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Objective To explore the clinical efficacy of marginal liver from elderly donors in liver transplantation. Methods According to the inclusion and exclusion criteria, the clinical data of 127 donors and recipients were retrospectively analyzed. According to the age of donors, 127 donors were divided into the elderly group (n=27) and control group (n=100). The recovery of liver function, the occurrence of postoperative complications and survival rate of the recipients after transplantation were statistically analyzed between two groups. Results The incidence of primary nonfunction (PNF) and initial poor graft function (IPGF) did not significantly differ between the elderly and control groups (both P > 0.05). Within postoperative 2 weeks, the average levels of alanine aminotransferase (ALT) and serum total bilirubin (TB) of liver transplant recipients in the elderly group was not significantly different from those in the control group (both P > 0.05). There was no significant difference in the incidence of postoperative complications in the postoperative elderly group compared with the control group (all P > 0.05). The 1-and 3-year survival rates of the recipients in the elderly group were 84% and 78% respectively, which did not significantly differ from 89% and 79% in the control group (both P > 0.05). Conclusions Strict and sufficient quality evaluation and functional maintenance should be done for elderly donor livers. It can achieve good transplantation results by intraoperative fine operation, reducing bleeding and trauma, shortening the time of cold ischemia and operation, strengthening postoperative monitoring and implementing enhanced recovery after surgery.
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Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.
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A disfunção precoce do enxerto é descrita como mau funcionamento inicial, função marginal ou retardo na função e incide entre 7% e 27% dos pacientes transplantados de fígado. A não função primária é a perda do enxerto e incide entre 1,4% e 8,4% nessa população. O presente estudo foi conduzido para analisar fatores de risco para disfunção e para não função primária de fígados transplantados. Foram pesquisados fatores do doador, do enxerto, do paciente e da logística do transplante. Trata-se de um estudo epidemiológico, tipo coorte histórica conduzido com 180 prontuários de pacientes transplantados e admitidos na Unidade de Terapia Intensiva, cujos doadores estavam em morte encefálica. Todos os transplantes foram realizados no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil, entre 2012 e 2018. Análises estatísticas descritiva, bivariada e multivariada foram realizadas usando o método de Kaplan-Meier e o teste Log-rank. Associação entre os fatores de risco e os desfechos foi estabelecida aplicando a regressão de Cox e o processo de seleção Backward, ajustada pelo Hazard ratio. Verificou-se que os receptores de fígado tinham idade média de 52,1 anos; em sua maioria homens brancos. As indicações do transplante foram: doença alcoólica, 31,7%; doença metabólica e Hepatite viral, 26,1%; tumor, 22,2%; doença colestática, 17,8% e doença vascular, 2,8%. Índice de Massa Corporal igual ou superior a 30 kg/m² foi encontrado em 3,9%. O escore médio do Model for End-Stage Liver Disease foi de 23 e a creatinina sérica média foi de 1,35mg/dl. Em relação aos doadores, a idade média foi de 37,6 anos, sendo 39,4% do sexo feminino. As causas da morte encefálica foram acidente vascular cerebral em 86 (47,8%), traumatismo craniano em 77 (42,8%) e por outras causas 17 (9,4%). A aspartato aminotransferase foi, em média, 77,20 UI/L, a alanina aminotransferase foi, em média, 60,42 UI/L. Sódio sérico >160 mmol/l ocorreu em 18,6% e a Gamaglutamiltransferase média foi de 77 UI/L. O Índice de Risco do Doador médio foi de 1,476. Quanto ao enxerto verificou-se que sua origem foi local em 37,8%; regional, em 56,7% e nacional, em 5,5% dos casos. O tempo de isquemia fria (>10 horas) ocorreu em 58 (32,2%). O tempo de isquemia quente (> 60 minutos) ocorreu em 14 (9,9%) % dos transplantes e o tempo médio da cirurgia do receptor foi de 6,1 horas. Estes receberam, em média, 4 U de plaquetas e 5 (2.8%) receberam Plasma Fresco Congelado > 30U. O Equilíbrio do Risco médio foi de 10. A evolução clínica9 normal ocorreu em 66 (36,7%) dos pacientes. A disfunção precoce do enxerto foi identificada em 104 (57,8%) e a não função primária em 10 (5,5%). Encontrou-se que o doador do sexo feminino, o tempo de isquemia quente do enxerto superior a 60 minutos e o consumo de Plasma Fresco Congelado > 30 U pelo receptor, constituem risco aumentado para disfunção precoce do enxerto nesta amostra. O fator de risco para a não função primária foi o volume de plaquetas consumido pelo receptor. O controle desses fatores de risco contribui para a função adequada do fígado após o transplante e melhora da sobrevida dos enxertos e dos pacientes.
Early graft dysfunction is described as initial malfunction, marginal function or delayed function, and it affects between 7% and 27% of liver transplant patients. The primary nonfunction is graft loss, and it affects between 1.4% and 8.4% of this population. The present study was conducted to analyze risk factors for dysfunction and non-primary function of transplanted livers. Donor, graft, patient, and transplant logistics factors were researched. This is an epidemiological study, with a historical cohort conducted with 180 medical records of transplanted patients admitted to the Intensive Care Unit, whose donors were brain dead. All transplants were performed at the Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil, between 2012 and 2018. Descriptive, bivariate, and multivariate statistical analyzes were performed using the Kaplan-Meier method and the Log-rank test. Association between risk factors and outcomes was assessed by Cox regression and the Backward selection process, adjusted by the Hazard ratio. The liver receptors were mostly white males with an average age of 52.1 years. Transplant indications were: alcoholic disease, 31.7%; metabolic disease and viral hepatitis, 26.1%; tumor, 22.2%; cholestatic disease, 17.8% and vascular disease, 2.8%. Body Mass Index equal to or greater than 30 kg / m² occurred 3.9%. The average score for the Model for End-Stage Liver Disease was 23, and the mean serum creatinine was 1.35mg / dl. Regarding donors, the average age was 37.6 years, with 39.4% being female. The causes of brain death were stroke in 86 (47.8%), head injury in 77 (42.8%), and for other causes in 17 (9.4%). Aspartate aminotransferase was, on average, 77.20 UI/L. Alanine aminotransferase was, on average, 60.42 UI/L. Serum sodium > 160 mmol/l occurred in 18.6%, and the mean Gamaglutamiltransferase was 77 IU / L. The average Donor Risk Index was 1.476. As for the graft, it was found that its origin was local in 37.8%; regional, in 56.7%; and national, in 5.5% of cases. The cold ischemia time (> 10 hours) occurred in 58 (32.2%), the warm ischemia time (> 60 minutes) occurred in 14 (9.9%) of the transplants. The average time of the recipient's surgery was 6.1 hours, who received 4 U of platelets on average. 5 (2.8%) received fresh frozen plasma > 30 U. The average Balance of risk was 10. The normal clinical evolution occurred in 66 (36.7%) of the patients. Early graft dysfunction occurred in 104 (57.8%), and primary non-function in 10 (5.5%). The risk factors for early graft dysfunction were the female donor, the graft warm ischemia time greater than 60 minutes, and the11 consumption of fresh frozen plasma > 30 U by the recipient. The risk factor for primary nonfunction was the volume of platelets consumed by the recipient. The control of these risk factors contributes to the adequate function of the liver after transplantation and to improve grafts and patient's survival
Subject(s)
Humans , Male , Adult , Liver Transplantation , Primary Graft Dysfunction/prevention & control , Liver Diseases , Intensive Care Units , LiverABSTRACT
Objective To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis. Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models. Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF. Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc.
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Objective To evaluate the effect of hypothermia status in the donors upon the renal graft function after renal transplantation from donation after citizen's death. Methods Thirty-six eligible donors were randomly divided into the normal temperature (body temperature 36.5-37.5 ℃ , n=19) and hypothermia groups (body temperature 34.0-35.0 ℃ , n=17). The matched recipients undergoing renal transplantation were also assigned into the normal temperature (n=38) and hypothermia groups (n=34). Perioperative conditions of the donors and recipients were compared between two groups. And postoperative renal graft function of the recipients were statistically compared between two groups, including the incidence of delayed graft function (DGF) and primary nonfunction (PNF). Results No statistical significance was identified in the perioperative amount of urine volume, serum creatinine (Scr), systolic blood pressure, saturation oxygen, warm ischemia time and cold ischemia time of the donors between two groups (all P>0.05). No statistical significance was noted in terms of the operation time, intraoperative mean blood glucose and intraoperative mean arterial pressure of the recipients between two groups (all P>0.05). Postoperative incidence of DGF of the recipients in the hypothermia group was 6%, significantly lower than that in the normal temperature group (24%) (χ2=4.393, P=0.036). Postoperative incidence of PNF of the recipients was 3% in both the hypothermia and normal temperature groups with no statistical significance (χ2=0.000, P=1). Conclusions The hypothermia status of the donors can significantly reduce the incidence of DGF, whereas exerts no evident effect upon the incidence of PNF in the recipients.
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There is a persistent shortage of allografts available for transplantation, so we envisioned using non-heart beating donation to expand the donor pool. Non-heart beating donors (NHBD) were categorized using four definitions. Controlled donors, consisting of categories III and IV, are the most suitable for NHBD. Delayed graft function is associated with the use of kidneys from such donors, but had no difference on graft survival in the long-term results compared with heart beating donors. The proportion of NHBD of deceased donors differs considerably among countries, but national programs in many nations have now been initiated to increase the rate of non-heart beating donation. In most cases, the organs from NHBD are not available for transplantation in Korea because of legal restrictions. The use of controlled NHBD is encouraged to expand available allografts in Korea, due to the shortage of such allografts
Subject(s)
Humans , Delayed Graft Function , Graft Survival , Heart , Kidney , Korea , Tissue Donors , Transplantation, Homologous , Transplants , Warm IschemiaABSTRACT
Primary non-function (PNF) after liver transplantation has been found to be the most common cause of early graft loss, which accounts for up to 36% of such failures. The cause of PNF is not known. The purpose of this study was to identify factors associated with and independently predictive of PNF after liver transplantation. Four hundreds twenty-four liver transplants performed at the Charles O. Strickler Transplant Center, University of Virginia were retrospectively reviewed. PNF was defined as the failure of an allograft after revascularization with no discernable cause, leading either to retransplantation or to patient death. Risk factors were analyzed using the Pearson chi-square test for univariate analysis and logistic regression for multivariate analysis. Factors found to be associated with PNF included: female recipient (6.4% vs. 2.6%, p=0.045), African-American donor (9.5% vs. 3.2%, p=0.043), inter-racial donor to recipient transplantation (9.5% vs. 2.8%, p=0.008), severe encephalopathy pretransplant (11.1% vs. 3.1%, p=0.034), pretransplant recipient PTT > 50 seconds (10.9% vs. 2.8%, p=0.004), portal vein reconstruction with conduit (15.0% vs. 3.5%, p=0.011), and downsizing of graft (22.9% vs. 3.8%, p=0.007). Logistic regression identified the use of donor iliac vein conduit for the portal vein reconstruction (p=0.003, odds ratio=3.15, 95% confidence interval: 1.49-6.64) and the racial difference between donor and recipient (p=0.012, odds ratio=2.31, 95% confidence interval: 1.20- 4.45) to be independent predictors of PNF. The exact cause of these findings, whether physiologic or immunologic, remains unknown. If confirmed in larger data sets, the attention to these factors may minimize the possibility of PNF in non- emergency situations.