Heparin and phentolamine combined, rather than heparin alone, improves hepatic microvascular procurement in a non-heart-beating donor rat-model

Richter, Sven; Yamauchi, Junichiro; Minor, Thomas; Menger, Michael D.; Vollmar, Brigitte

doi:10.1007/s001470050691

Cited by 9 publications

(4 citation statements)

References 14 publications

(8 reference statements)

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“…Optimizing cardiovascular physiology is also critical (59). When donor hemoglobin concentration is reduced, whole blood or packed red cells are transfused and, if there is potential for thrombophilia as in DCD donation, systemic heparinization is administered to maintain and improve graft perfusion (60). Heparinization may also have immunological advantages by decreasing anti‐TNFα activity, monocyte and T‐cell infiltration by reducing expression of graft major histocompatability complex II antigen (61).…”

Section: Donor Optimizationmentioning

confidence: 99%

Preservation of the donor pancreas for whole pancreas and islet transplantation

Ridgway

Manas

Shaw

et al. 2010

Clinical Transplantation

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Whole pancreas and islet cell transplantation are both reliant upon the procurement and preservation of a high quality donor pancreas for a successful outcome. In the climate of a reducing donor pool it is imperative that donor optimization, meticulous surgical retrieval and evidence based methods of preservation are practiced to ensure optimal graft quality. Moreover expanded criteria donors and novel methods of pancreas preservation have the potential to expand the number of usable grafts and increase the availability of these transplant modalities to suitable patients with diabetes. This article provides a review of the current literature surrounding donor management, surgical technique and the various technologies of organ preservation applicable to the donor pancreas.

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Section: Donor Optimizationmentioning

confidence: 99%

Preservation of the donor pancreas for whole pancreas and islet transplantation

Ridgway

Manas

Shaw

et al. 2010

Clinical Transplantation

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“…In livers, the induction of dual (i.e., hepatic arterial and portal venous) perfusion, as well as the increase of the portal venous perfusion pressure, markedly improve microvascular inflow of the preservation solution, which consequently reduces the overall heterogeneity of microcirculatory preservation quality (135,138). In addition, pretreatment of donors with heparin and phentolamine, as done clinically in organ harvesting from non-heart-beating donors, has shown that only combined application of heparin and phentolamine, but not heparin alone, improves microvascular procurement (136). However, a warm preflush of the organs of non-heart-beating donors containing streptokinase in RingerЈs lactate has been highly effective to almost normalize microvascular perfusion conditions of the preservation solution in both livers and kidneys (186,187).…”

Section: Techniques For the Study Of Microcirculatory Derangements Inmentioning

confidence: 99%

Role of Microcirculation in Transplantation

Menger

Vollmar

2000

Microcirculation

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Microcirculatory derangements in organ transplantation, characterized by capillary perfusion failure and inflammation-associated leukocyte recruitment, are major determinants for the manifestation of graft dysfunction and destruction. Although preservation/cold storage, posttransplant reperfusion, and rejection have to be considered as individual factors that contribute to injury, recent studies have indicated that ischemia-reperfusion-associated events may trigger immune-response-mediated late rejection. There is major evidence that the microcirculatory derangements induced by cold preservation and reperfusion involve oxygen radicals, complement, phospholipase A2, leukotrienes, thromboxane, platelet-activating factor, and endothelin-1 as well as the activation and function of leukocytic and endothelial selectins, beta 2-integrins, and ICAM-1. This view is based on the fact that blockade or neutralization of these inflammatory mediators and adhesion molecules results in significant amelioration of microvascular graft dysfunction. In parallel, rejection-mediated microcirculatory derangements may not only be ameliorated by immunosuppressive agents, such as cyclosporin, deoxyspergualin, or RS61443, but may, in addition, effectively be inhibited by counteracting oxygen radicals, complement, platelet-activating factor, and adhesion molecules. The introduction of novel techniques for the study of the microcirculation in men, such as thermodiffusion and orthogonal polarization spectral imaging, may in the future assist in improving both early diagnosis of microcirculatory derangements and monitoring of appropriateness of therapy in clinical transplantation surgery.

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“…The organ shortage and rising number of critical patients for liver transplantation are associated with the allocation of marginal organs procured from critical brain‐dead donors 1–3. To attenuate posttransplant organ dysfunction, research efforts during the last decade not only have focused on novel therapeutic strategies to reduce preservation and reperfusion injury but also have included pretreatment regimens for these critical organ donors 4–6…”

mentioning

confidence: 99%

Amiodarone pretreatment of organ donors exerts anti-oxidative protection but induces excretory dysfunction in liver preservation and reperfusion

Moussavian¹,

Kollmar²,

Schmidt³

et al. 2009

Liver Transpl

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The continuous shortage of organs necessitates the use of marginal organs from donors with various diseases, including arrhythmia-associated cardiac failure. One of the most frequently used anti-arrhythmic drugs is amiodarone (AM), which is given in particular in emergency situations. Apart from its anti-arrhythmic actions, AM provides anti-oxidative properties in cardiomyocytes. Thus, we were interested in whether AM donor pretreatment affects the organ quality and function of livers procured for preservation and transplantation. Donor rats were pretreated with AM (5 mg/kg of body weight) 10 minutes before flush-out of the liver with a cold (4°C) histidine-tryptophan-ketoglutarate solution (n ϭ 8). Livers were then stored for 24 hours at 4°C before ex situ reperfusion with a 37°C Krebs-Henseleit solution for 60 minutes in a nonrecirculating system. At the end of reperfusion, tissue samples were taken for histology and Western blot analysis. Animals with vehicle only (0.9% NaCl) served as ischemia/reperfusion controls (n ϭ 8). Additionally, livers of untreated animals (n ϭ 8) not subjected to 24 hours of cold ischemia served as sham controls. AM pretreatment effectively attenuated lipid peroxidation, stress protein expression, and apoptotic cell death. This was indicated by an AM-mediated reduction of malondialdehyde, heme oxygenase-1, and caspase-3 activation. However, AM treatment also induced mitochondrial damage and hepatocellular excretory dysfunction, as indicated by a significantly increased glutamate dehydrogenase concentration in the effluate and decreased bile production. In conclusion, AM donor pretreatment exerts anti-oxidative actions in liver preservation and reperfusion. However, these protective AM actions are counteracted by an induction of mitochondrial damage and hepatocellular dysfunction. Accordingly, AM pretreatment of donors for anti-arrhythmic therapy should be performed with caution. Liver Transpl 15:763-775, 2009.

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Heparin and phentolamine combined, rather than heparin alone, improves hepatic microvascular procurement in a non-heart-beating donor rat-model

Cited by 9 publications

References 14 publications

Preservation of the donor pancreas for whole pancreas and islet transplantation

Preservation of the donor pancreas for whole pancreas and islet transplantation

Role of Microcirculation in Transplantation

Amiodarone pretreatment of organ donors exerts anti-oxidative protection but induces excretory dysfunction in liver preservation and reperfusion

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