Organ Donor Research

Childress, James F.

doi:10.1001/jama.2017.16442

Cited by 13 publications

(6 citation statements)

References 5 publications

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“…Although some experts call for a more liberal use of DCD donor grafts in the light of the high waiting list associated mortality (in fact, for the US alone almost 5000 patients die annually while waiting for kidney transplant) [21], high incidences of delayed graft function and early graft loss in DCD grafts remain a major source of concern that prevents a more liberal use of this type of grafts [8]. As result, the use of kidney grafts donated after cardiac death as a highly significant source of donor organs remains a matter of great controversy [2]. In most societies including the US, the number of DCD procedures performed has stabilized at approximately 10–20% of the total of deceased donor procedures performed [22].…”

Section: Discussionmentioning

confidence: 99%

“…Kidney transplantation profoundly improves quality of life and longevity of end-stage renal disease patients and remains the only curative option for patients with end-stage renal disease [1]. In an era of growing waiting lists for renal transplants, and unacceptably high waiting list-associated mortality, pressing donor shortages have led to an increased use of so called “extended criteria grafts” and kidney grafts obtained from donors deceased following cardiac death (DCD) [2]. Transplantation procedures with DCD grafts are associated with increased incidences of primary non-function/early graft loss and delayed graft function.…”

Section: Introductionmentioning

confidence: 99%

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Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

et al. 2018

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Background Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified. Methods This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses. Findings Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5–75.2), combined recipient survival: 64.5% (95 CI: 63.0–66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55–0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts. Interpretation Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

et al. 2018

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“…In recent years, there has been a marked increase in the number of transplants from DCD donors [ 12 , 13 ]. At our center, where the DCD program was started in 2016 [ 18 ], there have been almost exclusively uDCD donors (category IIa from the modified Maastricht classification).…”

Section: Discussionmentioning

confidence: 99%

Hemolytic uremic syndrome and kidney transplantation in uncontrolled donation after circulatory death (DCD): A two-case report

Caroti

Cestone

Maria

et al. 2021

CNCS

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Background: Hemolytic uremic syndrome (HUS) is a rare disease characterized by microangiopathic hemolysis, thrombocytopenia, and renal involvement. Complement-mediated atypical HUS (aHUS) is a result of genetic defects in the alternative complement pathway components or regulators. The introduction of eculizumab has improved renal and overall survival of aHUS patients. Nowadays, given organ shortage, it is necessary to consider kidney transplantation (KT) even in protocols with a high risk of HUS recurrence, such as from donation after circulatory death (DCD) donors. Here, we describe two patients with HUS who underwent a KT from an uncontrolled DCD (uDCD). Case summary: The first patient, affected by aHUS due to a heterozygous deletion in CFHR3-CFHR1 and a novel heterozygous variant in CFHR5 gene, underwent a KT with eculizumab prophylaxis. The patient did not experience a post-transplant aHUS recurrence. The second patient, who experienced an HUS episode characterized by a hypertensive crisis and with no underlying mutations in complement system genes, underwent a KT without eculizumab prophylaxis. At day 5, anti-complement treatment commenced due to hematological signs of thrombotic microangiopathy (TMA). After the introduction of eculizumab, we observed a stabilization of kidney function and hematological remission. Conclusion: We present herein two different patients with HUS who both underwent successful KT from uDCD donation under the umbrella of eculizumab therapy. Taking into account the importance of increasing the number of organs available for transplantation, uDCD could represent an additional resource in this subset of HUS patients.

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“…Until now, the feasibility of ex vivo HK models in human cornea was limited for several reasons: 1/ corneal donation is generally far below demand, be it for transplantation [32] or research [33]; 2/ Available corneas are most often declared unsuitable for transplantation by eye banks and, therefore, have already been stored for several days or weeks; 3/ Corneal epithelium quickly degrades after donor death (drying out, abrasion); 4/ Its quality rapidly deteriorates during storage in hypothermia [34] and in OC [35]; 5/ the CPE characteristic of herpes infection causes further deterioration of the already impaired epithelium (as confirmed by our OC group).…”

Section: Discussionmentioning

confidence: 99%

Ex vivo model of herpes simplex virus type I dendritic and geographic keratitis using a corneal active storage machine

et al. 2020

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Background Herpetic keratitis (HK) models using whole human corneas are essential for studying virushost relationships, because of high species specificity and the role of interactions between corneal cell populations that cell culture cannot reproduce. Nevertheless, the two current corneal storage methods (hypothermia and organ culture (OC)) do not preserve corneas in good physiological condition, as they are characterized by epithelial abrasion, stromal oedema, and excessive endothelial mortality. Methods To rehabilitate human corneas intended for scientific use, we used an active storage machine (ASM) that restores two physiological parameters that are essential for corneal homeostasis: intraocular pressure and storage medium renewal (21mmHg and 2.6 μL/min, respectively). ASM storage regenerates a normal multilayer epithelium in 2 weeks. We infected six pairs of corneas unsuitable for graft by inoculating the epithelium with herpes simplex virus type 1 (HSV-1), and compared each ASM-stored cornea with the other cornea stored in the same medium using the conventional OC method. Results Only corneas in the ASM developed a dendritic (n = 3) or geographic (n = 2) epithelial ulcer reproducing typical HSV-1-induced clinical lesions. Corneas in OC showed only extensive desquamations. None of the uninfected controls showed epithelial damage. Histology,

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Organ Donor Research

Cited by 13 publications

References 5 publications

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

Hemolytic uremic syndrome and kidney transplantation in uncontrolled donation after circulatory death (DCD): A two-case report

Ex vivo model of herpes simplex virus type I dendritic and geographic keratitis using a corneal active storage machine

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