Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay. K E Y W O R D Sdelayed graft function, kidney (allograft) function/dysfunction, organ perfusion and preservation
Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.
Introduzione. L'infezione polmonare da Pseudomonas aeruginosa (PA) nei pazienti con Fibrosi Cistica (FC) provoca un notevole declino della funzionalità respiratoria. La maggior parte degli AA indica che una precoce terapia antibiotica può prevenire l'instaurarsi di un'infezione cronica da PA, è quindi estremamente importante isolare dall'espettorato, più precocemente possibile PA, così da poter instaurare, ai primi segni di infezione, una terapia antibiotica antipseudomonas. Scopo del nostro studio è verificare se la ricerca di PA diretta dall'espettorato mediante metodica molecolare in PCR possa contribuire a definire più precocemente, dell'esame colturale, la prima infezione da PA. Pazienti. Sono stati valutati 66 espettorati di altrettanti pazienti con Fibrosi Cistica, afferenti al Centro di Riferimento Regionale Lombardo. Metodi. I campioni di espettorato, dopo fluidificazione con sputasol e diluizioni seriali, sono stati seminati, su Agar sangue e Agar Mc Conkey. Dallo stesso campione utilizzato per l'esame colturale, è stato estratto il DNA genomico batterico mediante estrazione con resine (Extracell, Ditta Biosys ed Estraction Kit Roche) ed è stato amplificato un frammento di DNA specifico del genoma di PA che codifica per una proteina di membrana (gene oprL) Risultati. Dei 66 pazienti valutati con le due metodiche, 58 sono risultati perfettamente concordanti (11 PA positivi e 47 PA negativi). Con la metodica colturale sono risultati positivi 11 pazienti; con la metodica molecolare sono risultati positivi 19 pazienti. Degli 8 pazienti risultati positivi solo con la metodica molecolare, 5 erano risultati positivi per PA in modo intermittente all'esame colturale, negli anni precedenti . Conclusioni. Questo studio preliminare mette in evidenza che il metodo molecolare in PCR è un metodo idoneo per l'evidenziazione precoce di PA. L'utilizzo quindi di questa metodica potrebbe permettere al clinico di instaurare, nei pazienti infettati con PA, più precocemente la terapia antibiotica antipseudomonas, nel tentativo di ottenerne l'eradicazione.
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