Criteria Donors Research Articles

Living and Deceased Liver Donation Criteria of Baskent University.

Both living and deceased donor transplants require appropriate donor selection to increase the success of liver transplants. Proper deceased donor criteria will also increase the use of discarded and marginal donor livers. Here, we evaluated the Baskent University deceased and living donor criteria. Since 1988, our team has performed 704 liver transplants (490 from living [69.6&] and 214 from deceased [30.4&] donors) at our 3 transplant centers (Ankara, Adana, Istanbul). Living donor evaluations follow from simple and noninvasive tests to more complex and invasive, including liver biopsy, with social and medical evaluations being the most important. Living donor candidates must be relatives of the recipient (up to 4th degree) or the spouse of the recipient, and candidates must be ≥18 years old, with no health problems. Candidates undergo computed tomography to assess arterial and venous anatomy, to estimate total and remnant liver volume, and to detect any abnormalities. If graft-to-recipient weight ratio is >1 and remnant liver volume is ≥40% of total liver volume, then the candidate is accepted for further evaluation. All living donor candidates undergo liver biopsy. Age is not important for deceased donor candidates, but biopsy is the most important criterion in deceased donor selection. After histopathological examination, both living and deceased donor candidates are rejected if they have chronic hepatitis, cirrhosis, severe hepatocellular injury, diffuse hepatocellular ballooning, or moderate-to-severe macrovesicular fatty changes >20%. Additional refusal criteria for deceased donors are hypernatremia, sepsis, extracranial malignancy, and high-dose vasopressor support. A deceased donor is the first choice in organ transplant. Proper evaluations can decrease discard rates of deceased organs. Living donor liver transplants should be performed only at well-established centers with surgical teams who have appropriate medical expertise and adequate institutional resources. To reduce complications and provide adequately functional grafts, careful donor evaluation is imperative.

The Limited Value of the Extended Criteria Donor.

The use of deceased extended criteria donors has shortened wait times for potential transplant recipients. Their use has been quite helpful in allowing elderly recipients access to transplant before the onset of intractable complications. Resorting to living extended criteria donation on the other hand represents a total disregard of the interests of the living donor and should be actively discouraged.

Clinical Validation of a Novel Scoring System Based on Donor and Recipient Risk Factors for Predicting Outcomes in Liver Transplantation

BackgroundAdequate donor and recipient matching in liver transplantation is crucial to improve patient survival. Our objective was to propose and validate a new model for predicting outcomes using donor and recipient scoring criteria.Material/MethodsWe retrospectively analyzed data of all patients (n=932) who underwent liver transplantation (n=1106) from January 2006 to December 2018. For score standardization, 30% (n=280) of patients were randomly selected for analysis and divided into 3 categories: ≤4 points, 5 to 8 points, and >8 points. Scoring system validation was performed on a dataset with 70% (n=652) of the patients.ResultsSurvival of the stratified group (30%) was significant (P<0.001). Scores of 4 to 8 points presented lower risk of death (1.74 [CI 0.97–3.13; P=0.062]), while >8 points presented higher risk (2.74 [CI 1.36–5.57; P=0.005]). In the validation score (70%), global survival was significant (P<0.0016); patients with scores of 4 to 8 points had lower risk of death (1.16 [CI 1.16–2.38; P=0.005]); and scores >8 points (2.22 [CI 1.40–3.50; P<0.001]), retransplant, fulminant hepatitis, previous large abdominal/biliary tree surgery, MELD score, and serum creatinine before liver transplantation >1.5 mg/dL (P<0.05) presented higher risk. Individual recipient factors with 4 to 8 points had a lower risk of death (2.29 [CI 1.82–2.87; P<0.0001]) than those with scores >8 points (4.02 [CI 2.22–7.26; P<0.0001]).ConclusionsA novel prognostic-based scoring system using donor and recipient characteristics was proposed and clinically validated. Two-factor scoring indicated the superiority of the predictability outcome and improved prediction of higher mortality.

Predictors for Successful Liver Transplantation and Risk Factors

Liver transplantation is the only curative treatment option for end stage liver disease. Moreover, oncological liver disease (hepatocellular carcinoma) is an important relevant indication for liver transplantation, together with acute liver failure.Since the first successful liver transplantation by Professor Thomas Starzl in 1967, liver transplantation has changed in many aspects. This concerns not only surgical, anaesthesiological and immunological improvements and further technical developments, but also altered patient characteristics. Patients undergoing liver transplantation are nowadays often more challenging, due to their age and relevant comorbidities.The number of liver transplantations is constantly rising. However, there are more patients in need of liver transplantation than donor grafts are available. Discrepancies between liver transplant candidates and organ supply can only partially be compensated by split liver transplantation and liver transplantation from living donors.To boost the pool of donor grafts, even marginal organs within the extended donor criteria (EDC) are being increasingly allocated. In some countries, even "donation after cardiac death (DCD) organs" are allocated as well.Marginal donor grafts are often associated with reduced graft and patient survival after liver transplantation. To improve the quality of poor liver grafts, innovations in organ conservation with development of new techniques as the machine perfusion techniques have been established in recent years.In summary, the constellation of risk factors of donor grafts as well as transplant recipients has become more challenging in recent decades. It is important to know the specific risk factors and predictors for liver transplantation, in order to obtain the best possible graft and patient survival after liver transplantation.This review gives an overview of predictors for liver transplantation, specific risk scores and indices for donor/recipient match as well as new technical devices in liver transplantation.

P-344 Number of cryopreserved embryos stored in Spain depending on their destination

Abstract Study question How many frozen embryos are stored in Spain destined for donation to other couples, research, destruction, own use or abandoned? Summary answer In Spain, 5% of frozen embryos are destined for donation to other patients, 17% are fated for research, 17,7% for destruction and 12% are abandoned What is known already According to the latest data from the Spanish Fertility Society (SEF) registry, the total number of embryos stored in Spain in 2019, was 668.082. Clinics ask patients to specify their preferences for the embryo’s destinations such as: save the embryos for the future, donation to other patients, research, or discarding the embryos. Embryos were considered abandoned when a patient with frozen embryo/s stored failed to contact the clinic for &amp;gt; 2 years and the patient could not be located. However, it is not known how many embryos are assigned to each destination, neither in Spain nor in any other country Study design, size, duration Reflecting concern about the accumulation of frozen embryos in banks, SEF convened a focus group with key figures in ethics, law, and reproductive medicine to identify possible solutions. The first step was to carry out a questionnaire to all the reproduction centres in Spain to know the number of frozen embryos stored and their destinations. A total of 242 IVF units were contacted through SEF newsletter and participants answered between April and July 2021 Participants/materials, setting, methods Public and private IVF clinics which had cryopreserved embryos were sent questionnaires with requests regarding the number of frozen embryos in each destination: keeping for patients, donated to other patients who met donation criteria (same as for gamete donors) and who did not meet criteria, research to a specific project and without a project, destined for destruction that met the criteria established by law, and that did not meet criteria, and number of embryos abandoned. Main results and the role of chance A total of 71 filled-in questionnaires from 242 IVF clinics were obtained. The response rate to the questionnaire was 29%. Of the respondents, a total of 376.445 stored embryos were reported. 46% of the total cryopreserved embryos were kept for later use by patients. 3.7% were donated to other couples but did not meet the criteria for donation: obtained from women over 35 years, or lack of any required test. 1.4% of the embryos were donated fulfilling the criteria for donation to other patients. 17% of the embryos were donated for research, but less than 1% had an assigned project. 17.7% of the frozen embryos were destined for termination of their conservation, and 1.4% of them did not meet the criteria established by law. A total of 46.046 embryos could be considered abandoned since the patients could not be contacted after more than two years of storage. This represents 12.2% of embryos without a defined destination. Limitations, reasons for caution The main limitation of this study is the low response rate, since out of 242 centres, which obligatory sent their data to the National Registry in 2019, only 71 centres answered. This could be due to the lack of data from some reproduction units Wider implications of the findings It is not known precisely how many frozen embryos have been abandoned in Spain, or what are their other destinations. Clinics are not required by authorities to report these number but to have concrete data on the frozen embryos is crucial to solve the problem of embryo accumulation in banks. Trial registration number Not applicable

Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers

Ex situ normothermic machine perfusion (NMP) is increasingly used for viability assessment of high‐risk donor livers, whereas dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia‐reperfusion injury. We aimed to resuscitate and test the viability of initially‐discarded, high‐risk donor livers using sequential DHOPE and NMP with two different oxygen carriers: an artificial hemoglobin‐based oxygen carrier (HBOC) or red blood cells (RBC). In a prospective observational cohort study of 54 livers that underwent DHOPE‐NMP, the first 18 procedures were performed with a HBOC‐based perfusion solution and the subsequent 36 procedures were performed with an RBC‐based perfusion solution for the NMP phase. All but one livers were derived from extended criteria donation after circulatory death donors, with a median donor risk index of 2.84 (IQR 2.52–3.11). After functional assessment during NMP, 34 livers (63% utilization), met the viability criteria and were transplanted. One‐year graft and patient survival were 94% and 100%, respectively. Post‐transplant cholangiopathy occurred in 1 patient (3%). There were no significant differences in utilization rate and post‐transplant outcomes between the HBOC and RBC group. Ex situ machine perfusion using sequential DHOPE‐NMP for resuscitation and viability assessment of high‐risk donor livers results in excellent transplant outcomes, irrespective of the oxygen carrier used.

Pediatric heart transplantation: The past, the present, and the future

Heart transplantation (HTx) has a storied past, with origins dating back to the early twentieth century and the first pediatric orthotopic heart transplant performed in 1967 on a neonate with Ebstein abnormality. Today, approximately 500 pediatric HTx are performed annually, with survival times now measured in decades rather than days or weeks. In large part, advances in immunosuppression, critical care, dedicated transplant teams and mechanical circulatory support have paved the way for improvements in waitlist mortality and post-transplant survival, with future directions including the development of intracorporeal ventricular assist devices (VADs) for small children, expanding/standardizing donor criteria, and xenotransplantation.

Machine perfusion in liver transplantation

Although liver transplantation is a true success story, many patients still die awaiting an organ. The increasing need for liver grafts therefore remains an unsolved challenge to the transplant community. To address this, transplant donor criteria have been expanded and, for example, more liver grafts with significant steatosis or from donors with circulatory death are being used. These marginal grafts, however, carry an increased risk of graft-associated complications, such as primary nonfunction, delayed graft function, or late biliary injuries. Therefore, reliable assessment of graft viability before use is essential for further success. To achieve this, machine liver perfusion, a procedure developed more than 50 years ago but almost forgotten at the end of the last century, is again of great interest. We describe in this review the clinical most applied machine perfusion techniques, their mechanistic background, and a novel concept of combining immediate organ assessment during hypothermic oxygenated perfusion, followed by an extended phase of normothermic machine perfusion, with simultaneous ex situ treatment of the perfused liver. Such a new approach may allow the pool of usable livers to dramatically increase and improve outcomes for recipients.

Assessing the impact of gestational age of donors on the efficacy of amniotic epithelial cell-derived extracellular vesicles in experimental bronchopulmonary dysplasia

Background and rationaleExtracellular vesicles (EVs) are a potential cell-free regenerative medicine. Human amniotic epithelial cells (hAECs) are a viable source of cell therapy for diseases like bronchopulmonary dysplasia (BPD). However, little is known about the impact of gestational age of the donor on the quality of hAEC-derived EVs.AimsTo determine the impact of gestational age on hAEC-derived EVs in experimental BPD.ResultsTerm hAEC-derived EVs displayed a significantly higher density of surface epitopes (CD142 and CD133) and induced greater macrophage phagocytosis compared to preterm hAEC-EVs. However, T cell proliferation was more significantly suppressed by preterm hAEC-EVs. Using a model of experimental BPD, we observed that term but not preterm hAEC-EVs improved tissue-to-airspace ratio and septal crest density. While both term and preterm hAEC-EVs reduced the levels of inflammatory cytokines on postnatal day 7, the improvement in lung injury was associated with increased type II alveolar cells which was only observed in term hAEC-EV treatment group. Furthermore, only neonatal term hAEC-EVs reduced airway hyper-responsiveness, mitigated pulmonary hypertension and protected against right ventricular hypertrophy at 6 weeks of age.ConclusionTerm hAEC-EVs, but not preterm hAEC-EVs, have therapeutic efficacy in a mouse model of BPD-like lung injury. Therefore, the impact of donor criteria should be considered when applying perinatal cells-derived EV therapy for clinical use.

MO626: Risk of Type 2 Diabetes After Stress Hyperglycaemia in Surviving Neurological Patients Admitted to ICU: Assessment of Insulin Need in Pancreatic Donation

Abstract BACKGROUND AND AIMS ‘Stress hyperglycaemia’ is a condition characterized by elevated blood glucose levels during stress or illness. It is often multifactorial and leads to transient insulin resistance and/or insulin deficiency in critical ill patients. Patients with stress hyperglycaemia could be potential pancreas donors, although there is some concern about the influence of donor insulin use on pancreas graft survival. Studies have reported that stress hyperglycaemia increases the risk toward the development of type 2 diabetes (T2D) on the long term, but the patient profiles were of those not usually considered for pancreas donation. The objective of our study was to assess the impact of insulin requirements during intensive care unit (ICU) in surviving patients who otherwise would be potentially eligible for pancreas donation. The risk of T2D at 3 years after discharge was assessed to understand the pancreas function recovery after stress hyperglycaemia. METHOD we developed a retrospective study including patients admitted in the ICU between March 2011 and December 2017 due to severe neurological acute conditions [subarachnoid haemorrhage (SAH), head trauma, non-SAH haemorrhage or stroke]. Inclusion criteria were as follows: severe neurological condition requiring need for intubation, age &amp;lt;56 years and survival at discharge. Exclusion criteria included: obesity (BMI ≥30), diagnosis of diabetes prior to admission, HVB, HVC or HIV positive and lost to follow-up &amp;lt;3 years. Baseline characteristics, length of hospital and ICU stay, peak AST/ALT and amilase/lipase, insulin use during admission as well as variables associated with hyperglycaemia (use of parenteral nutrition, infections, use of corticosteroids or propofol sedation) were collected from patient's electronic medical records of our institution. Primary endpoint was diagnosis of T2D at 3 years after discharge (HbA1C ≥6.5% or fasting plasma glucose ≥126 mg/dL). RESULTS A total of 76 patients were included, with insulin requirement during ICU admission reported in only 5 (6.6%). Median age was 45 years (IQR 35–52), 50% were males, median Charlson index was 0, and 25 (32.9%) had present or past smoking habit. Hypertension was present in 11 (14.5%) and dyslipidaemia in 7 (9.2%). The main admission cause was SAH in 45 patients (59.2%) followed by head trauma in 21 (27.6%). As for hyperglycaemic factors, during admission, 6 (7.9%) received parenteral nutrition, 48 (63%) had an infectious complication, 51 (67%) received corticosteroids and 49 (64.5%) were under propofol sedation. A total of 55 (72.4%) received noradrenaline. Median amylase, lipase, AST and ALT peak were 115 U/L (69.5–233), 70 U/L (34–222), 51 U/L (33.25–101.5) and 94 U/L (35.5–165), respectively. Median ICU and hospital stay were 10 (5–17.75) and 29 (19–42.75) days, respectively. Those who required insulin had longer ICU stay compared with the median of the overall cohort (25 versus 10 days); all of them received corticosteroids and were diagnosed with SAH. At 3 years of follow-up, only three patients (3.9%) were diagnosed with T2D, but none of them had received insulin during admission. One patient was diagnosed 7 months after discharge and the other two were diagnosed 1 year after discharge. Three patients died during the follow-up, but any of them also required insulin during admission. CONCLUSION Insulin requirement in patients with severe neurological acute conditions who could meet criteria for pancreas donation was less common than expected, despite large use of corticoids, infectious complications and propofol sedation as hyperglycaemic factors. Remarkably, only three patients were diagnosed of T2D during the follow-up and none of them received insulin during admission. Prospective studies are needed in order to understand pancreas recovery after stress hyperglycaemia.

WITHDRAWN: Pediatric heart transplantation: The past, the present, and the future

Heart transplantation (HTx) has a storied past, with origins dating back to the early twentieth century and the first pediatric orthotopic heart transplant performed in 1967 on a neonate with Ebstein abnormality. Today, approximately 500 pediatric HTx are performed annually, with survival times now measured in decades rather than days or weeks. In large part, advances in immunosuppression, critical care, dedicated transplant teams and mechanical circulatory support have paved the way for improvements in waitlist mortality and post-transplant survival, with future directions including the development of intracorporeal ventricular assist devices (VADs) for small children, expanding/standardizing donor criteria, and xenotransplantation.

Blood donor eligibility criteria for medical conditions: A BEST collaborative study.

Donor eligibility questions and criteria for medical conditions vary between blood centres, suggesting that they are based more on local regulations or experience, rather than on published data, which are limited. As the donor population ages, medical conditions become more common. We assessed donor health assessment criteria at blood centre members of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Our aim was to compare eligibility criteria and determine their underlying basis. A REDCap survey was sent to blood centre participants, based on medical conditions of greatest interest suggested by the Donor Studies Team of the BEST Collaborative. Participants were asked about current donor health assessment questions, deferral criteria and the basis for their deferral policy (donor risk, recipient risk or both) for 20 medical conditions. Complete responses were received from 26 blood donor centres (24 separate responses) representing a combination of hospital-based centres, large regional centres and community/national blood centres in 14 different countries. Most centres specifically ask about heart and lung conditions, whereas fewer than half inquire about kidney, gastrointestinal or neurological conditions. North American blood centres tended to be less restrictive, while regulatory restrictions are more prevalent in Europe. Most participants felt that the criteria were based on regulatory requirements or experience, rather than on published data. There is considerable variability in criteria by region. Ideally, criteria would be more evidence-based rather than based on regulatory requirements or experience. Deferral criteria must balance donor and recipient safety and maintain an adequate blood supply.

Heart Transplantation from Donation After Circulatory Death Donors: An Update on the Australian Experience

<h3>Purpose</h3> With an expanding end-stage heart failure population the demand for donor hearts is increasing. Donation after circulatory death (DCD) is a pathway that could help address this; we explore the impact of DCD over the last 8-years on our unit and compare our early vs contemporary outcomes. <h3>Methods</h3> All DCD heart transplants at our unit were included. Inclusion criteria for DCD donors are: normal transthoracic echo, age <55yrs & nil previous cardiac history. DCD heart retrievals are subject to varying functional (when systolic blood pressure drops <90mmHg) and asystolic warm ischemic times (aWIT) prior to administration of cardioplegia - this warrants an assessment of viability through visual inspection and monitoring of lactate levels. Donor hearts are cannulated onto an ex-vivo normothermic machine perfusion device where 1.2-1.5L of donor blood is circulated in a Langendorff fashion. <h3>Results</h3> Since 2014 we have performed 69 DCD heart transplants. Since 2020, DCD donors account for 32% of our heart transplant activity (32/100). Overall 1yr & 5yr survival for DCD vs BD donor heart transplant recipients was not significantly different (p=0.27). In the early experience, 12/34 patients (35.3%) required immediate post-operative ECMO or mechanical support. Recent recipients have a significantly lower rate with 3/35 (8.57%) requiring ECMO/mechanical support post-transplant (p=0.009). Mean DCD donor & recipient age was 32.6yrs(+/-10.5yrs) & 53.6yrs(+/-12.7yrs) respectively. Mean donor aWIT was 12.3mins (+/-2.8mins). Recipients of donors with an aWIT >15mins had significantly higher post-transplant ECMO/mechanical support requirement compared to those with an aWIT <=15mins (66.17% vs 17.46%, p=0.0177, OR 9.455). Median hospital length of stay was 17.5days (11-27.5days). <h3>Conclusion</h3> DCD donors can contribute to heart transplantation activity with survival comparable to BD pathways. Donor hearts subject to an aWIT >15mins are more likely to require post-operative ECMO/mechanical support.

Using Donor Lungs ≥70 Years of Age for Transplantation - Do Long-Term Outcomes Justify the Use?

<h3>Purpose</h3> Donor shortage have led transplant centers in the past to extend acceptable criteria for lung donors, accepting older and more marginal donor organs for transplantation. Accepting donors ≥70 years of age as lung donors has shown good short-term outcomes in the past, however, no mid- and long-term outcome data on these extended criteria donors exists thus far. <h3>Methods</h3> All patients undergoing lung transplantation between 06/2010 and 12/2019 at our institution were included into the analysis, that compared outcomes between patients transplanted with donors <70 years of age vs. patients transplanted with donors ≥70 years old. Outcome parameters included pre-, peri- and postoperative clinical parameters as well as recipient overall survival and CLAD-free survival. Median follow-up was 8.9 years. <h3>Results</h3> Between 06/2010 and 12/2019, among the 1168 lung-transplanted patients, 62 (5.3%) patients received lungs from donors ≥70 years old. Recipient age of the patients receiving older organs was significantly higher as compared to recipients of <70 years old lungs (56.2±7.8 vs. 48.7±38.9 yrs; p<0.0001) and more patients with an obstructive disease pattern prior to transplantation received a donor lung ≥70 years old (40.3% vs. 27.6%; p=0.04). Mean donor age was 73.4±2.9 years in the ≥70 years old group as compared to 44.3±15.8 yrs in the other cohort (p<0.0001). Older donors were significantly shorter on mechanical ventilation prior to donation (4.0±3.6 vs 5.7±5.1 days; p=0.0007), had a higher median Horowitz index (412.5 (356;469) vs. 384 (316; 448); p=0.01) and fewer history of smoking (12.9% vs. 42.1%; p<0.0001).Primary graft dysfunction scores at 24 (p=0.99), 48 (p=0.60) and 72 (p=0.94) hours after transplant showed no significant difference between both groups. Similarly, time on mechanical ventilation (p=0.68), time on ICU (p=0.65) as well as total hospital stay (p=0.58) were comparable in both groups. One-, five- and 7-year survival in both groups showed no significant difference (1yr: 95.1 vs. 90.2%, 5yr: 77.8 vs. 73.2%, 7yr: 69.1 vs. 68.1%, p=0.71). CLAD-free survival showed no difference between both groups in the follow-up period (p=0.76). <h3>Conclusion</h3> Utilization of donor lungs ≥70 years of age leads to excellent mid- and long-term results that are similar to younger donor organs when carefully preselecting these older donor organs.

There is No Smoking Gun: LongTerm Lung Transplant (LTx) Outcomes Using Smoking Donors

<h3>Purpose</h3> Lung transplant (LTx) is limited by a supply of donor lungs. Donor lungs from smokers are known to have adverse effects on early post-LTx outcomes (Oto et al, 2004). As long-term survival outcomes remains under assessed we investigated the effect of donor smoking on long-term LTx survival and death from chronic lung allograft dysfunction (CLAD) using the cohort described by Oto et al. <h3>Methods</h3> 173 bilateral LTx recipient records between 1995-2002 were retrospectively reviewed. 97 (56.1%) of LTx donors had ceased or never smoked and 76 (43.9%) were current smokers. Kaplan-Meir models were used to assess long-term survival. Smoking donors were divided into two groups: 1-15 pack years (PY) (n=35) and >16 PY (n=21). 20 recipients received donors with a smoking history but unknown amount. Hazard ratios (HR) were used to assess survival outcomes between known smoking groups. <h3>Results</h3> No significant survival difference was found between LTx recipients for never/ ceased smokers and smokers (Figure 1) or between smoking dose cohorts (Figure 2). HR for smokers compared to never/ ceased smokers: 1.25, 95% CI 0.70 to 2.25, p=0.439. HR for 1-15 PY compared to never or ceased smokers: 1.21, 95% CI 0.57 to 2.53, p=0.615. HR for >16 PY compared to never/ ceased smokers: 0.83, 95% CI 0.28 to 2.41, p=0.721. There was no significant difference in death from CLAD between groups. <h3>Conclusion</h3> This study suggests that a smoking history in LTx donors does not significantly affect long-term survival or increase death from CLAD. This may have implications for expanding donor criteria, enabling LTx opportunities for more patients.

Special Considerations in the Management of HIV and Viral Hepatitis Coinfections in Liver Transplantation

Modern therapies for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus have become so effective that patients treated for these conditions can have normal life-expectancies. Suitable livers for transplantation remain a scarce and valuable resource. As such, significant efforts have been made to expand donation criteria at many centers. This constant pressure, coupled with the increasing effectiveness of antiviral therapies, has meant that more and more patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) may be considered appropriate donors in the right circumstances. Patients with these infections are also more likely to be considered appropriate transplantation recipients than in the past. The treatment of HBV, HCV, and HIV after liver transplantation (LT) can be challenging and complicated by viral coinfections. The various pharmaceutical agents used to treat these infections, as well as the immunosuppressants used post-LT must be carefully balanced for maximum efficacy, and to avoid resistance and drug–drug interactions.

Changes in echocardiographic parameters of the donor's heart before and after heart transplantation and their relationship with post-transplant survival.

BackgroundHeart transplantation is now widely performed in China, but the current entry criteria for heart transplantation donors are simple and lack reliable standards; there are still no studies on the effect of preoperative echocardiographic parameters of heart transplantation donors on the prognosis of the recipient. Therefore, the aim of this study is twofold: (I) to observe the characteristics of changes in echocardiographic parameters of the donor’s heart before and after heart transplantation and (II) to study the relationship between the changes in echocardiographic parameters of the donor’s heart pre- and post-transplant and transplant recipient survival.MethodsA total of 29 patients who underwent orthotopic heart transplant in our hospital from October 2016 to October 2019 were enrolled in this study. All recipients were followed up until April 2020. Echocardiographic data were collected pre-transplantation (donor) and at 1 week and 1 month post-transplant (recipient).ResultsCompared with the pretransplanted donor’s heart, there was an increase in the interventricular septal diameter, left ventricular posterior wall diameter, right atrium diameter and right ventricular diameter, while a decrease was found in the tricuspid annular systolic displacement and tricuspid annular peak systolic velocity at 1 week post-transplant. The survival curve showed that the postoperative survival time in the right atrium/ventricle ≥32 mm group was better than that in the right atrium/ventricle <32 mm group. The survival curve also showed that the postoperative survival time in the right atrium/ventricle enlargement <2 mm group was better than that in the right atrium/ventricle enlargement ≥2 mm group.ConclusionsIn the early post-transplant period, ventricular myocardial thickening, right heart enlargement and a decrease in right heart function were observed in the post-transplanted heart compared to the pretransplanted donor’s heart. Postoperative survival was higher among heart transplant patients who received a heart with right atrium/ventricle ≥32 mm. Postoperative survival was lower among heart transplant patients whose right atrium/ventricle was dilated ≥2 mm at 1 month postoperatively compared with the pretransplanted donor’s heart.

Mesenchymal Stromal/Stem Cells and Their Products as a Therapeutic Tool to Advance Lung Transplantation.

Lung transplantation (LTx) has become the gold standard treatment for end-stage respiratory failure. Recently, extended lung donor criteria have been applied to decrease the mortality rate of patients on the waiting list. Moreover, ex vivo lung perfusion (EVLP) has been used to improve the number/quality of previously unacceptable lungs. Despite the above-mentioned progress, the morbidity/mortality of LTx remains high compared to other solid organ transplants. Lungs are particularly susceptible to ischemia-reperfusion injury, which can lead to graft dysfunction. Therefore, the success of LTx is related to the quality/function of the graft, and EVLP represents an opportunity to protect/regenerate the lungs before transplantation. Increasing evidence supports the use of mesenchymal stromal/stem cells (MSCs) as a therapeutic strategy to improve EVLP. The therapeutic properties of MSC are partially mediated by secreted factors. Hence, the strategy of lung perfusion with MSCs and/or their products pave the way for a new innovative approach that further increases the potential for the use of EVLP. This article provides an overview of experimental, preclinical and clinical studies supporting the application of MSCs to improve EVLP, the ultimate goal being efficient organ reconditioning in order to expand the donor lung pool and to improve transplant outcomes.

Potential options to expand the intestinal donor pool: a comprehensive review.

Intestinal donation is currently restricted to 'perfect' donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated. Increasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient. Several potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.

An exploratory analysis of patient factors influencing acceptance of extended criteria liver grafts

Introduction and ObjectivesThere is a shortage of ideal donor organs with consequential increasing waitlist times, drop-off, and mortality. Teams have thus extended the donor criteria. Little is known about patients’ actual choices and what factors may influence their decisions regarding different extended criteria liver grafts. Patients and MethodsThe documented acceptance or refusal of seven extended criteria liver graft types of patients consented for transplant in a single institution over a 2-year period was reviewed. Patient factors including sex, age, indication, aetiology, and model for end-stage liver disease (MELD) score were analysed using logistic regression. ResultsMost patients were willing to accept most graft types. MELD score did not impact the acceptance or refusal of any graft type. Older patients and those with hepatocellular carcinoma (HCC) or ascites had significantly higher rates of acceptance. Hepatitis B or C disease aetiology was predictive of willingness to accept a similarly infected graft, respectively. HCC was predictive of acceptance of grafts from donors with a cancer history. ConclusionsIn general, patients embrace the available extended criteria donors. Our analysis suggests that consent should be revisited as patients deteriorate or ameliorate on the waitlist, especially if in the form of ascites or HCC but not necessarily MELD score.