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Liver Pool (liver + pool)
Selected AbstractsRescue policy for discarded liver grafts: a single-centre experience of transplanting livers ,that nobody wants'HPB, Issue 8 2010Lucas McCormack Abstract Background:, There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received ,livers that nobody wants' (LNWs) in Argentina. Methods:, Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival. Results:, We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups. Conclusions:, 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. [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] Anonymous Living Liver Donation: Donor Profiles and OutcomesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010T. W. Reichman There are no published series of the assessment process, profiles and outcomes of anonymous, directed or nondirected live liver donation. The outcomes of 29 consecutive potential anonymous liver donors at our center were assessed. We used our standard live liver assessment process, augmented with the following additional acceptance criteria: a logical rationale for donation, a history of social altruism, strong social supports and a willingness to maintain confidentiality of patient information. Seventeen potential donors were rejected and 12 donors were ultimately accepted (six male, six female). All donors were strongly motivated by a desire and sense of responsibility to help others. Four donations were directed toward recipients who undertook media appeals. The donor operations included five left lateral segmentectomies and seven right hepatectomies. The overall donor morbidity was 40% with one patient having a transient Clavien level 3 complication (a pneumothorax). All donors are currently well. None expressed regret about their decision to donate, and all volunteered the opinion that donation had improved their lives. The standard live liver donor assessment process plus our additional requirements appears to provide a robust assessment process for the selection of anonymous live liver donors. Acceptance of anonymous donors enlarges the donor liver pool. [source] Rapid in vitro conversion of fosphenytoin into phenytoin in sera of patients with liver disease: Role of alkaline phosphatase ,JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 5 2001Amitava Dasgupta Abstract Fosphenytoin, a phosphate ester pro drug of phenytoin, also cross-reacts with the fluorescence polarization immunoassay (FPIA) for phenytoin. We measured fosphenytoin concentrations using the FPIA kit and TDx analyzer. We prepared serum pools from normal volunteers and patients with liver disease. None of them received either fosphenytoin or phenytoin. Fosphenytoin standard solution (1 mg/ml) was prepared in water. We supplemented aliquots of normal and liver pools with known amounts of fosphenytoin and measured the concentrations at different time intervals. The conversion of fosphenytoin to phenytoin was slow in sera with normal alkaline phosphatase activities. The conversion was rapid in sera collected from patients with liver disease who also had high alkaline phosphatase activities. The observed concentrations were close to target concentrations within 0,2 min of supplementation with fosphenytoin. Surprisingly, the observed concentration then started to decline slightly but significantly with longer incubation time. In contrast, the observed concentration increased steadily in serum with normal alkaline phosphatase activity. For example, in the normal pool supplemented with 15.0 ,g/ml fosphenytoin (as the phenytoin equivalent), the observed concentrations were 6.9, 7.3, 7.7, 8.3, and 9.8 ,g/ml at 0,2, 10, 20, 30, and 60 min, respectively. However, in a serum pool prepared from patients with liver disease and supplemented with 15.0 ,g/ml of fosphenytoin (alkaline phosphatase: 2547 U/l), the observed phenytoin concentrations were 12.9, 12.1, 11.0, 10.7, and 10.7 ,g/ml at 0,2, 10, 20, 30, and 60 min, respectively. When we added alkaline phosphatase to the normal serum pool, we observed rapid conversion of fosphenytoin into phenytoin within 10 min, but the concentrations then declined with longer incubation time. However, when we repeated the experiment with protein-free ultrafiltrate, we observed rapid conversion of fosphenytoin to phenytoin, but the concentration did not decline with longer incubation time. J. Clin. Lab. Anal. 15:244,250, 2001. © 2001 Wiley-Liss, Inc. [source] | ||||||||||