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Donation after cardiac death

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https://www.readbyqxmd.com/read/29142490/postoperative-elevated-resistive-indices-do-not-predict-hepatic-artery-thrombosis-in-extended-criteria-donor-livers
#1
Eric J Siskind, Fauzia Vandermeer, Tamar R Siskind, David A Bruno, Samuel Sultan, Josue Alvarez-Casas, Arielle Stafford, Barton Lane, John C Lamattina, Rolf N Barth, Steven I Hanish
Postoperative transplant liver ultrasounds were analyzed in standard criteria donor (SCD), extended criteria donor (ECD), and donation after cardiac death (DCD) liver allografts to determine if elevated resistive indices (RIs) are consistently present and if they are pathological. Postoperative transplant liver ultrasounds were reviewed from 115 consecutive patients. Hepatic arterial RIs were stratified based on the type of donor: DCD, macrosteatosis (>30%), or standard criteria. In all patients with elevated RI, subsequent ultrasounds were reviewed to demonstrate RI normalization...
December 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/29128047/use-of-lung-allografts-from-donation-after-cardiac-death-donors-a-single-center-experience
#2
Joseph Costa, Lori Shah, Hilary Robbins, Kashif Raza, Sowmya Sreekandth, Selim Arcasoy, Joshua R Sonett, Frank D'Ovidio
BACKGROUND: Lung transplantation remains the only treatment for end-stage lung disease. Availability of suitable lungs does not parallel this growing trend. Centers using donation after cardiac death (DCD) donor lungs report comparable outcomes with those from brain-dead donors. Donor assessment protocols and consistent surgical teams have been advocated when considering using the use of DCD donors. We present our experience using lungs from Maastricht category III DCD donors. METHODS: Starting 2007 to July 2016, 73 DCD donors were assessed, 44 provided suitable lungs that resulted in 46 transplants...
November 8, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29120882/donation-after-circulatory-death-and-its-expansion-in-spain
#3
Eduardo Miñambres, Juan J Rubio, Elisabeth Coll, Beatriz Domínguez-Gil
PURPOSE OF REVIEW: Donation after circulatory death (DCD) is still performed in a limited number of countries. This article summarizes the development of DCD in Spain and presents recent Spanish contributions to gain knowledge on the potential benefits and the practical use of normothermic regional perfusion (nRP). RECENT FINDINGS: DCD now contributes to 24% of deceased donors in Spain. The development of DCD has been based on an assessment of practices in the treatment of cardiac arrest and end-of-life care to accommodate the option of DCD; the creation of an adequate regulatory framework; and institutional support, professional training and public education...
November 7, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29054231/lung-procurement-after-cardiac-death-in-a-donor-with-previous-median-sternotomy
#4
Chitaru Kurihara, Masashi Kawabori, Masahiro Ono, Syed T Hussain, Amit D Parulekar, Jeffrey A Morgan, Gabriel Loor
The shortage of lungs for organ donation is problematic, and meeting the demand by expanding the donor pool in lung transplantation is critical. Donation after cardiac death (DCD) is an under-used approach that could be a valuable source of organs. However, procuring lungs from donors with a previous median sternotomy is technically difficult and is usually avoided. Here, we describe the procurement of lungs from a DCD patient with a previous median sternotomy.
November 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29052563/predictive-score-model-for-delayed-graft-function-based-on-easily-available-variables-before-kidney-donation-after-cardiac-death
#5
Chen-Guang Ding, Qian-Hui Tai, Feng Han, Yang Li, Xiao-Hui Tian, Pu-Xun Tian, Xiao-Ming Ding, Xiao-Ming Pan, Jin Zheng, He-Li Xiang, Wu-Jun Xue
BACKGROUND: How to evaluate the quality of donation after cardiac death (DCD) kidneys has become a critical problem in kidney transplantation in China. Hence, the aim of this study was to develop a simple donor risk score model to evaluate the quality of DCD kidneys before DCD. METHODS: A total of 543 qualified kidneys were randomized in a 2:1 manner to create the development and validation cohorts. The donor variables in the development cohort were considered as candidate univariate predictors of delayed graft function (DGF)...
October 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29039506/hypothermic-machine-perfusion-ameliorates-inflammation-during-ischemia%C3%A2-reperfusion-injury-via-sirtuin%C3%A2-1%C3%A2-mediated-deacetylation-of-nuclear-factor%C3%A2-%C3%AE%C2%BAb-p65-in-rat-livers-donated-after-circulatory-death
#6
Cheng Zeng, Xiaoyan Hu, Weiyang He, Yanfeng Wang, Ling Li, Yan Xiong, Qifa Ye
Hypothermic machine perfusion (HMP) effectively reduces ischemia‑reperfusion injury (IRI) in livers donated after circulatory death (DCD) when compared with cold storage (CS). However, the underlying mechanisms remain unclear. The current study aimed to investigate the cellular mechanisms by which HMP ameliorates the inflammatory response during IRI. Adult male Sprague‑Dawley rat livers were exposed to 30 min of warm ischemia following cardiac arrest and preserved by CS or HMP for 3 h (n=3 per group)...
December 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29024427/combined-liver-kidney-perfusion-enhances-protective-effects-of-normothermic-perfusion-on-livers-grafts-from-donation-after-cardiac-death
#7
Xiaoshun He, Fei Ji, Zhiheng Zhang, Yunhua Tang, Lu Yang, Shanzhou Huang, Wenwen Li, Qiao Su, Wei Xiong, Zebin Zhu, Linhe Wang, Lei Lv, Jiyou Yao, Linan Zhang, Longjuan Zhang, Zhiyong Guo
It has been showed that combined liver-kidney normothermic machine perfusion (NMP) is able to better maintain the circuit's biochemical milieu. Nevertheless, whether the combined perfusion is superior to liver perfusion alone in protecting livers from donation after cardiac death (DCD) is unclear. We aimed to test the hypothesis and explored the mechanisms. Livers from 15 DCD pig donors were subjected to either static cold storage group (Group A), liver alone NMP group (Group B), or combined liver-kidney NMP group (Group C)...
October 10, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/29023512/the-ultrastructural-characteristics-of-porcine-hepatocytes-donated-after-cardiac-death-and-preserved-with-warm-machine-perfusion-preservation
#8
Hiroki Bochimoto, Naoto Matsuno, Yo Ishihara, Tatsuya Shonaka, Daisuke Koga, Yoshiki Hira, Yuji Nishikawa, Hiroyuki Furukawa, Tsuyoshi Watanabe
The effects of warm machine perfusion preservation of liver grafts donated after cardiac death on the intracellular three-dimensional ultrastructure of the organelles in hepatocytes remain unclear. Here we analyzed comparatively the ultrastructure of the endomembrane systems in porcine hepatocytes under warm ischemia and successive hypothermic and midthermic machine perfusion preservation, a type of the warm machine perfusion. Porcine liver grafts which had a warm ischemia time of 60 minutes were perfused for 4 hours with modified University of Wisconsin gluconate solution...
2017: PloS One
https://www.readbyqxmd.com/read/29018070/hypothermic-oxygenated-machine-perfusion-hope-for-orthotopic-liver-transplantation-of-human-liver-allografts-from-extended-criteria-donors-ecd-in-donation-after-brain-death-dbd-a-prospective-multicentre-randomised-controlled-trial-hope-ecd-dbd
#9
Zoltan Czigany, Wenzel Schöning, Tom Florian Ulmer, Jan Bednarsch, Iakovos Amygdalos, Thorsten Cramer, Xavier Rogiers, Irinel Popescu, Florin Botea, Jiří Froněk, Daniela Kroy, Alexander Koch, Frank Tacke, Christian Trautwein, Rene H Tolba, Marc Hein, Ger H Koek, Cornelis H C Dejong, Ulf Peter Neumann, Georg Lurje
INTRODUCTION: Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. In an attempt to improve the availability of donor allografts and reduce waiting list mortality, graft acceptance criteria were extended increasingly over the decades. The use of extended criteria donor (ECD) allografts is associated with a higher incidence of primary graft non-function and/or delayed graft function. As such, several strategies have been developed aiming at reconditioning poor quality ECD liver allografts...
October 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28975767/cd47-blockade-reduces-ischemia-reperfusion-injury-in-donation-after-cardiac-death-rat-kidney-transplantation
#10
Xuanchuan Wang, Min Xu, Jianluo Jia, Zhengyan Zhang, Joseph P Gaut, Gundumi A Upadhya, Pamela T Manning, Yiing Lin, William C Chapman
Modulation of nitric oxide (NO) activity through blockade of CD47 signaling has been shown to reduce ischemia-reperfusion injury (IRI) in various models of tissue ischemia. Here, we evaluate the potential effect of an antibody-mediated CD47 blockade in a syngeneic and an allogeneic DCD rat kidney transplant model. The donor organ was subjected to 1 hr of warm ischemia time after circulatory cessation, then flushed with a CD47 monoclonal antibody (CD47mAb) in the treatment group, or an isotype-matched immunoglobulin in the control group...
October 4, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28925929/canadian-guidelines-for-controlled-pediatric-donation-after-circulatory-determination-of-death-summary-report
#11
Matthew J Weiss, Laura Hornby, Bram Rochwerg, Michael van Manen, Sonny Dhanani, V Ben Sivarajan, Amber Appleby, Mary Bennett, Daniel Buchman, Catherine Farrell, Aviva Goldberg, Rebecca Greenberg, Ram Singh, Thomas A Nakagawa, William Witteman, Jill Barter, Allon Beck, Kevin Coughlin, Alf Conradi, Cynthia Cupido, Rosanne Dawson, Anne Dipchand, Darren Freed, Karen Hornby, Valerie Langlois, Cheryl Mack, Meagan Mahoney, Deepak Manhas, Christopher Tomlinson, Samara Zavalkoff, Sam D Shemie
OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature...
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28885771/impact-of-donor-age-in-donation-after-cardiac-death-liver-transplantation-is-the-cut-off-60-still-of-relevance
#12
Andrea Schlegel, Irene Scalera, M Thamara, P R Perera, Marit Kalisvaart, Hynek Mergental, Darius F Mirza, John Isaac, Paolo Muiesan
Background Advanced donor age has been identified as risk factor, when combined with donor warm ischemia, e.g. in donation after circulatory death (DCD). In several countries DCD livers, older than 60 years are not considered suitable due to concerns related to poor graft function and development of ischaemic cholangiopathy. We evaluate in this study outcome after DCD liver transplantation using grafts from donors older than 60 years. Methodology We analysed outcome after DCD liver transplantation (n=315), comparing donors >60 years (n=93) and donors ≤60 years (n=222) from our centre between 2005 and 2015...
September 8, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28883707/donor-derived-infections-among-chinese-donation-after-cardiac-death-liver-recipients
#13
Qi-Fa Ye, Wei Zhou, Qi-Quan Wan
AIM: To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients. METHODS: We retrospectively studied the results of blood cultures among our donation after cardiac death (DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors...
August 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28870676/hypothermic-oxygenated-perfusion-hope-for-fatty-liver-grafts-in-rats-and-humans
#14
Philipp Kron, Andrea Schlegel, Leandro Mancina, Pierre-Alain Clavien, Philipp Dutkowski
BACKGROUND & AIMS: Pretreatment of marginal organs by perfusion is a promising opportunity to make more organs available for transplantation. Protection of human donation after cardiac death (DCD) livers by a novel machine perfusion technique, hypothermic oxygenated perfusion (HOPE), was recently established. Herein, we tested whether HOPE is also useful for fatty liver grafts, using a rodent transplant model. METHODS: Rats were fed over three weeks with a special methionine-choline-deficient diet (MCDD) to induce severe hepatic macrosteatosis (≥60%)...
September 21, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28863026/transfusion-of-older-red-blood-cells-increases-the-risk-of-acute-kidney-injury-after-orthotopic-liver-transplantation-a-propensity-score-analysis
#15
Yue Wang, Qingshan Li, Tao Ma, Xuemin Liu, Bo Wang, Zheng Wu, Shaonong Dang, Yi Lv, Rongqian Wu
BACKGROUND: Acute kidney injury (AKI) is a common and serious complication of orthotopic liver transplantation (OLT). Transfusion of older red blood cells (RBCs) has been implicated in poor outcomes in trauma, cardiac surgery, and critically ill patients. However, whether transfusion of older RBCs plays any role in post-OLT AKI remained unknown. The aim of this study was to investigate the effect of the age of transfused RBCs on post-OLT AKI. METHODS: The clinical data of consecutive adult patients who received donation after cardiac death and underwent OLT from December 2011 to December 2015 were analyzed...
August 31, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28854432/ursolic-acid-improves-liver-transplantation-and-inhibits-apoptosis-in-miniature-pigs-using-donation-after-cardiac-death
#16
Wei Zhou, Li Lin, Ying Cheng, Yongfeng Liu
BACKGROUND: Ursolic acid (UA) possesses extensive pharmacological activities, including anti-oxidation, anti-infection, anti-inflammation, anti-tumor, liver protection. This study was designed to investigate the effect of UA on liver transplantation after liver transplantation using donation after cardiac death (DCD), and to assess the mechanisms. METHODS: 24 healthy experimental pigs were randomly divided into control and experimental groups. Each group received six DCD liver transplantations...
2017: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/28844933/early-detection-of-brain-death-using-the-bispectral-index-bis-in-patients-treated-by-extracorporeal-cardiopulmonary-resuscitation-e-cpr-for-refractory-cardiac-arrest
#17
Romain Jouffroy, Lionel Lamhaut, Alexandra Guyard, Pascal Philippe, Kim An, Christian Spaulding, Frédéric Baud, Pierre Carli, Benoît Vivien
BACKGROUND: Despite increasing use of extracorporeal cardiopulmonary resuscitation (E-CPR) for treatment of refractory cardiac arrest patients, prognosis remains dismal, often resulting in brain-death. However, clinical assessment of brain-death occurence is difficult in post-cardiac arrest patients, sedated, paralyzed, under mild therapeutic hypothermia (MTH). Our objective was to assess the usefulness of Bispectral-Index (BIS) monitoring at bedside for an early detection of brain-death occurrence in refractory cardiac arrest patients treated by E-CPR...
November 2017: Resuscitation
https://www.readbyqxmd.com/read/28839932/the-impact-of-alteplase-on-pulmonary-graft-function-in-donation-after-circulatory-death-an-experimental-study
#18
Annika Liersch-Nordqvist, Mohammed Fakhro, Leif Pierre, Joanna Hlebowicz, Malin Malmsjo, Richard Ingemansson, Sandra Lindstedt
OBJECTIVE: Lung transplantation is hampered by the lack of organs resulting in deaths on the waiting list. The usage of donation after circulatory death (DCD) lungs would dramatically increase donor availability. The most optimal organ preservation method, and the need for antithrombotic and fibrinolytic treatment to prevent thrombosis in the donor lungs is currently on debate. The present study investigated, in a simulated clinical DCD situation, whether the addition of alteplase in the flush-perfusion solution at the time of pulmonary graft harvesting could prevent thrombosis in the donor lung and thereby improve pulmonary graft function...
October 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28827516/development-and-assessment-of-normothermic-machine-perfusion-preservation-for-extracorporeal-splitting-of-pig-liver
#19
Zhi-Bin Zhang, Wei Gao, Lei Liu, Yuan Shi, Ning Ma, Zhong-Yang Shen
BACKGROUND Studies have shown that normothermic machine perfusion (NMP) exerts a significant protective role for donations after cardiac death (DCD) livers and verified the effects of NMP in preservation, repair, and preoperative assessment of human donor livers. The objective of this study was to verify the effectiveness and stability of NMP system by splitting pig livers in perfusion preservation. MATERIAL AND METHODS Four healthy Ba-Ma miniature pigs were used. The livers were harvested, and then connected to the NMP system to split the livers...
August 22, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28807212/comparison-of-normothermic-and-hypothermic-perfusion-in-porcine-kidneys-donated-after-cardiac-death
#20
COMPARATIVE STUDY
Matthew F Blum, Qiang Liu, Basem Soliman, Paul Dreher, Toshihiro Okamoto, Emilio D Poggio, David A Goldfarb, William M Baldwin, Cristiano Quintini
BACKGROUND: Normothermic machine perfusion (NMP) is an alternative strategy for preserving kidneys donated after cardiac death (DCD). The relative efficacy of prolonged NMP compared to hypothermic machine perfusion (HMP) in DCD kidneys with moderate ischemic injury is undetermined. This study compares NMP and HMP kidney preservation in a porcine DCD model. METHODS: Ten porcine kidneys underwent NMP or HMP preservation following 45 minutes of warm ischemia and 5 hours of cold ischemia...
August 2017: Journal of Surgical Research
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