Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’

McCormack, Lucas; Quiñonez, Emilio; Ríos, María Martha; Capitanich, Pablo; Goldaracena, Nicolás; Cabo, Javier Kerman; Anders, Margarita; Osatnik, Javier; Comignani, Pablo; Mezzadri, Norberto A; Mastaï, Ricardo

doi:10.1111/j.1477-2574.2010.00193.x

Cited by 26 publications

(33 citation statements)

References 27 publications

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“…The median hospital stay of this series was 9 days (range: 6-19). The median follow-up was 14 months (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. One patient died on postoperative day 17 due to sepsis without signs or serological evidence of Chagas infection (i.e.…”

Section: Resultsmentioning

confidence: 99%

“…In Argentina, despite the implementation of the MELD score allocation system in 2005, the mortality of patients on the liver waiting list is increasing, and has reached 15% and 25% for elective and emergency candidates, respectively (2,3). This scenario has forced our LT team to relax the deceased donor selection criteria, expanding the liver pool to include those organs from T. cruzi-infected donors (4,5).…”

Section: Introductionmentioning

confidence: 99%

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Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

McCormack

Quiñonez

Goldaracena

et al. 2012

American Journal of Transplantation

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Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas-infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13-month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow-up, two patients died without Chagas infection and only two (donorderived T. cruzi transmission rate: 2/9; 22%) patients developed donor-derived Chagas transmission without clinical symptoms. The median follow-up time of the seven live patients was 15 months (range: 13-20). At present, all are symptoms-free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas-infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

McCormack

Quiñonez

Goldaracena

et al. 2012

American Journal of Transplantation

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“…The paradox is that these organs are most susceptible to the consequences of preservation related injury (10)(11)(12). Many ECD livers are turned down by the recipient transplant team because of the inherent risk of preservation injury with limited available preservation technologies (7,13).…”

Section: Introductionmentioning

confidence: 99%

Hypothermic Machine Preservation Facilitates Successful Transplantation of “Orphan” Extended Criteria Donor Livers

Guarrera

Henry

Samstein

et al. 2015

American Journal of Transplantation

276

272

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Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region (''orphan livers''). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for EndStage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-88C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p ¼ 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p ¼ NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p ¼ 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 AE 10.9 vs. 20.14 AE 11.12 days in the SCS group, p ¼ 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.

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“…It is well known that suboptimal livers present increased vulnerability to ischemia/reperfusion injury (IRI) and are associated with poorer posttransplant outcomes . It has been observed that frequently ECD livers are not used for transplantation as a consequence of the intrinsic poor outcome risk, especially in relation to long ischemia time and mainly because of limited available preservation options . Therefore, preservation methods for suboptimal livers need to be further explored and validated …”

mentioning

confidence: 99%

Ischemia/reperfusion, does temperature matter? Laboratory perspective

Mas

2015

Liver Transpl

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Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’

Abstract: Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence.

Cited by 26 publications

References 27 publications

Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

Liver Transplantation Using Chagas-Infected Donors in Uninfected Recipients: A Single-Center Experience Without Prophylactic Therapy

Hypothermic Machine Preservation Facilitates Successful Transplantation of “Orphan” Extended Criteria Donor Livers

Ischemia/reperfusion, does temperature matter? Laboratory perspective

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