Recommendations for Use of Marginal Donors in Heart Transplantation: Brazilian Association of Organs Transplantation Guideline

Fiorelli, Alfredo Inácio; Stolf, Noedir Antônio Groppo; Pěgo‐Fernandes, Paulo M.; Oliveira, José Luís; Santos, Ronaldo Honorato Barros; Contreras, Carlos; Filho, Domingos D. Lourenço; Dinkhuysen, Jarbas J; Moreira, M.C.V.; Mejía, Juan Alberto Cosquillo; Castro, Maria Cristina Ribeiro de

doi:10.1016/j.transproceed.2010.12.047

Cited by 26 publications

(23 citation statements)

References 23 publications

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“…(87) Both echocardiography and PAC monitoring are used to identify hearts that are suboptimal candidates for transplantation (B). (8) Echocardiographic assessment of the left ventricular ejection fraction assists in predicting which organs are viable for transplantation (B).…”

Section: Which Invasive Hemodynamic Monitoring Methods (Pac) or Echocmentioning

confidence: 99%

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

Westphal¹,

Filho²,

Vieira³

et al. 2011

Rev. bras. ter. intensiva

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Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient. OBJECTIVEThese guidelines are aimed at contributing to the institutional coordination of organ transplantation and will provide "real world" guidelines that are appropriate in the Brazilian context for the uniform care of the deceased donor. Ultimately, this aim of this guide is to increase the quality and quantity of transplantable organs. METHODOLOGYThe Writing and Planning Committee, comprised of young intensive care physicians and intensive medicine residents, conducted an extensive literature review. From this review, they formulated questions and forwarded the questions to all of the authors of this article. These initial questions served as the starting point for receiving suggestions for the formulation of other questions and definitions.The final questions were revised by the Executive Committee and were returned to the authors to develop the guidelines presented in this article.The questions guided the literature review, which was conducted using the P.I.C.O. methodology where P stands for the target population, I for the intervention, C for the control or comparative group and O for the clinical outcome.The retrieved articles were critically analyzed and categorized according to their grade of recommendation and the strength of the presented evidence in the following manner:

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Section: Which Invasive Hemodynamic Monitoring Methods (Pac) or Echocmentioning

confidence: 99%

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

Westphal¹,

Filho²,

Vieira³

et al. 2011

Rev. bras. ter. intensiva

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“…Unfortunately, the number of donor hearts has remained unchanged over the last decades despite an increasing demand, and longer transplant waiting times (1,2). Long-term mechanical circulatory support with left ventricular assist devices (LVAD) is being increasingly utilized as a bridge to transplantation (BTT) strategy until a suitable donor organ becomes available (3).…”

Section: Introductionmentioning

confidence: 99%

Institutional Volume of Heart Transplantation with Left Ventricular Assist Device Explantation Influences Graft Survival

Maltais

Haglund

Feurer

et al. 2013

The Journal of Heart and Lung Transplantation

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Objective-We sought to assess the impact of institutional volume of LVAD explant-OHT on post-transplant graft survival.Background-There are increasing numbers of patients undergoing orthotopic heart transplantation (OHT) with left ventricular assist device (LVAD) explantation. We hypothesized that LVAD explant-OHT is a more challenging surgical procedure compared to OHT without LVAD explantation and that institutional LVAD explant-OHT procedural volume will be associated with post-transplant graft survival.

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“…Due to the shortage of donated hearts, selection criteria are under constant review in order to increase the number of marginal donors [3,4]. Nevertheless, studies in the field of myocardial protection have great relevance for the advancement of heart transplantation [1].…”

Section: Introductionmentioning

confidence: 99%

Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíaco

Lima¹,

Fiorelli²,

Vassallo³

et al. 2012

Rev Bras Cir Cardiovasc

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Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíacoComparative experimental study of myocardial protection with crystalloid solutions for heart transplantation Abstract Background: There is a growing need to improve myocardial protection, which will lead to better performance of cardiac operations and reduce morbidity and mortality. Therefore, the objective of this study was to compare the efficacy of myocardial protection solution using both intracellular and extracellular crystalloid type regarding the performance of the electrical conduction system, left ventricular contractility and edema, after being subjected to ischemic arrest and reperfusion.Methods: Hearts isolated from male Wistar (n=32) rats were prepared using Langendorff method and randomly divided equally into four groups according the cardioprotective solutions used Krebs-Henseleit-Buffer (KHB), Bretschneider-HTK (HTK), St. Thomas-1 (STH-1) and Celsior (CEL). After stabilization with KHB at 37°C, baseline values (control) were collected for heart rate (HR), left ventricle systolic pressure (LVSP), maximum first derivate of rise left ventricular pressure (+dP/dt), maximum first derivate of fall left ventricular pressure (-dP/dt) and coronary flow (CF). The hearts were then perfused at 10°C for 5 min and kept for 2 h in static ischemia at 20°C in each cardioprotective solution. Data evaluation was done using analysis of variance in completely randomized One-Way ANOVA and Tukey's test for multiple comparisons. The level of statistical significance chosen was P<0.05.Results: HR was restored with all the solutions used. The evaluation of left ventricular contractility (LVSP, +dP/ dt and -dP/dt) showed that treatment with CEL solution was better compared to other solutions. When analyzing the CF, the HTK solution showed better protection against edema.Conclusion: Despite the cardioprotective crystalloid solutions studied are not fully able to suppress the deleterious effects of ischemia and reperfusion in the rat heart, the CEL solution had significantly higher results followed by HTK>KHB>STH-1.

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Recommendations for Use of Marginal Donors in Heart Transplantation: Brazilian Association of Organs Transplantation Guideline

Cited by 26 publications

References 23 publications

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

Institutional Volume of Heart Transplantation with Left Ventricular Assist Device Explantation Influences Graft Survival

Estudo comparativo experimental da proteção miocárdica com soluções cristalóides para transplante cardíaco

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