Chinese Pediatric Organ Donation With Scheduled Cardiac Arrest After Brain Death: A Novel China Classification Beyond Maastricht

Wu, Zhixian; Gao, Xiangyang; Chen, F.; Tao, Xiaoqin; Cai, Jie; Guo, Jianxin; Chen, Xizhong; Tan, Ming Jen; Yang, Song

doi:10.1016/j.transproceed.2015.10.029

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…Additionally, 9.1% cases from DBCD group suffered from AR compared with 8.6% in DBD group ( P = 1.0). According to a previous published study, we divided warm ischemia time into two groups: ≤18 min and > 18 min [ 18 ]. Compared with the ≤18 min group, 54 donors (23.7%) had WIT> 18 min, of whom 17(31.5%) had DGF (31.5% versus 15.2%, P = 0.02).…”

Section: Resultsmentioning

confidence: 99%

Donation after brain death followed by circulatory death, a novel donation pattern, confers comparable renal allograft outcomes with donation after brain death

et al. 2018

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BackgroundOrgan donation after brain death (DBD) is the standard strategy for organ transplantation; however, the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide. Hence, a novel donation pattern has been established in China which outlines the concept of donation after brain death followed by circulatory death (DBCD). Differently from any current donation classification, this new concept is formulated based on combination of recognizing brain death and circulatory death. Should approval be gained for this definition and approach, DBCD will pave a novel donation option for billions of people who cannot accept DBD due to their cultural beliefs.MethodsA multi-center, cohort study was conducted from February 2012 to December 2015. 523 kidney transplant recipients from four kidney transplant institutions were enrolled into the study, of which, 383 received kidneys from DBCD, and 140 from DBD. Graft and recipient survivals following transplantation were retrospectively analyzed. Postoperative complications including delayed graft function,, and acute rejection, were also analyzed for both groups.ResultsDBCD could achieve comparable graft and recipient survivals in comparison with DBD (Log-rank P = 0.32 and 0.86,respectively). One-year graft and recipient survivals were equal between DBCD and DBD groups (97.4% versus 97.9%, P = 0.10;98.4% versus 98.6%, P = 1.0, respectively). Furthermore, DBCD did not increase incidences of postoperative complications compared with DBD, including delayed graft function (19.3% versus 22.1%, P = 0.46) and acute rejection (9.1% versus 8.6%, P = 1.0). Additionally, antithymocyte globulin as induction therapy and shorter warm ischemia time decreased incidence of delayed graft function in DBCD group (16.8% on antithymocyte globulin versus 27.2% on basiliximab, P = 0.03; 16.7% on ≤18 min versus 26.7% on > 18 min group, P = 0.03).ConclusionsKidney donation through DBCD achieves equally successful outcomes as DBD, and could provide a feasible path to graft availability for billions of people who face barriers to organ donation from DBD.

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Section: Resultsmentioning

confidence: 99%

Donation after brain death followed by circulatory death, a novel donation pattern, confers comparable renal allograft outcomes with donation after brain death

et al. 2018

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“…Donors with a history of CPR had a higher incidence of DGF (47.0% in CPR vs. 17.0% in no CPR, p = 0.007). According to a previous published study, WIT was divided into two groups: ≥ 18 min and >18 min [17]. In WIT >18 min, 31.5% had developed DGF compared with 15.2% in WIT ≤18 min (p = 0.015).…”

Section: Donor and Recipient Characteristics Related To Dgfmentioning

confidence: 99%

“…A novel donation concept, organ donation after brain death followed by circulatory death (DBCD), was officially initiated in China in 2011, and could be regarded as a combination of Maastricht donation types 3 and 4 [8][9][10][11]. Despite a planned protocol for mechanical support and subsequent implementation of cardiac death protocols after brain death, the new donation pattern was also expected to be associated with a high risk of DGF because it involves additional warm ischemia time (WIT) [10,11].…”

Section: Introductionmentioning

confidence: 99%

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

Sun

Huang

Zhou

et al. 2018

Kidney Blood Press Res

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Background/Aims: Delayed graft function (DGF) is a common complication following kidney transplantation adversely affecting graft outcomes. Donation after brain death followed by circulatory death (DBCD), a novel donation pattern, is expected to correlate with high incidence of DGF. However, little information is available about factors associated with DGF in DBCD. Methods: A total of 383 kidney transplants from DBCD donation in three institutions were enrolled. Associations of DGF with the clinical characteristics of recipients and donors were quantified. Results: In this retrospective multi-center study, the incidence of DGF was 19.3%. Lower incidence of DGF was found in recipients for whom antithymocyte globulin was used for induction (p < 0.05), which was an independent protective factor against DGF (odds ratio [OR] = 0.48; 95% CI 0.27-0.86). Two novel explicative variables were recognized as independent risk factors, including use of vasoactive drugs (OR = 3.15; 95% CI 1.39-7.14) and cardiopulmonary resuscitation (OR = 2.51; 95% CI 1.05-6.00), which contributed significantly to increased risk of DGF (p < 0.05). Prolonged warm ischemia time (> 18 min; OR = 2.42; 95% CI 1.36-4.32), was also predictive of DGF in DBCD. A prediction model was developed and achieved an area under the curve of 0.89 in predicting DGF when combined with reported parameters. Conclusion: The novel factors, confirmed for the first time in our study, will help to improve risk prediction of DGF and to determine optimal interventions to prevent DGF in clinical practice.

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“…All donor grafts were donated to the Red Cross Society of Hubei Province and were allocated by the China Organ Transplant Response System. The study was approved by the Ethics Committee of Tongji Medical College of Huazhong University of Science and Technology (IORG No: IORG0003571) and was performed in accordance with the national program for deceased-donor organ donation in China [4] (national protocol for China category I [5]). The clinical and research activities being reported are consistent with the principles of the Declaration of Istanbul and Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

Orthotopic Heart Transplantation for Congenital Heart Disease with Dextrocardia: A Single-Center Clinic Experience

Wang

Zhang

et al. 2020

BioMed Research International

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Background. We report a modified transplantation surgical technique for CHD with dextrocardia which is rare and surgically challenging. Methods. From January 2015 to May 2018, 5 patients with end-stage CHD with dextrocardia underwent heart transplantation at our institute. They were 10, 29, 13, 15, and 22 years old, respectively; 3 of them had dextroversion, and the other 2 had mirror-image dextrocardia and post-TCPC. The atrial-atrial anastomosis was performed first between the donor’s upper-left PVO and the recipient’s lower-left PVO. The apex thereby rotated approximately 90° clockwise (to the right). The end-to-end donor and recipient aortas, vena cava, and pulmonary arteries were then anastomosed. Results. The cold ischemic time of the donor heart was 284.6±108.3 min, and the CPB time was 190.2±43.8 min. The postoperative X-ray showed the apex on the right. Four patients were successfully discharged, and the follow-up times were 47 months, 36 months, 12 months, and 12 months. One post-TCPC patient died because of pneumonia and hypoxia at 59 postoperative days. Conclusions. Heart transplantation with dextrocardial CHD is rare. A 90° rotation at the left atrial level, aortic end-to-end anastomosis, and vena cava reconstruction by vascular prosthesis or systemic atrial cuff is a simple and effective surgical strategy.

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Chinese Pediatric Organ Donation With Scheduled Cardiac Arrest After Brain Death: A Novel China Classification Beyond Maastricht

Cited by 12 publications

References 27 publications

Donation after brain death followed by circulatory death, a novel donation pattern, confers comparable renal allograft outcomes with donation after brain death

Donation after brain death followed by circulatory death, a novel donation pattern, confers comparable renal allograft outcomes with donation after brain death

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

Orthotopic Heart Transplantation for Congenital Heart Disease with Dextrocardia: A Single-Center Clinic Experience

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