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Donation after cardiac death

Janske Reiling, Elizabeth Forrest, Kim R Bridle, Laurence J Britton, Nishreen Santrampurwala, Darrell H G Crawford, Cornelis H C Dejong, Jonathan Fawcett
Background: In recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia. Methods: Data on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Australia and New Zealand organ donation registry. Temporal changes in donor characteristics were assessed and a logistical regression analysis was performed to evaluate their association with liver nonuse...
December 2017: Transplantation Direct
Jessica Lindemann, Leigh Anne Dageforde, Neeta Vachharajani, Emily Stahlschmidt, Diane Brockmeier, Jason R Wellen, Adeel Khan, William C Chapman, Majella Doyle
BACKGROUND: Donation after cardiac death (DCD) is one method of organ donation. Nationally, more than half of evaluated DCD donors do not yield transplantable organs. There is no algorithm for predicting which DCD donors will be appropriate for organ procurement. DCD program costs from an organ procurement organization (OPO) accounting for all evaluated donors have not been reported. STUDY DESIGN: Hospital, transportation, and supply costs of potential DCD donors evaluated at a single OPO from January 2009 to June 2016 were collected...
March 2, 2018: Journal of the American College of Surgeons
Kevin Koomalsingh, Jon A Kobashigawa
The first human-to-human heart transplant was performed 50 years ago in 1967. Heart transplantation has now entered an era of tremendous growth and innovation. The future of heart transplantation is bright with the advent of newer immunosuppressive medications and strategies that may even result in tolerance. Much of this progress in heart transplant medicine is predicated on a better understanding of acute and chronic rejection pathways through basic science studies. The future will also include personalized medicine where genomics and molecular science will dictate customized treatment for optimal outcomes...
January 2018: Annals of Cardiothoracic Surgery
Christopher W White, Simon J Messer, Stephen R Large, Jennifer Conway, Daniel H Kim, Demetrios J Kutsogiannis, Jayan Nagendran, Darren H Freed
Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD) have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement...
2018: Frontiers in Cardiovascular Medicine
Abbas Rana, Rohini R Sigireddi, Karim J Halazun, Aishwarya Kothare, Meng-Fen Wu, Hao Liu, Michael L Kueht, John M Vierling, Norman L Sussman, Ayse L Mindikoglu, Tamir Miloh, N Thao N Galvan, Ronald T Cotton, Christine A O'Mahony, John A Goss
BACKGROUND: An index that predicts liver allograft discard can effectively grade allografts and can be used to preferentially allocate marginal allografts to aggressive centers. AIM: to devise an index to predict liver allograft discard using only risk factors available at the time of initial DonorNet offer. METHODS: Using univariate and multivariate analyses on a training set of 72,297 deceased donors, we identified independent risk factors for liver allograft discard...
February 26, 2018: Transplantation
Shaifali Sandal, Xun Luo, Allan B Massie, Steven Paraskevas, Marcelo Cantarovich, Dorry L Segev
Background: The use of machine perfusion (MP) in kidney transplantation lowers delayed graft function (DGF) and improves 1-year graft survival in some, but not all, grafts. These associations have not been explored in grafts stratified by the Kidney Donor Profile index (KDPI). Methods: We analyzed 78 207 deceased-donor recipients using the Scientific Registry of Transplant Recipients data from 2006 to 2013. The cohort was stratified using the standard criteria donor/expanded criteria donor (ECD)/donation after cardiac death (DCD)/donation after brain death (DBD) classification and the KDPI scores...
February 20, 2018: Nephrology, Dialysis, Transplantation
Ilker Iskender, Marcelo Cypel, Tereza Martinu, Manyin Chen, Jin Sakamoto, Hyunhee Kim, Keke Yu, Huiqing Lin, Zehong Guan, Kohei Hashimoto, Thomas K Waddell, Mingyao Liu, Shaf Keshavjee
BACKGROUND: Ischemia-reperfusion injury related to lung transplantation is a major contributor to early postoperative morbidity and mortality. We hypothesized that donation after cardiac death donor lungs experience warm ischemic conditions that activate different injurious mechanisms compared with donor lungs that undergo prolonged cold ischemic conditions. METHODS: Rat donor lungs were preserved under different cold ischemic times (CIT: 12 hours or 18 hours), or under warm ischemia time (WIT: 3 hours) after cardiac death, followed by single left lung transplantation...
February 20, 2018: Transplantation
A Vileito, M J Siebelink, A A E Verhagen
AIM: Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population. METHODS: PubMed, Web of Science, Embase and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates...
February 22, 2018: Acta Paediatrica
M Barber Ansón, A N García Herrera, J Roldán Ramírez, M Loinaz Bordonabe, O Agudo Pascual, I Osés Munarriz
Donation after circulatory death (Maastricht type III donation) or controlled cardiac death refers to the retrieval of organs for transplantation purposes following death confirmed using circulatory criteria after the withdrawal of life support. The persistent shortfall in organ availability has prompted the development of donation programs following circulatory death for lung transplantation. The combined thorax-abdomen extraction in these cases is carried out in only twelve centres in Spain, while the combined use of abdominal normothermic regional perfusion (NRP) is even more exceptional...
February 21, 2018: Anales del Sistema Sanitario de Navarra
Helena Grufman, Troels Yndigegn, Isabel Gonçalves, Jan Nilsson, Alexandru Schiopu
BACKGROUND AND AIMS: IL-27 is an immunoregulatory cytokine belonging to the IL-6/IL-12 family that was found to be elevated in acute coronary syndrome (ACS) patients. We investigated whether IL-27 is related to post-ischemic cardiac remodeling and long-term prognosis in this patient group. METHODS: We included 524 ACS patients, defined as acute myocardial infarction (AMI) or unstable angina (UA). A subgroup of 107 patients donated blood samples 6 weeks after the index event, and underwent a follow-up echocardiographical examination at 1 year...
February 7, 2018: Cytokine
Q Tai, W Xue, X Ding, P Tian, H Xiang, X Feng, H Yan, J Hou
BACKGROUND: Donation after cardiac death is the only source of the deceased donor in China at present. Hypothermic machine perfusion has been used increasingly over the years. We determined the hypothermic machine perfusion parameters associated with early transplant outcomes based on the expanded criteria donor (ECD) designation. METHODS: There were 446 consecutive kidneys donated after cardiac death and preserved by hypothermic machine perfusion (LifePort) in our center that were included in this study...
January 2018: Transplantation Proceedings
J X Tang, N Na, J J Li, L Fan, R H Weng, N Jiang
BACKGROUND: Controlled donation after cardiac death (CDCD) is increasingly common for liver transplantation due to donor shortage. However, the outcomes, in terms of grafts and recipients, remain unclear. The current study is a systematic review and meta-analysis that compared CDCD with donation after brain death (DBD). METHODS: We conducted an electronic search of MEDLINE, EMBASE, and the Cochrane Database (from January 2007 to May 2017). Studies reporting Maastricht category III or IV CDCD liver transplantation were screened for inclusion...
January 2018: Transplantation Proceedings
T Yunhua, Z Qiang, J Lipeng, H Shanzhou, Z Zebin, J Fei, Z Zhiheng, W Linhe, J Weiqiang, W Dongping, G Zhiyong, H Xiaoshun
BACKGROUND: The incidence of end-stage renal disease (ESRD) after liver transplant (LT) has increased. The actual benefit of kidney transplantation (KT) is not completely understood in LT recipients with ESRD. METHODS: We analyzed Scientific Registry of Transplant Recipients data for all KT candidates with prior LT from 1998 to 2014; the benefits of KT relative to remaining on dialysis were compared by means of multivariate Cox proportional hazards regression analysis...
January 2018: Transplantation Proceedings
Kristopher P Croome, Amit K Mathur, David D Lee, Adyr A Moss, Charles B Rosen, Julie K Heimbach, C Burcin Taner
INTRODUCTION: As the population in the United States continues to age, an increase in the number of potential DCD donors with advanced chronological age can be expected. The aim of this study was to analyze a multi-institutional experience in liver transplantation using DCD donor age ≥50 years. METHODS: All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Rochester and Mayo Clinic Arizona from 2002-2016 were included. Recipients of DCD LT were divided into 2 groups: those with donor age ≥50 years(N=155) and those with donor age <50 years(N=316)...
January 31, 2018: Transplantation
Jaskiran K Sandha, Christopher W White, Alison Müller, Emma Avery, James Thliveris, Ian M C Dixon, Rakesh C Arora, Ganghong Tian, Larry V Hryshko, Jayan Nagendran, Darren H Freed
BACKGROUND: Normothermic ex vivo heart perfusion (EVHP) has been shown to improve the preservation of hearts donated after circulatory arrest and facilitate clinical successful transplantation. Steroids are added to the perfusate solution in current clinical EVHP protocols; however, the impact of this approach on donor heart preservation has not been previously investigated. We sought to determine the impact of steroids on the inflammatory response and development of myocardial edema during EVHP...
January 27, 2018: Annals of Thoracic Surgery
Xingyu Wang, Roumen Parapanov, Cyril Francioli, Jean Yannis Perentes, Igor Letovanec, Michel Gonzalez, Christian Kern, Hans-Beat Ris, Lise Piquilloud, Carlo Marcucci, Thorsten Krueger, Lucas Liaudet, Fabrizio Gronchi
OBJECTIVES: Volatile anaesthetics can provide significant protection against reperfusion injury in various experimental settings. The aim of this study was to assess the potential of sevoflurane treatment, the most commonly used volatile anaesthetic in modern anaesthesia, in rat lungs donated after circulatory death and reconditioned in an ex vivo lung perfusion (EVLP) system. METHODS: Fifteen rats were sacrificed and divided into 3 groups. In the control and sevoflurane groups, the heart-lung blocks were exposed to 1 h of warm ischaemia and 2 h of cold ischaemia and were mounted on an EVLP circuit for 3 h, in the absence or in the presence of 2% sevoflurane...
January 24, 2018: Interactive Cardiovascular and Thoracic Surgery
Ioannis Dimarakis, Nicholas R Banner, Sally Rushton, Ha Sum Esther Wong, Marius Berman, Neil Howell, John Payne, John Dark, Jenny Mehew, Rajamiyer Venkateswaran
OBJECTIVES: The optimum time after brainstem death (BSD) at which to assess the function of donor hearts is unknown. We hypothesized that a longer interval may be associated with a higher transplantation rate due to improved function. METHODS: Data were obtained from the UK Transplant Registry for the period between April 2010 and March 2015. The time when fixed dilated pupils were first noted in the donor was considered as the time of BSD. Retrieval was defined as the time when the abdominal organs were surgically perfused...
January 22, 2018: European Journal of Cardio-thoracic Surgery
Tomasz Kłosiewicz, Mateusz Puślecki, Marcin Zieliński, Michał Mandecki, Marcin Ligowski, Sebastian Stefaniak, Marek Dąbrowski, Marek Karczewski, Łukasz Gąsiorowski, Maciej Sip, Agata Dąbrowska, Wojciech Telec, Bartłomiej Perek, Marek Jemielity
The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition...
December 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Marit Kalisvaart, Andrea Schlegel, Ilaria Umbro, Jubi E de Haan, Irene Scalera, Wojciech G Polak, Jan Nm IJzermans, Darius F Mirza, M Thamara Pr Perera, John I Isaac, James Ferguson, Anna Paola Mitterhofer, Jeroen de Jonge, Paolo Muiesan
BACKGROUND: Acute kidney injury (AKI) is a common complication after liver transplantation and more frequently observed when high-risk grafts, such as DCD grafts are used. Our aim was to investigate the impact of the ischemia periods on development of AKI in DCD liver transplantation. METHODS: We performed a 2-center retrospective study with 368 DCD graft-recipients. Donor warm ischemia time (DWIT) was divided into agonal phase (withdrawal of life-support - cardiac arrest) and asystolic phase (cardiac arrest - start cold perfusion)...
January 11, 2018: Transplantation
Anastasio Salazar-Bañuelos, Mauricio Monroy-Cuadros, Hoover Henriquez-Cooper
BACKGROUND: Minimizing ischemia is paramount in the procurement of kidneys for transplantation. A fast cooling and expeditious removal is ideal to minimize damage from warm ischemia, however, since the removal of kidneys is delayed in cadaver donation until all other organs are harvested, the risk of kidney damage increases due to contact with the warmer soft body tissues. Surgical techniques that expedite organ retrieval were developed to avoid organ damage. METHODS: We test a modification of Thomas Starzl's improved technique for multi-organ harvesting by interposing an ice bag between the posterior aspect of the kidney and the psoas muscle in a randomized trial with 21 multi-organ cadaver donors...
January 4, 2018: American Journal of Surgery
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