Improving donor management and transplantation success: more research is needed

Greer, David M.; Valenza, Franco; Citerio, Giuseppe

doi:10.1007/s00134-015-3661-0

Cited by 12 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Small studies have access to more granular specific variables that may prove to be predictors of 1-year mortality. Public access to a repository of such studies will be a useful starting point for authors of future reviews that may be interested in evaluating these factors when more studies are available.Finally, the current opioid crisis [10], efforts in expanding the pool of donors [11], and an ever-growing interest in better understanding the management of deceased donors [12] may change the risk of 1-year mortality. For this reason, it is useful to better understand the risk of 1-year mortality by identifying and exploring the characteristics of the low- and high-risk lung transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the current opioid crisis [10], efforts in expanding the pool of donors [11], and an ever-growing interest in better understanding the management of deceased donors [12] may change the risk of 1-year mortality. For this reason, it is useful to better understand the risk of 1-year mortality by identifying and exploring the characteristics of the low- and high-risk lung transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of 1-year mortality in adult lung transplant recipients: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

Background Upon surviving the first year post-lung transplantation, recipients can expect a median survival of 8 years. Within the first year, graft failure and multi-organ failure (possibly secondary to graft failure) are common causes of mortality. To better understand the prognosis within the first year, we plan on conducting a systematic review and meta-analysis of observational studies addressing the association between the patient, donor, and transplant operative factors and graft loss 1-year post-lung transplant. Methods We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register, and PubMed supplemental for non-MEDLINE records for observational studies identifying independent risk factors for early mortality (1 year) in adult lung transplant recipients. We plan on including cohort studies and secondary analyses of randomized controlled trials studying adult lung transplant recipients undergoing their first lung transplant, without any simultaneous organ transplant. We will conduct a random-effects meta-analysis that pools the effect estimates from all eligible studies to obtain a summary estimate and confidence interval for all independent non-therapeutic factors identified in the primary studies. Discussion The results from this study may inform future guidelines on the selection of candidates and donors for transplantation and predictive model development and inform the decision-making process that the physician and patient undertake together. Furthermore, through the conduction of this review, we can identify the limitations with the current best evidence, which will encourage the need for studies with a better methodology to reassess the predictors of mortality. Electronic supplementary material The online version of this article (10.1186/s13643-019-1049-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of 1-year mortality in adult lung transplant recipients: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Ex-situ lung perfusion allows an objective assessment of lung function, thereby overcoming the uncertainties associated with in-vivo evaluation which leads to high rates of unnecessary decisions to abort lung retrieval [76]. Ex-situ lung perfusion also allows lungs to be maintained for many hours without deterioration in function thereby allowing longer periods to obtain histopathological or microbiological results [77], as well as the potential to treat injured donor lungs prior to transplantation [76]. Heart transplantation from DCD donors is also emerging as a realistic opportunity as longer preservation times become a reality.…”

Section: Ex-situ Perfusionmentioning

confidence: 99%

Organ donation after circulatory death: current status and future potential

et al. 2019

View full text Add to dashboard Cite

The continuing shortage of deceased donor organs for transplantation, and the limited number of potential donors after brain death, has led to a resurgence of interest in donation after circulatory death (DCD). The processes of warm and cold ischemia threaten the viability of DCD organs, but these can be minimized by well-organized DCD pathways and new techniques of in-situ organ preservation and ex-situ resuscitation and repair post-explantation. Transplantation survival after DCD is comparable to donation after brain death despite higher rates of primary non-function and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway. There remains a worldwide shortage in organ availability, and it seems unlikely that expanding standard DCD programs in isolation will be sufficient to address this. It is therefore likely that reliance on extended criteria donors will increase, with the attendant imperative to minimize ischemic injury to candidate organs. Normothermic regional perfusion and ex-situ perfusion techniques allow enhanced preservation, assessment, resuscitation and/or repair of damaged organs as a way of improving overall organ quality and preventing the unnecessary discarding of DCD organs. This review will outline exemplar controlled and uncontrolled DCD pathways, highlighting practical and logistical considerations that minimize warm and cold ischemia times while addressing potential ethical concerns. Future perspectives will also be discussed. Take home message Donation after circulatory death (DCD) is an effective means of expanding the potential donor pool, and has comparable transplantation survival to donation after brain death despite higher rates of primary nonfunction and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway.

show abstract

“…[5][6][7] The impact of these and other donor interventions remain largely unknown. 5 While improvements in the standards of deceased donor care are likely to increase the number and quality of transplanted organs, [8][9][10][11] research in this field is sparse and provides very limited support for evidencebased guidelines. 5,10,12 In 2015, the Canadian Critical Care Trials Group and Canadian National Transplant Research Program together launched a unique program of research in deceased donor care: Canada-DONATE.…”

Section: Résumémentioning

confidence: 99%