and accepted by another Eurotransplant (ET) center. Five (10.2%) of these kidneys were ultimately judged as "not transplantable" by the accepting center and discarded. After exclusion of early unrelated graft losses, 43 kidney pairs from the same donor were eligible for direct comparison of eHMP vs CS only: primary non-function and delayed graft function (DGF) were 0% vs 9.3% (P=.04) and 11.6% vs 20.9% (P=.24). There was no statistically significant difference in 1-year graft survival (eHMP vs CS only: 97.7% vs 88.4%, P=.089). In a multivariate analysis, eHMP was an independent factor for prevention of DGF (OR: 0.28, P=.041). Development of DGF was the strongest risk factor for 1-year graft failure (Renal resistance: 38.2, P<.001). In summary, eHMP is a promising reconditioning technique to improve the quality and acceptance rate of suboptimal grafts.
Collapse
Affiliation(s)
- Anja Gallinat
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Vera Amrillaeva
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dieter P Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Peri Kocabayoglu
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tamas Benko
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jürgen W Treckmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Thomas Minor
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
15
|
Andrassy J, Wolf S, Lauseker M, Angele M, van Rosmalen MD, Samuel U, Rogiers X, Werner J, Guba M. Higher retransplantation rate following extended right split-liver transplantation: An analysis from the eurotransplant liver follow-up registry. Liver Transpl 2018; 24:26-34. [PMID: 29144580 DOI: 10.1002/lt.24980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
Abstract
Split-liver transplantation has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant Liver Allocation System (ELAS) envisages that the extended right lobes (ERLs) after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of extended right lobe transplantation (ERLT) in comparison to whole liver transplantation (WLT) recipients remains unclear. Data on all liver transplantations performed between 2007 and 2013 were retrieved from the Eurotransplant Liver Follow-up Registry (n = 5351). Of these, 5013 (269 ERL, 4744 whole liver) could be included. The impact of the transplant type on patient and graft survival was evaluated using univariate and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times were significantly prolonged for ERLTs (P < 0.001). Patient survival was not different between ERLT and WLT. In the univariate analysis, ERLT had a significantly higher risk for retransplantation (P = 0.02). For WLT, the risk for death gradually and significantly increased with laboratory Model for End-Stage Liver Disease (MELD) scores of >20. For ERLT, this effect was seen already with laboratory MELD scores of >14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs. Liver Transplantation 24 26-34 2018 AASLD.
Collapse
Affiliation(s)
- Joachim Andrassy
- Department of Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Sebastian Wolf
- Department of Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Michael Lauseker
- Institute for Biometrics and Epidemiology, Ludwig-Maximilian University, Munich, Germany
| | - Martin Angele
- Department of Surgery, Ludwig-Maximilian University, Munich, Germany
| | | | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Xavier Rogiers
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Jens Werner
- Department of Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Markus Guba
- Department of Surgery, Ludwig-Maximilian University, Munich, Germany
| | | |
Collapse
|
16
|
Shaw D, Gardiner D, Lewis P, Jansen N, Wind T, Samuel U, Georgieva D, Ploeg R, Broderick A. Conscientious objection to deceased organ donation by healthcare professionals. J Intensive Care Soc 2017; 19:43-47. [PMID: 29456600 DOI: 10.1177/1751143717731230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this article, we analyse the potential benefits and disadvantages of permitting healthcare professionals to invoke conscientious objection to deceased organ donation. There is some evidence that permitting doctors and nurses to register objections can ultimately lead to attitudinal change and acceptance of organ donation. However, while there may be grounds for conscientious objection in other cases such as abortion and euthanasia, the life-saving nature of donation and transplantation renders objection in this context more difficult to justify. In general, dialogue between healthcare professionals is a more appropriate solution, and any objections must be justified with a strong rationale in hospitals where such policies are put in place.
Collapse
Affiliation(s)
- David Shaw
- 1Institute for Biomedical Ethics, University of Basel, Switzerland.,Department of Health, Ethics and Society, CAPHRI Research Institute, Maastricht University, the Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals Trust, Nottingham, UK
| | - Penney Lewis
- Dickson Poon School of Law, Kings College London, UK
| | - Nichon Jansen
- Dutch Transplant Foundation, Leiden, the Netherlands
| | - Tineke Wind
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | | | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, UK
| | | |
Collapse
|
17
|
Heylen L, Pirenne J, Samuel U, Tieken I, Naesens M, Sprangers B, Jochmans I. The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study. Am J Transplant 2017; 17:724-732. [PMID: 27593738 DOI: 10.1111/ajt.14031] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 01/25/2023]
Abstract
Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10-min increase, 95% confidence interval [CI] 1.06-1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97-1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.
Collapse
Affiliation(s)
- L Heylen
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - U Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - I Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - M Naesens
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - B Sprangers
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| |
Collapse
|
18
|
Blok JJ, Detry O, Putter H, Rogiers X, Porte RJ, van Hoek B, Pirenne J, Metselaar HJ, Lerut JP, Ysebaert DK, Lucidi V, Troisi RI, Samuel U, den Dulk AC, Ringers J, Braat AE. Longterm results of liver transplantation from donation after circulatory death. Liver Transpl 2016; 22:1107-14. [PMID: 27028896 DOI: 10.1002/lt.24449] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/05/2016] [Accepted: 03/09/2016] [Indexed: 12/13/2022]
Abstract
Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P < 0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD.
Collapse
Affiliation(s)
- Joris J Blok
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, University Hospital of Liège, Liège, Belgium
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Xavier Rogiers
- Department of Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Robert J Porte
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan P Lerut
- Starzl Unit of Abdominal Transplantation, Department of Abdominal Surgery and Transplantation, University Hospitals Saint Luc, Brussels, Belgium
| | - Dirk K Ysebaert
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp University, Belgium
| | - Valerio Lucidi
- Department of Abdominal Surgery, Hepatobiliary and Liver Transplantation Unit, Erasme Hospital ULB, Brussels, Belgium
| | - Roberto I Troisi
- Department of Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - A Claire den Dulk
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Jan Ringers
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Andries E Braat
- Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | | |
Collapse
|
19
|
Kopp WH, de Vries E, de Boer J, Putter H, Schareck W, Samuel U, Braat AE. Donor risk indices in pancreas allocation in the Eurotransplant region. Transpl Int 2016; 29:921-9. [PMID: 27188797 DOI: 10.1111/tri.12797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/16/2016] [Accepted: 05/12/2016] [Indexed: 12/24/2022]
Abstract
Pancreas donor selection and recognition are important to cope with increasing organ shortage. We aim to show that the PDRI is more useful than the P-PASS to predict acceptance and should thus be preferred over P-PASS. Eurotransplant donors from 2004 until 2014 were included in this study. PDRI logistical factors were set to reference to purely reflect donor quality (PDRI donor ). PDRI and P-PASS association with allocation outcome was studied using area under the receiver operating characteristic curve (AUROC). Regional differences in donor quality were also investigated. Of the 10 444 pancreata that were reported, 6090 (58.3%) were accepted and 2947 (28.2%) were transplanted. We found that P-PASS was inferior to PDRIdonor in its ability to predict organ reporting, acceptance, and transplantation: AUC 0.63, 0.67 and 0.73 for P-PASS vs. 0.78, 0.79 and 0.84 for PDRIdonor , respectively. Furthermore, there were significant differences in donor quality among different Eurotransplant countries, both in reported donors and in transplanted organs. PDRI is a powerful predictor of allocation outcome and should be preferred over P-PASS. Proper donor selection and recognition, and possibly a more liberal approach toward inferior quality donors, may increase donation and transplant rates.
Collapse
Affiliation(s)
- Wouter H Kopp
- Eurotransplant International Foundation, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Erwin de Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Jan de Boer
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
20
|
Abstract
Vascularized composite allografts (VCAs) are a growing field within the area of transplantation. In 2014, the birth of a healthy baby after a successful uterus transplant from a living donor was reported in Sweden. VCAs are not specifically mentioned in any of the transplant acts of the Eurotransplant (ET) member states, which all belong to the European Union (EU). The Competent Authorities (CA) of the EU decided in 2012 that VCAs are to be regarded as organs. At the moment, there are no general guidelines in the ET area concerning wait list registration, allocation, procurement and transplantation, and also no regulations concerning reimbursement. To further develop this aspect, common policies and guidelines within the ET member states have to be developed.
Collapse
Affiliation(s)
- Undine Samuel
- Eurotransplant International, Leiden, the Netherlands
| |
Collapse
|
21
|
Blok JJ, Putter H, Rogiers X, van Hoek B, Samuel U, Ringers J, Braat AE. Combined effect of donor and recipient risk on outcome after liver transplantation: Research of the Eurotransplant database. Liver Transpl 2015; 21:1486-93. [PMID: 26289765 DOI: 10.1002/lt.24308] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 02/06/2023]
Abstract
Recently the Eurotransplant donor risk index (ET-DRI) was published, a model based on data from the Eurotransplant database that can be used for risk indication of liver donors within the Eurotransplant region. Because outcome after liver transplantation (LT) depends both on donor and recipient risk factors, a combined donor-recipient model (DRM) would give a more complete picture of the overall risk involved. All liver transplants in adult recipients from January 1, 2008 to December 31, 2010 in the Eurotransplant region were included. Risk factors in donors and recipients for failure-free (retransplant free) survival were analyzed in univariate and multivariate analyses. A simplified recipient risk index (sRRI) was constructed using all available recipient factors. A total of 4466 liver transplants were analyzed. Median donor risk index and ET-DRI were 1.78 and 1.91, respectively. The ET-DRI was validated in this new cohort (P < 0.001; concordance index [c-index], 0.59). After construction of a simplified recipient risk index of significant recipient factors, Cox regression analysis showed that the combination ET-DRI and sRRI into a new DRM gave the highest predictive value (P < 0.001; c-index, 0.62). The combined model of ET-DRI and sRRI gave a significant prediction of outcome after orthotopic LT in the Eurotransplant region, better than the ET-DRI alone. This DRM has potential in comparing data in the literature and correcting for sickness/physical condition of transplant recipients. It is a first step toward benchmarking of graft survival in the Eurotransplant region.
Collapse
Affiliation(s)
- Joris J Blok
- Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Xavier Rogiers
- Department of Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Jan Ringers
- Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Andries E Braat
- Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | |
Collapse
|
22
|
Köster L, Krupka K, Höcker B, Rahmel A, Samuel U, Zanen W, Opelz G, Süsal C, Döhler B, Plotnicki L, Kohl CD, Knaup P, Tönshoff B. Integrating data from multiple sources for data completeness in a web-based registry for pediatric renal transplantation--the CERTAIN Registry. Stud Health Technol Inform 2015; 216:1049. [PMID: 26262348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patient registries are a useful tool to measure outcomes and compare the effectiveness of therapies in a specific patient population. High data quality and completeness are therefore advantageous for registry analysis. Data integration from multiple sources may increase completeness of the data. The pediatric renal transplantation registry CERTAIN identified Eurotransplant (ET) and the Collaborative Transplant Study (CTS) as possible partners for data exchange. Import and export interfaces with CTS and ET were implemented. All parties reached their projected goals and benefit from the exchange.
Collapse
Affiliation(s)
- Lennart Köster
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Germany
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Britta Höcker
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Axel Rahmel
- Stichting Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Stichting Eurotransplant International Foundation, Leiden, The Netherlands
| | - Wouter Zanen
- Stichting Eurotransplant International Foundation, Leiden, The Netherlands
| | - Gerhard Opelz
- Department of Transplantation Immunology, University Hospital of Heidelberg, Germany
| | - Caner Süsal
- Department of Transplantation Immunology, University Hospital of Heidelberg, Germany
| | - Bernd Döhler
- Department of Transplantation Immunology, University Hospital of Heidelberg, Germany
| | - Lukasz Plotnicki
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Christian D Kohl
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Germany
| | - Petra Knaup
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| |
Collapse
|
23
|
Schmidt T, Schub D, Wolf M, Dirks J, Ritter M, Leyking S, Singh M, Zawada AM, Blaes-Eise AB, Samuel U, Sester U, Sester M. Comparative analysis of assays for detection of cell-mediated immunity toward cytomegalovirus and M. tuberculosis in samples from deceased organ donors. Am J Transplant 2014; 14:2159-67. [PMID: 25040687 DOI: 10.1111/ajt.12787] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/07/2014] [Accepted: 04/16/2014] [Indexed: 01/25/2023]
Abstract
Cell-mediated immunity assays could be valuable for risk assessment of organ donors, but no data exist on their feasibility in deceased donors. In this study, 105 deceased donors (52.3 ± 16.9 years) were screened at the time of organ procurement. Pathogen-specific stimulation was performed using a cytomegalovirus (CMV) lysate, tuberculin (purified protein derivative [PPD]) and soluble Mycobacterium tuberculosis-specific ESAT-6/CFP-10 proteins in combination with an in-house fluorescence-activated cell sorting (FACS) assay or commercial assay formats (QuantiFERON-CMV/TB for ELISA, T-SPOT.TB for ELISPOT). CMV-IgG antibody titers were determined as gold standard for CMV infection; 51.4% of samples were CMV seropositive. Indeterminate results were observed in 47.6% of ELISA, 12.5% of FACS and 0% of ELISPOT assays. Agreement with serology was highest for FACS (95.6%, κ = 0.91), followed by ELISPOT (84.0%, κ = 0.68) and ELISA (80.0%, κ = 0.60). Agreement between ELISA and serology increased if the CMV lysate was used as stimulus (96.7%, κ = 0.92). Among the T cell assays, agreement between ELISPOT and FACS was highest (κ = 0.70). PPD-positive results among valid samples differed between assays (26.5% for ELISA, 23.1% for FACS and 50.5% for ELISPOT); 2.0% were QuantiFERON-TB positive, 3.3% were ESAT-6/CFP-10-positive in FACS and 13.4% were positive in the T-SPOT.TB assay. In conclusion, cellular immunity may be analyzed from samples of deceased donors, although the assays differ in the rate of positivity and indeterminate results.
Collapse
Affiliation(s)
- T Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Rey JW, Grass V, Barreiros AP, Haberstroh N, Bahnemann C, Hammer GP, Samuel U, Otto G, Galle PR, Werner C. [Organ procurement in Germany: a regional survey among students]. Dtsch Med Wochenschr 2012; 137:69-73. [PMID: 22241444 DOI: 10.1055/s-0031-1298796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVE In Germany the extent of organ donation is still low and not sufficent to duly address all patients on the waiting lists. It is likely that a lack of information and a consecutive uncertainty in the adult population relate to this imbalance. Virtually no data exist about teenagers' knowledge of the facts of organ donation. METHODS 4000 questionnaires were distributed in secondary schools in the state capital city Mainz, Germany. The students were asked to respond to 12 questions. The survey was voluntary and performed in class, without the students using any information sources. RESULTS Data from 1155 questionnaires were analysed. Overall 11.3 % of the teenagers carried an organ donor card. 48.9 % of the students had spoken about organ donation and brain death in their families. 37.0 % of the students declined organ donation. Of these, 72.4 % named a lack of education and informations as the primary reason for this statement. More non-German than German pupils declined organ donation (43.4 % vs. 36.2 %). CONCLUSIONS More than half of the pupils between 14 years and 20 years of age support the concept of organ transplantation as therapeutic option. Nevertheless the proportion of organ card holders is small among these students. These regional results identify an information deficit in young people in Germany as one of the main causes for inadequate acceptance of organ donation. Therefore, information and structured education should be intensified in German schools as possible measure to increase the number of future organ donor card holders in Germany.
Collapse
Affiliation(s)
- J W Rey
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ropers D, Samuel U. Riesenharnblase (4,5l) bei Prostatahyperplasie und konsekutiver Abflussstörung. Dtsch Med Wochenschr 2007; 132:671-2. [PMID: 17377881 DOI: 10.1055/s-2007-973601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D Ropers
- Medizinische Klinik, Universitätsklinik Erlangen
| | | |
Collapse
|
26
|
Abstract
Contaminated or infected catheters are a major source of nosocomial infections responsible for >40% of all episodes of nosocomial sepsis in acute-care hospitals. Antibiotics as well as surface modifications with, for example, hydrogels proved to be of little value in preventing the contamination of indwelling catheters. The even distribution of 10(12-13) activated silver nanoparticles per gram in various polymers, e.g. polyurethane and silicone, results in an excellent antimicrobial activity against a broad spectrum of organisms in vitro. Substantial reduction of incrustation of these catheters was also observed. These preliminary experimental data warrant clinical studies.
Collapse
Affiliation(s)
- U Samuel
- Department of Urology, The University of Erlangen, Loschgestr. 15, 91054 Erlangen, Germany
| | | |
Collapse
|
27
|
Samuel U, Lütjen-Drecoll E, Tamm ER. Gap junctions are found between iris sphincter smooth muscle cells but not in the ciliary muscle of human and monkey eyes. Exp Eye Res 1996; 63:187-92. [PMID: 8983976 DOI: 10.1006/exer.1996.0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Physiological studies indicate that in primate ciliary muscle there is little or no spread of electrical activity from cell to cell. To clarify to what extent primate intraocular smooth muscles express the structural correlate of electrical coupling, the localization of gap junctions in the ciliary and the iris sphincter muscle of human and monkey (Macaca fascicularis) eyes was analysed using electronmicroscopy and connexin43 immunocytochemistry. With both methods, numerous gap junctions were identified in the iris sphincter of both species, while no such junctions were observed between individual smooth muscle cells in the ciliary muscle. Both ciliary and iris sphincter smooth muscle cells were connected by numerous adherens-type junctions. These results further underline that primate ciliary muscle is an atypical smooth muscle which shares many common features with striated skeletal muscle.
Collapse
Affiliation(s)
- U Samuel
- Department of Anatomy II, University of Erlangen-Nürnberg, Germany
| | | | | |
Collapse
|