1
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Marklin GF, Stephens M, Gansner E, Ewald G, Klinkenberg WD, Ahrens T. Clinical outcomes of a prospective randomized comparison of bioreactance monitoring versus pulse-contour analysis in a stroke-volume based goal-directed fluid resuscitation protocol in brain-dead organ donors. Clin Transplant 2023; 37:e15110. [PMID: 37615632 DOI: 10.1111/ctr.15110] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
Eighty percent of brain-dead (BD) organ donors develop hypotension and are frequently hypovolemic. Fluid resuscitation in a BD donor is controversial. We have previously published our 4-h goal-directed stroke volume (SV)-based fluid resuscitation protocol which significantly decreased time on vasopressors and increased transplanting four or more organs. The SV was measured by pulse-contour analysis (PCA) or an esophageal doppler monitor, both of which are invasive. Thoracic bioreactance (BR) is a non-invasive portable technology that measures SV but has not been studied in BD donors. We performed a randomized prospective comparative study of BR versus PCA technology in our fluid resuscitation protocol in BD donors. Eighty-four donors (53.1%) were randomized to BR and 74 donors to PCA (46.8%). The two groups were well matched based on 24 demographic, social, and initial laboratory factors, without any significant differences between them. There was no difference in the intravenous fluid infused over the 4-h study period [BR 2271 ± 823 vs. PCA 2230 ± 962 mL; p = .77]. There was no difference in the time to wean off vasopressors [BR 108.8 ± 61.8 vs. PCA 150.0 ± 68 min p = .07], nor in the number of donors off vasopressors at the end of the protocol [BR 16 (28.6%) vs. PCA 15 (29.4%); p = .92]. There was no difference in the total number of organs transplanted per donor [BR 3.25 ± 1.77 vs. PCA 3.22 ± 1.75; p = .90], nor in any individual organ transplanted. BR was equivalent to PCA in clinical outcomes and provides a simple, non-invasive, portable technology to monitor fluid resuscitation in organ donors.
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Affiliation(s)
| | | | | | - Gregory Ewald
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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2
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Turkulainen E, Ihalainen J, Arvas M. Simulated effects of ferritin screening on C-reactive protein levels in recruited blood donors. Vox Sang 2023; 118:901-905. [PMID: 37622476 DOI: 10.1111/vox.13515] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/28/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Ferritin is commonly measured to evaluate iron stores in the body. Some countries have added or considered adding ferritin lower bounds to donor eligibility criteria. Ferritin is also elevated by inflammation. The main goal of this study is to estimate how different ferritin cut-offs would affect the proportion of donors with a C-reactive protein (CRP) level over 3 mg/L, which is the decision limit of the highest chronic cardiovascular risk. MATERIALS AND METHODS To simulate recruitment of new blood donors, we selected participants from two Finnish general population cohorts, namely FINRISK 1997 (n = 5369) and Health 2000 (n = 3278), that would likely fulfil the selection criteria of blood donation. We then calculated the proportion of individuals with high-sensitivity CRP values above 3 mg/L, over a range of ferritin values. RESULTS We found that for several ferritin cut-offs the proportion of potential donors with CRP > 3 mg/L would rise by a statistically significant amount. The trend was significant and similar for all subgroups but weaker for non-menstruating women as well as men. CONCLUSION Our results show that screening a population of potential blood donors with ferritin cut-offs raises the number of people with CRP > 3 mg/L within the blood donor population.
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Affiliation(s)
- Esa Turkulainen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Jarkko Ihalainen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Mikko Arvas
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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3
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Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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4
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Kransdorf EP, Rushakoff JA, Han J, Benck L, Malinoski D, Emerson D, Catarino P, Rampolla R, Kobashigawa JA, Khush KK, Patel JK. Donor hyperoxia is a novel risk factor for severe cardiac primary graft dysfunction. J Heart Lung Transplant 2023; 42:617-626. [PMID: 36682894 DOI: 10.1016/j.healun.2022.12.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary graft dysfunction (PGD) is a major cause of early mortality following heart transplant (HT). Donor risk factors for the development of PGD are incompletely characterized. Donor management goals (DMG) are predefined critical care endpoints used to optimize donors. We evaluated the relationship between DMGs as well as non-DMG parameters, and the development of PGD after HT. METHODS A cohort of HT recipients from 2 transplant centers between 1/1/12 and 12/31/19 was linked to their respective donors in the United Network for Organ Sharing (UNOS) DMG Registry (n = 1,079). PGD was defined according to modified ISHLT criteria. Variables were subject to univariate and multivariable multinomial modeling with development of mild/moderate or severe PGD as the outcome variable. A second multicenter cohort of 4,010 donors from the DMG Registry was used for validation. RESULTS Mild/moderate and severe PGD occurred in 15% and 6% of the cohort. Multivariable modeling revealed 6 variables independently associated with mild/moderate and 6 associated with severe PGD, respectively. Recipient use of amiodarone plus beta-blocker, recipient mechanical circulatory support, donor age, donor fraction of inspired oxygen (FiO2), and donor creatinine increased risk whereas predicted heart mass ratio decreased risk of severe PGD. We found that donor age and FiO2 ≥ 40% were associated with an increased risk of death within 90 days post-transplant in a multicenter cohort. CONCLUSIONS Donor hyperoxia at heart recovery is a novel risk factor for severe primary graft dysfunction and early recipient death. These results suggest that excessive oxygen supplementation should be minimized during donor management.
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Affiliation(s)
- Evan P Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Joshua A Rushakoff
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jiho Han
- Division of Cardiovascular Medicine, Stanford University, Stanford, California; Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Lillian Benck
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Darren Malinoski
- Critical Care and Acute Care Surgery, Oregon Health and Sciences University, Portland, Oregon
| | - Dominic Emerson
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro Catarino
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Reinaldo Rampolla
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon A Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Jignesh K Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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5
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Knight SR. Transplant Trial Watch. Transpl Int 2022; 35:10970. [PMID: 36530482 PMCID: PMC9751031 DOI: 10.3389/ti.2022.10970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Simon R. Knight
- Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom,Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom,*Correspondence: Simon R. Knight,
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6
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Spielberg DR, Melicoff E, Heinle JS, Hosek K, Mallory GB. Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation. J Heart Lung Transplant 2022; 42:522-532. [PMID: 36564335 DOI: 10.1016/j.healun.2022.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite clinical progress over time, a shortage of suitable donor organs continues to limit solid organ transplantation around the world. Lungs are the organs most likely to be assessed as unsuitable during donor management among all transplantable organs. Although the number of lung transplants performed in children is limited, death on the wait list remains a barrier to transplant success for many potential transplant candidates. Optimizing organ donor management can yield additional organs for transplant candidates. METHODOLOGY We accessed the Donor Management Goal (DMG) Registry to evaluate the efficiency and efficacy of donor management in the procurement of lungs for transplantation. Further, we stratified donors by age and compared pediatric age cohorts to adult cohorts with respect to attainment of donor management target goals and successful pathway to transplantation. We utilized recipient data from the Organ Procurement Transplantation Network (OPTN) to put this data into context. The DMG bundle consists of nine physiologic parameters chosen as end-points guiding donor management for potential organ donors. The number of parameters fulfilled has been regarded as an indication of efficacy of donor management. RESULTS We noted a markedly lower number of organ donors in the pediatric age group compared to adults. On the other hand, the number of donors greatly exceeds the number of infants, children and adolescents who undergo lung transplantation. Organs transplanted per donor peaks in the adolescent age group. At initial donor referral, DMG bundle attainment is lower in all age groups and improves during donor management. With respect to oxygenation, there is less overall improvement in younger donors compared to older donors during donor management. When donors who yield lungs for transplantation are compared to those whose lungs were not transplanted, oxygenation improved more substantially during donor management. Furthermore, improved oxygenation correlated with the total number of organs transplanted per donor. CONCLUSIONS In the face of continued wait list mortality on the pediatric lung transplant wait list, the number of young donors may not be a limiting factor. We believe that this dataset provides evidence that management of young pediatric donors is not as consistent or efficient as the management of older donors, potentially limiting the number of life-saving organs for pediatric lung transplant candidates. Across all ages, optimizing donor lung management may increase the potential to transplant multiple other organs.
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Affiliation(s)
- David R Spielberg
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ernestina Melicoff
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kathleen Hosek
- Department of Quality Assurance, Texas Children's Hospital, Houston, Texas
| | - George B Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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7
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M Ferreira C, Vieites Y, Goldszmidt R, B Andrade E. The effect of temporary deferrals on donor return: A 26-year assessment in a setting without retention activities. Transfusion 2022; 62:1583-1593. [PMID: 35855649 DOI: 10.1111/trf.17025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies that describe the negative association between temporary deferrals and donor return rates commonly come from settings where mechanisms are in place to win back lapsing donors. There is little evidence on the size and prevalence of this negative association in settings with no such retention activities. STUDY DESIGN AND METHODS We use data from more than 2 million donation attempts made at a blood collection agency in Brazil over a 26-year period. We describe the distribution of deferrals across donor demographic and behavioral characteristics, and estimate multivariate survival analysis models with matched samples to measure the impact of deferrals on return rates. We control for sex, race, age, education, donation type, number of previous attempts, previous donations, and previous deferrals. We test for heterogeneous effects in interaction models with selected donor demographic and behavioral characteristics. RESULTS Temporary deferrals were associated with a 50% decrease in the likelihood of return. Although the effect was observed for all population subgroups and across the full length of the dataset, it varied in magnitude. The influence of deferrals was more negative among older donors and those reporting replacement motives, and less negative among more educated donors and those with a previous donation. DISCUSSION We found that temporary deferrals meaningfully harm donor careers in a setting where specific retention activities are absent. Although the effects are widespread across the population and persistent in time, there are also heterogeneities, which must be considered when designing interventions targeted at wining-back specific groups of deferred donors.
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Affiliation(s)
- Claudio M Ferreira
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Yan Vieites
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Rafael Goldszmidt
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
| | - Eduardo B Andrade
- Brazilian School of Public and Business Administration, Fundação Getulio Vargas (FGV-EBAPE), Rio de Janeiro, Brazil
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8
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Kothari R, Tolles J, Adelmann D, Lewis RJ, Malinoski DJ, Niemann CU. Organ donor management goals and delayed graft function in adult kidney transplant recipients. Clin Transplant 2021; 36:e14528. [PMID: 34739731 DOI: 10.1111/ctr.14528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed graft function (DGF) after kidney transplantation is a common occurrence and correlates with poor graft and patient outcomes. Donor characteristics and care are known to impact DGF. We attempted to show the relationship between achievement of specific donor management goals (DMG) and DGF. METHODS This is a retrospective case-control study using data from 14 046 adult kidney donations after brain death from hospitals in 18 organ procurement organizations (OPOs) which were transplanted to adult recipients between 2012 and 2018. Data on DMG compliance and donor, recipient, and ischemia-related factors were used to create multivariable logistic regression models. RESULTS The overall rate of DGF was 29.4%. Meeting DMGs for urine output and vasopressor use were associated with decreased risk of DGF. Sensitivity analyses performed with different imputation methods, omitting recipient factors, and analyzing multiple time points yielded largely consistent results. CONCLUSIONS The development of DMGs continues to show promise in improving outcomes in the kidney transplant recipient population. Studies have already shown increased kidney utilization in smaller cohorts, as well as other organs, and shown decreased rates of DGF. Additional research and analysis are required to assess interactions between meeting DMGs and correlation versus causality in DMGs and DGF.
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Affiliation(s)
- Rishi Kothari
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Juliana Tolles
- Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Dieter Adelmann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Roger J Lewis
- Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Darren J Malinoski
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.,Department of Surgery, University of California San Francisco, San Francisco, California, USA
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9
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Van Zanden JE, 't Hart NA, Ottens PJ, Liu B, Rebolledo RA, Erasmus ME, Leuvenink HGD. Methylprednisolone Treatment in Brain Death-Induced Lung Inflammation-A Dose Comparative Study in Rats. Front Pharmacol 2021; 12:587003. [PMID: 33692687 PMCID: PMC7937885 DOI: 10.3389/fphar.2021.587003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/24/2020] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The process of brain death (BD) leads to a pro-inflammatory state of the donor lung, which deteriorates its quality. In an attempt to preserve lung quality, methylprednisolone is widely recommended in donor lung management. However, clinical treatment doses vary and the dose-effect relation of methylprednisolone on BD-induced lung inflammation remains unknown. The aim of this study was to investigate the effect of three different doses methylprednisolone on the BD-induced inflammatory response. Methods: BD was induced in rats by inflation of a Fogarty balloon catheter in the epidural space. After 60 min of BD, saline or methylprednisolone (low dose (5 mg/kg), intermediate dose (12.5 mg/kg) or high dose (22.5 mg/kg)) was administered intravenously. The lungs were procured and processed after 4 h of BD. Inflammatory gene expressions were analyzed by RT-qPCR and influx of neutrophils and macrophages were quantified with immunohistochemical staining. Results: Methylprednisolone treatment reduced neutrophil chemotaxis as demonstrated by lower IL-8-like CINC-1 and E-selectin levels, which was most evident in rats treated with intermediate and high doses methylprednisolone. Macrophage chemotaxis was attenuated in all methylprednisolone treated rats, as corroborated by lower MCP-1 levels compared to saline treated rats. Thereby, all doses methylprednisolone reduced TNF-α, IL-6 and IL-1β tissue levels. In addition, intermediate and high doses methylprednisolone induced a protective anti-inflammatory response, as reflected by upregulated IL-10 expression when compared to saline treated brain-dead rats. Conclusion: We showed that intermediate and high doses methylprednisolone share most potential to target BD-induced lung inflammation in rats. Considering possible side effects of high doses methylprednisolone, we conclude from this study that an intermediate dose of 12.5 mg/kg methylprednisolone is the optimal treatment dose for BD-induced lung inflammation in rats, which reduces the pro-inflammatory state and additionally promotes a protective, anti-inflammatory response.
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Affiliation(s)
- Judith E Van Zanden
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nils A 't Hart
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Petra J Ottens
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bo Liu
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rolando A Rebolledo
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Institute for Medical and Biological Engineering, Schools of Engineering, Biological Sciences and Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michiel E Erasmus
- Department of cardiothoracic surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henri G D Leuvenink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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10
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Axelrod DA, Malinoski D, Patel MS, Broglio K, Lewis R, Groat T, Lentine KL, Schnitzler M, Niemann CU. Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation. Clin Transplant 2020; 33:e13626. [PMID: 31162858 DOI: 10.1111/ctr.13626] [Citation(s) in RCA: 3] [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] [Received: 04/03/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard donor management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers.
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Affiliation(s)
- David A Axelrod
- Department of Transplantation and HPB Surgery, University of Iowa, Iowa City, Iowa
| | - Darren Malinoski
- Section of Surgical Critical Care, VA Portland Health Care System (VAPORHCS), Portland, Oregon.,Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Madhukar S Patel
- Section of Surgical Critical Care, VA Portland Health Care System (VAPORHCS), Portland, Oregon.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Tahnee Groat
- Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.,Department of Surgery, Division of Transplantation, University of California San Francisco, San Francisco, California
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11
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Marklin GF, Klinkenberg WD, Helmers B, Ahrens T. A stroke volume-based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain-dead donors. Clin Transplant 2020; 34:e13784. [PMID: 31957104 DOI: 10.1111/ctr.13784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
Brain-dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume-based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30 minutes for 4 hours by pulse contour analysis or esophageal Doppler. A 500 mL saline fluid bolus was infused over 30 minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10 minutes if the mean arterial pressure was greater than 65 mm Hg. The protocol group received 1937 ± 906 mL fluid compared to 1323 ± 919 mL in the control group (P = .003). Mean time on vasopressors was decreased from 957.6 ± 586.2 to 176.3 ± 82.2 minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR = 4.114, 95% Confidence Interval (CI) = 1.003-16.876). While more organs were transplanted per donor in the protocol group (3.39 ± 1.52) than in the control group (2.93 ± 1.44) (P = .268), the difference did not reach statistical significance. A goal-directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.
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12
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Abstract
RATIONALE Brain death (BD) precipitates cardiac dysfunction impairing the ability to transplant hearts from eligible organ donors. Retrospective studies have suggested that thyroid hormone may enhance myocardial recovery and increase hearts transplanted. We performed a randomized trial evaluating whether intravenous thyroxine (T4) improves cardiac function in BD donors with impaired ejection fraction (EF). METHODS All heart-eligible donors managed at a single-organ procurement organization (OPO) underwent protocolized fluid resuscitation. Those weaned off vasopressors underwent transthoracic echocardiography (TTE) within 12 hours of BD and, if EF was below 60%, were randomized to T4 infusion or no T4 for 8 hours, after which TTE was repeated. RESULTS Of 77 heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control (n = 11). Baseline EF was comparable (45%, interquartile range [IQR] 42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend to more hearts transplanted (59% vs 27%, P = .14). This difference appeared to be accounted for by more donors with a history of drug use in the T4 group, who exhibited greater improvements in EF (15% vs 0% without drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1 of 9, P = .01). CONCLUSIONS In this small randomized study of BD donors with impaired cardiac function, T4 infusion did not result in greater cardiac recovery. A larger randomized trial comparing T4 to placebo appears warranted but would require collaboration across multiple OPOs.
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Affiliation(s)
- Rajat Dhar
- Division of Neurocritical Care, Department of Neurology, Washington University School of Medicine in St Louis, MO, USA
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13
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Chandler T, Hiller J, Peine S, Stargardt T. Blood donation and donors: insights from a large German teaching hospital (2008-2017). Vox Sang 2019; 115:27-35. [PMID: 31642071 DOI: 10.1111/vox.12853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/15/2019] [Accepted: 09/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The availability of blood and blood products is crucial for the provision of high-quality hospital services. We analyse changes in whole blood donations, donors and their behaviour over 9 years at a large German teaching hospital. MATERIALS AND METHODS A descriptive analysis using data from over 34 000 donors and 265 000 donations from a large university hospital's blood centre was conducted using data from July 2008 to December 2017. The analysis focussed on (a) whole blood donations and (b) donor characteristics and how they changed over time. We categorized donors into four categories according to their donation activity (First-Time, Highly Active, Active and Reactivated). RESULTS We observed falling donations over time and that donors donated less frequently. Consequently, we show a downward trend in the number of Highly Active donors, whilst First-Time donors remained stable. We also provide evidence that donors donated well below their capacity and that the blood type of donors appeared to be in line with the wider German donor population. Lastly, we show a sharp drop in the return rates of First-Time donors over time. CONCLUSION We recommend that Highly Active donors and former Highly Active donors are more carefully considered when planning donor engagement strategies and effort made in (at the very least) maintaining their donation activity. Our results in the context of the literature highlight the need for further research into the changing attitudes towards blood donation and prosocial activities.
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Affiliation(s)
| | - Jens Hiller
- Institut für Transfusionsmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sven Peine
- Institut für Transfusionsmedizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics, Hamburg, Germany
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14
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Cohen J, Ashkenazi T. The implementation and utilization of an organ donation dedicated medical advisory service: A descriptive study. Clin Transplant 2019; 33:e13711. [PMID: 31529544 DOI: 10.1111/ctr.13711] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstacles encountered during the organ donation process may result in the loss of organs. A centralized medical advisory service (MAS), providing a 24/7/365 service, was established in 2007 to respond to queries from healthcare professionals regarding organ safety, brain death (BD) determination, and donor management. METHODS Data collected from 2007 to 2017 included the number and context of the queries and the mean number of organs transplanted/donor. Since 2012, the number of six donor management goals (DMGs) met at the time of consent has been monitored. RESULTS The number of queries relative to the number of potential donors increased from 12.4% (n = 78 queries) in 2007 to 48.2% (304 queries) in 2009 and has remained widely utilized, with most queries consistently related to organ safety. The context of the queries informed the formulation of protocols relating to donor infections and malignancy and identified difficulties regarding BD determination and subsequent implementation of solutions. A mean of 5.0 ± 0.7 DMGs was achieved, while the number of organs transplanted/donor increased from 3.4 in 2007 to 4.0 in 2017. CONCLUSION We suggest that this model may provide a valuable resource to improve the safety, standardization, and quality of the donation process.
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15
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Grosshuesch C, Johnson WK, DeVogel N, Yin Z, Wang T, Kindel SJ, Woods RK. Brain death interval and relationship to outcomes of pediatric cardiac transplantation. Pediatr Transplant 2019; 23:e13426. [PMID: 31062919 DOI: 10.1111/petr.13426] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/04/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to analyze brain death interval and outcomes of pediatric cardiac transplantation using national registry data. METHODS We retrospectively evaluated a pediatric cohort from the UNOS registry from 2005 to 2014. We restricted the donor cohort to those with a primary central nervous system event as the cause of hospitalization. Brain death interval (BDI) was defined as the time between hospital admission and organ procurement. Primary outcomes were recipient and graft survival time. Logistical regression modeling was used for multivariable analysis. RESULTS The donor cohort included 2565 cases. Multivariable analysis demonstrated no relationship between BDI and recipient or graft survival time. For patient survival time, the lowest HR was 0.94 (0.63-1.39), P = 0.531; for graft survival time, the lowest HR was 0.89 (0.53-1.49), P = 0.563. We obtained similar results using a non-restricted donor cohort. CONCLUSIONS There was no clear relationship between BDI and recipient or graft survival after pediatric cardiac transplantation.
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Affiliation(s)
| | - William K Johnson
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Milwaukee, Wisconsin
| | | | - Ziyan Yin
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tao Wang
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steven J Kindel
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Milwaukee, Wisconsin
| | - Ronald K Woods
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Milwaukee, Wisconsin
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16
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Oczkowski SJW, Durepos P, Centofanti J, Arsenau E, Dhanani S, Cook DJ, Meade MO. A Multidisciplinary Survey to Assess Facilitators and Barriers to Successful Organ Donation in the Intensive Care Unit. Prog Transplant 2019; 29:179-184. [PMID: 30895847 DOI: 10.1177/1526924819835826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Rates of successful organ donation vary between otherwise comparable intensive care units (ICUs). The ICU staff have a unique perspective into the facilitators and barriers underlying this variation in successful deceased organ donation. RESEARCH QUESTION What do ICU staff perceive to be the most meaningful facilitators and barriers to deceased organ donation? DESIGN We designed and conducted a survey of all disciplines working in the ICU to ascertain the perceived facilitators and barriers to donation in an academic tertiary care hospital. Survey reliability was assessed using Cronbach α. Factor analysis was used to assess construct validity and identify potentially redundant survey items. RESULTS We had responses from 108 ICU staff, including nurses (n = 75), respiratory therapists (n = 14), physicians (n = 12), chaplains (n = 2), as well as social work, pharmacy, physiotherapy, and occupational therapy (n = 1 each). Perceived facilitators included availability of organ donation organization coordinators, explicit institutional support for donation, ICU staff culture toward donation, standardized order sets for donation, presence of ICU staff with donation experience, and bedside nurse presence at discussions about donation. Perceived barriers included ICU staff ruling out potentially suitable donors before consulting a donor coordinator, physician communication skills, low priority for organ donation among operating room staff, limited family understanding of patient prognosis and organ donation, and limited emotional readiness of families to discuss donation. DISCUSSION Several staff-perceived facilitators and barriers to deceased organ donation were identified in the ICU. Future research could identify strategies to promote these facilitators and overcome barriers.
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Affiliation(s)
- Simon J W Oczkowski
- 1 Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- 2 Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Pamela Durepos
- 2 Hamilton Health Sciences, Hamilton, Ontario, Canada
- 3 Department of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - John Centofanti
- 1 Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- 2 Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Erika Arsenau
- 4 Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- 5 Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Deborah J Cook
- 1 Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- 4 Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, Ontario, Canada
- 6 St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Maureen O Meade
- 1 Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- 2 Hamilton Health Sciences, Hamilton, Ontario, Canada
- 4 Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, Ontario, Canada
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17
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van Zanden JE, Jager NM, Daha MR, Erasmus ME, Leuvenink HGD, Seelen MA. Complement Therapeutics in the Multi-Organ Donor: Do or Don't? Front Immunol 2019; 10:329. [PMID: 30873176 PMCID: PMC6400964 DOI: 10.3389/fimmu.2019.00329] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
Over the last decade, striking progress has been made in the field of organ transplantation, such as better surgical expertise and preservation techniques. Therefore, organ transplantation is nowadays considered a successful treatment in end-stage diseases of various organs, e.g. the kidney, liver, intestine, heart, and lungs. However, there are still barriers which prevent a lifelong survival of the donor graft in the recipient. Activation of the immune system is an important limiting factor in the transplantation process. As part of this pro-inflammatory environment, the complement system is triggered. Complement activation plays a key role in the transplantation process, as highlighted by the amount of studies in ischemia-reperfusion injury (IRI) and rejection. However, new insight have shown that complement is not only activated in the later stages of transplantation, but already commences in the donor. In deceased donors, complement activation is associated with deteriorated quality of deceased donor organs. Of importance, since most donor organs are derived from either brain-dead donors or deceased after circulatory death donors. The exact mechanisms and the role of the complement system in the pathophysiology of the deceased donor have been underexposed. This review provides an overview of the current knowledge on complement activation in the (multi-)organ donor. Targeting the complement system might be a promising therapeutic strategy to improve the quality of various donor organs. Therefore, we will discuss the complement therapeutics that already have been tested in the donor. Finally, we question whether complement therapeutics should be translated to the clinics and if all organs share the same potential complement targets, considering the physiological differences of each organ.
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Affiliation(s)
- Judith E. van Zanden
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Neeltina M. Jager
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Mohamed R. Daha
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Michiel E. Erasmus
- Department of Thoracic Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - Marc A. Seelen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
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18
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Dhar R, Stahlschmidt E, Yan Y, Marklin G. A randomized trial comparing triiodothyronine (T3) with thyroxine (T4) for hemodynamically unstable brain-dead organ donors. Clin Transplant 2019; 33:e13486. [PMID: 30689222 DOI: 10.1111/ctr.13486] [Citation(s) in RCA: 11] [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: 08/17/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE Brain-dead (BD) organ donors frequently exhibit hemodynamic instability and/or reversible cardiac dysfunction. Retrospective studies have suggested that thyroid hormone may stabilize hemodynamics and enhance myocardial recovery. Intravenous levothyroxine (T4) is most frequently utilized but studies have suggested that triiodothyronine (T3) may be superior. We performed a randomized comparative-effectiveness trial to address this uncertainty in donor management. METHODS All heart-eligible donors managed at a single OPO underwent standardized fluid resuscitation. If not weaned off vasopressors, donors underwent echocardiography (within 12 hours of BD) and were randomized to T3 or T4 infusion for eight hours. RESULTS A total of 37 BD donors were randomized (16 T3 vs 21 T4). Baseline ejection fraction (EF) was comparable (median 38% vs 45%, P = 0.87) as was vasopressor dosage (6 vs 12 μg/min of norepinephrine, NE, P = 0.12). Reduction in NE dose and proportion weaned off vasopressors was similar and LVEF improved in both groups (repeat EF: 50% vs 52.5%, P = 0.38) with almost half attaining EF ≥55%. Although more hearts were transplanted in the T3 group (10/16 vs 6/21, P = 0.04), this difference did not persist after adjusting for baseline imbalances in age and PF ratio. CONCLUSIONS Infusion of T3 does not appear to confer significant hemodynamic or cardiac benefits over T4 for hemodynamic unstable BD organ donors.
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Affiliation(s)
- Rajat Dhar
- Division of Neurocritical Care, Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri
| | | | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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19
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Sally MB, Malinoski DJ, Zaldivar FP, Le T, Khoshnevis M, Pinette WA, Hutchens M, Radom-Aizik S. A porcine model to study the effect of brain death on kidney genomic responses. J Clin Transl Sci 2018; 2:208-16. [PMID: 30800478 DOI: 10.1017/cts.2018.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/17/2018] [Accepted: 05/26/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction A majority of transplanted organs come from donors after brain death (BD). Renal grafts from these donors have higher delayed graft function and lower long-term survival rates compared to living donors. We designed a novel porcine BD model to better delineate the incompletely understood inflammatory response to BD, hypothesizing that adhesion molecule pathways would be upregulated in BD. Methods Animals were anesthetized and instrumented with monitors and a balloon catheter, then randomized to control and BD groups. BD was induced by inflating the balloon catheter and animals were maintained for 6 hours. RNA was extracted from kidneys, and gene expression pattern was determined. Results In total, 902 gene pairs were differently expressed between groups. Eleven selected pathways were upregulated after BD, including cell adhesion molecules. Conclusions These results should be confirmed in human organ donors. Treatment strategies should target involved pathways and lessen the negative effects of BD on transplantable organs.
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20
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Holndonner-Kirst E, Nagy A, Czobor NR, Fazekas L, Dohan O, Kertai MD, Lex DJ, Sax B, Hartyanszky I, Merkely B, Gal J, Szekely A. The Impact of l-Thyroxine Treatment of Donors and Recipients on Postoperative Outcomes After Heart Transplantation. J Cardiothorac Vasc Anesth 2018; 33:1629-1635. [PMID: 30467031 DOI: 10.1053/j.jvca.2018.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The effect of thyroid dysfunction on adverse outcomes has been studied in many different patient populations. The objective of this study was to investigate the effect of thyroid hormone supplementation of donors and recipients on postoperative outcomes after orthotopic heart transplantation. DESIGN Retrospective. SETTING Single center, university hospital. PARTICIPANTS Two-hundred and sixty-six consecutive patients undergoing heart transplantation. INTERVENTIONS No interventions. MEASUREMENTS AND MAIN RESULTS Demographic, hemodynamic, and clinical characteristics; donor and recipient United Network for Organ Sharing scores; and information on thyroid hormone support of donors and recipients were recorded. During the median follow-up of 4.59 years (interquartile range 4.26-4.92 y), 70 patients (26.3%) died. After adjustments were made for the United Network for Organ Sharing score, recipients who were treated preoperatively with l-thyroxine had a lower risk for all-cause mortality (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.06-0.98; p = 0.047) compared with recipients who were not treated with l-thyroxine. In addition, l-thyroxine treatment of donors was associated with a better recipient survival (HR 0.31, 95% CI 0.11-0.87; p = 0.025). CONCLUSIONS Pretransplantation thyroid hormone supplementation of donors and recipients was associated with improved long-term survival after heart transplantation.
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Affiliation(s)
- Eniko Holndonner-Kirst
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Budapest, Hungary
| | - Adam Nagy
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary
| | - Nikoletta Rahel Czobor
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary; Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Dohan
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Balazs Sax
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Janos Gal
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Szekely
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
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21
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Sampson BG, Wilson SR, Finnis ME, Hodak AM, Jones PN, O'Connor SL, Chapman MJ. A Quality Control Study of the Adherence to Recommended Physiological Targets for the Management of Brain-Dead Organ Donors in South Australian Intensive Care Units. Prog Transplant 2018; 28:386-389. [PMID: 30222049 DOI: 10.1177/1526924818800053] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Australian and New Zealand Intensive Care Society and the Australasian Transplant Coordinators Association provide recommendations on the physiological management of brain-dead donors. PROBLEM STATEMENT How often physiological targets are prescribed for brain-dead donors in Australian intensive care units (ICUs), and how well these compare to recommended targets is unknown. It is also unknown how often recommended targets are achieved, irrespective of prescribed targets. METHODS We performed a retrospective, observational quality control study in 81 adult (>18 years) brain-dead donors to describe how often physiological targets were prescribed, comparing these to current guidelines. We determined the proportion of observations within the recommended target range, irrespective of any prescribed target. We aimed to identify poor adherence to recommended targets to guide future quality improvement initiatives. OUTCOMES Seventy-four (91%) donors had at least 1 prescribed physiological target written on the ICU chart, with a median of 2 (range 2-5), and a maximum of 13 targets. Prescribed targets appeared to adhere well with recommended targets. Most recommended physiological targets were met irrespective of any prescribed target. However, one-quarter of serum sodium observations and one-third of blood glucose levels were above the recommended target. IMPLICATIONS FOR PRACTICE Quality improvement initiatives are required to improve the prescription of physiological targets in brain-dead donors in South Australia. Serum sodium and serum glucose targets were not met. However, this most likely reflects the need for current guidelines to be updated in line with current evidence.
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Affiliation(s)
- Brett G Sampson
- 1 Intensive and critical care Unit, Flinders Medical Centre, Bedford Park, Australia.,2 DonateLife SA, Adelaide, South Australia, Australia.,3 Department of Critical Care Medicine, Flinders University, Bedford Park, Australia
| | - Steven R Wilson
- 4 Department of Anaesthesia, Flinders Medical Centre, Bedford Park, Australia
| | - Mark E Finnis
- 5 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Stephanie L O'Connor
- 5 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marianne J Chapman
- 5 Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,6 School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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22
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Schmitz P. Information technology for brain banking. Handb Clin Neurol 2018; 150:157-65. [PMID: 29496138 DOI: 10.1016/B978-0-444-63639-3.00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Implementing and maintaining the information technology (IT) infrastructure of a brain bank can be a daunting task for any brain bank coordinator, particularly when access to both funds and IT professionals is limited. Many questions arise when attempting to determine which IT products are most suitable for a brain bank. The requirements of each brain bank must be assessed carefully to ensure that the chosen IT infrastructure will be able to meet those requirements successfully and will be able to expand and adapt as the size of the brain bank increases. This chapter provides some valuable insights to be considered when implementing the IT infrastructure for a brain bank and discusses the pros and cons of various approaches and products.
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23
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Cooper LB, Milano CA, Williams M, Swafford W, Croezen D, Van Bakel AB, Rogers JG, Patel CB. Thyroid hormone use during cardiac transplant organ procurement. Clin Transplant 2018; 30:1578-1583. [PMID: 27726211 DOI: 10.1111/ctr.12860] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. METHODS We developed a 15-question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal. RESULTS We received 29 responses, representing 24 OPOs. Seventy-two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use. CONCLUSIONS Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management.
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Affiliation(s)
- Lauren B Cooper
- Inova Heart & Vascular Institute, Falls Church, VA, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carmelo A Milano
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.,Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Melissa Williams
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Wendy Swafford
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Adrian B Van Bakel
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Chetan B Patel
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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24
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Martens A, Boada M, Vanaudenaerde BM, Verleden SE, Vos R, Verleden GM, Verbeken EK, Van Raemdonck D, Schols D, Claes S, Neyrinck AP. Steroids can reduce warm ischemic reperfusion injury in a porcine donation after circulatory death model with ex vivo lung perfusion evaluation. Transpl Int 2017; 29:1237-1246. [PMID: 27514498 DOI: 10.1111/tri.12823] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 03/30/2016] [Revised: 04/27/2016] [Accepted: 07/28/2016] [Indexed: 02/05/2023]
Abstract
Donation after circulatory death (DCD) is being used to increase the number of transplantable organs. The role and timing of steroids in DCD donation and ex vivo lung perfusion (EVLP) has not been thoroughly investigated. In this study, we investigated the effect of steroids on warm ischemic injury in a porcine model (n = 6/group). Following cardiac arrest, grafts were left untouched in the donor (90-min warm ischemia). Graft function was assessed after 6 h of EVLP. In the MP group, 500 mg methylprednisolone was given prior to cardiac arrest and during EVLP. In the CONTR group, no steroids were added. Median lung compliance (13 ml/cmH2 0) was significantly better preserved in the CONTR group than in the MP group (30.5 ml/cmH2 0). Also, median wet-to-dry weight (6.11 vs. 6.94) and CT density (182.5 vs. 352.9 g/l) were significantly better in the MP group than in the CONTR group, respectively. There was no difference in oxygenation and pulmonary vascular resistance. Perfusate cytokine analysis showed a significant reduction in IL-1β, IL-8, IFN-α, IL-10, TNF-α, and IFN-γ in MP. Cytokines in bronchoalveolar lavage were not decreased except for IFN-gamma. We demonstrated that warm ischemic injury in DCD donation can be attenuated by steroids when given prior to warm ischemia and during EVLP. Ethical context of donor preconditioning should be discussed further.
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Affiliation(s)
- An Martens
- Laboratory of Anesthesiology and Algology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium.,Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marc Boada
- Laboratory of Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Lung Transplant Unit, Laboratory of Pneumology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Stijn E Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Lung Transplant Unit, Laboratory of Pneumology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Lung Transplant Unit, Laboratory of Pneumology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Lung Transplant Unit, Laboratory of Pneumology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Eric K Verbeken
- Department of Histopathology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy (Rega Institute), Department of Microbiology and Immunology, Katholieke University Leuven, Leuven, Belgium
| | - Sandra Claes
- Laboratory of Virology and Chemotherapy (Rega Institute), Department of Microbiology and Immunology, Katholieke University Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Laboratory of Anesthesiology and Algology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven and University Hospitals, Leuven, Belgium. .,Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium.
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25
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Bergstrom B, de la Cruz JS, Sally M, Louis S, Friedman M, Petersen F, Malinoski D. The Use of Stroke Volume Variation to Guide Donor Management Is Associated With Increased Organs Transplanted per Donor. Prog Transplant 2017; 27:200-206. [PMID: 28617162 DOI: 10.1177/1526924817699966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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]
Abstract
BACKGROUND There is a national shortage of organs available for transplantation, and utilization rates for thoracic organs are less than 40%. In addition, the optimal method of assessing cardiovascular status during donor management is uncertain. FloTrac is a noninvasive hemodynamic technique that measures cardiac output and fluid responsiveness. Our objective was to measure the impact of using this technique to guide management on fluid balance, vasopressor usage, thyroid hormone usage, and pulmonary function. We hypothesized that FloTrac guidance will increase thoracic organs transplanted per donor (OTPD). METHODS Data were prospectively collected on a convenience sample of 38 donors after neurologic determination of death. Organs transplanted, net fluid balance, dosage of vasopressors, dosage of thyroid hormone, and Pao2:Fio2 were compared between treatment and control groups. RESULTS The treatment group had greater thoracic OTPD (1.3 [1.0] vs 0.4 [0.6], P = .004) and overall OTPD (4.3 [1.5] vs 2.7 [1.5], P = .002). Donors in the treatment group maintained a neutral fluid balance, had more thyroid hormone used, and had an improvement in oxygenation. CONCLUSION The implementation of this technology to aid providers may help ameliorate the shortage of thoracic and overall organs available for transplantation.
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Affiliation(s)
| | | | - Mitch Sally
- 3 Operative Care Division, Section of Critical Care, VA Portland Medical Center, Portland, OR, USA.,4 Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Scott Louis
- 5 Department of Cardiothoracic Surgery, University of Kansas Hospital, Kansas City, MO, USA
| | | | | | - Darren Malinoski
- 3 Operative Care Division, Section of Critical Care, VA Portland Medical Center, Portland, OR, USA.,4 Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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26
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Abstract
INTRODUCTION Optimization of lungs for organ donation is becoming increasingly important as donation rates stagnate despite growing waiting lists. Improving procurement and utilization of donated lungs has the ability to reduce mortality and time on the lung transplantation (LTx) waiting list. Additionally, assessment and optimization of donor lungs can reduce both early and late post-LTx morbidity and mortality, as well as reduce overall costs and resource utility. Areas covered: Strategies that we will discuss in detail include intensive care management practices, such as targeted ventilation protocols and therapeutic bronchoscopy, as well as the ever expanding possibilities within the arena of ex vivo lung perfusion (EVLP). Expert commentary: Donor lung quality is currently optimized both in vivo prior to organ procurement, and also via EVLP circuits. Despite good evidence demonstrating the utility of both approaches, data remain elusive as to whether EVLP is beneficial for all donor lungs prior to implantation, or instead as a tool by which we can evaluate and recondition sub-optimal donor lungs.
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Affiliation(s)
- Kovi Levin
- a Alfred Hospital - Lung Transplant Service , Department of Respiratory Medicine , Melbourne , Australia
| | - Sakhee Kotecha
- a Alfred Hospital - Lung Transplant Service , Department of Respiratory Medicine , Melbourne , Australia
| | - Glen Westall
- a Alfred Hospital - Lung Transplant Service , Department of Respiratory Medicine , Melbourne , Australia
| | - Gregory Snell
- a Alfred Hospital - Lung Transplant Service , Department of Respiratory Medicine , Melbourne , Australia
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27
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Westphal GA, Slaviero TA, Montemezzo A, Lingiardi GT, de Souza FCC, Carnin TC, Soares DR, Hachiya AH, Ferraz LL, de Andrade J. The effect of brain death protocol duration on potential donor losses due to cardiac arrest. Clin Transplant 2016; 30:1411-1416. [PMID: 27532678 DOI: 10.1111/ctr.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The severe inflammatory reaction that occurs after brain death (BD) tends to amplify over time, contributing to cardiovascular deterioration and occurrence of cardiac arrest (CA). Our purpose is to evaluate the effect of BD protocol duration (BDPD) on potential donor losses due to CA. METHODS This retrospective analysis included potential donors reported during the period from May 2012 to April 2014. The risk of losses due to CA was analyzed to identify the chronological threshold at which the probability of loss due to CA increases. RESULTS Three hundred and eighty-four potential donors were analyzed. There was a greater chance of CA after a 30-hour threshold (OR 1.67, 95% CI: 1.38-1.83), and the lowest risk of was identified for the range from 12 to 30 hours (OR 0.32, 95% CI: 0.19-0.52). Multivariate analysis identified the following variables as being associated with lower occurrence of CA: BDPD between 12 and 30 hours, management of a potential donor inside the intensive care unit, and the adherence to a goal-directed protocol. CONCLUSION A long duration between the first clinical test for BD diagnosis and the procurement of organs may be an important risk factor for the occurrence of cardiac arrest in deceased potential donors.
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Affiliation(s)
- Glauco Adrieno Westphal
- Transplantation Center of Santa Catarina, Santa Catarina, Brazil. .,University of the Region of Joinville, Santa Catarina, Brazil.
| | | | | | | | | | | | | | | | | | - Joel de Andrade
- Transplantation Center of Santa Catarina, Santa Catarina, Brazil
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28
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Abstract
Introduction: Despite continuous advances in transplant medicine, there is a persistent worldwide shortage of organs available for donation. There is a growing body of research that supports that optimal management of deceased organ donors in Intensive Care Unit can substantially increase the availability of organs for transplant and improve outcomes in transplant recipients. Methods: A systematic literature review was performed, comprising a comprehensive search of the PubMed database for relevant terms, as well as individual assessment of references included in large original investigations, and comprehensive society guidelines. Results: In addition to overall adherence to catastrophic brain injury guidelines, optimization of physiologic state in accordance with established donor management goals (DMGs), and establishment of system-wide processes for ensuring early referral to organ procurement organizations (OPOs), several specific critical care management strategies have been associated with improved rates and outcomes of renal transplantation from deceased donors. These include vasoactive medication selection, maintenance of euvolemia, avoidance of hydroxyethyl starch, glycemic control, targeted temperature management, and blood transfusions if indicated. Conclusions: Management of deceased organ donors should focus first on maintaining adequate perfusion to all organ systems through adherence to standard critical care guidelines, early referral to OPOs, and family support. Furthermore, several specific DMGs and strategies have been recently shown to improve both the rates and outcomes of organ transplantation.
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Affiliation(s)
- Margaret Kathleen Menzel Ellis
- Department of Anesthesiology, Sections of Anesthesiology and Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA
| | - Mitchell Brett Sally
- Division of Trauma, Critical Care, and Acute Care Surgery, Section of Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA
| | - Darren Malinoski
- Division of Trauma, Critical Care, and Acute Care Surgery, Section of Surgical Critical Care, Portland VA Medical Center, Oregon Health and Science University, Portland, OR, USA
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29
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Ramond A, Di Angelantonio E. 2014 European Conference on Donor Health and Management. Transfus Med 2015; 25:208-10. [PMID: 26381853 DOI: 10.1111/tme.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A Ramond
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.,NHS Blood and Transplant, Hertfordshire, UK
| | - E Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.,NHS Blood and Transplant, Hertfordshire, UK
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30
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Ware LB, Landeck M, Koyama T, Zhao Z, Singer J, Kern R, Neidlinger N, Nguyen J, Johnson E, Janz DR, Bernard GR, Lee JW, Matthay MA. A randomized trial of the effects of nebulized albuterol on pulmonary edema in brain-dead organ donors. Am J Transplant 2014; 14:621-8. [PMID: 24730050 PMCID: PMC3986821 DOI: 10.1111/ajt.12564] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor lung utilization rates are persistently low primarily due to donor lung dysfunction. We hypothesized that a treatment that enhances the resolution of pulmonary edema by stimulating the rate of alveolar fluid clearance would improve donor oxygenation and increase donor lung utilization. We conducted a randomized, blinded, placebo-controlled trial of aerosolized albuterol (5mg q4h) versus saline placebo during active donor management in 506 organ donors.The primary outcome was change in oxygenation arterial partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] from enrollment to organ procurement.The albuterol (n¼260) and placebo (n¼246)groups were well matched for age, gender, ethnicity,smoking, and cause of brain death. The change in PaO2/FiO2 from enrollment to organ procurement did not differ between treatment groups (p¼0.54) nor did donor lung utilization (albuterol 29% vs. placebo 32%,p¼0.44). Donors in the albuterol versus placebo groups were more likely to have the study drug dose reduced (13% vs. 1%, p<0.001) or stopped (8% vs. 0%,p<0.001) for tachycardia. In summary, treatment with high dose inhaled albuterol during the donor management period did not improve donor oxygenation or increase donor lung utilization but did cause tachycardia.High dose aerosolized albuterol should not be used in donors to enhance the resolution of pulmonary edema.
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Affiliation(s)
- Lorraine B. Ware
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN,Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jonathan Singer
- Pulmonary and Critical Care Medicine, University of California San Francisco, CA
| | - Ryan Kern
- Pulmonary and Critical Care Medicine, University of California San Francisco, CA
| | | | - John Nguyen
- California Transplant Donor Network, Oakland, CA
| | | | - David R. Janz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Gordon R. Bernard
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Jae W. Lee
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, CA
| | - Michael A. Matthay
- Pulmonary and Critical Care Medicine, University of California San Francisco, CA,Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, CA
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31
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Khush K, Pawlikowska L, Menza R, Goldstein B, Hayden V, Nguyen J, Kim H, Poon A, Sapru A, Matthay M, Kwok P, Young W, Baxter-Lowe L, Zaroff J. Beta-adrenergic receptor polymorphisms and cardiac graft function in potential organ donors. Am J Transplant 2012; 12:3377-86. [PMID: 22994654 PMCID: PMC3513582 DOI: 10.1111/j.1600-6143.2012.04266.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Prior studies have demonstrated associations between beta-adrenergic receptor (βAR) polymorphisms and left ventricular dysfunction-an important cause of allograft nonutilization for transplantation. We hypothesized that βAR polymorphisms predispose donor hearts to LV dysfunction after brain death. A total of 1043 organ donors managed from 2001-2006 were initially studied. The following βAR single nucleotide polymorphisms were genotyped: β1AR 1165C/G (Arg389Gly), β1AR 145A/G (Ser49Gly), β2AR 46G/A (Gly16Arg) and β2AR 79C/G (Gln27Glu). In multivariable regression analyses, the β2AR46 SNP was significantly associated with LV systolic dysfunction, with each minor allele additively decreasing the odds for LV ejection fraction <50%. The β1AR1165 and β2AR46 SNPs were associated with higher dopamine requirement during the donor management period: donors with the GG and AA genotypes had ORs of 2.64 (95% CI 1.52-4.57) and 2.70 (1.07-2.74) respectively for requiring >10 μg/kg/min of dopamine compared to those with the CC and GG genotypes. However, no significant associations were found between βAR SNPs and cardiac dysfunction in 364 donors managed from 2007-2008, perhaps due to changes in donor management, lack of power in this validation cohort, or the absence of a true association. βAR polymorphisms may be associated with cardiac dysfunction after brain death, but these relationships require further study in independent donor cohorts.
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Affiliation(s)
- K.K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - L. Pawlikowska
- Department of Anesthesia and Perioperative Care and Institute for Human Genetics, University of California, San Francisco
| | - R.L. Menza
- Graduate School of Nursing, Midwifery and Health, Victoria University, Wellington, New Zealand
| | - B.A. Goldstein
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - V. Hayden
- California Transplant Donor Network, Oakland, California
| | - J. Nguyen
- California Transplant Donor Network, Oakland, California
| | - H. Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Institute for Human Genetics, University of California, San Francisco
| | - A. Poon
- Cardiovascular Research Institute, University of California, San Francisco
| | - A. Sapru
- Department of Pediatrics, University of California, San Francisco
| | - M.A. Matthay
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco
| | - P.Y. Kwok
- Cardiovascular Research Institute and Institute for Human Genetics, University of California, San Francisco
| | - W.L. Young
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - L.A. Baxter-Lowe
- Immunogenetics and Transplantation Laboratory, University of California, San Francisco
| | - J.G. Zaroff
- Kaiser Northern California Division of Research, Oakland, California
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