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Extended criteria grafts

Elisa Fiume, Jacopo Barberi, Enrica Verné, Francesco Baino
Nowadays, bioactive glasses (BGs) are mainly used to improve and support the healing process of osseous defects deriving from traumatic events, tumor removal, congenital pathologies, implant revisions, or infections. In the past, several approaches have been proposed in the replacement of extensive bone defects, each one with its own advantages and drawbacks. As a result, the need for synthetic bone grafts is still a remarkable clinical challenge since more than 1 million bone-graft surgical operations are annually performed worldwide...
March 16, 2018: Journal of Functional Biomaterials
B Palkoci, M Vojtko, J Fialová, D Osinová, M Lajčiaková
Background: Collection of kidneys from extended criteria donors (ECD) with diagnosed brain-death forms a part of the collection program that increases the number of transplantations. Objective: To compare the results of ECD with those of standard criteria donors (SCD). Methods: In a retrospective analysis in a group of 156 kidney donors, we identified ECD donors. We detected the basic parameters of the donors before kidney collection, and then evaluated the function of the graft, the survival of the graft, and the survival of the patients after 1, 3, and 5 years of transplantation...
2018: International Journal of Organ Transplantation Medicine
Felix Kork, Alexandra Rimek, Anne Andert, Niklas Jurek Becker, Christoph Heidenhain, Ulf P Neumann, Daniela Kroy, Anna B Roehl, Rolf Rossaint, Marc Hein
BACKGROUND: The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD). METHODS: In this single center retrospective analysis of 122 cadaveric LT recipients, we investigated predictors of postreperfusion syndrome (PRS) including transplant liver quality categorized by both histological assessment of steatosis and subjective visual assessment by the transplanting surgeon using multivariable regression analysis...
March 9, 2018: BMC Anesthesiology
Roberta Angelico, Alessandra Nardi, René Adam, Silvio Nadalin, Wojciech G Polak, Vincent Karam, Roberto Troisi, Paolo Muiesan
BACKGROUND: Split liver transplantation(SLT) has been widely adopted across Europe resulting in remarkable reduction of the paediatric waiting-list mortality. Left split graft(LSG) are commonly used for paediatric recipients, however deceased donor criteria selection aren't universal. METHOD: The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors of graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed...
March 5, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Maria Monteagudo Vela, Diana García Sáez, Andre R Simon
Fifty years after the first successful heart transplantation, despite multiple advances in the treatment of advanced acute and chronic heart failure, there is still no equivalent to heart transplantation as a long-term treatment for end-stage heart failure. Transplantation is, however, limited by the scarcity and quality of heart allografts. Donors are nowadays significantly older, particularly in European countries, and traumatic head injury as the cause of death has been replaced by intracerebral hemorrhage or hypoxic brain damage in the majority of cases...
January 2018: Annals of Cardiothoracic Surgery
Michael J Englesbe
In this issue of AJT, Querard et al. estimate the population average effect of graft loss of an Extended Criteria Donor (ECD) kidney compared to Standard Criteria Donor (SCD) kidney (1). This manuscript can be best summarized as… "Maybe ECD kidneys aren't as bad as I thought?" The well-established hazard ratio (HR) for graft loss associated with an ECD kidney, compared to an SCD kidney, is 1.7 (2). This number is derived from the standard population-based survival analysis in which relevant donor and recipient covariates are included in a Cox proportional hazards model...
February 25, 2018: American Journal of Transplantation
L Rostaing
Renal transplantation is the best option for patients with end stage renal failure, since it significantly improves their duration and quality of life. The number of patients waiting for a kidney transplant continues to increase while the overall rate of organ procurement in France is stable. The graft shortage is worsening, as is the waiting time on list. Identifying the causes of this crisis and discussing the various options for addressing the kidney graft shortage is the aim of this talk. Among the solutions: (i) improving identification of potential donors through a national and hospitals policy to promulgate organ donation and understanding better the grounds for refusal; (ii) using infusion machines for all grafts with extended criteria; (iii) developing transplantation programs from deceased donors after cardiac arrest; (iv) developing transplantation programs from living donors...
June 2017: Néphrologie & Thérapeutique
Sander Florman, Flavio Vincenti, Antoine Durrbach, Marwan Abouljoud, Barbara Bresnahan, Valter Duro Garcia, Laura Mulloy, Kim Rice, Lionel Rostaing, Carlos Zayas, Kellie Calderon, Ulf Meier-Kriesche, Martin Polinsky, Lingfeng Yang, Jose Medina Pestana, Christian P Larsen
Clinical outcomes are generally worse for black versus non-black renal allograft recipients. In BENEFIT and BENEFIT-EXT, recipients were randomized to belatacept more-intense-based, belatacept less-intense-based, or cyclosporine-based immunosuppression. At year 7, belatacept was associated with superior graft survival versus cyclosporine in BENEFIT (recipients of living or standard criteria deceased donor kidneys); belatacept was associated with similar graft survival versus cyclosporine in BENEFIT-EXT (recipients of extended criteria donor kidneys)...
February 20, 2018: Clinical Transplantation
Alireza Atashi, Ilona W Verburg, Hesam Karim, Mirmohammad Miri, Ameen Abu-Hanna, Evert de Jonge, Nicolette F de Keizer, Saeid Eslami
INTRODUCTION: ICU Length of stay (LoS) prediction models are used to compare different institutions and surgeons on their performance, and is useful as an efficiency indicator for quality control. There is little consensus about which prediction methods are most suitable to predict (ICU) length of stay. The aim of this study is to systematically review models for predicting ICU LoS after coronary artery bypass grafting and to assess the reporting and methodological quality of these models to apply them for benchmarking...
February 8, 2018: Journal of Cardiovascular Surgery
Andrea Proneth, Andreas A Schnitzbauer, Peter Schenker, Andreas Wunsch, Falk Rauchfuss, Helmut Arbogast, Steffen Manekeller, Silvio Nadalin, Michael Heise, Michael A Ströhlein, Bernhard Banas, Peter Schemmer, Thomas Becker, Wolf O Bechstein, Andreas Pascher, Richard Viebahn, Edward K Geissler, Hans J Schlitt, Stefan A Farkas
BACKGROUND: Pancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age 50-60 years or BMI 30-34kg/m). METHODS: Utilization of EDC organs required the implementation of a new allocation system within Eurotransplant...
February 5, 2018: Transplantation
F H Peng, J J Chen, L K Peng, X B Xie, G B Lan, S J Yu, Y Wang, X T Tang, H L Dai, C Gao, C H Fang
Objective: To summarize the clinical data of pre-implantation biopsy donors in our hospital and explore the clinical characteristics of those donors in pathological high-risk, and to provide references for the selective histological evaluation of extended criteria donor kidneys. Methods: We retrospectively reviewed the clinical data and pre-implantation renal pathologic score of donors from January 1, 2015 to May 1, 2017.During this period, 247 cases of donation after citizen's death (DCD) occurred.After clinical evaluation and selective machine perfusion( Lifeport) evaluation, 30 cases of pre-implantation pathological evaluation were performed...
January 16, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Karim Hamaoui, Sally Gowers, Bynvant Sandhu, Natalie Vallant, Terry Cook, Martyn Boutelle, Daniel Casanova, Vassilios Papalois
BACKGROUND: Hypothermic machine perfusion (HMP) is increasingly being used for extended criteria kidney grafts. Pancreatic HMP is challenging because physiologically the pancreas is a low-flow organ susceptible to edema. We report the successful development of preclinical HMP models using porcine pancreases, as well as human pancreases unsuitable for clinical transplantation. METHODS: Ten porcine pancreases were used in the development of these perfusion models...
January 8, 2018: Journal of Surgical Research
A H Querard, F Le Borgne, A Dion, M Giral, G Mourad, V Garrigue, L Rostaing, N Kamar, A Loupy, C Legendre, E Morelon, F Buron, Y Foucher, E Dantan
From a prospective and multicentric French cohort, we proposed an external validation study for the Expanded Criteria Donor (ECD), based on 4833 kidney recipients transplanted for the first time between 2000 and 2014. We estimated the subject-specific effect from a multivariable Cox model. We confirmed a 1.75-fold (95%CI from 1.53 to 2.00, p<0.0001) increase in graft failure risk if a given patient received an ECD graft compared to a graft from a donor with standard criteria (SCD). Complementarily, we estimated the population-average effect using propensity scores...
January 9, 2018: American Journal of Transplantation
Vikram Wadhera, Norifumi Harimoto, Nir Lubezky, Ilias Gomatos, Matias Facciuto, David Gonzalez, Ashley Stueck, Maria Isabel Fiel, Thomas Schiano, Marcelo E Facciuto
BACKGROUND: The utilization of extended criteria liver allografts (ECD) shortens time to transplantation. OBJECTIVE: To characterize the effect of liver allograft fibrosis on graft and patient survival after liver transplantation (LT), with particular attention to fibrosis progression. METHODS: Retrospective database search of donor and recipient liver allograft histology of liver transplants performed between 2007 and 2011. Donor and patient characteristics were analyzed...
January 3, 2018: Clinical Transplantation
Tiffany J Zens, Juan S Danobeitia, Glen Leverson, Peter J Chlebeck, Laura J Zitur, Robert R Redfield, Anthony M D'Alessandro, Scott Odorico, Dixon B Kaufman, Luis A Fernandez
INTRODUCTION: Renal transplant outcomes result from a combination of factors. Traditionally, donor factors were summarized by classifying kidneys as extended criteria or standard criteria. In 2014, the nomenclature changed to describe donor factors with the kidney donor profile index (KDPI). We aim to evaluate the relationship between KDPI and delayed graft function, and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD) ...
January 3, 2018: Clinical Transplantation
Syed Ali Husain, Mariana C Chiles, Samnang Lee, Stephen O Pastan, Rachel E Patzer, Bekir Tanriover, Lloyd E Ratner, Sumit Mohan
BACKGROUND AND OBJECTIVES: The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted...
January 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Viniyendra Pamecha, Deeplaxmi Purushottam Borle, Senthil Kumar, Kishore Gurumoorthy Subramanya Bharathy, Piyush Kumar Sinha, Shridhar Vasantrao Sasturkar, Vibuti Sharma, Chandra Kant Pandey, Shiv Kumar Sarin
BACKGROUND: Deceased donor liver transplant (DDLT) is an uncommon procedure in India. We present our experience of DDLT from a public sector teaching hospital. METHODS: A retrospective analysis of all DDLT was performed from April 2012 till September 2016. Demographics, intraoperative, donor factors, morbidity, and outcome were analyzed. RESULTS: During the study period, 305 liver transplants were performed, of which 36 were DDLT (adult 32, pediatric 4; 35 grafts; 1 split)...
November 29, 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Mathilde Lemoine, Dominique Guerrot, Dominique Bertrand
Due to the increase in life expectancy and the ageing of end-stage renal disease patients, the number of patients older than 65 years receiving a kidney transplant has been continuously growing over the last fifteen years. The benefits of renal transplantation compared to dialysis in terms of survival and quality of life have been shown in selected recipients over 65, or 70 years. However, the age remains the main limiting factor for the access to the waiting list, and the reluctance of the clinicians can be explained by the multiple comorbidities of these candidates, their limited life expectancy or the shortage of grafts...
November 21, 2017: Néphrologie & Thérapeutique
S A Townsend, M A Monga, P Nightingale, D Mutimer, A M Elsharkawy, A Holt
INTRODUCTION: Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist. METHODS: This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014...
November 2017: Transplantation Proceedings
Gerold Thölking, Katharina Schuette-Nuetgen, Thomas Vogl, Ulrich Dobrindt, Barbara C Kahl, Marcus Brand, Hermann Pavenstädt, Barbara Suwelack, Raphael Koch, Stefan Reuter
BACKGROUND: Urinary tract infection (UTI) is the most common infection after renal transplantation (RTx). Although female sex is a well-known risk factor for the development of UTI after RTx, the role of the donor sex in this context remains unclear. METHODS: In this case control study 6,763 RTx cases were screened for UTI when presenting at our transplant outpatient clinics. 102 different RTx patients fulfilled the inclusion criteria and were compared to 102 controls...
2017: PloS One
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