Donation After Brain Death Research Articles

A Novel National Program to Maximize Utilization of Heart and Lung Allografts from Donors After Brain Death (DBD) and Donors After Circulatory Death (DCD) for Transplantation

<h3>Purpose</h3> Build a national network of dedicated cardiothoracic surgical procurement and Organ Care System (OCS™) ex-vivo perfusion clinical experts to: Maximize cardiothoracic donor organ utilization for transplantation; overcome logistical and infrastructural burden of distant organ procurements and national allocation; standardize clinical quality of care of ex-vivo perfusion management of cardiothoracic allografts; and establish a better work-life balance for transplant teams across the U.S. <h3>Methods</h3> Leveraging the OCS, the only FDA approved portable perfusion technology for heart and lung transplantation, to build a national infrastructure to enable a turn-key service. This program comprehensively covers: donor screening, donor surgical procurement, OCS perfusion management and transportation of allografts from donor hospitals to any transplant program in the U.S. <h3>Results</h3> The National OCS Program (NOP) was initiated in 2021 for lung transplantation using the OCS Lung technology in 9 major regions across the U.S. Early experience is very encouraging and demonstrated the capabilities of NOP to significantly expand thoracic organ retrieval distance. Enabling cross-country thoracic organ sharing to benefit more patients awaiting transplants while unburdening transplant programs resources. The map below demonstrates actual NOP lung transplants. NOP is now expanding to include OCS Heart and provide similar service to heart transplant programs across the U.S. <h3>Conclusion</h3> The process of cardiothoracic donor organ procurement and related logistics are challenging and unscalable to meet the growing national demand for increased donor organ utilization for lung and heart transplantation. NOP was designed to create a collaborative partnership between industry, OPOs and transplant programs to provide solutions to overcome the existing challenges and transform the field of cardiothoracic transplantation in the U.S.

Heart Transplant Outcomes with Donation After Cardiac Death: UNOS Registry Analysis

<h3>Purpose</h3> Limitations in organ donation have led to approaches to expand the existing donor pool. Donation after cardiac death (DCD) has continued to increase after efforts led by the United Kingdom and Australia. We sought to describe the United States experience. <h3>Methods</h3> 5153 heart transplant (HT) recipients were identified in the UNOS Registry between 1/2019 and 6/2021, of which 229 were DCD recipients. HT recipients were grouped by DCD status or donation after brain death (DBD). Comparisons between groups were assessed using standard statistical methods, survival analysis was censored at 12-months via the Kaplan-Meier method. Multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, dialysis, life support, waiting time & HLA mismatch) were performed. <h3>Results</h3> Recipients of DCD donors were of lower UNOS status (p<0.001), increased VAD use (p=0.01), and less dialysis (p=0.011). Additionally, DCD donor recipients had longer wait times (46.0 vs 30.0d, p=0.007), longer ischemic times (p<0.001) but younger donors (29.8 vs 23.4y, p<0.001). There was no difference in 1-month or 1-year survival by donor type (p=0.720). Unadjusted analysis demonstrated HR 0.91 (0.52-1.57) and following adjustment HR 0.88 (0.48-1.61). <h3>Conclusion</h3> Short-term survival of DCD donors is similar to DBD donors in this UNOS Registry analysis. DCD donor use has potential to expand the donor pool. Further study is warranted to assess longer term outcomes as well as best strategies for donation.

Early Single Center Experience of Heart Transplantation from Donation After Circulatory Death Donors in the United States

<h3>Purpose</h3> Heart transplantation (HT) from donation after circulatory death (DCD) donors has been proposed as a means of addressing the scarcity of available donor grafts. International experience has suggested that DCD HT is safe, with outcomes comparable to donation after brain death (DBD) HT. Herein we describe our center's early experience using 2 DCD heart procurement strategies: 1) A direct procurement and perfusion (DPP) protocol, and 2) A thoracoabdominal normothermic regional perfusion (TA-NRP) protocol. <h3>Methods</h3> In September 2020, we launched a DCD HT program as part of a randomized trial using DPP and the OCS Transmedics platform. We subsequently launched a TA-NRP program. The TA-NRP protocol uses mobile cardiopulmonary bypass (CPB) to assess hearts in situ following declaration of death. Functional warm ischemic time (FWIT) was defined as the time from onset of mean pressure <50mm Hg or oxygen saturation <70%, to cold flush (DPP) or initiation of CPB (TA-NRP). FWIT was ≤30 minutes for DPP, while there was no pre-defined limit for TA-NRP. Data was prospectively collected. Donor and recipient characteristics were analyzed. We report 30-day survival as the primary endpoint. Secondary endpoints include incidence of primary graft dysfunction requiring mechanical support, immediate cardiac performance, ventilator days, need for renal replacement therapy, and intensive care and hospital length of stay. <h3>Results</h3> From September 2020 to October 2021, our center attended 50 candidate DCD donors, and performed 33 DCD HTs (66.0%), comprised of 13 DPP and 20 TA-NRP protocol donors. Among candidate DPP donors, 13 of 23 (56.5%) hearts were transplanted, whereas among candidate TA-NRP donors, 20 of 27 (74.1%) were transplanted. Year-to-date, DCD as a proportion of all HTs at our center has been 43.1%. Comparing similar time periods before and after implementing our DCD heart transplant program revealed a 20.3% increase in transplant activity. Donor and recipient characteristics are described in tabular format. 30-day survival is 100% among all DCD heart recipients. The incidence of primary graft dysfunction and other secondary endpoints are comparable with standard DBD HT. <h3>Conclusion</h3> DCD HT using both the DPP and TA-NRP procurement protocols is feasible and safe. Outcomes in our early single center experience are comparable with standard DBD HT.

Early Outcomes of Lung Transplantation for COVID-19 Related Lung Disease. Single Center Experience

PurposeLung transplantation (LT) is a lifesaving treatment for Covid-19 related lung disease with early outcomes similar to other indications.MethodsSeven patients underwent LT for Covid-19 related lung disease at our center: 5 for ARDS and 2 for IPF exacerbation post SARS-CoV-2 infection.ResultsSeven patients (5 men) with single organ failure underwent bilateral LT. Median age was 47 years old. All ARDS cases had poor lung mechanics on invasive mechanical ventilation with radiographic evidence of lung fibrosis: pneumatocele, GGO, consolidations, subpleural reticulations and traction bronchiectasis. vvECMO was bridge to transplant in 5 cases (bridge to recovery in 2). Median ECMO duration for ARDS was 32 days (range 7-99). Median time to LT from Covid diagnosis was 59 days (Q1-IQ3, 54-62). Two patients were post-partum women with ARDS. Explanted pathology showed UIP, DAD, diffuse hemorrhage and one case of fibrosing NSIP. Pulmonary hypertension was seen in 4 cases. One patient did not survive. Organizing pneumonia and granuloma were present in this patient. Most ARDS patients were unable to tolerate lower sedation and consent by a substitute decision-makers was obtained. Post operative ECMO decannulation was possible in all cases. Induction, maintenance immunosuppression and antimicrobials were standard for our program. Donated grafts were from deceased brain death donors and negative for 2019-nCoV. Rehabilitation potential and strong social support were absolute inclusion criteria. All survivors have excellent lung function.ConclusionIn the USA, over 130 LT have listed Covid-19 as the diagnosis indication. Although Covid-19 ARDS makes up for the majority of these LT, other diagnosis are post Covid pulmonary fibrosis and underlying fibrosis with SARS-CoV-2 induced exacerbation. LT for ARDS poses several challenges and is reserved for the minority of carefully selected patients dependent on extracorporeal life support. As others have reported, good short-term survival is described.

Time Will Tell: An Updated Analysis of Brain Death and Adult Cardiac Transplantation Outcomes After a Change to the UNOS Allocation System

<h3>Purpose</h3> The process of brain death produces a series of physiological changes including shifts in catecholamines, hormones, and inflammatory mediators. Previous studies have looked at the effect of brain death on transplant outcomes. However, in October 2018, the United Network for Organ Sharing (UNOS) underwent an update to the allocation system for adult cardiac transplants. The effect of the change in allocation system on both donor variables and recipient outcomes has not yet been investigated in detail. <h3>Methods</h3> A retrospective review of all adults (≥ 18 years) in the UNOS database undergoing single organ cardiac transplantation from 2015 - 2021 was performed. The population was divided into a pre-allocation change and a post-allocation change group. Statistical analysis was performed using univariate T-test and Chi-Square tests to compare differences in patient variables between the cohorts. Our primary outcome was donor brain death time pre- and post-allocation system change. Secondary outcomes included patient and graft survival at one year, ischemic time, renal failure requiring dialysis, stroke prior to discharge, pacemaker requirement, rejection within one year, and length of stay post-transplant. <h3>Results</h3> 16,538 patients were identified in the population, 9,322 prior to the allocation change and 7,216 after. Mean brain death time was not significantly different between pre (2.45 days) and post (2.67 days) allocation change groups (p = 0.297), however mean ischemic time was much longer in the post group (3.44 hours vs 2.96 hours, p <0.001). Patient survival at one year post transplant was not significantly different in the post allocation change group (91.3%) compared to the pre (91.6%) (p = 0.616). The post group had a higher one year graft survival (48.7% vs 20.3%, p < 0.001), but also a higher rate of dialysis prior to discharge (13.4% vs 11.6%, p < 0.001). <h3>Conclusion</h3> Brain death time was found to be no different when comparing patients from before and after the UNOS allocation change. Graft survival was improved in the post allocation change group however this group also had a higher rate of dialysis after transplant. Therefore, it is unlikely but still unclear if brain death time has a significant effect on cardiac transplant outcomes. Further study is needed to investigate causes of the differences in some outcomes between groups.

Risk factors for renal allograft survival with China novel donation category: Donation after brain death followed by cardiac arrest

IntroductionTo meet the need for transplantable organs, a new donation program was initiated by the Chinese government. This novel policy created three categories for deceased organ donations: donation after circulatory death cardiac death (DCD), donation after brain death (DBD), and donation after brain death followed by circulatory death (DBCD) meaning complete cardiac arrest. In fact, the DBCD method is a combination of both DBD and DCD methods. A DBCD donor meets the criteria of for brain death, but the organ procurement begins after the withdrawal of life support and the subsequent cardiac arrest death. The purpose of this study was to evaluate the long-term outcomes of kidney transplantation in our center with the DBCD policy. Potential risk factors for affecting the renal allograft survival were also analyzed based on our data. MethodA retrospective study, involving 421 kidney transplants derived from 214 donors, was conducted between December 2011 and October 2019. In particular, 373 (88.6%) transplanted organs met the criteria for DBCD, and 48 (11.4%) for DCD. The log-rank test was used to compare the difference in survival. The Cox regression analysis was used for risk factor screening. ResultAnalysis showed that the DBCD group was better than the DCD group in terms of overall (p = 0.031) as well as death-censored (p = 0.026) allograft survival using the log-rank test. A Cox regression analysis revealed that increasing donor age (p = 0.002, HR = 1.820/10 years incremental older), increasing recipient age (p = 0.028, HR = 1.521/10 years increment older), prolonged dialysis duration (p = 0.007, HR = 1.018), occurrence episodes of acute rejection (p = 0.016, HR = 2.697), delayed graft function (p = 0.012, HR = 2.962), mismatch ≥4 HLA loci (p = 0.038, HR = 3.606), and warm ischemia time > 15 min (p = 0.022, HR = 2.915), were all independent risk factors affecting the graft survival. ConclusionThe new DBCD policy of donation produced acceptable results similar or even better than the DCD practice. Based on our analysis, the graft survival of DBCD transplants may be better than DCD transplants. The main risk factors for allograft loss included an increasing donor age, recipient age, warm ischemia time > 15 min, prolonged dialysis duration, acute rejection, delayed graft function, and HLA mismatch ≥4 HLA loci.

Rapid Access in Donation After Circulatory Death (DCD): The Single-Center Experience With a Classic Pathway in Uncontrolled DCD Algorithm

In Poland, 95% of organs for transplantation come from donation after brain death (DBD). In 2010, Poland officially joined the European countries in which donation after circulatory death is accepted by law. Currently, the Pomeranian Medical University Transplant Center is the only active location for uncontrolled donation after circulatory death (uDCD) in Poland. To estimate the results of uDCD kidney transplantation with a classical approach to organ recovery, we analyzed data from an early phase of uDCD program. Prospective observation of uDCD kidney allografts (group 1; n=8) compared with DBD kidney allografts (group 2; n=30). The organ recovery protocol was set up on rapid abdominal access without regional perfusion before procurement. The organs recovered from uDCD during a 24-month period increased the volume of kidneys transplanted at the center by 9.2%. Delayed graft function was diagnosed in 100% vs 46% of allografts (P=.03), respectively. Nevertheless, early posttransplant follow-up did not reveal any graft loss or recipient death cases in the DCD group. After 12 months of follow-up, the mean glomerular filtration rate was 44.5 vs 57.9 mL/min (P < .02), respectively. Crucial factors for acceptable results of uDCD are strict pretransplant assessment of recovered organs and efficient coordination of the transplant team. Conservative recovery protocol in uDCD under strict prerequisites is feasible to consider in the organ procurement pathway. Preliminary results provide space for an increase in the organ donor pool.

Association of Donor Brain Death Due to Stroke With Prognosis After Heart Transplantation

BackgroundThe proximate cause of donor brain death is not considered a conventional risk factor in modern heart transplantation. ObjectivesThis study aimed to investigate the effect of the cause of donor brain death on recipients. MethodsUsing the United Network for Organ Sharing registry, long-term mortality and allograft failure were compared in recipients who underwent heart transplantation in the United States from 2005 through 2018 between allograft recipients from donors with stroke as the cause of brain death (n = 3,761) vs nonstroke causes (n = 14,677). Inverse probability weighting was used for risk adjustment. Interactions were investigated between the cause of brain death and other conventional donor risk factors for recipient mortality. ResultsThere was an interaction between the cause of brain death and donor age (Pinteraction = 0.008). When allografts were procured from donors aged 40 years or younger, stroke as the cause of brain death was associated with an increased risk of mortality (23% vs 19% at 5 years; HR: 1.17; 95% CI: 1.02-1.35) and allograft failure (HR: 1.30; 95% CI: 1.04-1.63). When donors were older than 40 years, the cause of brain death was not associated with outcomes. ConclusionsAs the cause of donor brain death, stroke had a substantially different effect on recipient and allograft survival depending on donor age. In the case of younger donor ages, stroke was associated with higher recipient mortality and allograft failure than other causes of brain death. The strength of this association decreased with increasing donor age such that the increased hazard was no longer present in donors older than approximately 40 years.

Histological evaluation of ischemic alterations in donors after cardiac death: A useful tool to predict post-transplant renal function.

Kidneys retrieved from donors after cardiac death (DCD) pose significant challenges from a clinical and technical point of view, undergoing a variable degree of ischemia-reperfusion injury. At present, the utilization of kidneys is assessed according to the Karpinski score, which does not take into account the ischemic insult and does not predict the functional recovery of the organ once transplanted. Therefore, the correlation between biopsy results and post-transplant graft function is still debated. In this study we examined kidney biopsies from DCD donors; we calculated the Karpinski score and subsequently identified and quantified the ischemic lesions in the glomerular, interstitial, and tubular compartments. These same lesions were quantified in kidney biopsies from donors after brain death (DBD) in a case-control analysis. The collected data were correlated with the clinical data of the donors and the post-transplant follow-up. Proximal tubule alterations are crucial in ischemia-reperfusion damage, showing precise histological alterations, which are more frequent in DCD than in DBD donors and are statistically correlated with functional recovery of the organ. Quantification of ischemic tubular lesions in biopsies of kidneys from DCD donors is a useful tool for predicting post-transplant renal function and a valid parameter for assessing the quality of the graft.

Organ donation after circulatory death as compared with organ donation after brain death in Switzerland - an observational study.

Organ donation after circulatory death (DCD) was reintroduced in Switzerland in 2011 and accounts for a third of deceased organ donors today. Controversy persists if DCD transplants are of similar quality to transplants following donation after brain death (DBD), mainly due to warm ischaemia time DCD organs are exposed to. We compared DCD with DBD in Switzerland. Data on deceased adults who were referred to and approved for organ donation from 1 September 2011 to 31 December 2019 were retrospectively analysed (217 DCD, 840 DBD donors). We compared DCD and DBD donor/organ characteristics, transplant rates of lungs, liver, kidneys, and pancreas, and early liver and kidney graft function in the recipient. The effect of DCD/DBD on transplant rates (organ transplanted or not) and 72-hour recipient graft function (moderate/good vs delayed graft function / organ loss) was analysed using multivariable logistic regression. Among utilised DCD donors, we analysed the effect of functional warm ischaemia time (FWIT) and donor age on 72-hour post-transplant liver and kidney graft function, also using multivariable logistic regression. DCD donors were more often male (64.5% vs 56.8% p = 0.039), presented with heart disease (36.4% vs 25.5%, p <0.001), were resuscitated before hospital admission (41.9% vs 30.7%, p = 0.006), and died from anoxia (41.9% vs 23.9%). Kidney function before transplantation was comparable, lung, liver and pancreas function were poorer in DCD than DBD. Eighty-one and 91% of approved DCD and DBD donors were utilised (p <0.001). Median FWIT in DCD was 29 minutes (interquartile range 25-35). DCD transplant rates ranged from 4% (pancreas) to 73% (left kidney) and were all lower compared with DBD. Seventy-two-hour liver graft function was comparable between DCD and DBD (94.2% vs 96.6% moderate/good, p = 0.199). DCD kidney transplants showed increased risk of delayed graft function or early organ loss (odds ratios 8.32 and 5.05; 95% confidence intervals CI 5.28-13.28 and 3.22-7.95; both p <0.001, for left and right kidney transplants, respectively). No negative effect of prolonged FWIT or higher donor age was detected. Despite less favourable donor/organ characteristics compared with donation after brain death, donation after circulatory death donors are increasingly referred and today provide an important source for scarce transplants in Switzerland. We identified a higher risk for delayed graft function or early organ loss for DCD kidney transplants, but not for DCD liver transplants. When carefully selected and allowed for other risk factors in organ allocation, prolonged functional warm ischaemia time or higher age in donation after circulatory death does not seem to be associated with impaired graft function early after transplantation.

Brain death hormone therapy and Graft survival: A systematic review of the literature

IntroductionDuring brain death, several events occur, including hormonal. metabolic and systemic changes. This systematic review aims to find the role of hormone therapy in cadaver donors and its impact on graft function and/or survival following solid organ transplantation. Method and materialsRandomized clinical trials were reviewed to investigate the effects of hormone therapy on graft survival amongst brain death cases. studies from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were identified and reviewed for this current work. Two reviewers independently rated the quality of the study. As a result, 18 studies met inclusion criteria and were included in this study. ResultsOver 2235 titles were retrieved from various search sources and 16 full papers were identified for possible inclusion. Trial sample sizes varied widely from 25 to 12,333 patients. Multiple therapy schemes were developed and applied for brain death donors. The first scheme simply involved applying Triiodothyronine, Dopamine, Immunosuppressive, Vasopressin and Desmopressin separately. The second scheme consisted of applying double hormone therapy using Methylprednisolone and Vasopressin simultaneously. Finally, triple hormone therapy was applied which included Methylprednisolone, Triiodothyronine and Arginine vasopressin. ConclusionsResults from this systematic study indicated no significant effects on overall organ survival in recipients who received brain death hormone therapy. Thus, the potential effects of hormone therapy in brain death scenarios are still unknown and need further investigation.

Living donor liver transplantation versus donation after brain death and donation after circulatory death liver transplantation in the US

While previous research has compared outcomes between living donor liver transplantation (LDLT) and deceased donor liver transplantation, evidence is lacking regarding how donation after circulatory death (DCD) vs donation after brain death (DBD) affects this comparison. Using data from the Scientific Registry of Transplant Recipients for adults listed for liver transplant from 2012 to 2018, we compared 5-year patient and graft survival, readmissions, posttransplant chronic kidney disease (CKD), and return to work for 25,151 patients who underwent LDLT (1223 [4.9%]), DCD-LT (1431 [6.4%]), and DBD-LT (22,497 [89.4%]). LDLT recipients were significantly more likely to have a Model for End-Stage Liver Disease (MELD) score < 15 and to be working prior to transplant (P < 0.001 for both). At 5 years posttransplant, LDLT recipients had significantly more readmissions, but significantly less CKD and better survival than DBD-LT and DCD-LT recipients, as well as significantly better graft survival than DCD-LT recipients (P ≤ 0.01 for all). Significantly more LDLT recipients also returned to work for income (P < 0.01). This study shows a clear advantage of LDLT vs DCD-LT. This information should be weighed in transplantation decisions for patients such as those with low MELD scores who will realistically only be considered for DCD-LT.

Over 30 Years of Pediatric Liver Transplantation at the Charité-Universitätsmedizin Berlin.

Background: Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center. Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité – Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991–2004, 2005–2014 and 2015–2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board. Results: Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12% (n = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days. Conclusion: The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.

Selection Criteria Optimal for Recovery of Inner Ear Tissues From Deceased Organ Donors.

To identify optimal conditions for recovering viable inner ear tissues from deceased organ donors. Tertiary recovery hospitals and Donor Network West Organ Recovery Center. Recovering bilateral inner ear tissues and immunohistological analysis. Immunohistochemical analysis of utricles from human organ donors after brain death (DBD) or donors after cardiac death (DCD). Vestibular tissues from 21 organ donors (39 ears) were recovered. Of these, 18 donors (33 utricles) were examined by immunofluorescence. The sensory epithelium was present in seven utricles (two from DBD and five from DCD). Relative to DBD utricles, DCD organs more commonly displayed dense populations of hair cells and supporting cells. Relative to DBD, DCD had significantly shorter postmortem interval time to tissue recovery (<48 h). Compared to donors with no sensory epithelium, donors with intact and viable sensory epithelium (both DCD and DBD) had significantly shorter lag time to resuscitation prior to hospital admission (6.4 ± 9.2 vs 35.6 ± 23.7 min, respectively) as well as a shorter time between pronouncements of death to organ recovery (22.6 ± 30.4 vs 64.8 ± 22.8 h, respectively). Organ donors are a novel resource for bilateral inner ear organs. Selecting tissue donors within defined parameters can optimize the quality of recovered inner ear tissues, thereby facilitating future research investigating sensory and nonsensory cells.

POS-800 OUTCOMES OF DECEASED DONOR KIDNEY TRANSPLANTATION AT CHO RAY HOSPITAL, VIETNAM

Cho Ray Hospital (CRH) started the kidney transplantation from deceased donor program with donor after brain death (DBD) in 2008, and with donor after circulatory death (DCD) in 2015. The aim of the study was to evaluate the outcomes of the deceased donor program of Cho ray Hospital, Ho Chi Minh City (HCMC), over 12 years. Case series study, both DBD and DCD kidney transplantation at CRH from 2008 to 2020. Of 30 donors, we had 25 DBD, 5 DCD, 24 males. Median age of donors was 39 Yo. 5 donors were extended criteria donor (ECD). 15 donors had Kidney Donor Profile Index < 80%. Causes of donor death included 5 strokes, 25 head traumas. 7 kidneys from 4 DBD were procured outside HCMC, the longest distance was 1712 km. We proceeded 55 kidney transplants (46 pts from DBD and 9 pts from DCD). 4 DBD recipients (DBDR) had second kidney transplant, 1 DCD recipient (DCDR) had dual kidney transplant from an ECD. Median waiting time were 45 months for DCDRs and 39 months for DBDRs (p=0.005). Median HLA mismatches was 4 antigens. Mean cold ischemic time of DCDRs was higher than that of DBDRs (no statistic significant). DCDRs had higher rate of delayed graft function (DGF) than that of DBDRs (77.9% vs 19.5%). Surgical complications were 4 hematomas, 2 ureteral stenosis, 1 symptomatic lymphocele, 1 renal artery thrombosis. Both DCD and DBD recipients had similar graft function at discharge time. Our deceased donor transplant had graft survival of 98.2%, and 84.7% at 1 year, and 5 years and patient survival of 92.7% and 89.5% at 1 year, and 5 years. Acute rejection in the first year and later were 6/55 cases (10.9%) and 5/55 cases (9.1%), respectively. DCDRs had lower graft and patient survival than DBDRs. 5 pts died with graft functioning. The most common infections occurred post-transplant were cytomegalovirus (CMV) infection (19 pts), and polyoma (BK) virus infection (8 pts). Median onset time of CMV and BK infection was 5 months, and 16 months, respectively. Tabled 1AllDCDDBDPNumber of recipients (n)55946Age at kidney Tx (median)3744360.461Male (n)398310.188WIT (min)(median)1213.550.001SWIT (min) (median)3837380.617CIT (h)(median)7.7115.20.065DGF (n)16880.000PNF (n)110Length of stays (days) (median)1227100.095Serum creatinine at discharge (mg%) (median)1.31.71.30.807Induction therapy (n)• Â · IL-2inhibitor397320.836• Â · Leukocyte depletion14212Maintenance immunosuppressive therapy (n)• Â · Tac+MMF/MPA+Pred498410.983• Â · Cyc+MMF/MPA+Pred615Biopsy-proven AR (n)7160.874• Â · ACR5050.300• Â · AMR2110.190Non-biopsy proven AR4130.628Graft survival• Â · At 1-year98.2%88.9%100%0.086• Â · At 5-year84.7%71.1%87.8%Pts survival• Â · At 1-year92.7%66.7%97.8%0.002• Â · At 5-year89.5%66.7%94.2%Death with graft functioning (n)5230.210Death total (n)9360.132Causes of death (n)• Â · Sudden cardiacdeath1010.150• Â · Aortic aneurysmrupture101• Â · Sepsis due tobacteria523• Â · PCP110• Â · SARS-COVI-2101Infection post-transplant (n)• Â · CMV196130.027• Â · BK virus8350.080• Â · PCP6240.234• Â · Pulmonary TB5230.134 Open table in a new tab Deceased donor kidney transplantation at CRH showed feasible outcomes and has increased the chance of kidney transplantation to patients on waiting list.

Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the European Liver Transplant Registry

Knowledge of living donor liver transplantation (LDLT) for autoimmune liver diseases (AILDs) is scarce. This study analyzed survival in LDLT recipients registered in the European Liver Transplant Registry with autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC) and the non-autoimmune disorder alcohol-related cirrhosis. In total, 29902 individuals enrolled between 1998 and 2017 were analyzed, including 1003 with LDLT. Survival from >90days after LDLT for AILDs in adults was 85.5%, 74.2%, and 58.0% after 5, 10, and 15years. Adjusted for recipient age, sex, and liver transplantation era, adult PSC patients receiving LDLT showed increased mortality compared to donation after brain death (DBD) (hazard ratio [HR]=1.95, 95% confidence interval [CI]=1.36-2.80, p<.001). Pediatric PSC patients showed also increased mortality >90days after LDLT compared to DBD (HR=3.00, 95% CI 1.04-8.70, p=.043). Multivariate analysis identified several risk factors for death in adult PSC patients receiving LDLT including a male donor (HR=2.49, p=.025). Adult PSC patients with LDLT versus DBD conferred increased mortality from disease recurrence (subdistribution hazard ratio [subHR]=5.36, p=.001) and biliary complications (subHR=4.40, p=.006) in multivariate analysis. While long-term outcome following LDLT for AILD is generally favorable, PSC patients with LDLT compared to DBD might be at increased risk of death.

Ex Vivo Donor Heart Perfusion using the TransMedics Organ Care System in Orthotopic Heart Transplant

To accommodate the growing demand for heart transplantation, there has recently been renewed interest in the use of ex vivo perfusion technology, which may expand the donor pool in two ways: donation after brain death (DBD) and donation after circulatory death (DCD). The TransMedics Organ Care System (TransMedics, Andover, MA) is the first commercially available, portable system that allows the beating donor heart to be maintained under near-physiologic, warm blood circulation (34°C) immediately after organ explant from a deceased donor. Here, these two uses of the TransMedics Organ Care System (DCD and DBD) are discussed.

A1101 - Perioperative and functional outcomes after kidney transplantation from uncontrolled donors after circulatory death vs. expanded-criteria donors after brain death vs. standard-criteria donors: Toward an evidence-based refinement of allocation strategies

A1101 - Perioperative and functional outcomes after kidney transplantation from uncontrolled donors after circulatory death vs. expanded-criteria donors after brain death vs. standard-criteria donors: Toward an evidence-based refinement of allocation strategies

Use of DCD organs: Expanding the donor pool to increase pediatric transplantation.

The number of children being listed for transplant continues to be greater than the number of available organs. In fact, over the past decade, rates of liver and kidney transplants in pediatric transplantation are essentially unchanged (Am J Transplant. 2020;20:193 and Am J Transplant. 2020;20:20). The use of DCD donors offers a potential solution to organ scarcity; however, the use of DCD organs in pediatric transplantation remains a rare event. Pediatric transplants done using carefully chosen DCD donor organs have shown to have outcomes similar to those seen with the use of donation after brain death (DBD) donors. Herein, we review the literature to examine the utilization of DCD livers and kidneys, outcomes of these allografts, and assess if DCD organs are a viable method to increase organ availability in pediatric transplantation.

Blocking protease-activated receptor 4 alleviates liver injury induced by brain death

Brain death (BD) induces a systemic inflammatory response that influences donor liver quality. Protease-activated receptor 4 (PAR4) is a thrombin receptor that mediates platelet activation and is involved in inflammatory and apoptotic processes. Therefore, we investigated the role of PAR4 blockade in liver injury induced by BD and its associated mechanisms. In this study, we constructed a BD rat model and treated rats with TcY-NH2, a selective PAR4 antagonist, to block PAR4 signaling at the onset of BD induction. Our results revealed that PAR4 protein expression increased in the livers of rats with BD. PAR4 blockade alleviated liver injury induced by BD, as indicated by lower serum ALT/AST levels and an improvement in histomorphology. Blood platelet activation and hepatic platelet accumulation in BD rats were reduced by PAR4 blockade. Additionally, PAR4 blockade attenuated the inflammatory response and apoptosis in the livers of BD rats. Moreover, the activation of NF-κB and MAPK pathways induced by BD was inhibited by PAR4 blockade. Thus, our results suggest that PAR4 contributes to liver injury induced by BD by regulating inflammation and apoptosis through the NF-κB and MAPK pathways. Thus, PAR4 blockade may provide a feasible approach to improve the quality of organs from BD donors.