Donor Maintenance Research Articles

Organ Donation Process for Transplantation: A Scoping Review

Objectives: To identify studies in the literature that address the strategies used in the organ donation process. Method: Scoping review based on the Joanna Briggs Institute ( JBI) methodology, in the databases Medical Literature and Retrieval System Online (MEDLINE), Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), and Embase via the Virtual Health Library (VHL), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, carried out from August to December 2023. Results:"irty-three studies were eligible, which showed that the donation process must happen systematically, following the steps: 1) identi#cation of patients suspected of having brain death (BD); 2) opening the protocol and notifying organizations; 3) con#rmation of the diagnosis of BD; 4) communicating the death to the family; 5) conducting the interview; 6) consent to donation; 7) donor maintenance; 8) procurement and allocation of organs; 9) transplant; and 10) follow-up. Conclusion: Donation requires a multifaceted approach, including awareness, investment, evaluation and research.

Improvement Gaps to Deal with the Shortage of Lungs for Transplant From a Middle Income Country's Perspective.

Our study aimed to identify the potential causes for the low lung procurement rate in Argentina and to develop strategies to the actual problems in donor management focused on lung retrieval. We performed a crosssectional study in which we analyzed data obtained from digital self-reported surveys conducted on professionals participating in the organ procurement process in Argentina. The surveys included questions on donor management, selection criteria, and resource availability involving increasing lung procurement. Among professionals surveyed, 23.7% did not use advanced hemodynamic monitoring in their donor maintenance and limited their use to central venous pressure. Only 35.8% of participants considered maintaining central venous pressure <10 mm Hg during donor maintenance. With regard to donors with severe deterioration of the ejection fraction, 47.4% of participants would not use restrictive fluid, and only 23.2% would use an advanced monitoring of the hemodynamic status to guide fluid management. Only 27.8% of participants routinely would use steroids to improve lung function in donors. With regard to mechanical ventilation, 80.4% of participants used protective ventilation, but only 4.10% used it adequately. Recruitment maneuvers were routinely used by only 3.1% of those surveyed. With regard to expanded selection criteria (age >55 years, smoking habit of >20 packs/year, positive upper airway cultures, unspecific infiltrates in radiography, and >72 hours of mechanical ventilation), 92.8% of surveyed participants would discount patients with some of these expanded selection criteria without considering offering the lungs for donation. Opportunities for improvement may involve training physicians involved in the donor maintenance process and reviewing the donor selection criteria used to increase adherence to expanded selection criteria.

Basic situation and trend analysis in heart transplantation research funded by the National Natural Science Foundation of China.

This study analyzes heart transplantation funding provided by the National Natural Science Foundation of China (NSFC) between 1986 and 2022. The findings offer an objective and scientific reference for heart transplantation research. CiteSpace visualization was used to present keywords in heart transplantation research. From 1986 to 2022, the NFSC disbursed ¥117.68 million to fund 259 projects related to heart transplantation. Hubei, Shanghai, Beijing, Guangdong, and Heilongjiang received the most funding. General and youth science fund projects accounted for 58.69% and 30.50%, respectively. The main discipline category was organ transplantation and transplantation immunity, accounting for 40.93%. Research hotspots included "immune tolerance," "rejection reaction," "t cell" "dendritic cell," "stem cell," and "transplantation tolerance." Research foci were "rejection reaction," "heart failure," "immune tolerance," "heart transplantation," "stem cell," "suppressor cell," "dendritic cell," "dilated cardiomyopathy," and "t cell." In the past 5years, the research frontier has targeted "transplantation tolerance," "ischemia-reperfusion injury," and "heart transplantation." Continuous NSFC funding for heart transplantation research has promoted the development of disciplines and cultivation of talent. Novel technologies (e.g., artificial hearts and donor maintenance) have generated new requirements for heart transplantation research.

ASSISTÊNCIA AO POTENCIAL DOADOR DE ÓRGÃOS EM MORTE ENCEFÁLICA EM PRONTO-SOCORRO ADULTO: PERSPECTIVA CONVERGENTE-ASSISTENCIAL

ABSTRACT Objective: to investigate situations that interfere with health professionals’ performance, in the identification and maintenance of potential brain-dead donors in an Adult Emergency Care Unit, and to indicate actions, from the health team’s perception, that can promote care for these patients. Method: this is a qualitative, convergent care research, carried out with health professionals from an adult emergency unit, a large public teaching hospital located in southern Brazil. Data were collected between February 2020 and January 2021 through structured participant observation, semi-structured interview and convergence group. Data analysis was performed according to the stages of gathering, synthesis, theorization and transfer. Results: based on data analysis, the difficulties in caring for brain-dead persons, lack of information, inadequate structure and difficulties in the work process were identified as situations that interfere with health professionals’ performance in relation to brain-dead potential donors. Actions were signaled to promote care for these people through continuing education activities on the subject, dissemination of information, construction of technologies/protocols, organization of infrastructure and the work process with support for professionals who assist these people. Conclusion: it was evidenced that professional education, the organization of the donation process and systematized actions to improve the work are fundamental factors for the effective care for brain-dead potential organ donors.

“Kidney First” Retrieval: A Viable Concept for Emerging Transplant Centers

To increase deceased donation in an organ-depleted country like India, improved understanding of the mechanisms influencing donor yield is important. Certain technical and emotional modifications in approach and methods can help in increasing donations. “Kidney first” retrieval in situations such as delay in heart/liver team’s arrival, diagnostic dilemma for quality of organ, or single surgeon for both kidney transplants can prove useful in optimizing donor maintenance quality and cost and minimizing cold ischemia time of the other kidney, without altering the structural viability of other organs. Early handover of the deceased body for cremation adds a positive perspective to the grieving family’s decision for consent. This approach can be safely suggested for emerging transplant centers yearning to increase their scope of organ transplantation amidst the constraints of time, expertise, logistics, and infrastructure.

PELATIHAN PENGGUNAAN APLIKASI PENGGALANGAN DANA SECARA ONLINE PADA YAYASAN ASSALAFIYAH SURABAYA

Assalafiyah Foundation Surabaya is an orphanage foundation for orphans and the poor in Rungkut District, Surabaya City. Around 60% of the orphans fostered by this foundation come from outside Surabaya, so the payment of school fees is not from BOS funds. Therefore, the Assalafiyah foundation must find large enough funds to finance the schooling of these less fortunate children. In meeting school needs and other expenses, the foundation only receives regular monthly donors from the local community and not many non-permanent donors. With these limited funds, the Assalafiyah foundation must obtain funds from the wider community. Because the PkM implementing lecturer made a fundraising application for the Assalafiyah foundation. The problem is that the foundation does not yet know how to use the fundraising application, so the PkM implementing lecturers conduct training on the use of fundraising applications at the Assalafiyah foundation. The training materials include: maintenance of foundation activities, maintenance of donors, maintenance of foundation account data, maintenance of foster children's data, confirmation of donors, and donor history. Evaluation of the training by distributing questionnaires to 14 respondents from the Assalafiyah foundation. After being processed and analyzed, the results showed that the overall application was good.

Brain death and organ and tissue donor management in the Intensive Care Unit

Introduction: brain death is defined as the irreversible cessation of all brain and brainstem functions. The timely management and maintenance of these vital functions and correction of the physiopathological alterations of the potential donor make organ donation possible, providing a second chance to patients who depend on a transplant. Aim: to describe the concept of encephalic death in the patient and its current management as a potential organ and tissue donor in the intensive care unit. Methodology: a non-experimental, descriptive, literature review study was carried out.Results: the process of organ and tissue donation after encephalic death is a challenge in terms of diagnosis and subsequent hemodynamic management with the aim of maintaining tissue perfusion so that these have vitality and viability to be transplanted to the recipient patient.Conclusions: it is recommended to use an established brain death protocol and apply it correctly, to avoid legal problems. Once the diagnosis has been made, it is possible to carry out the evaluation to establish whether the patient is a donor candidate or not. The pathophysiological changes that appear in the process of BD make these critical patients to be managed with extreme care. Donor maintenance is a major challenge for all health personnel in the intensive care area, since its treatment is extremely complex and the availability of donors is limited compared to the high demand of recipient patients waiting for an organ

Medical Students Perception about the Donation and Transplantation of Organs and Tissues

Objective: To evaluate medical students’ perception about organ and tissue donation and transplantation. Methods: This is a cross-sectional study, with quantitative analysis, which evaluated students from the 1st to the 12th semester of the Bahia Medical School of the Bahia Federal University (FMB/UFBA), grouped by year of graduation (1st to 6th year), through a questionnaire. Data were statistically analyzed using R for Windows, considering significant values of p ≤ 0.05. Results: Of the 393 participants, 207 (52.7%) were female, 250 (63.3%) were between 21 to 25 years old, 144 (36.6%) had no religion, and 80 (20.3%) were boarding students. Of all the interviewees, 159 (40.5%) self-assessed their knowledge as regular and 153 (38.8%) as bad and terrible. About the exposure to the subject, 222 (56.6%) had never attended a class and, among those who had, 187 (60.1%) evaluated the information as insufficient. A total of 324 students (82.4%) would have the intention of being a post-mortem donor and 42 (61.6%) would accept to participate in a living donor transplantation, although 245 (62.3%) said they did not know the risks. Among the students, 327 (83.2%) said they knew the concept of brain death, 119 (30.3%) the legal terms of donation, and 105 (26.7%) the donor maintenance measures. However, 72 (18.3%) said they had a good knowledge of how to diagnose brain death. A total of 275 (70%) got right what is needed to declare a donor. There were 359 answers that would exclude alcoholics, smokers and users of illicit drugs from the transplant list, and 363 (92.7%) considered that the severity of the problem is the most appropriate criterion for priority on the waiting list. Conclusion: Students perceive their level of knowledge as unsatisfactory and understanding about specific issues is still low. No significant influence of sociodemographic aspects was observed regarding the desire to be a donor.

Competences of the Nurse Member of the Intrahospital Commission for Organ and Tissue Donation for Transplantation

Abstract:Introduction: Among the members that compose the Brazilian Intrahospital Commission for Organ and Tissue Donation for Transplantation (Cihdott), the nurse is the professional who has the greatest contact with potential donors and their families because of the care provided to patients in intensive care units, thus becoming a reference for the family. The nurse’s performance as a member of Cihdott has been recognized and related to the success of organ donation. Objective: To identify the competences of the nurse member of Cihdott. Methods: Descriptive study, with a qualitative approach. Nurses who had been members of Cihdott for at least six months and agreed to participate in the research were included, selected by means of the snowball technique. Semistructured interviews were conducted, and data analysis was done by thematic grouping, using Minayo’s referential. Results: Ten nurses, aged between 32 and 50 years and working at a Cihdott for 4 to 11 years, participated in the study. From the data analysis, four categories emerged: “The role of the nurse from the beginning to the end of the donation process”; “Competences and attributions of the Cihdott nurse”; “Personal qualities that influence the professional ambit”; and “Limiting factors for the nurse’s performance.” Final considerations: The nurse member of the Cihdott acts in several activities in the donation and transplantation process, among them: active search, family interview, donor maintenance, follow-up of the organ and tissue removal and transplantation process, organ packaging for transplantation, body reconstitution follow-up, and body return to the donor family, and training with the teams. Besides this, administrative and bureaucratic attributions are part of the Cihdott nurse’s routine.

243.9: Equality and Equity in Transplant for Children

Introduction: Thomas E. Starzl, conducted the first paediatric liver transplant in 1963, a routine successful clinical procedure today due to his pioneering efforts. India the second most populous country, 41% under 18 yrs of age, has followed on the heels of developed nations with 1522 pediatric transplants from 2013-2020 for all organs but majority done in private sector. To enable equality and equity, Govt of India has proposed establishing department of transplant medicine in major government hospitals, at least one in each state in the latest National Organ Transplant Program Guidelines. Our aim is to develop an SOP for the establishment of paediatric transplant units in line with the Transplantation of Human Organs and Tissues Rules 2014, starting with VMMC & SJH. Materials & Methods: In 2019, India reported 4,49,002 Road traffic accidents(RTA) with resultant 1,51,113 deaths. Delhi accounted for 5610 RTA with 1463 deaths.DD transplants prove to be exceptionally useful in diseases with high risk of recurrence particularly in children. VMMC & SJH is one of the largest govt tertiary care centres in Delhi catering to a large paediatric population and a large proportion of the RTA victims, the greatest source of deceased donor (DD) organs, if tapped. Living Donor Renal transplant is conducted in adult patients on a regular basis by urologists. A paediatric nephrologist being available, the paediatric renal transplant program can be started by a combined team of paediatric surgeons & urologists. Training in paediatric liver transplants can be done either locally in ILBS, Delhi or internationally through TTS-ILTS paired centers program similar to JIPMER, Pondicherry with St.James University hospital Leeds, UK. TTS in collaboration with NOTTO conducted an online survey of intensivists with regard to brain death declaration. The intensivists need to be trained for brain death declaration and donor maintenance to enable DD transplants. Augmentation of pediatric transplant intensive care beds and personnel is required along with round the clock lab facilities. Results: The Govts of Delhi, Tamilnadu, Kerala, Maharashtra, etc have issued have issued GOs for mandatory declaration of brain death in all patients who fulfill the criteria. DGHS has sought monthly submission of brain death data. Intensivist training for brain death declaration and donor maintenance was first started by NOTTO during the CAST 2019 congress and two more have followed. However, progress can only be achieved with implementation of training and establishment of dedicated centers.

400.9: The First Independent Provincial OPO in China: Shanxi Experience

Introduction: While the reform of organ transplantation in China has achieved success, the organ procurement model for different regions in the country varies. Starting from a hospital-based organ procurement organization (OPO), Shanxi OPO was established as the first independent non-profit provincial OPO in China, which covers a donation area of 37.29 million population and serves 6 transplant hospitals in the region. Shanxi OPO was established in 2018 under the supervision of Shanxi provincial health commission. This study compares results before and after the establishment in regard to the quantity, quality and efficiency of organ donation and transplantation (OD & OT) within Shanxi Province, aiming at exploring a feasible and up-to-date procurement management mode in China. Method: From the point of organizational structure, personnel composition, equipment management and core quality indicators, we analyze the data from 2015 to 2021 and compare the results before and after the establishment of the provincial OPO. Results: In the past two years, a professional team with 7 departments has been built. Besides, advanced facilities like those for donor maintenance and information collection are equipped. Then in 2020, an ethics and scientific committee have been founded to guide scientific research and supervise ethical norm compliance. Through analyzing the quality control indicators, the number of OD has increased from 35 cases (PMP: 0.99) in 2015 to 126 cases (PMP: 3.61) in 2021, with an increase rate of 260%. The growth trend remains within Shanxi Province even under the influence of COVID-19 pandemic in 2020, while the case number of the country decreased. Since 2018, the number of organs procured from per donor and the organ utilization rate of Shanxi OPO have risen year by year, reaching 3.02 and 98.7% respectively in 2021. Moreover, the DBD rate has increased from 1.1% in 2019 to 20.63% in 2021, though there is still a gap compared to the national and international level. These positive changes indicate that the quality of our service in organ viability assessment, donor maintenance, organ recovery and coordination have been gradually improved. Conclusion: Efficiency and quality of the organ procurement and allocation have been greatly improved in the past few years because of the establishment of Shanxi OPO. This kind of provincial OPO also provides a solution, which will lead a clear direction for the standardization of organ procurement in China.

P5.01: Belt &amp; Road Organ Donation Capacity Improvement Cooperation Training Project (BROAOD)

Background: The lack of awareness and knowledge about organ donation (OD) and transplantation (OT) among health professionals is one of the main reasons contributing to donor shortage. Seeing the need to improve the donation activities in China and Belt and Road countries, China Organ Transplantation Development Foundation and Donation (COTDF) and Transplantation Institute (DTI) Foundation jointly initiated the Belt and Road Organ Donation Capacity Improvement Cooperation Training Project to provide intensive training in OD and OT to health professionals from these regions. Methods: The program used an interactive and dynamic online modality consisting of round table discussion, presentation of clinical cases, gaming, and workgroup interaction. The bilingual training (Chinese and English) adopted the best practices in OT and OD and was delivered by international experts. A questionnaire to evaluate changes in perception, confidence, and capability towards essential components of organ donation was administered pre-and post-course. Results: Three editions of the 3-day course were conducted in May, August, and December of 2021. A total of 182 participants were trained, of which 23% (n=42) were international participants from the B & R countries. The participants consist of majority intensive care doctors and other health professionals involved in OT and OD such as donor coordinators, emergency physicians, and nephrologists from more than 60 different hospitals. Seventy-four matched pairs of responses from the pre-and post-course survey were available for analysis. Whilst 16% of the participants showed positive change in their perception towards organ donation, majority (77%) expressed that their perception remained unchanged. Increased confidence was observed among the participants in effective donor maintenance (19/74; 26%), communication with coordinator (17/74; 23%), initial family communication (16/74; 22%). There was 24% (18/74) showed decreased confidence in detection of potential donor. Large proportion (55 – 78%) of the participants stated no changes of confidence in these areas. Nearly all the participants showed above average improvement of capability in various processes of organ donation. Conclusion: This program improved the capability of the participants to perform donation activities. Continuous and in-depth training with more simulations is needed to further enhance confidence of the health care professionals especially in donor detection. The course served as a platform for the participants to exchange opinions and differences in practices with international experts. This international cooperation initiative promoted by the COTDF and DTI Foundation is an excellent example of leading international engagement and supporting the global community to reach self-sufficiency in OD and OT.

The expectations of voluntary blood donors and the motivation for continued blood donation action

Introduction: Investing in maintaining the trust of blood donors, the safety of blood and blood products and the effectiveness of health professionals is vital because it can enhance the attraction of donors. Purpose: The main purpose of this research is to highlight the most prevalent motivational factors of blood donation. Methodology: A mixed research project was conducted after quantitative and qualitative methodologies were used in the blood donation unit of the hospital with a sample of 416 blood donors, volunteers and nonvolunteers. Research questionnaires were formulated for the year 2020.The data was collected in the form of a specially designed questionnaire. The statistical analysis was performed with the software program Statistical Package for Social Sciences (IBMSPSS), version 22.0. Results: In a percentage of 70.7%, the majority of blood donors were men, aged 36-50 years old. The evaluation of the study results showed that the blood donors were volunteers in a percentage of 82.95%, while the remaining percentage of 17.1% were urged to donate blood, due to a need of a relative. Conclusions: The findings of the study show the need for substantial interventions, application of better techniques and approach methods as well as maintenance of blood donors. The urge of people to donate blood constitutes a procedure of great importance which requires constant efforts. The sufficiency of blood is ensured only with constant, systematic blood donors.

Attitudes Toward and Knowledge of Brain Death and Deceased Organ Donation Among Anesthesiologists in the Northeastern Region of Poland

Because in Poland transplant of organs from deceased donors is the predominant form of transplant, anesthesiology and intensive care specialists play a key role in the process. Insight into the work organization in intensive care units, anesthesiologists' and intensivists' level of knowledge and expertise, as well as personal opinions regarding declaring brain death and critical care of potential donors may be helpful in increasing transplant rates. The objective of this survey was to identify factors and challenges influencing donation rates in intensive care units of hospitals of various reference levels in region. An anonymous, 31-question survey was sent to anesthesiology and intensive care specialists working in hospitals in one of the regions of eastern Poland. The survey was completed by 133 physicians, and a quantitative analysis was conducted on the data collected from submitted answers. The average age of responders was 46 years (±10.24 years). Anesthesiology and intensive care specialists made up 80.45% of respondents. A vast majority of respondents (97%) expressed positive attitude toward transplant and are willing to donate their organs after death (92.19%). Meanwhile, more than 50% of them admit their lack of sufficient knowledge when it comes to declaring brain death. More than 53% of surveyed physicians have never had the opportunity to participate in training in methodology in performing brain death provided by their hospital or know about such training taking place. A vast majority of respondents (94.76%) see the need for workshops in potential organ donor care and brain death determination and would like to attend them. This study shows a positive outlook toward organ donation and transplant but at the same time reveals a lack of knowledge and expertise among doctors working in intensive care units. That is why implementing education tools for identification, declaration, and maintenance of brain-dead donors could be one of the keys to enhancing donation.

Hospital Characteristics and Nursing Attitude toward Organ Donation

Background: In our organ procurement unit, based on empirical evidence, the chance of turning a potential donor into an actual one is less than 30 percent and nursing plays a crucial role in this regard. Aim: We aimed to clarify nursing viewpoints and probe limitations that affect the organ donation process. Methods: In this cross-sectional study, a self-constructed 28-item questionnaire including information regarding hospital characteristics, nursing attitudes, and level of knowledge was prepared. Our study population was all nurses who consented to fill in the questionnaire using the Quota sampling method. After content validity, the questionnaire was circulated in cyberspace and the nursing society was invited to complete it. After one month, the response rate was 46 percent and the completed forms were analyzed. Results: The majority of participants had not attended any organ donation training program (67%). Also, only 30% of nurses were aware of their crucial role in the donation process. In total, 61.7% of the participants had a high level of knowledge regarding brain death definition and donor maintenance. A positive attitude was observed in 59.1% of nurses with a significant difference in the high record of services (p=0.04). It was also, significantly higher in whom with the experience of working in private hospital (64% vs. 54%, p=0.05); hospitals with neurosurgery-ward (67.7% vs. 54.7%, p=0.01), transplant ward (67.4% vs. 54.9%, p=0.03). Attending training programs had a considerable impact (67.7% vs. 50.8%, p=0.03) but, being in ICU didn't affect nursing attitudes. Conclusion: Hospital characteristics affect the nursing attitude toward organ donation and transplantation. It is recommended that all health staff obtain appropriate working experience in transplantation wards of the hospitals.

Experimental study to assess the impact of vasopressors administered during maintenance of the brain-dead donation in the quality of the intestinal graft.

The hemodynamic maintenance of brain-dead donors will influence the quality of the organs procured for transplantation, including the intestine. Although norepinephrine (NE) and dopamine (DA) are commonly used to sustain mean arterial pressure in humans, there are no standardized protocols for their use during maintenance of brain-dead donors. Our aim was to compare the effects of each drug, in the intestinal graft quality using a rat brain-dead donation model. Wistar rats (N = 17) underwent brain death (BD) for 2 hours with NE (NE group) or with DA (DA group) administration; the control group was mechanically ventilated for 2 hours without BD. Jejunum biopsies were obtained at the end of the maintenance period. Histological damage was evaluated using Park-Chiu scale. Villi/crypt ratio, mucosal thickness, Goblet cell count, and villi density were evaluated using ImageJ software (US National Institutes of Health, Bethesda, MD). Barrier damage was assessed by bacterial translocation culture counting on liver samples. The inflammatory status of the intestine was evaluated by CD3+ counting by immunohistochemistry and gene expression analysis of interleukin (IL)-6, IL-22, and CXCL10. Norepinephrine-treated donors had higher focal ischemic injury in the intestinal mucosa without a substantial modification of morphometrical parameters compared with DA-treated donors. CD3+ mucosal infiltration was greater in intestines procured from brain-dead donors, being highest in NE (p ˂ 0.001). Local inflammatory mediators were affected in BD: DA and NE groups showed a trend to lower expression of IL-22, whereas CXCL10 expression was higher in NE versus control group. Brain death promoted intestinal bacterial translocation, but the use of NE resulted in the highest bacterial counting in the liver (p ˂ 0.01). Our results favor the use of DA instead of NE as main vasoactive drug to manage BD-associated hemodynamic instability. Dopamine may contribute to improve the quality of the intestinal graft, by better preserving barrier function and lowering immune cell infiltration.

Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study.

This retrospective multicenter (n=18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower-bound-95%CI OR upper-bound-95%CI ) were male gender (1.066 1.2491.463 ), diabetic kidney disease (1.053 1.2961.595 ), time on dialysis (1.005 1.0071.009 ), retransplantation (1.035 1.3971.885 ), preformed anti-HLA antibodies (1.011 1.3831.892 ), HLA mismatches (1.006 1.0661.130 ), donor age (1.011 1.0171.023 ), donor final serum creatinine (sCr) (1.239 1.3171.399 ), cold ischemia time (CIT) (1.031 1.0431.056 ), machine perfusion (0.401 0.5420.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) (0.658 0.8000.973 ). Duration of DGF>4days was associated with inferior renal function and DGF>14days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.

Development and prospect of clinical research on lung transplantation in post-COVID-19 era.

Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation. (English) [ABSTRACT FROM AUTHOR] 肺移植技术在全球经历了近半个世纪的发展，在中国也高速发展了二十余年，中国肺移植逐渐融 入国际肺移植大家庭。2020 年新型冠状病毒肺炎（新冠肺炎）疫情暴发，既是对中国肺移植发展的挑战，也使 得全球同行关注中国肺移植发展，加速了国际间的交流与合作。随着对新冠肺炎重症患者肺移植的临床和基础 研究逐步深入，移植科医师对于未来中国肺移植在供者的维护、高龄和儿童受者的选择、围手术期管理等方面 有了更多的认知和思考。对于肺移植相关学科交叉领域的研究，需要开展设计优良、多方协作的临床试验，不 断推进学科理论和实践的创新。 (Chinese) [ABSTRACT FROM AUTHOR] Copyright of Organ Transplantation / Qi Guan Yi Zhi is the property of Organ Transplantation Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

P168112-MONTH SURVEILLANCE BIOPSIES IN RENAL TRANSPLANT PATIENTS AT LOW IMMUNOLOGICAL RISK. ARE THEY STILL WORTH OF BEING DONE?

Abstract Background and Aims In renal transplant field, the progressive increase both of donor and recipient age has led further challenges in patient management. In this setting, the personalization of immunosuppressive therapies (IT) has been strongly suggested. We have investigated renal histology at 12 months after transplantation to assess whether surveillance biopsies (SB) could be considered an additional tool to further improve management of immunosuppression. Method Monocentric retrospective analysis of SB performed 12 months post-transplant (Tx) between 2009-2018. For each SB were collected recipient and donor demographic data, HLA mismatch, induction and maintenance IT, DGF, cold ischemia time, PRA, DSA and nDSA, previous episodes of acute rejection (AR), serum creatinine (Cr) at the time of SB and 1, 3 and 5 years later, histological score according to Banff classification in force at the time of SB. Statistics included comparison between groups and Cox regression. Results We analyzed 209 SB in as many pts, most of them at low immunological risk (first Tx in 94.3%, PRA &amp;lt;30% in 88%, DSA at time of Tx in 5.4%). All pts received induction therapy; maintenance IT included calcineurine inhibitors in 97%, mycophenolate mofetil in 49%, mTOR inhibitors in 30%, azathioprine in 10% and corticosteroids in 33%. SB showed normal histology in only 26.3% of cases. There were no differences in renal function between normal and pathological biopsies (Cr 1.40 vs 1.46 mg/dl, p=NS). Major histologic findings, isolated or associated with each other [Fig. 1], were vascular lesions (VL, 40%), IFTA (33%) and inflammatory lesions (IL, 32%). VL correlated with donor age (OR 1.07, p&amp;lt;0.001), whereas IFTA with both donor age (OR 1.03, p=0.04) and DGF (OR 1.07, p=0.04). IFTA was the only histological pattern associated with a lower renal function (Cr 1.58 vs 1.39 mg/dl, p=0.016). IL included interstitial infiltrates (14.8% of specimens), tubulitis (9.6%), glomerulitis (19.6%) and capillaritis (ptc, 13.9%). Both glomerulitis and capillaritis were associated with the presence of DSA, both at Tx (OR 4.35, p=0.037) and at biopsy (OR 5.45, p&amp;lt;0.001). All types of lesions were found to be related with previous AR (VL with OR 3.08, p= 0.003, IFTA with OR 2.15, p=0.04, IL with OR 4.71, p&amp;lt;0.001) and to be more frequent in the last 5 year biopsies, according to an older donor age (59.5 vs. 52.3 ys, p&amp;lt; 0.001) and a lower HLA-matching (mismatch AB &amp;gt;2: 50.5% vs 32%, p=0.045). Indipendent histological variables that predicted a worsening of renal function were glomerulitis/capillaritis (HR 6.996, P&amp;lt;0.001) and VL (HR 2.229, p=0.038). Conclusion Our data confirm that stable renal function does not exclude the presence of subclinical histological lesions, even in patients at low immunological risk. Abnormal findings are present in 73.7% of our SB. Glomerulitis/capillaritis and VL can affected renal function, so their recognition should be considered for immunosuppression optimization. Patients with previous AR are at higher risk for all types of histologic lesions and may require a closer monitoring.

Effects of mild hypothermia on serum HMGB1 of brain-dead donors and its impact on kidney transplantation recipients.

Investigate the effect of mild hypothermia on serum inflammatory factor HMGB1 of brain-dead donors, and its significance for renal transplantation recipients.In our hospital between January 2018 and January 2019 up to the standard of brain death donor (aged 18 to 65 years old) prospective cohort study, brain death donor were randomly divided into mild hypothermia group and the non-mild hypothermia group. Serum were collected from donor at different periods, and enzyme-linked immunoassay (ELISA) was used to determine the serum HMGB1 concentration to compare the difference between the 2 donor groups. The early recovery of renal function after renal transplantation was followed up, and the incidence of delayed graft function (DGF) and early recovery of renal function were compared between the 2 groups. The correlation between donor HMGB1 and recipient DGF was analyzed.Between 17 donors in the mild hypothermia group and 17 in the non-mild hypothermia group, there were no statistically significant differences in the age, perioperative urine volume and ICU stay between the 2 groups. After mild hypothermia treatment, serum HMGB1 levels of brain death donors were significantly decreased. While in non-mild hypothermia brain death donor group without treatment, serum HMGB1 was significantly increased. There were no statistically significant differences in age and preoperative creatinine between the 2 recipient groups, including 33 patients in the mild hypothermia group and 34 patients in the non-mild hypothermia group. DGF incidence was lower in mild hypothermia group comparing with non-mild hypothermia group with statistical significance. The levels of HMGB1 from donor before procurement is correlated with the occurrence of DGF of the recipient.Mild hypothermia therapy can reduce the levels of serum HMGB1, improve the function of donor organs. The levels of HMGB1 before donor procurement can be used to predict the occurrence of DGF in kidney transplant recipients. Our study shows that HMGB1 can be potentially used as therapeutic target of early intervention for brain death donors. Furthermore, mild hypothermia therapy can be applied in the maintenance of brain death donors for kidney transplant recipient to improve the successful rate of transplantation.