Liver transplantation from Maastricht category 2 non-heart-beating donors

Otero, Alejandra; Gómez-Gutiérrez, Manuel; Suárez, Francisco; Arnal, F; Fernández-García, Antón; Aguirrezabalaga, J.; García-Buitron, J.M.; Alvarez, J.; Máñez, Rafael

doi:10.1097/01.tp.0000085043.78445.53

Cited by 113 publications

(111 citation statements)

References 23 publications

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“…Similarly, Merion et al 17 analyzed the results of the Scientific Registry of Transplant Recipients database, including 472 NHBD transplants performed between In our country, Otero et al 4 published their experience with 20 OLT procedures using UNHBDs. They reported 2 different methods of maintaining the donor prior to harvesting.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] After unrecovered cardiac arrest is diagnosed, the donor is transferred to our center. During transportation, advanced cardiopulmonary resuscitation is performed, and it is interrupted at our center for only 5 minutes for the declaration of death according to Spanish law.…”

Section: Octubre University Hospital Protocolmentioning

confidence: 99%

“…In 2003, Otero et al 4 from La Coruñ a, Spain, published their series of 20 recipients of UNHBD grafts, reporting higher graft and recipient survival than previous series (55% and 80%, respectively). In their experience, 2 different methods of donor maintenance prior to washout were used.…”

mentioning

confidence: 98%

“…According to previous clinical and experimental models, [4][5][6] we initially adopted a maximum normothermic extracorporeal ischemia time of 4 hours. Nevertheless, on the basis of our own results, we extended this maximum time by 30 more minutes.…”

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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: Octubre University Hospital Protocolmentioning

confidence: 99%

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confidence: 98%

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

et al. 2009

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“…Recently, CD donors have increased to 10-20% of the liver donor pool in some European countries (Monbaliu et al 2012). Some researchers have reported that these liver grafts are associated with primary graft nonfunction and biliary complications (Otero et al 2003). Importantly, no standard criteria or retrieval procedures have been established for CD donors.…”

Section: Introductionmentioning

confidence: 99%

Soluble Thrombomodulin Ameliorates Ischemia-Reperfusion Injury of Liver Grafts by Modulating the Proinflammatory Role of High-Mobility Group Box 1

Kashiwadate

Miyagi

Hara

et al. 2016

Tohoku J. Exp. Med.

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Transplantation using grafts obtained after cardiac death (CD) is considered a promising solution for graft shortages. However, no standard criteria for organ preservation have been established for CD donors. High-mobility group box 1 (HMGB1) is a DNA-binding protein that is released from dying hepatocytes as an early mediator of inflammation and organ tissue damage. HMGB1 stimulates immunocytes to produce inflammatory cytokines, thereby amplifying the inflammatory response. Thrombomodulin is an integral membrane protein that functions as an endothelial anticoagulant cofactor, and it binds HMGB1 through the extracellular domain. We investigated the effects of ART-123, recombinant human soluble thrombomodulin, on warm ischemia-reperfusion injury in liver grafts. Male Wistar rats were divided into four ex vivo groups: heart-beating (HB) group, in which livers were isolated from HB donors; CD group, in which livers were isolated from CD donors exposed to apnea-induced conditions and warm ischemic conditions for 30 min after cardiac arrest; and two CD groups pretreated with ART-123 (1 or 5 mg/kg). Each isolated liver was reperfused for 1 h after cold preservation for 6 h. The perfusate levels of HMGB1, LDH, TNF-α, and IL-6 were significantly lower in the CD group pretreated with ART-123 (5 mg/kg) than in the CD group. Bile production was significantly higher in the CD group pretreated with ART-123 (5 mg/kg) than in the CD group. The sinusoidal spaces were significantly narrower in the CD group than in the other groups. We propose that ART-123 maintains sinusoidal microcirculation by reducing endothelial cell damage during warm ischemia-reperfusion injury.

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Deceased Donor Retrieval

Wolthuis¹,

Monbaliu²,

Coosemans³

et al. 2012

Handbook of Renal and Pancreatic Transplantation

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Liver transplantation from Maastricht category 2 non-heart-beating donors

Abstract: Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.

Cited by 113 publications

References 23 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

Soluble Thrombomodulin Ameliorates Ischemia-Reperfusion Injury of Liver Grafts by Modulating the Proinflammatory Role of High-Mobility Group Box 1

Deceased Donor Retrieval

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