Organ Preservation Solutions in Transplantation: A Literature Review.

OBJECTIVES: Renal transplant with ABO-incompatible donors expands the donor pool. Earlier studies have focused the use of protocol biopsies in ABOincompatible transplant patients. Our study described outcomes of indication (for cause) renal biopsies and clinical outcomes in patients with ABO-incompatible renal transplant. MATERIALS AND METHODS: This retrospective study included 164 patients from January 2012 to June 2019. Biochemical parameters, serial immunoglobulin G anti-ABO titers, and class I and II donor-specific antibody findings were obtained from hospital records, and renal graft biopsies were reviewed according to the Banff 2017 update. RESULTS: We analyzed the results of 65 biopsies from 54 patients. Biopsy-proven acute antibody-mediated rejection (12.8%) was found to be more prevalent than acute cellular rejection (1.8%). Patients with antibodymediated rejection all had microvascular inflammation (g+ptc score of 2 or more, where g+ptc is the sum of the glomerulitis and peritubular capillaritis scores) and were positive for C4d. Acute tubular injury per se was seen in 10.3% of patients; 65% of these patients had C4d positivity in peritubular capillaries, and only 1 patient developed chronic active antibody-mediated rejection on follow-up. Patient and death-censored graft survival rates were 92% and 98% at 1 year after transplant and 88% and 91% at 3 years, respectively. Patients with an episode of antibody-mediated rejection had lower rates of patient (76.5%) and deathcensored graft survival (84.6%) at 1 year. CONCLUSIONS: The microvascular inflammation score (g+ptc score of 2 or higher) is more reliable than diffuse C4d positivity to determine antibody-mediated rejection in ABO-incompatible transplants because diffuse C4d positivity may also be seen in etiologies unrelated to antibody-mediated rejection. Acute tubular injury with C4d positivity without microvascular injury does not confirm antibody-mediated rejection. We suggest that Banff classification be updated in ABOincompatible transplants to include diagnostic criteria for the diagnosis of antibody-mediated rejection.

Cytotoxicity of solutions recommended for the storage of avulsed teeth in cultures with periodontal ligament cells. / Citotoxicidad de soluciones recomendadas para el almacenamiento de dientes avulsionados en cultivo con células del ligamento periodontal.

Introduction: The medium for avulsed teeth storage until their reimplantation is key to the preservation of human periodontal ligament fibroblasts (HPLF). Objective: Our purpose was to compare the cytotoxic effect of milk and isotonic solution, used for the storage of avulsed teeth, on the preservation of HPLF. Method: A subculture of periodontal ligament fibroblasts was carried out with a density of 1:2 (3 ×105 cells/mL) and was incubated for 48 hours. The cells were divided in two groups, which were placed either in milk or isotonic solution for 24 hours at 5% CO2, 37 ºC and 95% humidity. The number of viable cells was determined with a colorimetric fast assay by the reduction of MTT and mitochondrial activity. Data were processed with the Shapiro-Wilk normality test, Student's t-test and paired Student's t-test (with significance set at 0.05). Results: The cells exposed to milk for 24 hours showed statistically significant cytotoxicity at concentrations of 0.09, 0.39, 0.78, 1.56, 3.125, 6.25 and 50%. HPLFs exposed to isotonic solution showed no significant reduction in the number of cells at concentrations of 25 and 50%. Conclusion: Isotonic solution appears to be better for HPLF 24-hour storage in comparison with whole milk.

Introducción: El medio de almacenamiento de los dientes avulsionados hasta su reimplante es vital para conservar los fibroblastos del ligamento periodontal humano (HPLF). Objetivo: Comparar el efecto citotóxico para conservar los HPLF de la leche y la solución isotónica para almacenamiento de dientes avulsionados. Método: Se realizó subcultivo de fibroblastos del ligamento periodontal con una densidad de 1:2 (3 × 105 células/mL), que fueron incubados por 48 horas. Se integraron dos grupos de células, que se colocaron en leche y solución isotónica durante 24 horas a 5 % de CO2, a 37°C y 95 % de humedad. El número de células viables fue determinado por colorimetría rápida por reducción de MTT y actividad mitocondrial. Los datos fueron sometidos a pruebas de normalidad de Shapiro-Wilk, t de Student y t de Student pareada (significación de 0.05). Resultados: Las células expuestas a la leche por 24 horas mostraron citotoxicidad estadísticamente significativa a concentraciones de 0.09, 0.39, 0.78, 1.56, 3.125, 6.25 y 50 %. Los HPLF expuestos a solución isotónica no mostraron reducción significativa del número de células a concentraciones de 25 y 50 %. Conclusión: La solución isotónica parece mejor para el almacenamiento de HPLF en 24 horas, comparada con la leche entera.

Association Safety of Liver Preservation Solutions at the State University of Campinas From 2010 to 2014.

The probable reason for mixing solutions during the harvesting procedure is due to the presence of multiple transplant teams that have their own solution usage tradition. Despite numerous studies comparing the efficacy of different preservation solutions, there is no study addressing the associating solution and if there is any impact on liver graft and patient survival. The aim was to evaluate the effect of the association of preservation solutions during the harvesting procedure on liver transplantation outcomes, especially in relation to the degree of preservation injury in the postreperfusion period and patient survival. We analyzed 206 transplants that were distributed as follows: when there was association (89/206 = 43.2%) and when there was no association (117/206 = 56.8%). There was a statistically significant difference in relation to the degree of preservation injury correlated to cold ischemia time (P = .009, odds ratio 1.992; 95% confidence interval 1.185-3.347). Severe harvesting (grades III and IV) was 71.8% when the solution was not associated (P = .008). There was no difference regarding patient survival either. We found that the association of liver preservation solutions has no impact on patient survival, so it can be done safely. The best survival rate was associated with minimal harvesting.

Hyperkalemia by Euro-Collins solution in anesthesia for renal transplantation: a case report.

OBJECTIVE: To describe anesthesia for renal transplantation that progressed to a sharp potassium increase after kidney reperfusion with Euro-Collins' solution in the operative field. We will also report on diagnosis and treatment used. CONCLUSION: The use of infusion solutions in the surgical field requires careful monitoring, such as electrocardiography, measurement of serum potassium, and availability of calcium gluconate, insulin, and albuterol for immediate use. The replacement of Euro-Collins' solution for saline solution immediately before the implant may be a useful option in patients with high levels of potassium.

Perfusion fluid contamination in relation to recipient survival and acute cellular rejection in orthotopic liver transplantation: retrospective analysis.

INTRODUCTION: A perfusion fluid used in the preservation of a grafted liver represents a medium suitable for microorganism growth. This study investigated the prevalence of perfusion fluid contamination, acute cellular rejection (ACR) episodes, and patient survival rate. METHOD: This is a retrospective study, based on an electronic database allocating cases of orthotopic liver transplantation. The exclusion criteria were as follows: having been submitted to multiple organ transplantation, liver retransplantation only, and those whose samples had not been collected or sent on the back table procedure or were unobtainable (usually the samples were sent when there was donor infection suspicion/positivity). Our posttransplantation infection prophylactic protocol consisted of ampicillin/sulbactam for 72 hours. The variables in the study were as follows: fluid contamination, presence of acute cellular rejection (ACR, Banff classification), and recipient survival at the first year. Statistical analysis was performed using descriptive statistics and chi-square with Fisher exact test considering significant P<.05. RESULTS: We observed perfusion fluid contamination in 15/121 (12.39%). The agents were as follows: Klebsiella pneumoniae in 6 (4.96%), Staphylococcus epidermidis in 5 (4.13%), and Acinetobacter baumanii in 3 (2.48%) and negative cultures in 106 (87.60%). Only 1 patient had matching for donor infection and positivity hemoculture after the transplantation (K pneumoniae) and he was the only patient associated with fluid infection and death. The recipients who had their fluid preservation with positive cultures had more ACR and the survival rate was similar among those with or without infection. CONCLUSION: Optimization of microbiological procedures can be performed including fungal and bacterial cultures.

Analysis of the liver effluent as a marker of preservation injury and early graft performance.

In liver transplantation, the effluent solution, which represents the washout of residual preservation solution, can be collected before reperfusion to determine the release of the markers of endothelial cell injury and damage to the liver. The enzyme activities detected in the washout solution may allow the development of an index that could be clinically valuable for the prediction of early posttransplant graft function. In the present study, we collected liver effluents from 47 livers at the time of graft rinsing to measure liver enzymes (aminotransferases and lactate dehydrogenase) as well as the serum enzyme levels of the recipients for correlation with early postoperative graft viability (1-month survival). The patients were divided into two groups: death (D) and survival (S). Nonparametric statistical analysis was used with the level of significance set at P < .05. Aminotransferases and lactate dehydrogenase levels higher among the D group (P < .05 for all measurements), leading us to conclude that the effluent represents a good marker of preservation injury and early graft performance.

Influência do pH na preservaçäo de córneas em Optisol / pH variation in Optical and its effectt in corneal storage

Os autores analizaram a influência de pequenas variaçöes do pH na preservaçäo de córneas em Optisol (Chiron Ophthalmics, Irvine, California). Dez pares de córneas humanas foram armazenadas por cinco dias, com Optisol, em pH 7,0 7,2 e 7,5 e depois analisados com lâmpada de fenda, microscópio especular e microscopia eletrônica. Näo foram encontradas diferenças significativas nem na contagem endotelial,nem nas caacterísticasmorfológicas do endotélio corneano nas córneas preservadas nesses pHs