Comparison of liver transplantation outcomes from adult split liver and circulatory death donors

Mallik, Mekhola; Callaghan, Chris; Hope, M.; Gibbs, Paul; Davies, Susan; Gimson, Alexander; Griffiths, William; Pettigrew, Gavin J.

doi:10.1002/bjs.8755

Cited by 35 publications

(41 citation statements)

References 32 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Donation after circulatory death (DCD) organs are the primary target to expanding potential donor pools, and in fact, DCD LT has recently increased in Western countries, coupled with current remarkable developments of MP techniques . In DCD LT, however, ischemic cholangiopathy is one of the main causes of graft loss . Arterial HyFACS successfully maintained microvilli formation in bile canaliculi even after prolonged CS as long as 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Hydrogen Flush After Cold Storage as a New End‐Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury

Tamaki¹,

Hata²,

Okamura³

et al. 2018

Liver Transpl

View full text Add to dashboard Cite

Cold storage (CS) remains the gold standard for organ preservation worldwide, although it is inevitably associated with ischemia/reperfusion injury (IRI). Molecular hydrogen (H ) is well known to have antioxidative properties. However, its unfavorable features, ie, inflammability, low solubility, and high tissue/substance permeability, have hampered its clinical application. To overcome such obstacles, we developed a novel reconditioning method for donor organs named hydrogen flush after cold storage (HyFACS), which is just an end-ischemic H flush directly to donor organs ex vivo, and, herein, we report its therapeutic impact against hepatic IRI. Whole liver grafts were retrieved from Wistar rats. After 24-hour CS in UW solution, livers were cold-flushed with H solution (1.0 ppm) via the portal vein (PV), the hepatic artery (HA), or both (PV + HA). Functional integrity and morphological damages were then evaluated by 2-hour oxygenated reperfusion at 37°C. HyFACS significantly lowered portal venous pressure, transaminase, and high mobility group box protein 1 release compared with vehicle-treated controls (P < 0.01). Hyaluronic acid clearance was significantly higher in the HyFACS-PV and -PV + HA groups when compared with the others (P < 0.01), demonstrating the efficacy of the PV route to maintain the sinusoidal endothelia. In contrast, bile production and lactate dehydrogenase leakage therein were both significantly improved in HyFACS-HA and -PV + HA (P < 0.01), representing the superiority of the arterial route to attenuate biliary damage. Electron microscopy consistently revealed that sinusoidal ultrastructures were well maintained by portal HyFACS, while microvilli in bile canaliculi were well preserved by arterial flush. As an underlying mechanism, HyFACS significantly lowered oxidative damages, thus improving the glutathione/glutathione disulfide ratio in liver tissue. In conclusion, HyFACS significantly protected liver grafts from IRI by ameliorating oxidative damage upon reperfusion in the characteristic manner with its route of administration. Given its safety, simplicity, and cost-effectiveness, end-ischemic HyFACS may be a novel pretransplant conditioning for cold-stored donor organs.

show abstract

Section: Discussionmentioning

confidence: 99%

Hydrogen Flush After Cold Storage as a New End‐Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury

Tamaki¹,

Hata²,

Okamura³

et al. 2018

Liver Transpl

View full text Add to dashboard Cite

show abstract

“…While surgical outcomes have improved with experience, outcomes for right trisegment graft transplantation are still controversial[25]. Due to the procedure’s technical complexity, the incidence of biliary and vascular complications can be as high as 40% and 25%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Split liver transplantation in adults

Hashimoto¹,

Fujiki²,

Quintini³

et al. 2016

WJG

View full text Add to dashboard Cite

Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues.

show abstract

“…26–28 Furthermore, there is concern that a proportion of DCD donors might have become DBD donors had they been managed differently. However, the management of patients dying in critical care must be made by critical care clinicians acting in the best interest of the patient independently of transplant clinicians and there is no clear evidence that the increase in DCD donors in the UK has occurred at the expense of DBD donors.…”

Section: Discussionmentioning

confidence: 99%

Standardized deceased donor kidney donation rates in the UK reveal marked regional variation and highlight the potential for increasing kidney donation: a prospective cohort study

Summers

Hudson

et al. 2014

British Journal of Anaesthesia

View full text Add to dashboard Cite

BackgroundThe UK has implemented a national strategy for organ donation that includes a centrally coordinated network of specialist nurses in organ donation embedded in all intensive care units and a national organ retrieval service for deceased organ donors. We aimed to determine whether despite the national approach to donation there is significant regional variation in deceased donor kidney donation rates.MethodsThe UK prospective audit of deaths in critical care was analysed for a cohort of patients who died in critical care between April 2010 and December 2011. Multivariate logistic regression was used to identify the factors associated with kidney donation. The logistic regression model was then used to produce risk-adjusted funnel plots describing the regional variation in donation rates.ResultsOf the 27 482 patients who died in a critical care setting, 1528 (5.5%) became kidney donors. Factors found to influence donation rates significantly were: type of critical care [e.g. neurointensive vs general intensive care: OR 1.53, 95% confidence interval (CI) 1.34–1.75, P<0.0001], patient ethnicity (e.g. ‘Asian’ vs ‘white’: OR 0.17, 95% CI 0.11–0.26, P<0.0001), age (e.g. age >69 vs age 18–39 yr: OR 0.2, 0.15–0.25, P<0.0001), and cause of death [e.g. ‘other’ (excluding ‘stroke’ and ‘trauma’) vs ‘trauma’: OR 0.04, 95% CI 0.03–0.05, P<0.0001]. Despite correction for these variables, kidney donation rates for the 20 UK kidney donor regions showed marked variation. The overall standardized donation rate ranged from 3.2 to 7.5%. Four regions had donation rates of >2 standard deviations (sd) from the mean (two below and two above). Regional variation was most marked for donation after circulatory death (DCD) kidney donors with 9 of the 20 regions demonstrating donation rates of >2 sd from the mean (5 below and 4 above).ConclusionsThe marked regional variation in kidney donation rates observed in this cohort after adjustment for factors strongly associated with donation rates suggests that there is considerable scope for further increasing kidney donation rates in the UK, particularly DCD.

show abstract

Comparison of liver transplantation outcomes from adult split liver and circulatory death donors

Cited by 35 publications

References 32 publications

Hydrogen Flush After Cold Storage as a New End‐Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury

Hydrogen Flush After Cold Storage as a New End‐Ischemic Ex Vivo Treatment for Liver Grafts Against Ischemia/Reperfusion Injury

Split liver transplantation in adults

Standardized deceased donor kidney donation rates in the UK reveal marked regional variation and highlight the potential for increasing kidney donation: a prospective cohort study

Contact Info

Product

Resources

About