Donation After Citizens Death Research Articles

Clinical characteristics of 15 cases of renal transplantation with pre-exsiting donor-specific antibody.

Currently, patients with pre-exsiting donor-specific antibody (DSA) are prone to antibody-mediated rejection (AMR) after surgery and are at a relatively high risk of postoperative complications and graft failure. The risk of postoperative complications and graft failure is relatively high. This study aims to discuss the clinical outcome of DSA-positive kidney transplantation and analyze the role and safety of preoperative pretreatment in DSA-positive kidney transplantation, providing single-center treatment experience for DSA-positive kidney transplantation. We retrospectively analyzed the clinical data of 15 DSA-positive kidney transplants in the Department of Renal Transplantation of First Affiliated Hospital of Zhengzhou University from August 2017 to July 2022. Eight cases were organ donation after citizen's death (DCD) kidney transplant recipients, of which 3 cases in the early stage were not treated with preoperative desensitisation therapy (DCD untreated group, n=3), and 5 recipients were treated with preoperative rituximab desensitisation (DCD preprocessing group, n=5). The remaining 7 cases were living related donors recipients (LRD) who received preoperative desensitisation treatment with rituximab and plasma exchange (LRD preprocessing group, n=7). We observed and recorded the incidence of complications with changes in renal function and DSA levels in the recipients and the survival of the recipients and transplanted kidneys at 1, 3 and 5 years, and to compare the differences in recovery and postoperative complications between 3 groups. All 15 recipients were positive for preoperative panel reactive antibody (PRA) and DSA and were treated with methylprednisolone+rabbit anti-human thymocyte immunoglobulin induction before kidney transplantation. DCD untreated group all suffered from DSA level rebound, delayed renal graft function (DGF) and rejection reaction after surgery. After the combined treatment, DSA level was reduced and the graft renal function returned to normal. The DCD preprocessing group were all without antibody rebound, 1 recipient developed DGF and the renal function returned to normal after plasmapheresis, and the remaining 4 recipients recovered their renal function to normal within 2 weeks after the operation. In the LRD preprocessing group, 2 cases had antibody rebound and 1 case had rejection, but all of them recovered to normal after treatment, and DSA was maintained at a low level or even disappeared. The incidence of DGF and rejection in the DCD untreated group were significantly higher than that in the DCD preprocessing group and the LRD preprocessing group; and there were no significant difference in the incidence of postoperative haematuria, proteinuria, bacterial and fungal infections, and BK virus infection between the 3 groups (all P>0.05). A total of 11 of the 15 recipients were followed up for more than 1 year, 6 for more than 3 years, and 1 for more than 5 years, and the survival rates of both the recipients and the transplanted kidneys were 100%. Effective preoperative pretreatment with desensitization therapy can effectively prevent antibody rebound in DSA-positive kidney transplantation and reduce perioperative complications.

Pre-Transplant Peripheral Lymphocyte Subsets Predict Pneumonia After Renal Transplantation.

BackgroundKidney transplantation (KTx) has been considered as the most effective therapeutic method for end-stage renal disease. Immune monitoring of peripheral lymphocyte subsets (PLS) reflects the real immune status and has been used for diagnosis of pneumonia after KTx. We aimed to investigate the association between pre-transplant PLS and pneumonia in renal allograft recipients.Material/MethodsA total of 152 patients receive donation after citizen’s death (DCD) kidney allografts in our center between January 2018 and December 2019. Among them, 114 patients were enrolled in our study based on inclusion and exclusion criteria. During the first-year follow-up after KTx, 32 recipients developed pneumonia, and the other 82 recipients did not (stable group). The pre-clinical information and PLS (including the percentages and absolute numbers (Ab No.) of peripheral T, B, and NK cells, as well as CD4/CD8 ratio) results in these 2 groups were calculated by the Mann-Whitney test and receiver operating curve (ROC) analysis. Univariate and multivariate logistic regression analyses were employed to identify risk factors.ResultsCompared to the stable group, the Ab No. of CD3+, CD8+, and CD4+ T cells, as well as B cells and NK cells, were notably reduced in the pneumonia patients. The area under the curve (AUC) of CD3+ T cell Ab No. was 0.7022. Multivariate analysis demonstrated that pre-transplant B cell Ab No. was the independent risk factor for pneumonia progression after KTx (OR=0.353, P=0.037).ConclusionsPre-transplant Ab No. of PLS were closely related to pneumonia after KTx. Monitoring pre-transplant PLS could provide more timely and effective prevention and therapy for post-operative pneumonia after KTx.

Risk factors of early liver dysfunction after liver transplantation using grafts from donation after citizen death donors

BackgroundAs an early complication after liver transplantation, early allograft dysfunction (EAD) indicates a poor prognosis. This study analyzes the risk factors related to early allograft dysfunction (EAD) after liver transplantation using grafts from donation after citizen death (DCD) to provide a reference for the prevention of EAD after DCD liver transplantation. MethodsA total of 32 patients who underwent DCD liver transplantation in the organ transplantation center of our hospital from September 2013 to January 2021 were enrolled in this study. The patients were divided into the EAD group and non-EAD group according to whether they developed EAD after transplantation. The general data of the donors and recipients before transplantation, intraoperative conditions, and clinical data within one week after transplantation were compared between the two groups, and related complications were statistically analyzed. The follow-up time was one week postoperatively or, if they died within the first week postoperatively, until the patient died. ResultsThe subjects included 10 females and 22 males, and the incidence of postoperative EAD was 25% (8/32). Four patients (12%) had primary malignant tumors (primary liver cancer and cholangiocarcinoma), and five donors (15%) had fatty liver. The univariate analysis revealed that the donor BMI (P = 0.005), degree of fatty liver (P = 0.025), aspartate aminotransferase (P = 0.001), alanine aminotransferase (P < 0.001), and total bilirubin (P = 0.009) were related to the occurrence of EAD after DCD liver transplantation. By analyzing the correlation between the incidence EAD and postoperative complications after liver transplantation using grafts from DCD donors, it was shown that the incidence of primary nonfunction (PNF) is related to EAD (P = 0.024). ConclusionDonor BMI, the degree of fatty liver, and preoperative liver function are risk factors for EAD after DCD liver transplantation, and the occurrence of EAD after DCD liver transplantation significantly increases the probability of PNF.

Effect of disseminated intravascular coagulation on donation after citizens' death donor kidneys.

BackgroundTo investigate the effect of disseminated intravascular coagulation (DIC) on donor kidney in donation after citizens’ death (DCD) donors.MethodsThe clinical and laboratory data of 159 DCD donors obtained by our center in 2018 were retrospectively analyzed. The DIC diagnosis was performed according to the Chinese DIC scoring system (CDSS). The donors were divided into two groups: DIC (+) and DIC (−). The difference between kidney rejection rate and zero puncture glomerular microthrombus formation rate were compared.ResultsAmong the 159 DCD donors, 11 were discarded (accounting for 6.91%). The reasons for the discarded cases included 5 cases (3.14%) for moderate and severe glomerular microthrombus formation in the renal zero puncture pathology; 2 cases (1.26%) for glomerular sclerosis ratio over 50%; 2 cases (1.26%) for long-term low blood pressure before pregnancy and significantly increased serum creatinine level and no urine; 1 case (0.73%) for kidney stones and stagnant water; 1 case (0.63%) for malignant tumor. The donor rejection rate of the DIC (+) group was higher than that of the DIC (−) group, and the difference was statistically significant (P<0.05). Among all donors, 10 cases (6.29%) were found to have glomerular microthrombus at zero puncture, and the microthrombotic rate in the DIC (+) group was significantly higher than that in the DIC (−) group (P<0.05). Of the 10 microthrombotic donors, 5 donors with severe glomerular microthrombus were discarded.ConclusionsDonor-induced DIC can easily cause renal glomerular microthrombus formation, and the donor kidney rejection rate has increased.

Selective preimplantation pathological evaluation in renal transplantation: a single center's experience

Objective: To summarize the clinical data of pre-implantation biopsy donors in our hospital and explore the clinical characteristics of those donors in pathological high-risk, and to provide references for the selective histological evaluation of extended criteria donor kidneys. Methods: We retrospectively reviewed the clinical data and pre-implantation renal pathologic score of donors from January 1, 2015 to May 1, 2017.During this period, 247 cases of donation after citizen's death (DCD) occurred.After clinical evaluation and selective machine perfusion( Lifeport) evaluation, 30 cases of pre-implantation pathological evaluation were performed.According to Remuzzi scores, donors were divided into low-risk and high-risk group.Nine cases of low-risk group (bilateral kidney's Remuzzi score ≤3) and 16 cases of high-risk group (bilateral or unilateral kidney's Remuzzi score ≥4, severe glomerular micro-thrombi or severe tubular necrosis) were included.Five cases of donors were excluded due to only unilateral renal pathological result available.Both high-risk and low-risk groups' clinical data, including sex, age, height, body weight, body mass index, proteinuria, hematuria, urinary glucose, baseline or admission serum creatinine, serum creatinine before procurement, history of hypertension and/or diabetes mellitus, cardiopulmonary resuscitation or not, with or without the history of shock, urine output prior to acquisition, macroscopical manifestations of donor kidney, cause of death were statistically analyzed. Results: The donors' baseline serum creatinine/upper limit of normal serum creatinine range in high-risk group were significantly higher than that in low-risk group [(129.8±42.2)% vs(92.4±30.5)%, P=0.029]. The poor macroscopical manifestations of donor kidneys were significantly more frequent in high-risk group than that in low-risk group (12/16 vs 0/9, P= 0). No significant differences between two groups were found regarding their age, height, weight, BMI, proteinuria, hematuria, urine glucose, pre-procure creatinine level, history of hypertension and/or diabetes mellitus, cause of death and so on (P>0.05). Conclusions: After clinical evaluation and selective Lifeport evaluation, donor grafts of whose baseline serum creatinine levels increased beyond normal range and of whose grafts' macroscopical manifestations were poor, should undergo pre-implantation pathological evaluation further.Also, it is reasonable to perform pre-implantation biopsy in cases of equivocal results after Lifeport evaluation.This will be beneficial to identify histological high-risk donors and also be predictive to allocate the grafts.

The Main Features of DCD Donors in China (Hunan province experience)

Introduction The shortage of organ resources is considered a significant problem in countries all over the world. How to promote organ donation after citizen death (DCD) has become one of the key issues of organ transplantation. The objective of this paper is to analyze the main features of DCD donors in China. Based on the experience of organ donation in our transplantation center, we aim to explore the improvement of the organ donation in China within recent years. Method We collected 221 cases of successful donation from our transplantation center and analyzed the data by SPSS. In this paper, we comprehensively analyzed the key features of organ donors in China from various aspects, including age, sex, educational level, occupation, cause of death, and family structure. Result Our center, one of the pioneers of DCD work in China, has been devoted to DCD work since 2010. Among more than one thousand potential donors, 221 successfully donated. From 2010 to 2016, our rate of successful donation increased by 16.5 folds. The annual average increase rate is as high as 74.8%. Among the 221 cases, 177 were male donors and 44 were female. All donors were divided into 3 groups according to their age. In the young age group (under 18 years old, n = 30), more than half died of tumors (n = 21). In the middle age group (between 19 and 49 years old, n = 142), 87.32% were male (n = 124). 73.94% of donors in this group received primary and junior school education (n = 105), while 85.9% of them were farmers or urban migrant workers whose jobs were highly instable (n = 122). Their death mainly resulted from craniocerebral trauma by traffic accidents and occupational injuries (n = 90). 54.22% of them were either unmarried, divorced, or has suffered from loss of spouse (n = 77). In the old age group (between 50 and 65 years old, n = 38), 68% of donors died of spontaneous intracerebral hemorrhage or brain tumors (n = 26). Conclusion Based on the data above, the organ donors in China were younger than those in developed countries, and mainly were male. Farmers or urban migrant workers with instable jobs, low education levels, and a simple family structure composed the largest part of organ donation. Meanwhile, the main cause of adult donor death is craniocerebral trauma from traffic accidents and occupational injuries. The study was funded by Wu Jieping Medical Foundation (320.6750.15070) and Natural Science Foundation of Hunan Province (2016JJ4105).

Prophylaxis of fungal infections in liver transplantation from donation after citizen's death

As one of the commonest postoperative complications after liver transplantation, fungal infection has a high incidence and mortality. Nowadays, the development of the organ transplantation technique in China has already entered into the era of donation after citizen's death (DCD). Donors of DCD are mainly derived from the patients after brain death, cardiac death or death of both brain and cardiac. These donors usually suffer from long-term hypotension, ischemia, anoxia and secon-dary recessive or dominant infections during emergency treatment. Hence, preventing the fungal infections in donor organs and recipients after transplantation plays an important role in improving the success rate of liver transplantation. This review focuses on the clinical significance of preventing fungal infection in DCD of liver transplantation. Key words: Fungal infection; Liver transplantation; Risk factors; Prophylaxis

Sarcomatoid Renal Cell Carcinoma Arisen after the Renal Allograft from Donation after Citizen Death: A Case Report and Literature Review

The aim of this study was to discuss the causes and preventions of sacromatoid renal cell carcinoma (SRCC) after renal allograft from donation after citizens death (DCD). It was reported on a 45-year-old male patient had undergone renal transplantation in other hospital because of chronic renal insufficiency uraemia in August of 2014. Two months later, lesions found in the renal parenchyma in the right iliac fossa via the color doppler ultrasound. The area of renal transplantation was bulged with tenderness. The renal dysfunction and microscopic haematuria were found. The review color doppler ultrasound and CT showed that the allograft kidney is enlarged rapidly. On 22^nd December 2014, a surgical exploration was performed. An irregular and hard mass within the parenchyma of engrafted kidney was found, which was considered as malignant. The nephrectomy of the renal allograft was performed in the operation. First postoperative day, his condition was deteriorating rapidly. Finally, the patient died of cardiac functional failure. The tumor was pathologically diagnosed as sacromatoid renal cell carcinoma (SRCC). SRCC found in the donor allograft kidney is highly malignant and poorly prognosis. The repeated imaging investigations are necessary to exclude the hidden trouble of tumors, such as SRCC. Postoperative immunosuppressive regimens should be modified and the screening program of renal tumor for the early control and prevention should be strengthen.