Liver transplantation from maastricht category 2 non–heart-beating donors: a source to increase the donor pool?

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

doi:10.1016/j.transproceed.2004.03.027

Cited by 29 publications

(14 citation statements)

References 9 publications

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“…For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (199 organs 357,358,360 ) or adult livers (60 organs 355,358,361 ). For the important outcome of graft survival for 5 years, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (177 organs 357,360 ) or adult livers (34 organs 355 ).…”

Section: October 20 2015mentioning

confidence: 94%

“…other types of donors for adult kidneys (203 organs [357][358][359][360] ) or adult livers (64 organs 355,358,361,362 ). For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (199 organs 357,358,360 ) or adult livers (60 organs 355,358,361 ).…”

Section: October 20 2015mentioning

confidence: 99%

See 1 more Smart Citation

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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Section: October 20 2015mentioning

confidence: 94%

Section: October 20 2015mentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

View full text Add to dashboard Cite

show abstract

“…In contrast, types Ⅲ/Ⅳ donors have a more predictable course before the cardiac death and were termed "controlled" donors. The outcomes of livers from uncontrolled DCD donors were poor; only a few reports have been published on liver transplantation using these donors and some form of cardio-pulmonary support was employed in these donors to maintain recirculation [8,21] . Substantial data on renal transplantation from uncontrolled DCD donors exists; however, most liver transplant programs only use controlled DCD donors at present [22] .…”

Section: Historical Perspectivesmentioning

confidence: 99%

“…The exaggerated ischemia reperfusion injury might be potentially life threatening to the recipient upon reperfusion of the graft [7] . A higher incidence of significant organ dysfunction, delayed graft function with primary nonfunction is reported with organs from DCD donors [8,9] . Dependency on organ support in the immediate post operative period is an added burden on healthcare systems, in addition to increased risk of long term complications e.g.…”

Section: Introductionmentioning

confidence: 99%

Current status and recent advances of liver transplantation from donation after cardiac death

Perera

Bramhall

2011

WJGS

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The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

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“…When utilizing controlled DACD for transplantation, emerging data indicates that recipient and graft survival are diminished when compared to deceased and living donor liver transplantation with a higher incidence of primary nonfunction, biliary injury, and requirement for retransplantation. However, several centers have reported acceptable outcomes when utilizing controlled DACD organs, particularly those without significant ischemia in well-selected recipients (15).…”

Section: Liver Transplantation: Source Of Organsmentioning

confidence: 99%

Liver Transplantation

Gaglio¹

2006

Encyclopedia of Medical Devices and Instrumentation

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Liver transplantation is the treatment of choice for appropriately selected patients with end‐stage liver disease. Over the last several decades, significant advances in surgical technique and immunosuppression, selection of appropriate donors, grafts, and recipients, as well as improved therapies to prevent and treat postoperative complications have greatly improved posttransplantation outcomes. Enhanced posttransplantation survival has led to the emergence of complications associated with patient longevity, including nonhepatic disease, complications of immunosuppression, infections, neoplasia, and recurrence of the primary disease for which the liver transplantation was indicated. This article will outline the history of and indications for liver transplantation, delineate short‐ and long‐term complications associated with the procedure, and discuss the role of immunosuppressive therapy, intrinsic to the long‐term success of the procedure.

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Liver transplantation from maastricht category 2 non–heart-beating donors: a source to increase the donor pool?

Cited by 29 publications

References 9 publications

Part 4: Advanced Life Support

Part 4: Advanced Life Support

Current status and recent advances of liver transplantation from donation after cardiac death

Liver Transplantation

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