Technical Complications in Organ Procurement

Fernández, Emilio Domínguez; Schmid, M.; Schlosser, Katja; Mauer, D.

doi:10.1016/j.transproceed.2007.07.092

Cited by 8 publications

(14 citation statements)

References 6 publications

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“…The same argument goes for kidney transplantation where poor perfusion and poor biopsy results may lead to a withdrawal as shown in a recent report from the OPTN [20]. The refusal based on surgical injury is much higher for pancreas recovery, where the incidence ranges from 16.6% to 52% with loss of transplantation in 12% up to 17.2% after the initial acceptance as described in earlier studies [8,9,21,22]. The margin of error is therefore much narrower when it comes down to pancreas recovery.…”

Section: Discussionmentioning

confidence: 72%

“…Eighty-four (31.8%) had surgical injuries of which 46 (54.7%) could be salvaged for transplantation. The mean donor age was 35 years (SD 12.5 years), and mean BMI was 23 (range [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The majority of the pancreases were recovered in the Netherlands (88.6%) with only 11.4% being imported from other countries within the Eurotransplant region (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

et al. 2016

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Professional abdominal organ recovery with certification has been mandatory in the Netherlands since 2010. This study analyses the effects of certification (January 2010-September 2015) on pancreas transplantation and compares it to an era before certification (February 2002-May 2008) for surgical injuries and the number of pancreases transplanted. A total of 264 cases were analysed. Eighty-four recovered pancreases (31.8%) with surgically injuries were encountered. Forty-six of those were surgically salvaged for transplantation, resulting in a total of 226 (85.6%) being transplanted. It was found that certified surgeons recovered grafts from older donors (36.8 vs. 33.3; P = 0.021), more often from donation after circulatory death (DCD) donors (18% vs. 0%; P < 0.001) and had less surgical injuries (21.6% vs. 41.0%; P < 0.001). Certification (OR: 0.285; P < 0.001) and surgeons from a pancreas transplant centre (OR: 0.420; P = 0.002) were independent risk factors for surgical organ injury. Predictors for proceeding to the actual pancreas transplantation were a recovering surgeon from a pancreas transplantation centre (OR: 3.230; P = 0.003), certification (OR: 3.750; P = 0.004), donation after brain death (DBD) (OR: 8.313; P = 0.002) and donor body mass index (BMI) (OR: 0.851; P = 0.023). It is concluded that certification in abdominal organ recovery will limit the number of surgical injuries in pancreas grafts which will translate in more pancreases available for transplantation.

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Section: Discussionmentioning

confidence: 72%

Section: Resultsmentioning

confidence: 99%

Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

et al. 2016

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“…Injuries in procured livers are reported in 10–34% . The highest injury rate was reported in a study from the Netherlands that revealed injury in 34% of all procured livers, of which 6.6% were clinically relevant .…”

Section: Introductionmentioning

confidence: 99%

“…The number of patients on the waiting list for organ transplantation clearly shows the need for more suitable organs in the Eurotransplant (ET) region . Complications during procurement may lead to the loss of organs or to inferior outcome . Therefore, optimal quality of organ procurement is essential.…”

Section: Introductionmentioning

confidence: 99%

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Abdominal organ procurement in the Netherlands - an analysis of quality and clinical impact

Boer

Kopp

Ooms³

et al. 2017

Transpl Int

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Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume is associated with fewer injuries.

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Technik der Leberentnahme bei postmortaler Spende

Schnitzbauer

Bechstein

2013

Chirurg

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Literature review and discussion of critical aspects concerning the procurement of liver allografts. The procurement of livers should be performed by qualified transplantation and organ procurement surgeons (certification). The technique is standardized in German guidelines. A thoracotomy can help to optimize exposition which is essential to avoid technical complications and injuries to the graft especially in a training situation. Dissection in the cold is recommended. Knowledge of the anatomic variations of the hepatic artery is essential in procuring liver allografts. Documentation of errors and anatomic variations, packing of organs and a standardized closure of the thorax and abdomen are obligations of the responsible leading organ procurement surgeon.

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Technical Complications in Organ Procurement

Cited by 8 publications

References 6 publications

Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

Abdominal organ procurement in the Netherlands - an analysis of quality and clinical impact

Technik der Leberentnahme bei postmortaler Spende

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