Non-heart-beating Donors Research Articles

Hypothermic machine perfusion of a donor kidney using an experimental dextran-40-based preservation solution and orthotopic transplantation (experimental study)

Objective: to evaluate the efficacy of hypothermic machine perfusion (HMP) of a donor kidney obtained from a non-heartbeating (NHB) donor, using an experimental dextran-40-based preservation solution, in subsequent orthotopic transplantation in a rabbit model.Materials and methods. Twenty grey giant rabbits weighing 2,500–3,100 g, divided into donors (n = 10) and recipients (n = 10), were used in the study. After obtaining kidney from an NHB donor, ex vivo HMP of the left donor kidney using a dextran-40-based preservation solution was performed and peripheral vascular resistance (PVR) parameters were measured. This was followed by bilateral nephrectomy and orthotopic transplantation. The follow-up period was 12 days. Creatinine levels, urea levels, and glomerular filtration rate (GFR) were measured during follow-up.Results. During ex vivo HMP of donor kidneys from NHBs, PVR dropped progressively from 1.90 ± 0.27 mmHg/mL/min to 0.72 ± 0.09 mmHg/mL/min at p < 0.001. In the early post-transplant period (during the first 2 days after implantation), creatinine and urea levels were moderately elevated compared to normal. Creatinine and urea levels were 91.07 ± 11.49 μmol/L at p < 0.011 and 9.09 ± 1.06 mmol/L at p < 0.009 on day 2, respectively, but by day 12, they reverted to physiologic values, which were 77.17 ± 10.19 μmol/L at p < 0.019 and 4.88 ± 0.54 mmol/L at p < 0.022, respectively. These findings were correlated with GFR values, which ranged from 26.29 to 26.74 mL/min/1.72 m2 in mean values over the course of a 12-day follow-up period.Conclusion. Ex vivo HMP using dextran-40-based preservation solution has a positive effect on the kidney at 30 minutes of warm ischemia following asystole and achieves satisfactory graft function over 12 days of follow-up.

Organ Transplantation from Deceased Donor: myths and facts in Pakistan and world over.

Organ transplantation is remarkable scientific achievement in treatment of patients with end stage organ failure. Renal transplant was first solid organ transplant performed in early 50s. Initially only transplant from living donors were performed but later keeping in view of number of patients suffering from end stage organ failure and shortage of living donors, practice of retrieving organs from dead has been adopted. Such donors previously called ‘cadaver’ and now labelled as ‘deceased’ donors can be non-heart beating donors or donors with circulatory failure or could be brain dead donors. This article highlights types of organs which can be harvested from deceased donors. The ethical dimensions (which covers social, cultural, legal, religious and ethical issues) of deceased organ donation and their impact. Verdicts from religious point of view of different world religions is referred at end of article as consideration of religion cannot be denied in field of transplantation. This article also highlights definition and diagnosis of brain death, conditions necessary to fulfil retrieving organs from brain death and the ethical dimensions (which covers social, cultural, legal, religious and ethical issues) of organ donation from brain dead.

Organ procurement requiring the authorization of the judicial authority. An epidemiological investigation in the Veneto region (Italy)

BackgroundWhen death occurs through a mechanism requiring a forensic investigation, consent for organ harvesting must be sought from the Judicial Authority (JA). AimTo perform a retrospective study of potential organ donors in the Veneto region over a six-year period (2012–2017), analysing any differences between cases in which the JA approved or denied organ harvesting. Material and methodsBoth non-heart beating (NHB) and heart beating (HB) donors were included. For HB cases, personal and clinical data were collected. To evaluate the correlation between the JA response and the circumstantial and clinical data a logistic multivariate analysis was performed, estimating the adjusted odds ratios (adjORs). ResultsBetween 2012 and 2017, 17,662 organ and/or tissue donors were included, of which 16,418 were NHB donors and 1,244 HB-donors. Among the 1,244 HB-donors, JA authorization was asked in 200 cases (16.1%), approved in 154 cases (77.0%), limited in 7 cases (3.5%) and denied in 39 cases (19.5%). The JA denied the authorization for organ harvesting in 53,3% of cases with hospitalizations of less than 1 day and in 9,4% of cases with hospitalization exceeding one week [adjOR(95%CI) = 10.67 (1.92–59.22)]. The performance of an autopsy was linked to a higher chance of denied outcome from the JA [adjOR(95%CI): 3.45 (1.42–8.39)]. ConclusionsImprovements in the communication between organ procurement organizations and the JA through efficient protocols furnishing detailed information on the cause of death might lead to a better procurement process with an increase in the number of transplanted organs.

The ischaemic preconditioning paradox and its implications for islet isolation from heart-beating and non heart-beating donors

The impact of ischaemia can severely damage procured donor organs for transplantation. The pancreas, and pancreatic islets in particular, is one of the most sensitive tissues towards hypoxia. The present study was aimed to assess the effect of hypoxic preconditioning (HP) performed ex-vivo in islets isolated from heart-beating donor (HBD) and non heart-beating donor (NHBD) rats. After HP purified islets were cultured for 24 h in hypoxia followed by islet characterisation. Post-culture islet yields were significantly lower in sham-treated NHBD than in HBD. This difference was reduced when NHBD islets were preconditioned. Similar results were observed regarding viability, apoptosis and in vitro function. Reactive oxygen species generation after hypoxic culture was significantly enhanced in sham-treated NHBD than in HBD islets. Again, this difference could be diminished through HP. qRT-PCR revealed that HP decreases pro-apoptotic genes but increases HIF-1 and VEGF. However, the extent of reduction and augmentation was always substantially higher in preconditioned NHBD than in HBD islets. Our findings indicate a lower benefit of HBD islets from HP than NHBD islets. The ischaemic preconditioning paradox suggests that HP should be primarily applied to islets from marginal donors. This observation needs evaluation in human islets.

401.9: Capnometry Values Are a Renal Transplant Evolution Predictor in Uncontrolled Cardiac Arrest Death Donors

Introduction: The evaluation of a potential donor patient involves a series of tests and molecular markers to assess the suitability of an organ and the safety for the recipient. A fundamental marker used in out-of-hospital emergency medicine is capnometry, which allows us to indirectly, but accurately, evaluate the potential donor’s organs’ perfusion. These values could help determine the adequacy of a possible donor in an uncontrolled non-heart beating donation (DACD) and donor selection during out-of-hospital medical emergencies. Capnometry values during cardiopulmonary resuscitation (CPR) are a renal transplant evolution predictor in DACD. Method: Ours is a retrospective study of DACD Maastricht type IIa during a calendar year. The inclusion criteria of the study were: patients who have suffered a witnessed cardiac arrest; age between 16 and 60; asystole electrocardiographic pattern; less than 15 minutes until advanced life support (ALS) arrival; at least 20 minutes of CPR; less than 120 minutes until arrival at the hospital; absence of thorax and abdomen exsanguinating lesions; absence of suspicion of neoplastic, infectious diseases or intravenous drug users (IDUs); chest circumference compatible with chest compression system for donors; and being on hemodialysis and on the renal transplant waiting list for recipients. The data collected from the donors were: age, sex, body mass index, medical history, cause of death, CPR start time, ALS arrival time, time of arrival at the hospital, time of death, cold ischemia and warm ischemia time of each organ, and capnometry values at the begining, at the middle point and at the end of CPR. As from the recipients, collected data were: transplanted organ, cause of chronic kidney disease (CKD), starting date of dialysis, number and type of transplant incompatibilities, renal failure, acute rejection, number of dialysis sessions after transplant, urologic complications, transplant-related infections, serum creatinine levels on 1st, 7th, 15th, 30th, 90th, 180th and 360th days after transplant, levels of proteinuria on 1st, 7th, 15th, 30th, 90th, 180th and 360th days after transplant, one-year transplanted organ survival, one-year recipient patient survival. The quantitative variables are summarized with their median and interquartile range (IR), and the qualitative variables are presented with their distribution of absolute (n) and relative (%) frequencies. We evaluated the correlation between capnometry values of the donor (at the beginning and at the middle point of CPR, and during hospital transference) with creatinine and proteinuria levels on the specified days using the Spearman correlation test. The association between qualitative variables with the capnometry values was evaluated with the Wilcoxon test. For all these tests, a p <0.05 was the accepted level of statistical significance. Results: During a calendar year, 34 donors were studied. The mean age of the donors was 46.9 years, and 82.4% of them were male. The median capnometry value was: 21.3 +/- 12 at the beginning of CPR, 27.4 +/- 12.2 at the middle point of CPR, and 23 +/- 11.7 during hospital transference. The analysis of the correlation between at-the-middle-point-of-CPR and hospital-transference capnometry values, and creatinine and proteinuria levels, showed a statistically significant moderate-to-high negative correlation. Also, a statistically significant association was observed between hospital-transference capnometry values and the number of after-transplant dialysis sessions the receptor needed. Conclusion: Capnometry is a useful tool to determine kidney transplant viability and prognosis. There is an association between donors capnometry values at the middle point of CPR and during hospital transference, and creatinine and proteinuria levels of the recipient, and another association between high capnometry values during hospital transference and a less need of after-transplant dialysis.

The airflow and cooling characteristics in the airway of NHBD lung with hypothermic ventilation

Hypothermic ventilation through trachea can cool Non-heart beating donor (NHBD) lungs noninvasively in vivo, thus avoiding warm ischemic damage. However, previous experimental studies with large lungs have shown poor cooling effect in bronchial terminal of NHBD lungs. To investigate the airflow and cooling characteristics of this process, a physiologically realistic upper airway model was established. In addition, droplet spraying was considered to enhance the heat transfer during the cooling process. The results show that the irregular geometry of realistic airway will lead to non-uniformity distribution of internal flow and temperature, and the local cooling effect in different regions is related to the velocity distribution. The secondary flow at the bifurcation can forcibly strengthen the heat exchange between the cold air and the hot air in the nearby low-speed area. Increasing the ventilation flow will strengthen the turbulence and heat exchange in the airway, so as to improve the overall cooling effect. The synergistic effect of cold air and droplet spraying can enhance the cooling effect in the airway. And large droplets (i.e. 10 μm) are conducive to the cooling enhancement of the central airway, while small droplets (i.e. 2 μm) are conducive to the cooling of the distal bronchus.

First Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ results

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Liver transplantation from discarded liver grafts: Expanding the donor liver pool in Mexico

Extended criteria donors (ECD) in liver transplantation has become a common policy because the shortage of optimal organs. Most of liver transplantation groups agree that prolonged cold ischemia, obesity, steatosis, age, hipernatremia, inotropic support, non heart beating donors (NHBD), split livers are related to primary non-function (PNF) of the liver graft with high morbidity and mortality. Discarded liver grafts by contrast accounts every year for more than two-fold the liver transplants done in Mexico. Poor donor characteristics such as steatosis > 40%, severe hyponatremia, alcohol abuse and obesity are frequently cause of declination by most transplant teams. A five year period was observed from January 2015 to January 2020. Donor variables such as severe hipernatremia (> 165 Meq/l), moderate steatosis (> 40%), BMI (> 30 kg/m2), alcohol abuse and cold ischemia time (CIT) more than 8 hr were recorded and considered risk factors for PNF. Delayed graft function (DGF), PNF and complications were evaluated. All liver donors were discarded by at least three main liver transplant centers in Mexico City. 155 LT were done. Marginal donors 60 (38.7%). Discarded livers 40 (66.6%). Severe hypernatremia (165-188 Meq/l), 19 (47.5%), obesity (30-45 kg/m2), 30 (75%) and moderate to severe steatosis (40-76%), 21 (52.5%), alcohol abuse 2 (5%). There were no differences in PNF rate, when three factors coexists DGF rate were slightly higher than control group. No differences in 1-year mortality. Discarded livers are an acceptable choice to expand liver pool donors. Moderate steatosis, severe hypernatremia and obesity seems to be good candidates for LT.

HYPOXIC PRECONDITIONING AMELIORATES ISCHEMIA-INDUCED DAMAGE OF ISOLATED RAT ISLETS

Aim: Islet isolation results in disruption of the native islet vascular network until posttransplant islet revascularisation is completed. Prolonged exposure to a hypoxic and nutrient-depleted environment has detrimental effects on morphological and functional integrity of isolated islets. In solid organ transplantation it was shown that short sublethal periods of anoxia can induce adaptive mechanisms in the affected tissue offering protection against subsequent potentially lethal hypoxic insults. This study was aimed to explore the potential of hypoxic preconditioning for isolated islets. Methods: Rat islets, isolated from 20 non-heartbeating donors, were subjected either to 2 x 2 min-periods of anoxia, intermitted by a 2 min-period of oxygen supply, or to sham-treatment. Hypoxic preconditioning and sham-treatment were followed by 4 hours of recovery in normoxia prior to 24 hr-culture at 1.5% oxygen. Islet characterisation included yield of islet equivalents (IEQ) or islet particle number (IN), viability (FDA-PI), DNA (pico-green) and ATP (luciferase assay) content, intraislet reactive oxygen species (ROS) production (DCFH-DA), gene expression (qRT-PCR), and glucose stimulation index (2 vs 20 vs 2 mM). Data were normalised to islet DNA content and are presented as mean ± SEM. Results: Hypoxic preconditioning had no effect on islet survival when compared with sham-treatment (64 ± 7 vs 61 ± 7%). Compared with preconditioned islets, sham-treated controls were characterised by increased fragmentation when determined as IN/IEQ ratio (1.51 ± 0.18 vs 1.24 ± 0.13, p<0.05). Fragmentation corrrelated inversely with viability of sham-treated and preconditioned islets (61 ± 3 vs 66 ± 3 %, p<0.01). ATP (0.66 ± 0.14 vs 0.73 ± 0.20 pM/ng DNA) and insulin content (51.1 ± 12.5 vs 46.3 ± 11.7 ng/ng) were not altered by hypoxic preconditioning compared with sham-treatment. ROS production was reduced after hypoxic preconditioning compared with sham-treatment (645 ± 73 vs 858 ± 88 AU/ng, p<0.01). Islets of both experimental groups responded with insulin release after glucose challenge, but the stimulation index of preconditioned islets was significantly larger compared with sham-treated islets (2.39 ± 0.37 vs 2.09 ± 0.33, p<0.05). Whilst pro-apoptotic BAX and CHOP gene expression was reduced by 54 ± 15% (p<0.05) and 49 ± 8% (p<0.05), hypoxic preconditioning increased HIF-1 alpha and VEGF-A gene expression by 90 ± 41% (p<0.01) and 184 ± 65% (p<0.05), respectively. Conclusion: Although hypoxic preconditioning could not ameliorate ischaemia-induced loss of islets, islet morphology and function was significantly improved presumably as result of reduced intraislet ROS production. qRT-PCR-determined gene expression suggests that hypoxic preconditioning induces rescue mechanisms islets and mediates a significant anti-apoptotic effect. This study describes a new option for pretransplant treatment of isolated human islets. European Union’s Cooperation Programme FP7 (HEALTH-F2-2012-305746). Oxford NIHR Biomedical Research Centre.

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors

ObjectiveThe capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DesignThe study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 transplanted kidneys in the period 2013–2017. ScopeThe population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PatientsA total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. InterventionsCapnometry and capnography measurements in potential uncontrolled non-heart beating donors. VariablesCapnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. ResultsA total of 55 out of 74 extracted kidneys were transplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (p = 0.016) between the capnometry values during resuscitation in the grafted kidneys (µ = 22.8 mmHg) and in the kidneys discarded for transplantation (µ = 17.35 mmHg). ConclusionsCapnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the transplanted organs in uncontrolled non-heart beating donors.

The Effects of Using Pancreases Obtained from Brain-Dead Donors for Clinical Islet Transplantation in Japan.

Background: The pool of brain-dead donors (BDDs) was increased with the revision to the relevant law in 2010, and islet transplantation from BDDs was started in 2013. The present study assessed the influence of using pancreases from BDDs on islet transplantation in Japan. Methods: The donor information registered with the secretariat of islet transplants from 2012 was reviewed, and the results of 86 clinical islet isolations performed in Japan between 2003 and 2018 with non-heart-beating donors (NHBDs) (n = 71) and BDDs (n = 15) were investigated. Results: The number of cases for which donor information was registered with the secretariat of islet transplants increased to 1.84 cases/month from 2013 to 2018 in comparison to 1.44/month in 2012, when only NHBDs were used. The median pancreatic islet yield was 275,550 IEQ (Islet equivalents) in the NHBD group but 362,700 in the BDD group, which amounted to a statistically significant difference (p = 0.02). As a result, 38/71 cases (53.5%) were achieved successful islet isolation (>5000 IEQ per recipient weight (kg)) was achieved in 38/71 cases (53.5%) in the NHBD group, and 12/15 cases (80.0%) in the BDD group; thus, the rate of successful islet transplantation was higher in the BDD group. Conclusion: The use of pancreases from BDDs has increased the overall number of cases for which donor information is registered with the secretariat of islet transplants and has improved the performance of islet isolation, thereby increasing the probability of successfully achieving islet transplantation.

Histological and clinical evaluation of marginal donor kidneys before transplantation: Which is best?

Organ shortage represents one of the major limitations to the development of kidney transplantation. To increase the donor pool and to answer the ever increasing kidney request, physicians are recurring to marginal kidneys as kidneys from older donors, from hypertensive or diabetic donors and from non-heart beating donors. These kidneys are known to have frequently a worse outcome in the recipients. To date major problem is to evaluate such kidneys in order to use or to discard them before transplantation. The use of such kidneys create other relevant question as whether to use them as single or dual transplant and to allocate them fairly according transplant programs. The pre-transplant histological evaluation, the clinical evaluation of the donor or both the criteria joined has been used and according the time each criterion prevailed over the others. Aim of this review has been to examine the advantages and the drawbacks of any criterion and how they have changed with time. To date any criterion has several limitations and several authors have argued for the development of new guidelines in the field of the kidney evaluation for transplantation. Several authors argue that the use of omic technologies should improve the organ evaluation and studies are ongoing to evaluate these technologies either in the donor urine or in the biopsies taken before transplantation.

Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era

AimsTo identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTRs). DesignAn observational, retrospective, nested cases–controls study from a consecutive cohort of LTRs was carried out. SettingUniversity hospital. PatientsAll consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. Main variables of interestPretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). ResultsThe MELD-Na score (OR=1.069, 95% CI=1.014–1.127), age >60 years (OR=2.479, 95% CI=1.226–5.015), and LTR height <163cm (OR=4.092, 95% CI=2.115–7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. ConclusionsIn LTR due to decompensated cirrhosis, the MELD-Na score, age >60 years, and height <163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality.

The efficacy of extracorporeal membrane oxygenation in liver transplantation from non-heart-beating donors: A systemic review and meta-analysis.

Background:A systematic review and meta-analysis was made to see whether extracorporeal membrane oxygenation (ECMO) in liver transplantation could improve non-heart-beating donors (NHBDs) recipients’ outcomes compared with donors after brain death (DBDs) recipients.Methods:We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for eligible studies. The study eligible criteria are cohort or case–control studies using ECMO in all NHBDs; studies involved a comparison group of DBDs; and studies evaluated 1-year graft and patient survival rate in NHBDs and DBDs groups.Results:Four studies with 704 patients fulfilled the inclusion criteria. The pooled odds ratio (OR) of 1-year patient survival rate in NHBDs recipients compared with DBDs recipients was 0.8 (95% confidence interval [CI], 0.41–1.55). The pooled OR of 1-year graft survival rate in NHBDs recipients compared with DBDs recipients was 0.46 (95% CI, 0.26–0.81). NHBDs recipients were at greater risks to the occurrence of primary nonfunction (PNF) (OR = 7.12, 95% CI, 1.84–27.52) and ischemic cholangiopathy (IC) (OR = 9.46, 95% CI, 2.76–32.4) than DBDs recipients.Conclusions:ECMO makes 1-year patient survival acceptable in NHBDs recipients. One-year graft survival rate was lower in NHBDs recipients than in DBDs recipients. Compared with DBDs recipients, the risks to develop PNF and IC were increased among NHBDs recipients.

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors.

The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (μ=22.8 mmHg) and in the kidneys discarded for transplantation (μ=17.35 mmHg). Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors.

Clinical Observation of Single Kidney Transplantation for Adult Recipients from Non-Heartbeating Pediatric Donors

Objective To investigate the early clinical effect of single kidney transplantation for adult recipients from non-heartbeating pediatric donors(<12y),comparing with single renal transplantation from adult kidney donor. Methods A retrospective review of clinical data of donors and recipients kidney transplantation from donation after deceased cardiac donors (DCD) performed from November 2013 to June 2017 in kidney transplantation department of the first affiliated hospital of Xi’an Jiaotong university. There were three groups divided by the long axis of the kidney:<6cm(8); 6-8cm(18); >8cm(30). Postoperative blood pressure, urinary protein, renal function of 50 recipients were monitored tightly. Results The long axis of the kidney before and after opening blood flow were 7.53±1.13cm and 8.48±1.10cm totally. Recipients’ blood pressure were held during 110/60 to 140/100mmHg and weight were 40-60kg. Respectively, renal function of there groups recovered(serum creatinine<177μmol/L) in 6.4±3.3, 10.6±2.4, 18.6±5.8 days. Disappearance of proteinuria were markedly correlated with control of postoperative blood pressure and donor renals size. Kidney volume increases significantly within one month after surgery and long axis of the kidney will be more than 10 cm after half a year. Conclusions Short-term out-comes of single kidney transplantation from pediatric donors seemed a little worse than adult donors. It mainly manifested in less urine, strict blood pressure control, long time proteinuria and more complications. So, we believe non-heartbeating pediatric donors is available resources, but recipients’ systolic pressure must be control about 120mmHg and proteinuria and renal function should be strict monitored, especially in the long axis of the kidney less than 6cm. It maybe relative to damage of the glomerular basement membrane. A further study is needed for the electron microscope. Key words: non-heartbeating pediatric donors; kidney transplantation; blood pressure; proteinuria

How to Select The Non-Heartbeating Donors Suffering from CPR

Objective To investigate perioperative treatment method and the early clinical effect of kidney transplantation from non-heartbeating donors suffering from cardiopulmonary resuscitation(CPR). Methods A retrospective review of clinical data of 41 donors and 73 recipients' kidney transplantation from non-heartbeating donors performed from December 2011 to June 2017 in kidney transplantation department of the first affiliated hospital of Xi’an Jiaotong university. Analysis of CPR’s impact on the prognosis of non-heartbeating donors renal transplant recipients. Results There were three groups divided by the time of CPR:<10min, 10-30min, >30min. Delayed graft function(DGF)of three groups recipients were 3.1%, 17.4% and 100% respectively. Early survival rate of human with kidney were 96.9%, 86.9% and 61.1% respectively. 1 year survive of kidney and recipients was 82.2/93.2% totally. The difference of three groups’ prognosis had statistical significance. Conclusions Our center summarized the following principles: If the time of CPR was less than 10 minutes and renal function was normal, we will implement organ donation directly; If the time of CPR was 10-30 minutes, we will assess blood pressure, kidney function and urine volume comprehensively and discuss the risk of operation; If the time of CPR was more than 30 minutes, we will suggest to give up donating. In addition, repair and maintenance of the donors of the primary diseases and organs function are very important. Especially, it is necessary to pay attention to potential infectious donors, observe the change of the urine and kidney function dynamically and application of hormone, heparin and urokinase before organ procurement. Application of lifepot, anti-infection and postoperative follow-up are all keys to assure outcomes of kidney transplantation.

Kidney Transplantation from Non-Heart-Beating Donors (NHBD) after Extracorporeal Membranous Oxygenation (ECMO) – initial experience and comparison to brain-dead donors (BDD) outcomes

Kidney Transplantation from Non-Heart-Beating Donors (NHBD) after Extracorporeal Membranous Oxygenation (ECMO) – initial experience and comparison to brain-dead donors (BDD) outcomes

Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era.

To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTR). An observational, retrospective, nested cases-controls study from a consecutive cohort of LTRs was carried out. University hospital. All consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. Pretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). The MELD-Na score (OR = 1.069, 95% CI = 1.014-1.127), age > 60 years (OR = 2.479, 95% CI = 1.226-5.015), and LTR height < 163cm (OR = 4.092, 95% CI = 2.115-7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. In LTR due to decompensated cirrhosis, the MELD-Na score, age > 60 years, and height < 163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality.

Survival and Evolution of Renal Function in Kidney Transplant Recipients From Type II Asystolic Donations: A Single-center Experience

BackgroundIn recent years, stagnation in the number of kidneys from after brain-dead donors (DBD) has stimulated the use of non–heart beating donors (NHBDs). Herein we present our 5-year experience with type II Maastricht NHBDs in renal transplantation. MethodsAll patients (n = 50) in this study received type II Maastricht NHBD kidneys (March 2012 to February 2017), with a median follow-up of 33 months. ResultsMean donor age was 39 ± 12 years, mean creatinine 1.24 ± 0.2 mg/dL, and the most frequently observed blood group (donors and recipients) was type A (64%). Recipients were slightly younger (51 ± 11 years old), with mean time on dialysis of 30 ± 24 months. Almost all were primary transplants. Pre-transplant panel-reactive antibodies (PRA) were <25%; initial immunosuppression was thymoglobulin, corticosteroids, mycophenolate mofetil, and delayed introduction of tacrolimus. Six percent were nonfunctioning kidneys; 79.6% presented with delayed renal function (mean duration 14 ± 9 days). Acute rejection was seen in 6% of patients. Mean creatinine at month 3 was 1.7 ± 0.8 mg/dL, and 1.5 ± 0.8 mg/dL in the first year. The last available mean creatinine was 1.54 ± 0.7 mg/dL. Proteinuria in the third month, first year, and third year was 0.70, 0.41, and 0.26 g/d, respectively. Recipient survival at the first, third, and fifth year was 100%, 100%, and 86%, and when graft-censored for death was 94%, 91%, and 91%, respectively. The incidence of acute rejection during first year was 6%, and 2% in the second year. Exitus incidence was 4% and cytomegalovirus infection was 21.3%. BK viremia between 1000 and 10,000 copies/mL was seen in 4.3%, and reached >10,000 copies/mL in 2.1%. ConclusionsType II NHBD has shown limited frequency of nonfunctioning kidney and high functional delay. The results in survival and renal function are very acceptable, comparable with levels seen in donation after brain death.