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Deceased Donors (deceased + donor)
Terms modified by Deceased Donors Selected AbstractsHow Safe Is It to Transplant Organs from Deceased Donors with Primary Intracranial Malignancy?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010An Analysis of UK Registry Data Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, a perceived risk of tumor transfer to the organ recipient has limited their use. We evaluated the risk of tumor transmission by reviewing the incidence in patients transplanted in the UK. Information from the UK Transplant Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence of posttransplant malignancy in the recipients of the organs transplanted. Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list. [source] Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney InjuryAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009L. K. Kayler Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ,1.5, 1.6,2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6,2.0 and >2.0 mg/dL, compared to ,1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5,7.6) and 1.6,2.0 mg/dL (AOR 2.7; CI 2.5,2.9) relative to sCr ,1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury. [source] MARS®: a futile tool in centres without active liver transplant supportLIVER INTERNATIONAL, Issue 1 2007Chun-Tao Wai Abstract Background and aim: Studies on Molecular Adsorbent Recycling Systems (MARS®) showed inconclusive survival benefits. Patients and method: We evaluated the efficacy of MARS® for patients with either acute liver failure (ALF) or acute-on-chronic liver failure (AoCLF) at our centre, from February 2002 till April 2006 retrospectively. Results: Fifty ALF patients underwent median (range) three (1,10) sessions of MARS®. Acute exacerbations of chronic hepatitis B (n=26) and drug-induced liver injury (n=12) were the commonest causes. Living donors were available in 6, 2 paediatric patients underwent left lobe and four adults underwent right lobe living donor liver transplant. Among the 44 ALF patients without a suitable living donor, one underwent deceased donor liver transplant and survived, another 19-year-old male with acute exacerbations of chronic hepatitis B recovered without transplant, and the rest died. Twenty-six had AoCLF and underwent four (1,10) MARS® sessions. Sepsis (n=16) and upper gastrointestinal bleeding (n=4) were the commonest precipitating factors. None had a suitable living or deceased donor, suitable for transplantation during their hospitalization. Only one of 26 AoCLF patients survived the hospitalization, but the survivor died of sepsis 1 month later. Conclusion: In this non-randomized study, survival after MARS® was related to the availability of transplant, and in patients where living or deceased donor transplant was unavailable, MARS® was of little benefit. Randomized-controlled trials on MARS® are urgently needed to clarify its clinical utility. [source] Liver regeneration after adult living donor and deceased donor split-liver transplantsLIVER TRANSPLANTATION, Issue 3 2004Abhinav Humar As the number of living donor (LD) and deceased donor (DD) split-liver transplants (SLTs) have increased over the last 5 years, so too has the interest in liver regeneration after such partial-liver transplants. We looked at liver regeneration, as measured by computed tomography (CT) volumetrics, to see if there were significant differences among LDs, right-lobe LD recipients, and SLT recipients. We measured liver volume at 3 months postoperatively by using CT, and we compared the result to the patient's ideal liver volume (ILV), which was calculated using a standard equation. The study group consisted of 70 adult patients who either had donated their right lobe for LD transplants (n = 24) or had undergone a partial-liver transplant (right-lobe LD transplants, n = 24; right-lobe SLTs, n = 11; left-lobe SLTs, n = 11). DD (vs. LDs) were younger (P < 0.01), were heavier (P = 0.06), and had longer ischemic times (P < 0.01). At 3 months postoperatively, LDs had attained 78.6% of their ILV, less than the percentage for right-lobe LD recipients (103.9%; P = 0.0002), right-lobe SLT recipients (113.6%; P = 0.01), and left-lobe SLT recipients (119.7%; P = 0.0006). When liver size at the third postoperative month was compared with the liver size immediately postoperatively, LDs had a 1.85-fold increase. This was smaller than the increase seen in right-lobe LD recipients (2.08-fold), right-lobe SLT recipients (2.17-fold), and left-lobe SLT recipients (2.52-fold). In conclusion, liver regeneration, as measured by CT volume, seems to be greatest in SLT recipients. LD recipients seem to have greater liver growth than their donors. The reason for this remains unclear. (Liver Transpl 2004;10:374,378.) [source] Management of the pediatric organ donor to optimize lung donationPEDIATRIC PULMONOLOGY, Issue 6 2009George B. Mallory Jr. MD Abstract Lung transplantation in childhood is a highly specialized clinical practice confined to a few centers around the world. Organ availability remains an important limiting factor in extending the application of this procedure to more infants, children and adolescents. The lungs are the organ most vulnerable to injury, infection and dysfunction among transplantable organs in the brain dead deceased donor. In this manuscript, we review the pathophysiology of the most common and important disease states that affect the lungs in potential donors. Furthermore, we herein provide recommendations for optimal management of the pediatric organ donor with an emphasis on strategies to improve the opportunity for the lungs to be placed in candidates on the transplant list. Pediatr Pulmonol. 2009; 44:536,546. © 2009 Wiley-Liss, Inc. [source] End-stage renal disease due to ARPKD in the first months of life: Transplantation or dialysis?PEDIATRIC TRANSPLANTATION, Issue 6 2010Two case reports Beil S, Drube J, Gluer S, Lehner F, Ehrich JHH, Pape L. End-stage renal disease due to ARPKD in the first months of life: Transplantation or dialysis? , Two case reports. Pediatr Transplantation 2010: 14:E75,E78. © 2009 John Wiley & Sons A/S. Abstract:, ARPKD with renal insufficiency during the first months of life is a clinical challenge. We report on two children with ARPKD with massively enlarged kidneys requiring renal replacement therapy in early infancy. Patient 1 developed pulmonary insufficiency due to massively enlarged kidneys. At the age of six months the girl was listed for KT as "high urgency" on the Eurotransplant waiting list. A kidney from a deceased donor was pre-emptively transplanted and simultaneous nephrectomy performed. No postoperative complications were observed, and the patient was discharged from in-patient care 42 days after transplantation. Unexpectedly, she died at the age of one yr due to cerebral vascular spasms of unknown origin. Patient 2 was transferred at the age of three months to our clinic with life-threatening pulmonary insufficiency. Pre-emptive KT was not possible; therefore, bilateral nephrectomy was performed and PD begun. The boy is still doing well on PD one yr later. Pre-emptive KT and bilateral nephrectomy followed by PD are two options for infants with ARPKD and excessive kidney enlargement. PD could be complicated and in some cases become impossible by peritoneal damage during nephrectomy. On the other hand, KT covers a high risk of infections caused by immunosuppression. The decision, which method to choose, should be driven by the individual situation of the patient and the expertise of the center. [source] Pediatric living donor lobar lung transplantationPEDIATRIC TRANSPLANTATION, Issue 7 2006Stuart C. Sweet Abstract:, Living donor lobar lung transplantation (LDLLT) was developed in order to mitigate the growing competition for deceased donor (DD) lungs and resultant increase in waiting list mortality. Because each of the two donor lobes serves as an entire lung for the recipient, donors who are taller than the recipient are preferred. Therefore LDLLT is particularly well suited for pediatric recipients for whom adults serve as donors. Although long-term outcomes after LDLLT reported by the Organ Procurement and Transplantation Network (OPTN) are worse compared with DD recipients, overall pediatric outcomes as well as single center reports from the most experienced programs are more promising. Particularly encouraging are the findings that bronchiolitis obliterans (OB) is less frequent or less severe in LDLLT recipients in comparison to DD recipients. Moreover, outcomes may be improved by careful selection of donors to ensure adequately sized donor lobes and minimization of infectious risks. Although no donor deaths have been reported, there is a moderate risk of significant short-term complications. Long-term follow-up has not been reported. The use of LDLLT has decreased in recent years, and the recent change by the OPTN to an urgency/benefit allocation system for DD lungs in patients 12 yr and older may further reduce the demand. Nonetheless, we anticipate that LDLLT will continue to be utilized in select circumstances, particularly in children under 12 where access to DD organs remains challenging. [source] Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulationPEDIATRIC TRANSPLANTATION, Issue 4 2005Thomas G. Heffron Abstract:, The risk of hepatic artery thrombosis (HAT) after pediatric liver transplantation (PLT) has been reported to range from 0 to 25%. We report our experience focusing on the interrelationships between risk factors, surgical technique and the incidence of HAT after liver transplantation in the pediatric age group. From February 18, 1997 to December 31, 2003, 150 consecutive liver transplants were performed in 132 pediatric patients. There were similar numbers of whole grafts when compared with partial grafts, 80 (53.3%) vs. 70 (46.7%), p = 0.30. Four grafts (2.7%) developed HAT. Of the grafts with HAT, three were successfully revascularized within the first 24 h. Only one graft (0.66%) was lost to HAT. A single surgeon utilizing 3.5,6.0 magnification loupes performed all but one hepatic arterial anastomoses. All patients were followed postoperatively by a daily ultrasound protocol and with anticoagulation of aspirin and alprostadil only. Living and deceased donor left lateral segment grafts had an increased rate of HAT when compared with whole liver grafts. HAT with subsequent graft loss may be minimized in PLT with the use of surgical loupes only, anticoagulation utilizing aspirin, alprostadil, and daily ultrasounds. [source] Lung transplantation from a deceased donor into an Asian cystic fibrosis patientRESPIROLOGY, Issue 3 2009Hsao-Hsun HSU No abstract is available for this article. [source] Therapeutic mTOR Inhibition in Autosomal Dominant Polycystic Kidney Disease: What Is the Appropriate Serum Level?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010G. Canaud Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease, and sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been shown to significantly retard cyst expansion in animal models. The optimal therapeutic dose of sirolimus is not yet defined. Here, we report the history of a previously unknown ADPKD deceased donor whose kidneys were engrafted in two different recipients. One of the two received an immunosuppressive regimen based on sirolimus for 5 years while the other did not. After transplantation, both patients developed severe transplant cystic disease. Donor DNA sequence identified a new hypomorphic mutation in PKD1. The rate of cyst growth was identical in the two patients regardless of the treatment. While sirolimus treatment reduced the activation of mTOR in peripheral blood mononuclear cells, it failed to prevent mTOR activation in kidney tubular cells, this could account for the inefficiency of treatment on cyst growth. Together, our results suggest that the dose of sirolimus required to inhibit mTOR varies according to the tissue. [source] Outcome Evaluation of ,Sharing the Gift of Life': An Organ and Tissue Donation Educational Program for American IndiansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010N. L. Fahrenwald Culturally focused education about deceased donation is needed for American Indians (AIs). This study tested a program designed to impact intention to serve as a deceased donor for reservation dwelling AIs. A pre/posttest design and a community-based participatory research approach were used. The study was based upon the Transtheoretical Model. Adult participants (N = 1580, 58% women) were from four Northern Plains reservations. An outreach coordinator delivered the program using print and video materials. The outcome was stage of motivational readiness (SMR) to serve as a deceased donor. McNemar's test was used to compare pre- to postintervention changes in SMR. At baseline, 55% of participants were not thinking about being a donor (precontemplation stage) and 45% were thinking about it (contemplation stage). Postintervention, 43.1% of participants were unchanged in SMR and 56.9% progressed in SMR. Of those who progressed, 26.5% (n = 418) changed to the contemplation stage, 19.4% (n= 306) changed to the preparation stage (signed a donor card or joined a registry), and 11.1% (n = 175) confirmed a discussion of the decision with family (action stage). Progression in SMR from pre/post was significant, ,2(1) = 18.32, p < 0.05. The intervention resulted in important changes in deceased donor intentions for reservation dwelling AIs. [source] Kidney and Pancreas Transplantation in the United States, 1999,2008: The Changing Face of Living DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010D. A. Axelrod The waiting list for kidney transplantation continued to grow between 1999 and 2008, from 41 177 to 76 089 candidates. However, active candidates represented the minority of this increase (36 951,50 624, a 37% change), while inactive candidates increased over 500% (4226,25 465). There were 5966 living donor (LD) and 10 551 deceased donor (DD) kidney transplants performed in 2008. The total number of pancreas transplants peaked at 1484 in 2004 and has declined to 1273. Although the number of LD transplants increased by 26% from 1999 to 2008, the total number peaked in 2004 at 6647 before declining 10% by 2008. The rate of LD transplantation continues to vary significantly as a function of demographic and geographic factors, including waiting time for DD transplant. Posttransplant survival remains excellent, and there appears to be greater use of induction agents and reduced use of corticosteroids in LD recipients. Significant changes occurred in the pediatric population, with a dramatic reduction in the use of LD organs after passage of the Share 35 rule. Many strategies have been adopted to reverse the decline in LD transplant rates for all age groups, including expansion of kidney paired donation, adoption of laparoscopic donor nephrectomy and use of incompatible LD. [source] Outcome of Subclinical Antibody-Mediated Rejection in Kidney Transplant Recipients with Preformed Donor-Specific AntibodiesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009A. Loupy This study describes clinical relevance of subclinical antibody-mediated rejection (SAMR) in a cohort of 54 DSA-positive kidney transplant recipients receiving a deceased donor. In 3 months screening biopsies, 31.1% of patients met the criteria of SAMR. A total of 48.9% had an incomplete form of SAMR (g+/ptc+/C4d-negative) whereas 20% had no humoral lesions. Patients with SAMR at 3 months had at 1 year: a higher C4d score, ptc score, and arteriosclerosis score, higher rate of IFTA (100% vs. 33.3%, p < 0.01) and a higher rate of transplant glomerulopathy (43% vs. 0%, p = 0.02) compared to patients without 3-month SAMR. Patients with SAMR at 3 months exhibited at 1 year a higher class II MFImax-DSA and a lower mGFR compared to patients without SAMR (39.2 ± 13.9 vs. 61.9 ± 19.2 mL/min/1.73 m2 respectively, p < 0.01). The group of patients with C4d-negative SAMR at 3 months developed more ptc and IFTA lesions, and lower GFR at 1 year in comparison to biopsies without humoral lesions. SAMR is a frequent entity in KTR with preexisting DSAs and promotes subsequent GFR impairment and development of chronic AMR. C4d-negative SAMR patients displayed an intermediate course between the no-SAMR group and the C4d+ SAMR group. Screening biopsies may be useful to recognize patients more likely to develop SAMR. [source] Stimulus for Organ Donation: A Survey of the American Society of Transplant Surgeons MembershipAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009J. R. Rodrigue Federal legislation has been proposed to modify the National Organ Transplant Act in a way that would permit government-regulated strategies, including financial incentives, to be implemented and evaluated. The Council and Ethics Committee of the American Society of Transplant Surgeons conducted a brief web-based survey of its members' (n = 449, 41.6% response rate) views on acceptable or unacceptable strategies to increase organ donation. The majority of the membership supports reimbursement for funeral expenses, an income tax credit on the final return of a deceased donor and an income tax credit for registering as an organ donor as strategies for increasing deceased donation. Payment for lost wages, guaranteed health insurance and an income tax credit are strategies most strongly supported by the membership to increase living donation. For both deceased and living donation, the membership is mostly opposed to cash payments to donors, their estates or to next-of-kin. There is strong support for a government-regulated trial to evaluate the potential benefits and harms of financial incentives for both deceased and living donation. Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation. [source] Kidney Injury Molecule-1 is an Early Noninvasive Indicator for Donor Brain Death-Induced Injury Prior to Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009W. N. Nijboer With more marginal deceased donors affecting graft viability, there is a need for specific parameters to assess kidney graft quality at the time of organ procurement in the deceased donor. Recently, kidney injury molecule-1 (Kim-1) was described as an early biomarker of renal proximal tubular damage. We assessed Kim-1 in a small animal brain death model as an early and noninvasive marker for donor-derived injury related to brain death and its sequelae, with subsequent confirmation in human donors. In rat kidney, real-time PCR revealed a 46-fold Kim-1 gene upregulation after 4 h of brain death. In situ hybridization showed proximal tubular Kim-1 localization, which was confirmed by immunohistochemistry. Also, Luminex assay showed a 6.6-fold Kim-1 rise in urine after 4 h of brain death. In human donors, 2.5-fold kidney injury molecule-1 (KIM-1) gene upregulation and 2-fold higher urine levels were found in donation after brain death (DBD) donors compared to living kidney donors. Multiple regression analysis showed that urinary KIM-1 at brain death diagnosis was a positive predictor of recipient serum creatinine, 14 days (p < 0.001) and 1 year (p < 0.05) after kidney transplantation. In conclusion, we think that Kim-1 is a promising novel marker for the early, organ specific and noninvasive detection of brain death-induced donor kidney damage. [source] Unrecognized Acute Phosphate Nephropathy in a Kidney Donor with Consequent Poor Allograft OutcomeAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009N. Agrawal Acute phosphate nephropathy following a large phosphate load is a potentially irreversible cause of kidney failure. Here, we report on the unfavorable graft outcome in two recipients of deceased donor kidneys from a donor who had evolving acute phosphate nephropathy at the time of organ procurement. The donor, a 30-year-old with cerebral infarction, developed hypophosphatemia associated with diabetic ketoacidosis and was treated with intravenous phosphate resulting in a rise in serum phosphorus from 0.9 to 6.1 mg/dL. Renal biopsies performed on both recipients for suboptimal kidney function revealed acute tubular injury and diffuse calcium phosphate microcrystal deposits in the tubules, which were persistent in subsequent biopsies. A retrospective review of preimplantation biopsies performed on both kidneys revealed similar findings. Even though initial renal histology in both recipients was negative for BK virus, they eventually developed BK viremia with nephropathy but both had a substantive virologic response with therapy. The first patient returned to dialysis at 6 months, while the other has an estimated glomerular filtration rate of 12 mL/min, 17 months following his transplant. We conclude that unrecognized acute phosphate nephropathy in a deceased donor contributed substantially to poor graft outcome in the two recipients. [source] Unique Early Gene Expression Patterns in Human Adult-to-Adult Living Donor Liver Grafts Compared to Deceased Donor GraftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009J. De Jonge Because of inherent differences between deceased donor (DD) and living donor (LD) liver grafts, we hypothesize that the molecular signatures will be unique, correlating with specific biologic pathways and clinical patterns. Microarray profiles of 63 biopsies in 13 DD and 8 LD liver grafts done at serial time points (procurement, backbench and postreperfusion) were compared between groups using class comparisons, network and biological function analyses. Specific genes were validated by quantitative PCR and immunopathology. Clinical findings were also compared. Following reperfusion, 579 genes in DD grafts and 1324 genes in LDs were differentially expressed (p < 0.005). Many upregulated LD genes were related to regeneration, biosynthesis and cell cycle, and a large number of downregulated genes were linked to hepatic metabolism and energy pathways correlating with posttransplant clinical laboratory findings. There was significant upregulation of inflammatory/immune genes in both DD and LD, each with a distinct pattern. Gene expression patterns of select genes associated with inflammation and regeneration in LD and DD grafts correlated with protein expression. Unique patterns of early gene expression are seen in LD and DD liver grafts, correlating with protein expression and clinical results, demonstrating distinct inflammatory profiles and significant downregulation of metabolic pathways in LD grafts. [source] 2202 Kidney Transplant Recipients with 10 Years of Graft Function: What Happens Next?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2008A. J. Matas The ultimate goal of clinical transplantation is for the recipients to achieve long-term survival, with continuing graft function, that is equivalent to that of the age-matched general population. We studied subsequent outcome in kidney transplant recipients with 10 years of graft function. In all, 2202 kidney transplant recipients survived with graft function >10 years. For 10-year survivors, the actuarial 25-year patient survival rate for primary transplant living donor (LD) recipients was 57%; graft survival, 43%. For primary transplant deceased donor (DD) recipients, the actuarial 25-year patient survival rate was 39%; graft survival, 27%. The two major causes of late graft loss were death (with graft function) and chronic allograft nephropathy (tubular atrophy and interstitial fibrosis). The two major causes of death with function were cardiovascular disease (CVD) and malignancy. For nondiabetic recipients, the mean age at death with function from CVD was 54 ± 13 years; for diabetic recipients, 53 ± 7 years. By 20 years posttransplant, morbidity was common: >40% recipients had skin cancer (mean age for nondiabetic recipients, 53 ± 13 years; for diabetics, 49 ± 8 years), >10% had non-skin cancer (mean age for nondiabetic recipients, 53 ± 16 years; for diabetics, 46 ± 9 years), and >30% had CVD (mean age for nondiabetic recipients, 53 ± 15 years; for diabetics, 47 ± 9 years). We conclude that long-term transplant recipients have a high rate of morbidity and early mortality. As short-term results have improved, more focus is needed on long-term outcome. [source] Successful Management of Eviscerated Renal Allograft with Preservation of FunctionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2008H. Jeon Although most wound complications after renal transplantation are minor, the renal allograft, in its superficial and extraperitoneal location, is vulnerable to exposure if there is wound breakdown resulting in loss of overlying tissue. We describe a 66-year-old man who received a renal allograft from a deceased donor for end-stage renal disease (ESRD) secondary to polycystic kidney disease. His immediate posttransplant course was complicated by delayed graft function from acute tubular necrosis, reexploration for perigraft hematoma and subsequent wound dehiscence. After unsuccessful conservative wound care, the renal allograft became completely eviscerated due to fascial retraction of the dehisced wound. While the allograft was initially covered with a pedicled rectus femoris muscle flap, several local tissue rearrangements were required for definitive coverage. The allograft function was recovered after initial flap coverage and was subsequently maintained; follow-up more than 2 years after transplantation has demonstrated not only continued stable graft function but also complete healing of the dehiscent wound. [source] Emigration from the British Isles to Southeastern Spain: A Study of Attitudes Toward Organ DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2007A. Ríos Southeastern Spain is a cosmopolitan area where there is a growing British and Irish population. The objective is to analyze the attitude toward organ donation among British and Irish citizens living in southeastern Spain. A sample was taken stratified according to a respondent's country of origin (n = 1700) between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire, which was self-administered and completed anonymously. A sample of 2000 Spanish citizens was used as a control group. The survey completion rate was 95% (n = 1611). Attitude toward donation is favorable in 72% (n = 1155) of respondents with 8% (n = 122) against and 20% (n = 334) undecided. Attitude is more favorable than in the control group (72% vs. 63%; p < 0.0001). The following factors influence this attitude: (1) attitude toward the donation of a family member's organs (OR = 4.891); (2) having discussed the matter of organ donation within the family (OR = 2.513); (3) a willingness to accept an autopsy if it were necessary (OR = 1.706); (4) having no concern about the mutilation of the deceased donor (OR = 3.294); (5) having a partner who is in favor of donation (OR = 2.786) and (6) a respondent's belief that he or she might need a transplant in the future (OR = 2.243). The attitude of this population is more positive than in the native Spanish population and is determined by many psychosocial factors. [source] Living Donor and Split-Liver Transplants in Hepatitis C Recipients: Does Liver Regeneration Increase the Risk for Recurrence?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2005Abhinav Humar Concern exists that partial liver transplants (either a living donor [LD] or deceased donor [DD] in hepatitis C virus (HCV)-positive recipients may be associated with an increased risk for recurrence. From 1999 to 2003, at our institution, 51 HCV-positive recipients underwent liver transplants: 32 whole-liver (WL) transplants, 12 LD transplants and 7 DD split transplants. Donor characteristics differed in that WL donors were older, and LD livers had lower ischemic times. Recipient characteristics were similar except that mean MELD scores in LD recipients were lower (p < 0.05). With a mean follow-up of 28.3 months, 46 (90%) recipients are alive: three died from HCV recurrent liver disease and two from tumor recurrence. Based on 1-year protocol biopsies, the incidence of histologic recurrence in the three groups is as follows: WL, 81%; LD, 50% and DD split, 86% (p = 0.06 for LD versus WL). The mean grade of inflammation on the biopsy specimens was: WL, 1.31; LD, 0.33 and DD split, 1.2 (p = 0.002 for LD versus WL; p = 0.03 for LD versus DD split). Mean stage of fibrosis was: WL, 0.96; LD, 0.22 and DD split, 0.60 (p = 0.07 for LD versus WL). Liver regeneration does not seem to affect hepatitis C recurrence as much, perhaps, as factors such as DD status, donor age and cold ischemic time. [source] A randomized trial of thymoglobulin vs. alemtuzumab (with lower dose maintenance immunosuppression) vs. daclizumab in renal transplantation at 24 months of follow-upCLINICAL TRANSPLANTATION, Issue 2 2008Gaetano Ciancio Abstract: Introduction: A long-term prospective randomized trial evaluating alemtuzumab, a humanized anti-CD52 monoclonal antibody, in a predominantly non-Caucasian population has yet to be reported. Methods: Ninety deceased donor (DD) first renal transplant recipients were randomized into three different antibody induction groups: group A, thymoglobulin (Thymo); group B, alemtuzumab; group C, daclizumab (Dac). In groups A and C, the target trough levels of tacrolimus were 8,10 ng/mL, mycophenolate mofetil (MMF) 1 g administered twice daily, and maintenance methylprednisolone. In group B, target tacrolimus trough levels were 4,7 ng/mL, 500 mg MMF administered twice-daily, without methylprednisolone. African-Americans and Hispanics comprised more than 50% in each group. Results: A minimum follow-up of 27 months showed no overall group differences in patient or graft survival (p = 0.89 and 0.66), but a trend towards worse death-censored graft survival in group B (p = 0.05). Acute rejection rates were not significantly different: six (20%), seven (23%), and seven (23%) in groups A, B, and C, respectively. The incidence of chronic allograft nephropathy was higher in group B than in A and C (p = 0.008). The mean calculated creatinine clearance at 24 months was 81.1 ± 5.5, 64.4 ± 4.5, and 80.7 ± 5.7 in groups A, B, and C, respectively (p = 0.01 for B vs. average of A and C). Conclusion: In this randomized 27-month minimum follow-up trial of predominantly non-Caucasian DD renal transplant recipients with alemtuzumab induction, lower maintenance tacrolimus, MMF, and steroid avoidance appear less effective than either Thymo or Dac with higher maintenance immunosuppression. [source] Acute liver failure and living donor liver transplantationHEPATOLOGY RESEARCH, Issue 2008Nobuhisa Akamatsu Acute liver failure (ALF) is defined by the presence of hepatic encephalopathy due to severe liver damage in patients without pre-existing liver disease. Although the mortality of ALF without liver transplantation is over 80%, the survival rates of ALF patients have improved considerably with the advent of liver transplantation, up to 60,80% in the last decade. Living donor liver transplantation (LDLT), which has mainly evolved in Asian countries where organ availability from deceased donors is extremely scarce, has also improved the survival rate of ALF patients. According to recent reports, the overall survival rate of adult ALF patients who underwent LDLT is 60% to 90%. Although there is still controversy regarding the graft type, the optimal graft volume, and ethical issues of defining the indications for LDLT in ALF patients with respect to donor risk, LDLT has become an established treatment option for ALF in areas where the use of deceased donors organs is severely restricted. [source] The biopsied donor liver: Incorporating macrosteatosis into high-risk donor assessment,LIVER TRANSPLANTATION, Issue 7 2010Austin L. Spitzer To expand the donor liver pool, ways are sought to better define the limits of marginally transplantable organs. The Donor Risk Index (DRI) lists 7 donor characteristics, together with cold ischemia time and location of the donor, as risk factors for graft failure. We hypothesized that donor hepatic steatosis is an additional independent risk factor. We analyzed the Scientific Registry of Transplant Recipients for all adult liver transplants performed from October 1, 2003, through February 6, 2008, with grafts from deceased donors to identify donor characteristics and procurement logistics parameters predictive of decreased graft survival. A proportional hazard model of donor variables, including percent steatosis from higher-risk donors, was created with graft survival as the primary outcome. Of 21,777 transplants, 5051 donors had percent macrovesicular steatosis recorded on donor liver biopsy. Compared to the 16,726 donors with no recorded liver biopsy, the donors with biopsied livers had a higher DRI, were older and more obese, and a higher percentage died from anoxia or stroke than from head trauma. The donors whose livers were biopsied became our study group. Factors most strongly associated with graft failure at 1 year after transplantation with livers from this high-risk donor group were donor age, donor liver macrovesicular steatosis, cold ischemia time, and donation after cardiac death status. In conclusion, in a high-risk donor group, macrovesicular steatosis is an independent risk factor for graft survival, along with other factors of the DRI including donor age, donor race, donation after cardiac death status, and cold ischemia time. Liver Transpl 16:874,884, 2010. © 2010 AASLD. [source] Usefulness 18F-FDG positron emission tomography/computed tomography for detecting recurrence of hepatocellular carcinoma in posttransplant patientsLIVER TRANSPLANTATION, Issue 6 2010Young-Kyu Kim 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has recently been shown to be able to predict a poor outcome after liver transplantation (LT) for patients with hepatocellular carcinoma (HCC). However, there are few reports on the usefulness of PET during follow-up after LT. In this study, we assessed the efficacy of 18F-FDG PET/CT for the detection of HCC recurrence after LT. From February 2005 to December 2008, out of 93 adult LT cases (91 living donors and 2 deceased donors), 10 patients who showed HCC recurrence and received 18F-FDG PET/CT during follow-up were included. The accuracy of 18F-FDG PET/CT was assessed with imaging and histological studies. The most common sites of recurrence were extrahepatic (60%). The most common extrahepatic sites were the lungs and bone (31.3% each). Among 4 patients with intrahepatic recurrence, 1 patient (25%) was positive according to 18F-FDG PET/CT. The detection rate of 18F-FDG PET/CT was 92.9% for extrahepatic metastases , 1 cm and 0% for lesions < 1 cm. The detection rate of 18F-FDG PET/CT was 100% in bone and the lymph nodes, 60% in the lungs, and 0% in the brain. 18F-FDG PET/CT identified 2 lesions in bone that were not found in a bone scan. In conclusion, because of its limitations for small lesions, intrahepatic lesions, and brain lesions, 18F-FDG PET/CT is not suitable as a screening tool after LT. However, 18F-FDG PET/CT could provide additional information beyond that provided by conventional modalities, and it could contribute to the clinical management of HCC recurrence after LT, especially in patients with extrahepatic recurrence. Liver Transpl 16:767-772, 2010. © 2010 AASLD. [source] Graft weight/recipient weight ratio: How well does it predict outcome after partial liver transplants?LIVER TRANSPLANTATION, Issue 9 2009Mark J. Hill Partial graft liver recipients with graft weight/recipient weight (GW/RW) ratios < 0.8% are thought to have a higher incidence of postoperative complications, including small-for-size syndrome (SFSS). We analyzed a cohort of such recipients and compared those with GW/RW < 0.8% to those with GW/RW , 0.8%. Between 1999 and 2008, 107 adult patients underwent partial graft liver transplants: 76 from live donors [living donor liver transplantation (LDLT)] and 31 from deceased donors [split liver transplantation (SLT)]. Of these, 22 had GW/RW < 0.8% (12 with LDLT and 10 with SLT), and 85 had GW/RW , 0.8% (64 with LDLT and 21 with SLT). The baseline demographics and median length of follow-up were similar. SFSS developed in 3 recipients with GW/RW < 0.8% (13.6%) and in 8 recipients with GW/RW , 0.8% (9.4%; P = not significant). Other early complications were similar between the 2 groups. Inflow modification with splenic artery occlusion was performed in 13 recipients: 7 with GW/RW < 0.8% and 6 with GW/RW , 0.8%. Graft survival at 1 year post-transplant did not differ (91% versus 92%; P = not significant). In conclusion, GW/RW did not appear to be the only determinant of outcome after partial liver transplantation. Using techniques such as inflow modification may help to prevent some of the problems seen with smaller grafts. Liver Transpl 15:1056,1062, 2009. © 2009 AASLD. [source] Live donor/split liver grafts for adult recipients: When should we use them?LIVER TRANSPLANTATION, Issue S2 2005Peter Neuhaus Key Points 1Split liver transplantation for a child and an adult recipient is standard today. Living donor liver transplantation for small children should only be necessary in exceptional situations in a country with a well-organized organ donation program. 2True split liver transplantation for two adults is still not very common. In the United States between April 2000 and May 2001, 89 surgical teams transplanted only 15 left lobes and 13 right lobes. Especially left lobes from deceased donors have a poor outcome; in Europe the ELTR shows a 1-year graft survival of 47%. 3While in Asia left lobes, right lateral segments, and dual left lateral segments are more frequently used, living donor liver transplantation for adults in Europe and the United States is predominantly performed with right lobes.7, 8 This carries a significant morbidity and mortality risk for the donor. Outcome compared to deceased donor liver transplantation (DDLTx) is similar with a trend towards more short-term and long-term biliary complications. 4Living donor and split liver transplantation should be used mainly in an elective situation. Candidates are tumor patients, patients with cholestatic liver disease, and elective patients with bile disease. 5Urgent liver transplantation is not a good option for living donor and split liver transplantation. Hepatic assist devices may change the picture in the future. 6Living donor liver transplantation for metabolic disorders like Alpha-1-Antitrypsin deficiency, Hyperoxaluria, and others cannot be recommended at present since the genetically related donor and the patient may carry an unknown risk. (Liver Transpl 2005;11:S6,S9.) [source] Editorial: Cold Machine Perfusion or Static Cold Storage of Kidneys: Why the Debate ContinuesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010W. D. Irish The debate regarding the efficacy of cold machine perfusion versus static cold storage for prevention of delayed graft function in organs from deceased donors continues, despite the results of two well-designed clinical trials. See article by Watson et al on page 1991. [source] Marked Variation of the Association of ESRD Duration Before and After Wait Listing on Kidney Transplant OutcomesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010J. D. Schold Numerous studies report a strong association between pretransplant end-stage renal disease (ESRD) duration and diminished transplant outcomes. However, cumulative waiting time may reflect distinct phases and processes related to patients' physiological condition as well as pre-existing morbidity and access to care. The relative impact of pre- and postlisting ESRD durations on transplant outcomes is unknown. We examined the impact of these intervals from a national cohort of kidney transplant recipients from 1999 to 2008 (n = 112 249). Primary factors explaining prelisting ESRD duration were insurance and race, while primary factors explaining postlisting ESRD duration were blood type, PRA% and variation between centers. Extended time from ESRD to waitlisting had significant dose,response association with overall graft loss (AHR = 1.26 for deceased donors [DD], AHR = 1.32 for living donors [LD], p values < 0.001). Contrarily, time from waitlisting (after ESRD) to transplantation had negligible effects (p = 0.10[DD], p = 0.57[LD]). There were significant associations between pre- and postlisting ESRD time with posttransplant patient survival, however prelisting time had over sixfold greater effect. Prelisting ESRD time predominately explains the association of waiting time with transplant outcomes suggesting that factors associated with this interval should be prioritized for interventions and allocation policy. The degree to which the effect of prelisting ESRD time is a proxy for comorbid conditions, socioeconomic status or access to care requires further study. [source] Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac DeathAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010A. Rojas-Pena Donors after cardiac death (DCD) could increase the organ pool. Data supports good long-term renal graft survival. However, DCDs are <10% of deceased donors in the United States, due to delayed graft function, and primary nonfunction. These complications are minimized by extracorporeal support after cardiac death (ECS-DCD). This study assesses immediate and acute renal function from different donor types. DCDs kidneys were recovered by conventional rapid recovery or by ECS, and transplanted into nephrectomized healthy swine. Warm ischemia of 10 and 30 min were evaluated. Swine living donors were controls (LVD). ECS-DCDs were treated with 90 min of perfusion until organ recovery. After procurement, kidneys were cold storage 4,6 h. Renal vascular resistance (RVR), urine output (UO), urine protein concentration (UrPr) and creatinine clearance (CrCl), were collected during 4 h posttransplantation. All grafts functioned with adequate renal blood flow for 4 h. RVR at 4 h posttransplant returned to baseline only in the LVD group (0.36 mmHg/mL/min ± 0.03). RVR was higher in all DCDs (0.66 mmHg/mL/min ± 0.13), without differences between them. UO was >50 mL/h in all DCDs, except in DCD-30 (6.8 mL/h ± 1.7). DCD-30 had lower CrCl (0.9 mL/min ± 0.2) and higher UrPr >200 mg/dL, compared to other DCDs >10 mL/min and <160 mg/dL, respectively. Normothermic ECS can resuscitate kidneys to transplantable status after 30 min of cardiac arrest/WI. [source] | ||||||||||||||||||||||