ABSTRACT
Although domino liver transplantation (LT) is an established procedure, data about the operative risks are limited. This study aimed at evaluating the operative risks of domino LT. Two retrospective analyses were conducted (comparison of familial amyloid polyneuropathy [FAP] liver donors [61 patients] vs. FAP nondonors [39 patients] and FAP liver recipients [61 patients] vs. deceased donor liver recipients [61 patients]). First analysis showed a 60-day mortality of 6.6% for FAP donors and 7.7% for FAP nondonors (p = 1.0). No patient developed primary graft nonfunction. Acute rejection was higher in FAP nondonors compared to FAP donors (38.5% vs. 13.1%). Both groups had similar vascular and biliary complication rates. ICU stay was similar, whereas total hospitalization was longer for FAP nondonors. Both groups had similar 1- and 5-year patient and graft survival rates (83.4% vs. 87.2%, and 79.8% vs. 71.8%, p = 0.7) and (83.3% vs. 87.2%, and 79.1% vs.71.8%, p = 0.7). The second analysis showed a 1.6% mortality for FAP liver recipients vs. 3.2% of the control group (p = 1). Both groups had similar morbidity and technical complication rates (18.0% vs. 13.1%, p = 0.45) and (0.18 vs. 0.15, p = 0.65). The domino procedure does not add any risk to FAP donor or recipient. It increases the organ pool allowing transplantation of marginal recipients who otherwise are denied deceased donor liver transplantation.
Subject(s)
Amyloid Neuropathies, Familial/surgery , Liver Transplantation/methods , Living Donors , Cadaver , Cohort Studies , Female , Humans , Liver Transplantation/mortality , Male , Middle Aged , Retrospective Studies , Survival Rate , Tissue and Organ HarvestingABSTRACT
Working with the recently available recombinant haplotypes of the rat major histocompatibility complex (MHC)--RT1, we investigated the effect of various types of blood transfusion (BT) on allograft prolongation, including blood identical for the whole RT1 haplotype with that of the donor or for only a part of it. One or two milliliters of donor blood significantly prolonged graft survival in the (LEW X BN)F1----LEW or the LEW X 1W----LEW X 1A combination. The optimal regimen consisted of two BTs given 15 and 7 days prior to grafting; BTs given at day -30 were ineffective. A BT given on the day of the operation was effective, but sequential BTs after grafting did not further increase graft survival. In the (LEW X BN)F1----LEW combination, blood from congenic LEW X 1N rats significantly prolonged graft survival, but third-party BTs were ineffective or had only a borderline effect when transfused (1 ml, 8 times) within the three months before transplantation. This showed the major role of the RT1 system as well as the specificity of the model. Although the survival of LEW X 1A heart grafts transplanted into LEW X 1W recipients could not be significantly prolonged by donor blood, with the reverse--and "weaker"--combination (LEW X 1W----LEW X 1A), 2 ml of donor blood led, in all cases, to greater than 100 days graft survival. In this last combination, third-party BT (LEW X 1N) was again totally ineffective. Blood from RT1-recombinant rats was used to test the role of the respective RT1.A, B, and C regions, in the enhancing effect. BTs from LEW X 1AR2 or LEW X 1WR2 recombinants--sharing, respectively, RT1.C and RT1.A with the graft donor--were only moderately effective, as compared with BTs from the graft donor. On the other hand, LEW X 1WR1 BTs--sharing the RT1.A and RT1.B regions with the graft donor--had a much more powerful effect on heart survival. The results strongly suggest that the RT1.B region (coding for Ia-like antigens) must be shared by the graft and blood donor in order to mediate a significant graft prolongation.
Subject(s)
Blood Transfusion , Heart Transplantation , Major Histocompatibility Complex , Animals , Blood Donors , Humans , Rats , Rats, Inbred Lew , Rats, Inbred Strains , Species Specificity , Time Factors , Tissue Donors , Transplantation, HomologousABSTRACT
We investigated the role of various blood-transfusions regimens including donor specific and third-party blood transfusions in rat heart transplantations. One ml donor blood (BN; RT1n) given to the recipients (Lew, RT1(1)) of (Lew.BN)F1 rats 7 days prior to grafting prolonged heart survival (24 +/- 8 vs 9.9 +/- 2.7 in control). Heart graft survival was much less when donor blood was given to recipients 1 month before grafting. There was no complementary effect between BT from donor and from third party blood or vice-versa. In addition, although donor blood prolonged graft survival (19.7 +/- 7.5 vs 9.9 +/- 2.7) when given the day of surgery, post surgery sequential BT from the donor (day 0-3-7 and 14 after transplantation) did not further increased survival (14 +/- 4.6). The effect of donor-BT was RT1a specific since third-party blood (1 ml) was ineffective (9.5 +/- 1) whereas 1 ml of congenic RT1n rat (Lew. 1 N) blood increases heart survival: 14 +/- 2.14 vs 9.9 +/- 2.2 in control animals. Although only 1 ml of donor blood enhanced specifically the heart allografts of the corresponding RT1 phenotype, weekly repeated third-party BT (n = 8) did also prolong graft survival (13.7 +/- 3.4) suggesting that aside from classical and powerful model of active RT1 specific effect of BT, a nonspecific, dose-related mechanism can occur.
