Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
Transplantation ; 108(6): 1394-1402, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38467592

RESUMEN

BACKGROUND: In Italy, 20 min of continuous, flat-line electrocardiogram are required for death declaration. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled donation after circulatory death (cDCD) liver transplantation by combining normothermic regional and end-ischemic machine perfusion (MP). The aim of this study was to evaluate the safety and feasibility of the use of septuagenarian and octogenarian cDCD donors with this approach. METHODS: All cDCD older than 70 y were evaluated during normothermic regional perfusion and then randomly assigned to dual hypothermic or normothermic MP. RESULTS: In the period from April 2021 to December 2022, 17 cDCD older than 70 y were considered. In 6 cases (35%), the graft was not considered suitable for liver transplantation, whereas 11 (65%) were evaluated and eventually transplanted. The median donor age was 82 y, being 8 (73%) older than 80. Median functional warm ischemia and no-flow time were 36 and 28 min, respectively. Grafts were randomly assigned to ex situ dual hypothermic oxygenated MP in 6 cases (55%) and normothermic MP in 5 (45%). None was discarded during MP. There were no cases of primary nonfunction, 1 case of postreperfusion syndrome (9%) and 2 cases (18%) of early allograft dysfunction. At a median follow-up of 8 mo, no vascular complications or ischemic cholangiopathy were reported. No major differences were found in terms of postoperative hospitalization or complications based on the type of MP. CONCLUSIONS: The implementation of sequential normothermic regional and end-ischemic MP allows the safe use of very old donation after circulatory death donors.


Asunto(s)
Trasplante de Hígado , Perfusión , Donantes de Tejidos , Humanos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Perfusión/métodos , Perfusión/instrumentación , Perfusión/efectos adversos , Anciano , Masculino , Femenino , Donantes de Tejidos/provisión & distribución , Anciano de 80 o más Años , Isquemia Tibia/efectos adversos , Italia , Preservación de Órganos/métodos , Estudios de Factibilidad , Factores de Edad , Selección de Donante , Factores de Tiempo , Resultado del Tratamiento , Supervivencia de Injerto
2.
Liver Transpl ; 29(8): 813-826, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-36879554

RESUMEN

Livers from donations after circulatory death (DCDs) are very sensitive to ischemia/reperfusion injury and thus need careful reconditioning, such as normothermic regional perfusion (NRP). So far, its impact on DCDs has not been thoroughly investigated. This pilot cohort study aimed to explore the NRP impact on liver function by evaluating dynamic changes of circulating markers and hepatic gene expression in 9 uncontrolled DCDs (uDCDs) and 10 controlled DCDs. At NRP start, controlled DCDs had lower plasma levels of inflammatory and liver damage markers, including α-glutathione s-transferase, sorbitol-dehydrogenase, malate dehydrogenase 1, liver-type arginase-1, and keratin-18, but higher levels of osteopontin, sFas, flavin mononucleotide, and succinate than uDCDs. During 4-hour NRP, some damage and inflammatory markers increased in both groups, while IL-6, HGF, and osteopontin increased only in uDCDs. At the NRP end, the tissue expression of early transcriptional regulators, apoptosis, and autophagy mediators was higher in uDCDs than in controlled DCDs. In conclusion, despite initial differences in liver damage biomarkers, the uDCD group was characterized by a major gene expression of regenerative and repair factors after the NRP procedure. Correlative analysis among circulating/tissue biomarkers and the tissue congestion/necrosis degree revealed new potential candidate biomarkers.


Asunto(s)
Trasplante de Hígado , Obtención de Tejidos y Órganos , Humanos , Osteopontina , Proyectos Piloto , Donantes de Tejidos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Perfusión/métodos , Hígado/cirugía , Preservación de Órganos/métodos , Muerte , Supervivencia de Injerto
3.
Artif Organs ; 46(9): 1727-1740, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35733227

RESUMEN

BACKGROUND: Organs from donation after circulatory death (DCD) are increasingly used for liver transplantation, due to the persisting organ shortage and waiting list mortality. However, the use of DCD grafts is still limited by the inferior graft survival rate and the increased risk of primary non-function and biliary complications when compared to brain death donors' grafts. METHODS: Abdominal normothermic regional perfusion with extracorporeal membrane oxygenation (ECMO) is an in situ preservation strategy. which may mitigate ischemia-reperfusion injuries. and has been proposed to restore blood perfusion after the determination of death thus optimizing liver function before implantation. RESULTS: In this systematic review, we highlighted the clinical evidence supporting the use of normothermic regional perfusion in DCD liver underlying the pathophysiological mechanisms, and technical, logistic, and regulatory aspects. CONCLUSIONS: Despite the lack of properly designed, prospective, randomized trials, the current available data suggest beneficial effects of normothermic regional perfusion on clinical outcomes after liver transplantation.


Asunto(s)
Trasplante de Hígado , Obtención de Tejidos y Órganos , Supervivencia de Injerto , Humanos , Trasplante de Hígado/efectos adversos , Preservación de Órganos/efectos adversos , Perfusión , Estudios Prospectivos , Donantes de Tejidos
4.
Crit Care ; 24(1): 33, 2020 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-32014041

RESUMEN

BACKGROUND: Post-traumatic cerebral infarction (PTCI) is common after traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors. METHODS: This was a prospective multicenter cohort study of moderate and severe TBI patients. The primary objective was to evaluate if PTCI was an independent risk factor for the 6-month outcome assessed with the Glasgow Outcome Scale (GOS). We also assessed the PTCI occurrence and if it adds incremental value to the International Mission for Prognosis and Clinical Trial design in TBI (IMPACT) core and extended models. RESULTS: We enrolled 143 patients, of whom 47 (32.9%) developed a PTCI. In the multiple ordered logistic regression, PTCI was retained in both the core and extended IMPACT models as an independent predictor of the GOS. The predictive performances increased significantly when PTCI was added to the IMPACT core model (AUC = 0.73, 95% C.I. 0.66-0.82; increased to AUC = 0.79, 95% CI 0.71-0.83, p = 0.0007) and extended model (AUC = 0.74, 95% C.I. 0.65-0.81 increased to AUC = 0.80, 95% C.I. 0.69-0.85; p = 0.00008). Patients with PTCI showed higher ICU mortality and 6-month mortality, whereas hospital mortality did not differ between the two groups. CONCLUSIONS: PTCI is a common complication in patients suffering from a moderate or severe TBI and is an independent risk factor for long-term disability. The addition of PTCI to the IMPACT core and extended predictive models significantly increased their performance in predicting the GOS. TRIAL REGISTRATION: The present study was registered in ClinicalTrial.gov with the ID number NCT02430324.


Asunto(s)
Lesiones Traumáticas del Encéfalo/complicaciones , Infarto Cerebral/etiología , Evaluación de Resultado en la Atención de Salud/normas , Adulto , Área Bajo la Curva , Lesiones Traumáticas del Encéfalo/epidemiología , Infarto Cerebral/epidemiología , Estudios de Cohortes , Femenino , Escala de Consecuencias de Glasgow/estadística & datos numéricos , Humanos , Italia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Estudios Prospectivos , Curva ROC , Estadísticas no Paramétricas
5.
Infect Control Hosp Epidemiol ; 28(7): 867-9, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17564991

RESUMEN

Of 20 consecutive episodes of ventilator-associated pneumonia due to Acinetobacter baumannii, 18 were preceded by tracheobronchial colonization with strains ofA. baumannii that had the same antibiotic susceptibility pattern. When the results of routine surveillance cultures of endotracheal aspirate samples were compared with the results of bronchoalveolar lavage fluid cultures performed for patients who developed late-onset ventilator-associated pneumonia, the sensitivity of the surveillance cultures was 90%, and the negative predictive value was 96%. The positive predictive value of surveillance cultures for identifying causative pathogens in cases of pneumonia due to A. baumannii was good.


Asunto(s)
Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/aislamiento & purificación , Líquido del Lavado Bronquioalveolar/microbiología , Neumonía Asociada al Ventilador/microbiología , Infecciones por Acinetobacter/tratamiento farmacológico , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ventiladores Mecánicos/microbiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...