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1.
Ann Palliat Med ; 9(2): 359-367, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233631

RESUMO

BACKGROUND: To establish a stable ex vivo lung perfusion (EVLP) model and determine the preservation effect of the EVLP technique on donor lungs in vitro. METHODS: EVLP was performed on nonacceptable human donor and porcine lungs, and during perfusion, the oxygenation index was assessed and blood gas analysis was performed. RESULTS: After 4 h of EVLP of nonacceptable human donor and porcine lungs, lung function parameters remained stable, and lung energy metabolism was improved to a certain extent. CONCLUSIONS: EVLP can suitably maintain donor lungs in vitro for transplantation and is an effective method for ex vivo preservation of donor lungs.


Assuntos
Transplante de Pulmão/métodos , Perfusão/métodos , Obtenção de Tecidos e Órgãos/métodos , Animais , Humanos , Soluções para Preservação de Órgãos , Preservação Biológica , Suínos , Coleta de Tecidos e Órgãos/métodos
2.
PLoS One ; 15(3): e0229529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163429

RESUMO

Knowledge, attitude and willingness of ethnic minorities in China towards cadaver donation programs were assessed. Questionnaire and interviews were conducted to investigate Yi, Bai, Hani, Dai and Han ethnicities. Educational level and per capita income of ethnic minorities were lesser than those of Han ethnicity (p<0.01). Agriculture was the primary occupation and proportions of technical personnel and public officials was lesser among ethnic minorities (p<0.01). Surveyed ethnic minorities universally practice religious traditions, Bai and Dai ethnicities practice Buddhist beliefs also (p<0.01). Knowledge of Yi, Bai, Hani and Dai ethnic respondents was lesser than those of Han ethnicity (p<0.01). Over 83.8% of Yi, Bai, Hani and Dai ethnicity residents were unwilling to register for body donation programs with receiving a driver's license (p<0.01). Less than 46.9% of ethnic minorities supported use of honorary certificates (p<0.01). Ethnic minorities were supportive of financial compensation for body donations and denied that financial compensation led to the commercialization of cadaver donation (p<0.01, p<0.01). Willingness of ethnic minorities to participate in cadaver donation programs was primarily related to religious beliefs (p<0.01), economic status (p<0.01). Knowledge, attitude and willingness of ethnic minorities to participate in cadaver donation programs were markedly different from those of Han ethnicity, and the religious belief and economic status played a decisive role. To increase participation, programs based on respecting religious belief should be developed to support improvements in economy, education, medical care and social security system.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Doadores de Tecidos/psicologia , Obtenção de Tecidos e Órgãos/tendências , Adulto , Idoso , Cadáver , China , Tomada de Decisões , Grupos Étnicos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Religião , Religião e Psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos
3.
Medicine (Baltimore) ; 99(10): e19335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150070

RESUMO

BACKGROUND: Pancreas graft quality directly affects morbidity and mortality rates after pancreas transplantation (PTx). The criteria for pancreas graft allocation are restricted, which has decreased the number of available organs. Suitable pancreatic allografts are selected based on donor demographics, medical history, and the transplant surgeon's assessment of organ quality during procurement. Quality is assessed based on macroscopic appearance, which is biased by individual experience and personal skills. Therefore, we aim to assess the histopathological quality of unallocated pancreas organs to determine how many unallocated organs are potentially of suitable quality for PTx. METHODS AND ANALYSIS: This is a multicenter cross-sectional explorative study. The demographic data and medical history of donor and cause of rejection of the allocation of graft will be recorded. Organs of included donors will be explanted and macroscopic features such as weight, color, size, and stiffness will be recorded by 2 independent transplant surgeons. A tissue sample of the organ will be fixed for further microscopic assessments. Histopathologic assessments will be performed as soon as a biopsy can be obtained. We will evaluate up to 100 pancreata in this study. RESULT: This study will evaluate the histopathological quality of unallocated pancreas organs from brain-dead donors to determine how many of these unallocated organs were potentially suitable for transplantation based on a histopathologic evaluation of organ quality. CONCLUSION: The comprehensive findings of this study could help to increase the pancreas graft pool, overcome organ shortage, reduce the waiting time, and also increase the number of PTx in the future. Registration number: ClinicalTrials.gov: NCT04127266.


Assuntos
Morte Encefálica/patologia , Pâncreas/patologia , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Distribuição de Qui-Quadrado , Protocolos Clínicos , Estudos Transversais , Alemanha , Sobrevivência de Enxerto , Humanos , Transplante de Pâncreas/métodos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/tendências
5.
Transplant Proc ; 52(1): 50-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32000942

RESUMO

PURPOSE: Many types of preservation fluid were used in liver procurement. Undoubtedly, the gold standard is the University of Wisconsin (UW) solution. But the solution is expensive. The aim of this study was to evaluate the results of combined acetated Ringer solution, Euro-Collins solution, and UW solution. MATERIALS AND METHODS: All patients undergoing adult liver transplantation from cadaveric donor during January 2013 to December 2017 in King Chulalongkorn Memorial Hospital were included in this study. Donor and recipient characteristics, preservation fluid, operative data, and postoperative outcomes were recorded. RESULTS: A total of 102 patients receiving liver transplants were enrolled into the study. The mean age of donors was 34.2 years. The mean total ischemic time was 420.93 minutes. In recipients, posttransplantation complications were the following: (1) primary nonfunction in 1 patient (0.98%); (2) early allograft dysfunction in 23 patients (22.5%); (3) hepatic artery thrombosis in 3 patients (2.7%); (4) hepatic venous outflow obstruction in 2 patients (1.96%); (5) biliary leakage in 1 patient (0.98%); (6) biliary anastomosis stenosis in 4 patients (3.92%); and (7) biliary nonanastomosis stenosis in 1 patient (0.98%). No inhospital mortality was occurred. Overall mortality rate is 7.8% (8/102). One-, 3-, and 5-year survival were 95.9%, 91.5%, and 88.4%, respectively. CONCLUSIONS: The combination of acetated Ringer solution, Euro-Collins solution, and UW solution is effective and economic for liver preservation. Further study should be conducted.


Assuntos
Soluções Hipertônicas , Fígado , Soluções para Preservação de Órgãos , Preservação de Órgãos/métodos , Obtenção de Tecidos e Órgãos/métodos , Adenosina , Adulto , Alopurinol , Combinação de Medicamentos , Feminino , Glutationa , Humanos , Insulina , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos/economia , Rafinose , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/economia
6.
Bull Cancer ; 107(1S): S94-S103, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31006487

RESUMO

Since 2010 there has been an exponential increase of the number of transplants performed from related donors. The development of haploidentical transplants increases the resort to related-donation, which presents two main advantages: a less important financial cost and a faster availability of the graft. Standards for mandatory accreditation exist, but the adherence to these recommendations is not optimal: currently, different practices regarding the organizational modalities of care, recruitment criteria, qualification and follow-up of related donors have been observed among French transplant centers. The Francophone Society of Marrow Transplant and Cellular Therapy (SFGM-TC) has developed guidelines for the consent and the non-eligibility criteria for hematopoietic stem cell donors. A multidisciplinary group has devised a booklet as a medium to inform donors about hematopoietic cell donation and transplantation in a clear and accessible language. This paper provides recommendations on post-donation follow-up, taking into account both medical standards and organizational constraints of French centers. Some tools are proposed.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Doadores de Tecidos , Aloenxertos , Família , Haplótipos/genética , Histocompatibilidade , Humanos , Consentimento Livre e Esclarecido , Comunicação Interdisciplinar , Doadores Vivos , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/normas
7.
Ann Transplant ; 24: 647-660, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31879416

RESUMO

BACKGROUND: Ex vivo lung perfusion (EVLP) is a relatively new technique that can be used to assess and repair the donor lungs, increasing the utilization of high-risk lungs. However, its effect on outcomes of lung transplantation patients is uncertainty. This meta-analysis is conducted to assess the impact of EVLP on donor lungs and outcomes of recipients compared with the standard lung transplantation. MATERIAL/METHODS: We systematically searched for studies comparatively analyzing the efficacy of EVLP and standard cold storage in lung transplantation. The hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) were used as the effect size (ES) to evaluate the survival outcomes, categorical variables, and continuous variables respectively. RESULTS: A total of 20 published articles (including 2574 donors and 2567 recipients) were eligible. The chest x-ray manifestations and PaO2/FiO2 100% were more deficient in the EVLP group than the standard group. EVLP improved the function of high-risk donor lungs with the conversion rate ranging from 34% to 100%. The EVLP group had a lower incidence of primary graft dysfunction 3, but longer intensive care unit stay. Other clinical outcomes between the 2 groups were similar. CONCLUSIONS: The pooled results indicated that EVLP could be used to assess and improve high-risk donor lungs and had non-inferior postoperative outcomes compared with the standard cold storage. EVLP not only increased the utilization of marginal donors, but also could extend preservation time and reduce the total ischemia time of donors.


Assuntos
Transplante de Pulmão/métodos , Preservação de Órgãos/métodos , Circulação Extracorpórea/métodos , Humanos , Técnicas In Vitro , Pulmão/fisiologia , Perfusão/métodos , Obtenção de Tecidos e Órgãos/métodos , Resultado do Tratamento
9.
Transplant Proc ; 51(9): 2967-2970, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31711579

RESUMO

INTRODUCTION: The use of grafts from donation after circulatory death (DCD) is an important additional source to implement within the donor pool. We herein report the outcomes of our early experience with DCD grafts for liver transplantation (LT). METHODS: Ten patients successfully underwent LT with grafts from DCD donors between August 2017 and January 2019 at the Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit of University of Modena and Reggio Emilia. All donors underwent normothermic regional perfusion after death declaration and, after the procurement, all the suitable grafts underwent ex situ hypothermic perfusion prior to transplantation. RESULTS: Mean postoperative hospital stay after transplant was 12.7 days (range, 5-26), and in 5 cases we placed a biliary drainage (Kehr tube) during surgery. Primary graft nonfunction did not occur after LT in this cohort, although, we registered one case of biliary anastomosis stricture that was managed endoscopically by endoscopic retrograde cholangiopancreatography. All patients are alive and none required retransplantation. CONCLUSIONS: In our experience with controlled DCD donors, the demonstration of: (1) a negative trend of lactate during normothermic regional perfusion; (2) an aspartate aminotransferase and alanine aminotransferase level lower than 2000 mU/dL; and (3) less than 1 hour of functional warm ischemia time along with no signs of microscopic or macroscopic ischemia of the grafts, are related to positive outcomes in the first year after transplant. A DCD risk score based on Italian population characteristics and regulations on death observation may improve donor-recipient match and avoid futile transplants.


Assuntos
Sobrevivência de Enxerto , Transplante de Fígado/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes , Adulto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Isquemia Quente
10.
J Laparoendosc Adv Surg Tech A ; 29(12): 1616-1622, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31687885

RESUMO

Background: Sequential liver-kidney transplantation (SeqLKT) from the same living donor has shown excellent results in children with primary hyperoxaluria type 1 (PH1), yet its experience is limited due to the invasiveness of two major procedures for liver-kidney procurement in a single donor. Despite laparoscopic nephrectomy and hepatic left lateral sectionectomy (LLS) being considered standard procedures in living donation, the sequential use of the two laparoscopic approaches in the same living donor has never been reported. Methods: Herein, we present the first two case series of laparoscopic liver-kidney procurement in the same living donor for SeqLKT in children with PH1 and review of the current literature on this topic. Results: In the first case, a 15-month-old boy received a SeqLKT from his 32-year-old mother, who underwent a laparoscopic LLS and, after 8 months, a laparoscopic left nephrectomy. In the second case, a 34-month-old boy received a SeqLKT from his 40-year-old father who underwent laparoscopic LLS followed by hand-assisted right nephrectomy after 4 months. Both donors had uneventful postoperative courses and were discharged within 5 days from each surgery. The first recipient had no complication; the second child after liver transplantation developed a partial thrombosis of the inferior vena cava, which did not preclude the sequential kidney transplantation. After 12 months, donors and recipients displayed normal liver and renal functions. Conclusions: Sequential laparoscopic liver-kidney procurement in the same living donor is safe and feasible, and might be considered as a possible strategy to promote SeqLKT in children with PH1 from the same living donor.


Assuntos
Hiperoxalúria Primária/cirurgia , Transplante de Rim/métodos , Laparoscopia/métodos , Transplante de Fígado/métodos , Doadores Vivos , Obtenção de Tecidos e Órgãos/métodos , Pré-Escolar , Humanos , Lactente , Masculino , Pais , Resultado do Tratamento
11.
S Afr Med J ; 109(9): 626-631, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635584

RESUMO

In 2016, deceased-donor organ procurement at Wits Transplant, based at Wits Donald Gordon Medical Centre in Johannesburg, South Africa (SA), was in a state of crisis. As it is the largest-volume solid-organ transplant unit in SA, and as we aspire to provide transplant services of an international standard, the time to address our procurement practice had come. The number of deceased donors consented through our centre was very low, and we needed a radical change to improve our performance. This article describes the Wits Transplant Procurement Model - the result of our work to improve procurement at our centre. The model has two core phases, one to increase referrals and the other to improve our consent rates. Within these phases there are several initiatives. To improve referrals, the threefold approach of procurement management, acknowledgement and resource utilisation was developed. In order to 'convert' referrals into consents, we established the Wits Transplant 'Family Approach to Consent for Transplant Strategy' (FACTS). Since initiation of the Wits Transplant Procurement Model, both our referral numbers from targeted hospitals and our conversion rates have increased. Referrals from targeted hospitals increased by 54% (from 31 to 57). Our consent rate increased from 25% (n=6) to 73% (n=35) after the initiation of Wits Transplant FACTS. We hope that other transplant centres in SA and further afield in the region will find this article helpful, and to this end we have created a handbook on the Wits Transplant Procurement Model that is freely available for download (http://www.dgmc.co.za/docs/Wits-Transplant-Procurement-Handbook.pdf).


Assuntos
Modelos Teóricos , Transplante de Órgãos/estatística & dados numéricos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/métodos , Centros Médicos Acadêmicos , Humanos , Encaminhamento e Consulta/estatística & dados numéricos , África do Sul
12.
Transplant Proc ; 51(9): 3030-3033, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611122

RESUMO

BACKGROUND: A nondirected altruistic living kidney donor is a person who wants to donate a kidney to anyone in need. In 2010, the Spanish National Transplant Organization developed a national protocol to make the assessment of every potential nondirected living kidney donor. The aim of this study was to describe the potential donor pool and its characteristics and the overall effect of the program. MATERIAL AND METHODS: A retrospective analysis was performed using data from the Spanish National Registry of Transplant Activity, and the Nondirected Donors National Database, between 2010 and 2017. Data related to sociodemographic characteristics, main motivations toward donation, and causes of dismissal were collected from all potential donors. The assessment of each candidate was carried out in a step-by-step process based on the national protocol. RESULTS: Two hundred seventy-two people contacted us, showing interest in the nondirected kidney donation, only 203 people underwent the early triage, and 16 of them successfully completed the assessment proces s, representing 8% of the total. The main motivation toward anonymous donation (n = 161) was: social awareness (22%) and to improve the quality of life of other people (9%). One hundred eighty-two candidates did not proceed, due to medical and psychological contraindications (42%) or donor refusal after specific information about the donation process (33%). The number of utilized nondirected altruistic living donors was 13 out of 203 (6%) of the candidates who began the early triage. Twelve transplant chains and a direct donation were performed, which made 38 kidney transplants possible (2.9 transplants per nondirected donor). CONCLUSIONS: We have to continue working to optimize our program. Our next steps will be to review the evaluation process, to detect areas for improvement, to understand why we lost many possible donors, and to ascertain if any of the reasons could be avoided.


Assuntos
Altruísmo , Transplante de Rim , Doadores Vivos/psicologia , Doadores Vivos/provisão & distribução , Obtenção de Tecidos e Órgãos/métodos , Transplantes/provisão & distribução , Feminino , Humanos , Estudos Retrospectivos , Espanha , Obtenção de Tecidos e Órgãos/organização & administração
13.
Transplant Proc ; 51(9): 3042-3043, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627913

RESUMO

OBJECTIVE: The objective is to describe the donations made with extracorporeal membrane oxygenation as a method of preservation to meet the characteristics of the donors and the transplants obtained. METHODS: This was a retrospective descriptive study, using the donation registration data made at Virgen de las Nieves Hospital from 2010 to February 2018. RESULTS: A total of 11 transfers occurred: 2 to the province of Jaen (Jaen Hospital, 92 km from Virgen de las Nieves Hospital; San Agustín Hospital, Linares, 136 km), 1 to Santa Ana Hospital, Motril (68 km), 1 to Poniente Hospital, El Ejido, Almeria (137 km), and 7 trips within the city of Granada. From these donations, a total of 21 kidneys, 3 livers, 10 corneal transplants, 4 extractions of osteotendinous tissue, and 1 extraction of vascular tissue were obtained. CONCLUSION: Extracorporeal membrane oxygenation mobile teams can enable donation in controlled donation after circulatory death with normothermic preservation in hospitals without these resources, which increases the donor group and optimizes graft results.


Assuntos
Oxigenação por Membrana Extracorpórea , Transferência de Pacientes/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/provisão & distribução
14.
Transplant Proc ; 51(9): 2880-2889, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627923

RESUMO

BACKGROUND: The national protocol for the handling of high-urgency (HU) liver organ procurement for transplant is administered by the Italian National Transplant Center. In recent years, we have witnessed a change in requests to access the program. We have therefore evaluated their temporal trend, the need to change the access criteria, the percentage of transplants performed, the time of request satisfaction, and the follow-up. METHODS: We analyzed all the liver requests for the HU program received during the 4-year period of 2014 to 2017 for adult recipients (≥18 years of age): all the variables linked to the recipient or to the donor and the organ transplants are registered in the Informative Transplant System as established by the law 91/99. In addition, intention to treat (ITT) survival rates were compared among 4 different groups: (1) patients on standard waiting lists vs (2) patients on urgency waiting lists, and (3) patients with a history of transplant in urgency vs (4) patients with a history of transplant not in urgency. RESULTS: Out of the 370 requests included in the study, 291 (78.7%) were satisfied with liver transplantation. Seventy-nine requests (21.3%) have not been processed, but if we consider only the real failures, this percentage falls to 13.1% and the percentage of satisfied requests rises to 86.9%. The average waiting period for liver transplantation (LT) is 1.7 days and most requests (74%) are met in less than 24 hours, if we consider the hours between the registration of the request and the donor reporting . The percentage of late retransplantations is 2.1%. The clinical indication for HU-LT that appears to improve over time is hepatic artery thrombosis (82.5%). The overall 1-year patient survival is 68.3%. The overall 1-year graft survival, performed on all the patients, is 89% and all the indications for HU-LT appear to go well over time with an average survival rate greater than 85%. CONCLUSIONS: The indications for HU-LT are changing according to the changes in the hepatologic field in recent years. The centralized management of requests has proven to be successful in optimizing responses. Urgent LT is confirmed to be lifesaving in its timeliness.


Assuntos
Transplante de Fígado , Obtenção de Tecidos e Órgãos/tendências , Adolescente , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Itália , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera
15.
Transplant Proc ; 51(9): 3044-3046, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627924

RESUMO

OBJECTIVE: To analyze metabolic differences during normothermic regional perfusion (NRP) between the dissimilar types of donation after circulatory death, uncontrolled (uDCD) and controlled (cDCD), and the evolution of the transplanted kidneys. METHODS: Observational, prospective, cohort study. We included patients from uDCD and cDCD maintained with NRP in 2017. Six consecutive blood gases were collected with determination of pH and lactic acid. Creatinine levels were monitored at 24 hours, 3 months, and 6 months after transplant and the need for renal replacement therapy was evaluated. Descriptive statistical analysis was performed, presenting the qualitative variables as frequencies and percentages, and quantitative as mean ± SD or median (interquartile range [IQR]). We used χ2 testing for bivariate analysis of qualitative variables. RESULTS: We collected 18 donors. Fifteen out of 18 (83.3%) were men with a median of 51 years (IQR, 46-60). Eleven out of 18 (61.1%) were cDCD and 7 out of 18 (38.9%) were uDCD. The blood gas results are illustrated in Table 1. A total of 28 renal transplants were obtained with a median age of 47 years (IQR, 45-57); 83% were male. Ten out of 28 (35.7%) came from uDCD and 18 out of 28 (64.7%) from cDCD. Table 2 shows the monitoring of the creatinine values of the recipients after the transplantation. CONCLUSIONS: There are more metabolic disorders in our series in uDCD organ donation compared with cDCD. The recovery of the renal function of organs from uDCD is slower than that of cDCD, however; the tendency is toward normality.


Assuntos
Transplante de Rim/métodos , Perfusão/métodos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Estudos de Coortes , Creatinina/sangue , Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doadores de Tecidos/provisão & distribução
16.
Transplant Proc ; 51(9): 2865-2867, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31630777

RESUMO

BACKGROUND: Donation after circulatory death (DCD) is an accepted strategy to widen organ procurement worldwide. Authorized centers in Italy are spreading, increasing kidney transplantation (KTX) from DCD donors (40 in 2017 vs 24 in 2016). In this study, we describe DCD KTX activity at the University of Modena and Reggio Emilia (Modena, Italy) since its beginning in November 2017. METHODS: We retrospectively studied DCD KTX performed in our center from November 2017 to June 2018. We considered donor characteristics (age, sex, cause of death) and recipient clinical data (length of hospital stay, serum creatinine, estimated glomerular filtration rate, delayed graft function [DGF]), primary nonfunction [PNF], HLA match). All the grafts underwent in situ normothermic (ExtraCorporeal Membrane Oxygenation-ECMO) and ex situ hypothermic oxygenated perfusion (HOPE) with Kidney Assist machines. We monitored ex situ perfusion solution biochemical (lactate dehydrogenase [LDH] and lactate) and dynamic (resistance and flow) parameters. A kidney biopsy was performed for allocation strategy according to Karpinski score. RESULTS: We performed 6 kidney transplants (3 single and 3 double); the mean recipient (57.5 ± 4.9) and donor age (57.3 ± 7.5) were similar. Mean ECMO duration was 3 h 27 ± 57 min, HOPE was 4 h 47 min ± 119 min, lactate sample values (collected every 15 minutes from the beginning of perfusion) were always lower than1.6 mmol/L, and LDH maximum value was 400 UI/L. Median cold ischemia time was 11 h 18 min. Mean Karpinski score was 3.6; mean HLA match 1.7.We experienced 1 DGF (16.6%), no PNF, with a mean hospital stay of 14.6 days, mean creatinine at hospital discharge 2 ± 1.04 mg/dL), and mean eGFR 53.8 ±27.3 mL/min); at 1 month, mean creatinine and eGFR were 2 ± 1.34 mg/dL and 59.8 ± 24.5 mL/min, respectively. CONCLUSIONS: DCD is a promising resource for increasing organ donation. The Emilia Romagna regional organization allowed short ischemia times, with solid KTX outcomes, supporting further development of this program.


Assuntos
Transplante de Rim , Doadores de Tecidos/provisão & distribução , Adulto , Função Retardada do Enxerto/epidemiologia , Função Retardada do Enxerto/etiologia , Feminino , Sobrevivência de Enxerto , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/métodos , Resultado do Tratamento
17.
Transplant Proc ; 51(9): 2873-2879, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606184

RESUMO

BACKGROUND: One of the main activities connected with transplantation is the rapid and timely transportation of patients, medical teams, and human organs from donation to transplantation centers under the compliance of national guidelines and principles of quality, performance, and safety. High-speed transportation on a railway network is becoming relevant both in terms of performance and extensiveness of the service. METHODS AND OBJECTIVES: Our study explores the feasibility of adopting a high-speed rail network for the transportation of those organs with large cold ischemia time and those less influenced by transportation-related perturbations (ie, temperature, speed, vibrations), assessing savings and relative performance improvement. In this study, only kidneys have been considered; the transplantation database has been integrated with the national high-speed railway network and timetables. A function is implemented that allocates to air transportations those records with 1 of the 2 ends situated on islands, remote regions, and abroad, while rail transportation is preferred where constraints on capacity and compliance with cold ischemia time are met. Road transportation is still feasible for those records involving 2 adjacent regions and for intraregional transportation. RESULTS: The opportunity of integrated road-rail transportation in place of air or all-road transportation allows users to lower generalized costs and reduce driven distance for personnel and vehicles allocated to a regional transplantation center's fleet and staff. Savings in fleet and staff usage can serve to improve the performances at the local level. CONCLUSIONS: The knowledge and analysis of transportation alternatives for human organs with less stringent safety and preservation criteria allow a more efficient allocation of resources both at the local and national level-without compromising quality and reliability of the system.


Assuntos
Ferrovias/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes , Humanos , Itália , Reprodutibilidade dos Testes , Obtenção de Tecidos e Órgãos/organização & administração
18.
Transplant Proc ; 51(9): 2890-2898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606185

RESUMO

BACKGROUND: Transplantation of kidneys from donation after cardiocirculatory death (DCD) donors is becoming an ever-increasing reality. So far, biopsy histologic assessment is the main parameter for evaluation of graft suitability, but it has several drawbacks and has poor reliability. The aim of this study is to verify if real-time renal resistance (RR) measurement during hypothermic machine perfusion (HMP) can be used as a reliable parameter to evaluate the quality of grafts from DCD and extracorporeal membrane oxygenation (ECMO) donors. METHODS: From January 2015 to September 2018, HMP has been systematically applied to all organs from DCD and ECMO donors. All grafts underwent preimplantation biopsy histologic assessment with Karpinski's score. Single kidney transplants (SKTs) or double kidney transplants (DKTs) were performed according to biopsy score results. Kidneys were considered suitable for transplant if RR reached ≤ 1.0 within 3 hours of perfusion. RR trend and postoperative outcome were analyzed considering biopsy score and donor type. RESULTS: A total of 30 kidneys (15 from DCD and 15 from ECMO donors) were used to perform 26 transplants (22 SKTs and 4 DKTs). Considering RR trend, all grafts were considered suitable for transplant within 1 hour of perfusion. Biopsy confirmed this result in all cases, and median score was 3 (range, 0-7). SKT score kidneys had lower starting RR than DKT ones (1.88 vs 2.88; P = .04) but identical final RR (0.58 vs 0.57; P = .76). DKT recipients had faster postoperative creatinine reduction than SKT recipients but similar postoperative day 30 value (1.42 vs 1.15 mg/dL; P = .20). No differences were found between DCD and ECMO grafts in terms of RR trend and postoperative outcome. CONCLUSIONS: HMP can be an alternative to histologic biopsy assessment for evaluation of transplant suitability of DCD and ECMO kidneys. If acceptability threshold is reached, SKT can be performed in all cases. ECMO donors should be considered like DCD donors.


Assuntos
Transplante de Rim/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes/patologia , Transplantes/provisão & distribução , Biópsia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Sobrevivência de Enxerto , Humanos , Nefropatias/diagnóstico , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Projetos Piloto , Fatores de Tempo , Doadores de Tecidos/provisão & distribução , Transplantes/normas
19.
Transplant Proc ; 51(9): 2868-2872, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606187

RESUMO

BACKGROUND: The gap between organ availability and patients on the waiting list for deceased donor kidney transplants has resulted in the wide use of extended criteria donors (ECDs).We aimed to compare the surgical outcomes of single kidney transplantation (KT) performed at our institute with standard criteria donor (SCD) or ECD grafts, according to the Organ Procurement and Transplantation Network definition. PATIENTS AND METHODS: Our retrospective analysis studied 115 adult recipients of KT from January 2016 to July 2018, with kidney grafts procured from adult donors after brain or circulatory death, performed at our institute. Among the 2 recipients' groups, we compared the incidence of early graft loss, delayed graft function, hospitalization, and surgical complications. We compared the evaluation of time to early graft loss with Kaplan-Meier estimators and curves; the hypothesis of no difference in time to graft loss between the 2 groups was tested using the log-rank statistics. RESULTS: Of the 103 deceased donor kidney transplants during the study period, 129 grafts were used after the regional network sharing allocation. More frequently, ECDs had a greater body mass index than SCDs (25.2 ± 3.9 vs 27.7 ± 5.0, P = .005) and type II diabetes mellitus (0% vs 18%, P = .002). KT recipients who received an ECD graft (73, 63.5%) were older (59.8 ± 9.8 vs 45.2 ± 15.4, P < .001) and presented a higher rate of delayed graft function (56% vs 24%, P = .001). Post-transplant graft loss did not differ among the 2 groups. CONCLUSION: Based on clinical experience in a single transplant center, ECD use for KTs is crucial in facing the organ shortage, without impairing post-deceased donor kidney transplant outcomes.


Assuntos
Transplante de Rim/métodos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/métodos , Adulto , Grupos de Populações Continentais , Função Retardada do Enxerto/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
20.
Med Sante Trop ; 29(3): 317-321, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573529

RESUMO

Blood product suppliers have two options for blood collection: at fixed sites and mobile collection sites. Those preferring voluntary, unpaid donations must move ever closer to the population by organizing mobile collection. The objective of this study was to analyze the impact of mobile collection in the production of the Côte d'Ivoire's CNTS. Our results, based on data from the CNTS from 2014 through 2016 and interviews with 22 managers of blood transfusion centers, confirm the increasing preponderance of this approach. Thus, our results raise the problem of blood safety in a context where the prevalence of transfusion-transmissible infections is higher in mobile collections, where most donors are giving blood for the first time.


Assuntos
Bancos de Sangue/métodos , Bancos de Sangue/organização & administração , Coleta de Amostras Sanguíneas/métodos , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Costa do Marfim , Humanos , Unidades Móveis de Saúde , Estudos Retrospectivos , Fatores de Tempo
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