Successful liver transplantation from agonal non-heart-beating donors in pigs

Abstract

An effective way to overcome shortage of donors in liver transplantation (LTx) is to consider such from non-heart-beating donors (NHBDs). We investigated how a liver graft should be treated before and/or after procurement for successful LTx from an NHBD. Porcine LTx was performed with FR167653 (FR), a dual inhibitor of tumor necrosis factor-a (TNF-a) and interleukin-1 / 3 (IL-1 p), and/or prostaglandin El (PG). Animals were allocated to an FR group (n = 4, donors and recipients were treated with FR), a PG group (n = 4, donors and recipients were treated with PG), or an FRPG group (n=4, donors and recipients were treated with both FR and PG). No recipients in the FR group and only two of four recipients in the PG group survived, whereas all recipients in the FRPG group survived. Suppression of TNF-a and IL-lp and maintenance of microcirculation are the key to successful transplantation from NHBDs.

The feasibility of an experimental model of donors after cardiac death in remote ischemic preconditioning studies for renal transplantation in porcine

“…This study supports the applicability of the proposed protocol by Morais et al 13 This method has no pharmacological drugs interference, which could compromise graft function by influencing the Na/K transport between membranes, neither the precocious effects of ischemia-reperfusion injury provided by exsanguination described by Schön et al 15 , nor the imprecise analysis of variables and outcomes in the model proposed by Sato et al 16 , once the latter is absent of specification of electrocardiographic criteria and points high variability of time between the withdrawal of life support and cardiac arrest 15,16 . Since no pharmacologic agents or life support withdraw were used in our study with the intent of cardiac arrest, we speculate that organ preservation can be achieved with minimal experimental bias.…”

Non heart beating organ donor: new experimental model in pigs

“…Sato et al 15 presented a study in which cardiorespiratory support was removed to obtain the model of cardiac arrest.…”

Safe time to warm ischemia and posttransplant survival of liver graft from non-heart-beating donors

“…Moreover, in liver transplantation, the allograft sustains inevitable cold ischemia in addition to rewarming injury during liver reperfusion [5] . Therefore, warm ischemia-reperfusion injury of liver grafts has become a hot topic with theoretical and clinical significance, and it has drawn more and more attention [1] . It is a main unfathomed problem of how to evaluate the quality of liver grafts and how to ascertain the safety time limit for warm ischemia of liver grafts.…”

“…Quality of liver graft is a key factor for liver transplantation. Organs from NHBD (non-heart-beating donors) seem to be an option to alleviate the problem of liver donor shortage effectively [1] . However, warm ischemia to the liver related to cardiac arrest remained a main obstacle to the use of livers from NHBD [2][3][4] .…”