Liver transplantation from controlled non-heart–beating donors

D’Alessandro, Anthony M.; Hoffmann, Robert M.; Knechtle, Stuart J.; Odorico, Jon S.; Becker, Yolanda T.; Musat, Alexandru I.; Pirsch, John D.; Sollinger, Hans W.; Kalayoğlu, Münci

doi:10.1067/msy.2000.108421

Cited by 170 publications

(105 citation statements)

References 17 publications

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“…Interestingly, some groups have compared the outcomes with those with CNHBDs and BDDs and reported similar graft and recipient survival as well as a low postoperative complication rate. [8][9][10][11][12][13] It is accepted by most teams that CNHBD liver transplantation could be used as a strategy to increase the donor pool. However, many issues regarding UNHBDs remain unclear, and this keeps this graft source underused.…”

Section: Discussionmentioning

confidence: 99%

“…The indications for OLT in this group were alcoholic cirrhosis (n ϭ 18), hepatitis C cirrhosis (n ϭ 13), hepatitis B cirrhosis (n ϭ 6), hepatocellular carcinoma (n ϭ 2), and cryptogenic cirrhosis (n ϭ 1). The mean Child-Pugh score was 8.7 Ϯ 1.9 (range, [6][7][8][9][10][11][12], and the mean MELD score was 15.5 Ϯ 4.6 (range, 9-30).…”

Section: Recipient Characteristicsmentioning

confidence: 99%

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Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n ϭ 1) for the UNHBD group and 0% for the BDD group (P ϭ 0.15). The rate of primary nonfunction was 10% (n ϭ 2) in UNHBD recipients and 2.5% (n ϭ 1) in BDD recipients (P ϭ 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P ϭ 0.012). After a mean follow-up of 330.4 Ϯ 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P ϭ 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P ϭ 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

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Section: Discussionmentioning

confidence: 99%

Section: Recipient Characteristicsmentioning

confidence: 99%

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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“…Use of NHBD could contribute to an increase in the number of solid organs for transplantation including 20% or more to the supply of kidneys, and increasing the supply of other solid organs including liver, pancreas or pancreatic islet cells. [21][22][23][24][25][26][27] Successful heart and lung transplants have been performed in animal models, and appear to be technically feasible. [28][29][30] Recently, one centre has reported the retrieval and transplant of a lung from a controlled NHBD.…”

Section: Conclusion : Les Centres Canadiens Peuvent Apprendre à Partimentioning

confidence: 99%

Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues

Doig

Rocker

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding the use of organs from these donors.S So ou ur rc ce e: : Narrative review from selected Medline references, and other published reports.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : NHBD protocols have been established in many countries including the United States. Despite numerous publications, and extensive debate in the literature, significant ethical issues remain unresolved in the retrieval of organs from donors that have died from cessation of cardiac activity. The ethical concerns primarily arise in the determination of death, the tension between the time constraints on recovering organs viable for transplantation, and procedures to enhance organ viability. Despite a concerted effort in the United States, less than half of the organ procurement organizations have NHBD protocols.

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“…11,12 Conversely, results with non-heart-beating donors and severely steatotic livers have been less favorable. 13,14 Hepatitis B core antibody-positive (HBcAb ϩ ) cadaveric donor livers also are considered marginal because of the 25% to 90% risk for hepatitis B virus (HBV) transmission to the recipient. 15,16 However, outcomes in selected hepatitis B surface antigen (HBsAg) ϩ and seropositive (i.e., HBcAb ϩ or antibody to HBsAg [HBsAb] ϩ ) recipients generally have been favorable.…”

mentioning

confidence: 99%

Are we ready for marginal hepatitis B core antibody-positive living liver donors?

Fontana¹

2003

Liver Transplantation

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Liver transplantation from controlled non-heart–beating donors

Cited by 170 publications

References 17 publications

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues

Are we ready for marginal hepatitis B core antibody-positive living liver donors?

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