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Extended criteria grafts

P García, M Huerfano, M Rodríguez, A Caicedo, F Berrío, C Gonzalez
BACKGROUND: Renal transplantation is the best treatment for end stage renal disease. Acute graft rejection is one of the main complications and may influence graft survival. OBJECTIVE: To determine the incidence and features of acute cellular rejection (ACR) episodes confirmed by biopsy. METHODS: We studied a cohort of 175 patients who underwent renal transplantation between 2004 and 2012 to determine the cumulative incidence of ACR confirmed by biopsy and to identify the associated risk factors using multivariate analysis...
2016: International Journal of Organ Transplantation Medicine
Thomas Kerforne, Frédéric Favreau, Raphaël Thuillier, Thierry Hauet, Michel Pinsard
The increased number of patients in waiting list for renal transplantation requires the establishment of recommendations regarding graft preservation techniques. The preservation method impacts graft function and survival particularly in case of extended criteria donors. Based on our experience, the aim of this review is to establish a decisional diagram to draw graft management to 5years in relation to donor type and graft quality. Novel biomarkers are necessary to evaluate graft quality. Nuclear magnetic resonance or transcriptomic analyses are promising...
October 3, 2016: Néphrologie & Thérapeutique
Kayvan Mohkam, Benjamin Darnis, Jean-Yves Mabrut
Porcine models of extended hepatectomy and liver transplantation (LT) of reduced graft have been widely used for studying the small-for-size (SFS) syndrome and the various modalities of portal inflow modulation (PIM). However, considerable heterogeneity exists among the studies and their results. The aim of this review was to assess the main advantages and drawbacks of the different porcine models of SFS LT and SFS hepatectomy, and propose a standardized anatomical nomenclature for the various models. The MEDLINE database was searched for articles reporting porcine models of reduced graft LT or hepatectomy of more than 65%...
October 6, 2016: Journal of Hepato-biliary-pancreatic Sciences
M Rayar, G B Levi Sandri, C Cusumano, C Locher, P Houssel-Debry, C Camus, N Lombard, V Desfourneaux, M Lakehal, B Meunier, L Sulpice, K Boudjema
During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia-reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECD). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLT performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group)...
October 5, 2016: Liver Transplantation
Elisabetta Loggi, Fabio Conti, Alessandro Cucchetti, Giorgio Ercolani, Antonio Daniele Pinna, Pietro Andreone
The scarcity of available organs and the gap between supply and demand continue to be the main limitations of liver transplantation. To relieve the organ shortage, current transplant strategies have implemented extended criteria, which include the use of liver from patients with signs of past or present hepatitis B virus (HBV) infection. While the use of liver grafts from donors with evidence of past HBV infection is quite limited, some data have been collected regarding the feasibility of transplanting a liver graft from a hepatitis B surface antigen (HBsAg) positive donor...
September 21, 2016: World Journal of Gastroenterology: WJG
Francesca M Dimou, Hemalkumar B Mehta, Deepak Adhikari, Robert C Harland, Taylor S Riall, Yong-Fang Kuo
BACKGROUND: Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. METHODS: The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014)...
August 20, 2016: Surgery
Somak Das, Sudeepta Kumar Swain, Pavan Kumar Addala, Ramakrishnan Balasubramaniam, C V Gopakumar, Dinesh Zirpe, Kirubakaran Renganathan, Harsha Kollu, Darshan Patel, Bipin B Vibhute, Prashantha S Rao, Elankumaran Krishnan, Mahesh Gopasetty, Anand K Khakhar, Anil Vaidya, Anand Ramamurthy
BACKGROUND: Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF)...
August 19, 2016: Progress in Transplantation
Sebastian Pratschke, Hannah Arnold, Alfred Zollner, Michael Heise, Andreas Pascher, Peter Schemmer, Marcus N Scherer, Andreas Bauer, Karl-Walter Jauch, Jens Werner, Markus Guba, Martin K Angele
BACKGROUND: Organ shortage results in the transplantation of extended donor criteria (EDC) livers which is associated with increased ischemia-reperfusion injury (IRI). Experimental studies indicate that an organ rinse with the calcineurin inhibitor tacrolimus before implantation protects against IRI. The tacrolimus organ perfusion study was initiated to examine the effects of ex vivo tacrolimus perfusion on IRI in transplantation of EDC livers. METHODS: A prospective randomized multicenter trial comparing ex vivo perfusion of marginal liver grafts (≥2 EDC according to Eurotransplant manual) with tacrolimus (20 ng/mL) or histidine-tryptophane-ketoglutarate solution (control) was carried out at 5 German liver transplant centers (Munich Ludwig-Maximilians University, Berlin, Heidelberg, Mainz, Regensburg) between October 2011 and July 2013...
June 2016: Transplantation Direct
Jaime Penchyna Grub, Enrique Ortíz Hernández, Gustavo Teyssier Morales, Ivan Rivas Rivera, Diego Preciado, Hiram Álvarez-Neri
BACKGROUND AND OBJECTIVE: Severe laryngotracheal stenosis in childhood poses a complex surgical challenge for specialists in airway surgery. Patients with severe subglottic stenosis with vocal cord involvement are particularly difficult to manage successfully. The goal of this work was to review our experience with extended CTR in a cohort of young children with severe SGS and determine which clinical parameters would be associated with surgical success. METHODS: Retrospective analysis of the outcome of consecutive patients with severe glottic-subglottic stenosis submitted to an extended double-stage CTR between 2004 and 2014 at a large tertiary referral center...
September 2016: International Journal of Pediatric Otorhinolaryngology
Ana K Islam, Richard J Knight, Wesley A Mayer, Adam B Hollander, Samir Patel, Larry D Teeter, Edward A Graviss, Ashish Saharia, Hemangshu Podder, Emad H Asham, A Osama Gaber
Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0...
2016: Journal of Transplantation
Giuliano Bolondi, Federico Mocchegiani, Roberto Montalti, Daniele Nicolini, Marco Vivarelli, Lesley De Pietri
Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff...
July 14, 2016: World Journal of Gastroenterology: WJG
Matteo Ravaioli, Gennaro Grande, Paolo Di Gioia, Alessandro Cucchetti, Matteo Cescon, Giorgio Ercolani, Massimo Del Gaudio, Cristina Morelli, Antonio D Pinna
OBJECTIVES: To evaluate the risk avoidance policy at liver transplant centers. BACKGROUND: Transplant center improvements have extended the indications for the sickest patients and the use of extended criteria donors (ECD). This may result in lower survival, perhaps paradoxically discouraging transplant centers from these procedures. We evaluated the outcome of recipients or donors refused by other transplant centers and transplanted by our transplant unit without risk avoidance policy...
July 15, 2016: Annals of Surgery
Viviane S Tabar
INTRODUCTION: Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting a million people in the United States alone. The advent of deep brain stimulation (DBS) has made a significant impact on the quality of life of a subset of patients. However, reconstruction of basal ganglia circuitry remains an ultimate goal that stands a better chance of addressing various aspects of the disease in a permanent and sustained manner. METHODS: Our team has developed robust protocols for the derivation of dopamine (DA) neurons from human embryonic stem cells (ES)...
August 2016: Neurosurgery
Jule Pinter, Camilla S Hanson, Jonathan C Craig, Jeremy R Chapman, Klemens Budde, Fabian Halleck, Allison Tong
BACKGROUND: Kidney transplantation offers improved survival and quality of life to an increasing number of elderly patients with end-stage kidney disease. However, elderly kidney transplant recipients may face unique challenges due to a higher burden of comorbidity, greater cumulative risk of immunosuppression-related complications and increasing frailty. We aimed to describe the perspectives of elderly kidney transplant recipients. METHODS: Electronic databases were searched to April 2015...
September 2016: Nephrology, Dialysis, Transplantation
N Morito, H Obara, N Matsuno, S Enosawa, K Watanabe, M Furukori, H Furukawa
INTRODUCTION: Machine perfusion (MP) is particularly expected to preserve and resuscitate an organ obtained from extended criteria donors or donation after cardiac death to expand the donated organ pool for organ transplantation. This method requires to be investigated an optimal preservation condition. The aim of this study is investigation of the optimal oxygenation conditions under rewarming MP (RMP). METHODS: Porcine livers were perfused with an RMP system developed by our research group...
May 2016: Transplantation Proceedings
Christian Denecke, Matthias Biebl, Josef Fritz, Andreas Brandl, Sascha Weiss, Tomasz Dziodzio, Felix Aigner, Robert Sucher, Claudia Bösmüller, Johann Pratschke, Robert Öllinger
BACKGROUND In kidney transplantation, the association of cold ischemia time (CIT), anastomosis time (AT), and delayed graft function (DGF) is particularly detrimental in grafts from marginal donors; however, actual cut-off criteria are still debated. MATERIAL AND METHODS Data from patients >65 years (n=193) and patients <65 years (n=1054) transplanted between 2000 and 2010 were retrospectively analyzed regarding the age-dependent impact of ischemia times and DGF. RESULTS Overall death censored graft survival was inferior for ECD/DCD organs...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
D Jung, S Park, S H Kim, M Eom, J S Kim, J W Yang, B G Han, S O Choi
BACKGROUND: The utilization of expanded-criteria donors (ECDs) has increased to overcome donor shortages. Unfortunately, the discard rate has also increased, especially in ECDs with acute kidney injury (AKI). We evaluated the outcomes of kidney transplantation in ECDs and standard-criteria donors (SCDs) with and without AKI. METHODS: We reviewed the medical records of patients who underwent kidney transplantation. We used the AKI definition published by the Kidney Disease: Improving Global Outcomes group and reviewed the demographic characteristics of donors and recipients...
April 2016: Transplantation Proceedings
S Florman, T Becker, B Bresnahan, A Chevaile-Ramos, D Carvalho, G Grannas, F Muehlbacher, P J O'Connell, U Meier-Kriesche, C P Larsen
The phase III BENEFIT-EXT study compared more-intensive (MI) or less-intensive (LI) belatacept-based immunosuppression with cyclosporine (CsA)-based immunosuppression in recipients of extended-criteria donor kidneys. In this post-hoc analysis, patient outcomes were assessed according to donor kidney subtype. In total, 68.9%, 10.1%, and 21.0% of patients received an expanded-criteria donor kidney (United Network for Organ Sharing [UNOS] definition), donation after cardiac death (DCD) kidney, or a kidney with an anticipated cold ischemic time ≥24 h, respectively...
May 27, 2016: American Journal of Transplantation
P Battaglia, M Turri-Zanoni, F De Bernardi, P Dehgani Mobaraki, A Karligkiotis, F Leone, P Castelnuovo
Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect...
June 2016: Acta Otorhinolaryngologica Italica
Piotr Gabryel, Cezary Piwkowski, Paweł Zieliński, Wojciech Dyszkiewicz
Video-assisted thoracic surgery (VATS) lobectomy has been proven to be a safe operation associated with a low complication rate and good long-term results comparable to those obtained by the thoracotomy approach. During the development of thoracoscopic anatomical lung cancer resections, eligibility criteria for the operation have been gradually extended. Currently, even as complicated cases as bronchial and vascular sleeve resections or pneumonectomies are being performed by VATS. However, minimally invasive surgery after previous coronary artery bypass graft surgery merits special consideration due to the consequences of potential injury to the bypass graft...
March 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
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