Preservation Fluids Research Articles

Attraction of pitfall trap preservation fluids complicates the estimation of Collembola density

Collembola (springtail) communities consist of three eco-morphologically defined life forms: the euedaphics dwell inside the soil matrix, the epedaphics (including atmobiotics) live on the ground and in vegetation, and the hemiedaphics are intermediate. The vast majority of springtail community studies focus on the belowground (eu- and hemiedaphic) forms that are generally collected by taking and extracting soil cores. Few investigations have dealt with epedaphic Collembola that are usually captured with pitfall traps, and only very few studies so far covered all three life forms. When epedaphic and belowground species are sampled using both methods simultaneously, core data (true densities, [individuals m−2]) and pitfall data (activity abundances, [individuals trap−1 length of trapping period−1]) may be analyzed independently, but are incompatible in a common statistical framework. As a remedy, two competing numerical approaches to estimate true densities from activity abundances have been described in literature: the nested-cross array and the two-circle method. Attraction or deterrence effects of trap preservation fluids bias the density estimation of the nested-cross array, but not of the two-circle method. To determine whether this bias may be expected for Collembola, and thus which of the two methods should be used in future studies, we experimentally tested potential effects of preservation fluids on trap catch rates. Three preservation fluids (sodium benzoate, propylene glycol, formaldehyde) and a detergent (Tween80) significantly increased the number of captured springtails, thus demonstrating an attraction effect and the deficiency of the nested-cross array. In future studies of collembolan communities, we therefore suggest complementing the traditional focus on the eu- and hemiedaphic life forms by sampling epedaphic species using pitfalls, and subsequently remodelling the trapping data with the two-circle method.

Interpreting and managing preservation fluids positive for Gram-negative bacteria.

Culturing preservation fluids of solid organs before transplantation is not a standardized procedure. In this review, we aim to describe the state-of-the-art of literature evidence in this debated setting with a special focus on Gram-negative bacteria (GNB). Contamination of preservation fluids is frequent, but preservation fluids related infections are rare and most commonly caused by high-risk pathogens, including GNB. GNB preservation fluids related infections are characterized by high morbidity and mortality. Recent studies showed improved outcomes in solid organ transplant recipients receiving antibiotic therapy tailored according to preservation fluids cultures especially when multidrug-resistant GNB are found. A robust procurement network is needed to alert recipients' centers in cases of positivity and the support of transplant infectious diseases specialists is essential to choose the best therapy. Culturing preservation fluids is a further step into preventing donor-derived infections. Interpreting and managing GNB positivity require a multidisciplinary team with specific skills. Standardized randomized trials are needed for insight into the real utility of preservation fluids cultures, the role of preservation fluids positivity, and the impact of antimicrobial therapy.

Assessing the impact of positive cultures in preservation fluid on renal transplant outcomes: a scoping review.

Infection following kidney transplantation is a significant risk factor for adverse outcomes. While the donor may be a source of infection, microbiological assessment of the preservation fluid (PF) can mitigate potential recipient contamination and help curb unnecessary antibiotic use. This scoping review aimed to describe the available literature on the association between culture-positive preservation fluid, its clinically relevant outcomes, and management. Following the Joanna Briggs Institute's scoping review recommendations, a comprehensive search in databases (EMBASE, MEDLINE, and gray literature) was conducted, with data independently extracted by two researchers from selected studies. We analysed 24 articles involving 12,052 samples, predominantly published post-2000, 91%of whichretrospective. The prevalence of culture-positive preservation fluid varied from 0.86 to 77.8%. Coagulase-negative staphylococci emerged as the most frequently isolated pathogen in 14 studies. The presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), observed in two studies involving 1074 donors, was significantly associated with an increased risk of probable donor-derived infections (p-DDI). Of the reviewed articles, 14 reported on probable donor-derived infections, while 19 addressed the topic of preemptive antibiotic therapy. Routine culturing of preservation fluid is crucial for the identification of pathogenic organisms, facilitates targeted treatment and prevents probable donor-derived infections. Furthermore, this approach helps avoid the treatment of low-virulence contaminants, thereby reducing unnecessary antimicrobial use and the risk of antibiotic resistance. In cases where ESKAPE or Candida species are detected, preemptive therapy appears to be an important strategy. Given that the current evidence primarily stems from retrospective studies, there is a pressing need for large-scale, prospective trials to corroborate these recommendations. This scoping review currently represents the most thorough compilation of evidence on how contamination of preservation fluids affects kidney transplant management.

Modification of Preservative Fluids with Antioxidants in Terms of Their Efficacy in Liver Protection before Transplantation.

Transplantation is currently the only effective treatment for patients with end-stage liver failure. In recent years, many advanced studies have been conducted to improve the efficiency of organ preservation techniques. Modifying the composition of the preservation fluids currently used may improve graft function and increase the likelihood of transplantation success. The modified fluid is expected to extend the period of safe liver storage in the peri-transplantation period and to increase the pool of organs for transplantation with livers from marginal donors. This paper provides a literature review of the effects of antioxidants on the efficacy of liver preservation fluids. Medline (PubMed), Scopus, and Cochrane Library databases were searched using a combination of MeSH terms: "liver preservation", "transplantation", "preservation solution", "antioxidant", "cold storage", "mechanical perfusion", "oxidative stress", "ischemia-reperfusion injury". Studies published up to December 2023 were included in the analysis, with a focus on publications from the last 30 years. A total of 45 studies met the inclusion criteria. The chemical compounds analyzed showed mostly bioprotective effects on hepatocytes, including but not limited to multifactorial antioxidant and free radical protective effects. It should be noted that most of the information cited is from reports of studies conducted in animal models, most of them in rodents.

Determination of Process Parameters For Removing Impurities from Motor Oils for Their Use as The Basis of Working and Preservation Fluids

Motor oil that has spent a certain period of time in combined engines has a reserve of operational properties and can be considered as a basis for the preparation of working and conservation oil when storing equipment for a long period of storage [1].

Optimal Perioperative Antimicrobial Management Strategies of Kidney Transplant Recipients Guided by Metagenomic Next-Generation Sequencing of Deceased Donors' Microbiology Samples.

There is no consensus on the optimal use of perioperative antibiotics prophylaxis after kidney transplantation, but there is a common trend to limit the duration of antibiotic use worldwide. Metagenomic next-generation sequencing (mNGS) has emerged as a novel technology for pathogen detection in clinical practice due to its noninvasive, rapid, precise and high susceptibility to detect infectious pathogens. However, data are lacking on whether mNGS analyses could be used to detect pathogens and guide anti-infection regimens in kidney transplant donors and recipients. We conducted a retrospective study to review all clinic data of mNGS and traditional laboratory methods (TMs) for pathogen detection in kidney transplant recipients and their corresponding deceased donors from August 1, 2021 to October 30, 2022 in our center. A total of 57 donors and 112 of their corresponding recipients were included. The antimicrobial strategy mainly depended on mNGS results combined with traditional pathogen culture and clinical conditions. The percentages of positive pathogen detected by mNGS in blood, urine, bronchoalveolar lavage fluid (BALF) and preservation fluids (PFs) were 50.9% (29/57), 35.1% (20/57), 84.2% (48/57) and 54.4% (31/57) respectively, and were 24.6% (14/57), 15.8% (9/57), 57.9% (33/57) and 14.1% (8/57) respectively when using TMs. mNGS could detected all of pathogens which were detected by TMs. However, samples with negative TMs testing can be additionally detected as positive by mNGS (15/43 in blood, 11/48 in urine, 15/24 in BALF and 23/49 in PFs). Drug resistance genes were detected in 9 donors by mNGS,which were consistent with 6 donors by TMs. There was only one case of donor-derived infection in this study. This study showed that it is effective to combine mNGS with traditional pathogen detection methods and clinical features to develop optimal perioperative antimicrobial management strategies for deceased donor kidney transplantation.

Preservation fluids of heritage anatomical specimens - a challenge for modern science. Studies of the origin, composition and microbiological contamination of old museum collections.

Anatomical museums preserve specimens of great historical value and undiscovered scientific potential. However, frequently these collections lack documentation of the techniques of preparation and the composition of preservative substances (conservation principles). This poses a huge problem for the care and preservation of these materials, more so because understanding this issue requires knowledge of fundamentals from different scientific disciplines. The aim of the research was to obtain information about the composition of substances used to preserve historic specimens, as well as to conduct a microbiological assessment of the specimens to detect possible factors causing their deterioration. Furthermore, we wanted to fill an existing gap in the literature, as there is a lack of reports on analytical methods that could be successfully applied by anatomists involved in the daily care of museum collections in human anatomy departments. The starting point was the analysis of the sources and history of the collections, on which basis the choice of research methods was made. Methods based on simple chemical reactions and specialised methods (such as gas chromatography-tandem mass spectrometry, Fourier transform infrared spectroscopy, inductively coupled plasma optical emission spectroscopy) were used in the analyses of the composition of fluids. Microbiological analyses were based on culture and isolation methods, analysis of microscopy slides and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry analysis. As a result of these analyses, some components of the preservative mixtures and their concentrations were determined. The presence of methanol, ethanol, formaldehyde and glycerol was detected, among other chemicals. The concentrations of these substances were different between the samples and their determination required the use of a variety of methods suitable for the individual components of the preservative mixture. In microbiological tests, both bacteria and fungi were isolated from swabs taken from anatomical specimens. The bacterial flora was less numerous than the fungal flora. Among the bacteria, environmental Gram-positive Bacillus cereus, Bacillus thuringiensis and a rare bacterium of the Cupriavidus genus were isolated, whereas among the fungal organisms, the yeast-like fungi Candida boidinii and Geotrichum silvicola as well as mould fungi Penicillium sp. and Fusarium sp. were detected. However, the microscopic evaluation showed a greater diversity of microorganisms, which may be related to the fact that many environmental bacteria cannot be cultured using classical methods, but can be observed under the microscope. The results of the research made it possible to draw conclusions about the mutual influence of physical, chemical, and microbiological factors on the condition of historical anatomical specimens. In the course of the research, information was obtained on the processes which could have taken place during the storage of these collections. Maintaining the integrity of a container housing a preserved anatomical specimen has a major impact on maintaining the concentration of preservative fluid and keeping the specimen environment sterile. Many conservation procedures for historical specimens carried out nowadays pose a risk of destroying valuable specimens, as well as a health risk for the person carrying out the work. The exploration of the topic of conservation of anatomical specimens, especially those that lack documentation of their origin, is a key issue in current research on historical collections of anatomical specimens.

Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission.

Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

Protective Effect of Organ Preservation Fluid Supplemented With Nicorandil and Rutin Trihydrate: A Comparative Study in a Rat Model of Renal Ischemia.

The objective of organ preservation is sustained viability of detached/removed/isolated organs and subsequent successful posttransplant outcomes. Nicorandil (an ATP-sensitive potassium channel opener) is an efficacious agent to preserve lungs and heart. Rutin trihydrate (an antioxidant) inhibits free radical-mediated cytotoxicity and lipid peroxidation. We aimed to evaluate the efficacy of nicorandil and rutin trihydrate to enhance kidney preservation. We prepared 2 versions of organ preservation fluid, supplemented with either nicorandil or rutin trihydrate, and used 3-(4,5- dimethylthiazol-2-yl)-2,5-diphenyltetrazolium assays to evaluate the efficacy of these solutions in vitro (HEK293 human embryonic kidney cells), according to various cellular parameters such as ATP levels, reactive oxygen species, and cell viability. We also investigated the in vivo preservation efficacy in a rat model of renal ischemia and evaluated the immunohistological expression of apoptotic markers (caspase 3) in preserved rat kidney. We observed significant improvement of intracellular ATP levels (32 999 ± 1454 pmol/cell, n = 3; P < .05) in cells preserved in the nicorandil- supplemented solution compared with Custodiol solution (23 216 ± 1315 pmol/cell). Reactive oxygen species declined 1.25-fold (P < .05) in the presence of rutin trihydrate. Cell viability assays revealed a 4.8-fold increase in viability of renal cells preserved in the solutions supplemented with nicorandil or rutin trihydrate after 24-hour incubation compared with controls. In vivo, there were significant effects on serum creatinine (0.5480 ± 0.052, 0.956 ± 0.043 mg/dL) and blood urea nitrogen (85.36 ± 4.64, 92.85 ± 3.15 mg/dL) with the nicorandil and rutin trihydrate solutions, respectively. We observed suppressed expression of the apoptotic marker caspase 3 in groups treated with the 2 supplemented preservation fluids. Our results showed that solutions of organ preservation fluid supplemented with either nicorandil or rutin trihydrate can ameliorate cellular problems/dysfunction and facilitate sustained impro - vement of tissue survival and subsequent organ viability.

Perfusate Metabolomics Content and Expression of Tubular Transporters During Human Kidney Graft Preservation by Hypothermic Machine Perfusion.

Ischemia-related injury during the preimplantation period impacts kidney graft outcome. Evaluating these lesions by a noninvasive approach before transplantation could help us to understand graft injury mechanisms and identify potential biomarkers predictive of graft outcomes. This study aims to determine the metabolomic content of graft perfusion fluids and its dependence on preservation time and to explore whether tubular transporters are possibly involved in metabolomics variations. Kidneys were stored on hypothermic perfusion machines. We evaluated the metabolomic profiles of perfusion fluids (n = 35) using liquid chromatography coupled with tandem mass spectrometry and studied the transcriptional expression of tubular transporters on preimplantation biopsies (n = 26), both collected at the end of graft perfusion. We used univariate and multivariate analyses to assess the impact of perfusion time on these parameters and their relationship with graft outcome. Seventy-two metabolites were found in preservation fluids at the end of perfusion, of which 40% were already present in the native conservation solution. We observed an increase of 23 metabolites with a longer perfusion time and a decrease of 8. The predictive model for time-dependent variation of metabolomics content showed good performance (R 2 = 76%, Q 2 = 54%, accuracy = 41%, and permutation test significant). Perfusion time did not affect the mRNA expression of transporters. We found no correlation between metabolomics and transporters expression. Neither the metabolomics content nor transporter expression was predictive of graft outcome. Our results call for further studies, focusing on both intra- and extratissue metabolome, to investigate whether transporter alterations can explain the variations observed in the preimplantation period.

Early graft function and intrarenal resistant index after kidney transplantation using Biolasol-A new solid organ preservation fluid.

Biolasol is a newly developed preserving solution for cold organ storage prior to transplantation. To date, only animal model experiments results are available. The aim of this single-center analysis was to summarize the clinical experience concerning the early post-transplant course of kidney grafts preserved with Biolasol in comparison with other preservation solutions. Before transplantation, 173 kidney grafts were preserved using Biolasol and 240 organs with other solutions (University of Wisconsin-UW, Institute Georges Lopez-IGL-1, or StoreProtect Plus solutions). Early graft function was defined based on serum creatinine concentration at day 3 (<3mg/dL-immediate graft function, IGF or >3mg/dL-slow graft function, SGF) or the need of dialysis therapy during first post-operative week (delayed graft function, DGF). The analysis included intrarenal resistive indices measured by Doppler sonography early after transplantation and before discharge from the hospital. IGF was more frequent in patients with organs preserved with IGL-1 (33.5%) and StoreProtect Plus (38.8%) than Biolasol (18.5%), whereas there was no difference in the occurrence of DGF. Both initial and discharge median resistance index values were significantly higher in the Biolasol subgroup (0.77 and 0.75) than in all three other subgroups (P values for all comparisons <.001), also after 1:1 propensity score matching for baseline characteristics. Multiple logistic regression analysis based on the propensity score-matched cohort revealed that the use of Biolasol solution [OR 0.59 (0.35-0.98); P<.05] independently decreased the occurrence of IGF. In our single-center clinical experience, kidney preservation using Biolasol solution was associated with significantly higher intrarenal resistant index in comparison with other preservation fluids, as well as worse early graft function than in the IGL-1 and the StoreProtect Plus subgroups. Long-term follow-up is needed in order to assess the kidney graft and patient survival.

Transplanting Marginal Organs in the Era of Modern Machine Perfusion and Advanced Organ Monitoring.

Organ transplantation is undergoing profound changes. Contraindications for donation have been revised in order to better meet the organ demand. The use of lower-quality organs and organs with greater preoperative damage, including those from donation after cardiac death (DCD), has become an established routine but increases the risk of graft malfunction. This risk is further aggravated by ischemia and reperfusion injury (IRI) in the process of transplantation. These circumstances demand a preservation technology that ameliorates IRI and allows for assessment of viability and function prior to transplantation. Oxygenated hypothermic and normothermic machine perfusion (MP) have emerged as valid novel modalities for advanced organ preservation and conditioning. Ex vivo prolonged lung preservation has resulted in successful transplantation of high-risk donor lungs. Normothermic MP of hearts and livers has displayed safe (heart) and superior (liver) preservation in randomized controlled trials (RCT). Normothermic kidney preservation for 24 h was recently established. Early clinical outcomes beyond the market entry trials indicate bioenergetics reconditioning, improved preservation of structures subject to IRI, and significant prolongation of the preservation time. The monitoring of perfusion parameters, the biochemical investigation of preservation fluids, and the assessment of tissue viability and bioenergetics function now offer a comprehensive assessment of organ quality and function ex situ. Gene and protein expression profiling, investigation of passenger leukocytes, and advanced imaging may further enhance the understanding of the condition of an organ during MP. In addition, MP offers a platform for organ reconditioning and regeneration and hence catalyzes the clinical realization of tissue engineering. Organ modification may include immunological modification and the generation of chimeric organs. While these ideas are not conceptually new, MP now offers a platform for clinical realization. Defatting of steatotic livers, modulation of inflammation during preservation in lungs, vasodilatation of livers, and hepatitis C elimination have been successfully demonstrated in experimental and clinical trials. Targeted treatment of lesions and surgical treatment or graft modification have been attempted. In this review, we address the current state of MP and advanced organ monitoring and speculate about logical future steps and how this evolution of a novel technology can result in a medial revolution.

Comparing Methods of Determining Formalin Concentration in Fluid Preservatives

Abstract Formalin (3.7% weight/weight [w/w], 4% weight/volume [w/v] aqueous formaldehyde) is commonly used as a fixative to prevent postmortem changes in the tissues of a specimen. The specimen is then either maintained in formalin or transferred to another fluid preservative, such as ethanol or isopropanol, for long-term preservation. Residual formalin often remains in the preservation fluid. As formaldehyde is a known carcinogen, it is important to know the concentration present in preservation fluids. A titration method has been developed to determine formalin concentration in fluid preservatives. It utilizes sodium sulfite to react with formaldehyde in solution. An adjustable, repeating pipette and a digital titrator allow for the rapid determination of formalin concentrations in small samples (&amp;lt;1 ml). This method of titration is compared with three commercially available methods of determining formaldehyde and formalin concentration: two brands of formaldehyde test strips, Quantofix® (Machery-Nagel GmbH) and MQuant® (EMD Millipore Corp), and a drop count titration test kit (Hach® formaldehyde test kit, model FM-1). A comparison and evaluation are made on the effectiveness of each method in determining the concentration of formalin in preservation fluids.

Donor-derived bacterial infections in lung transplant recipients in the era of multidrug resistance

ObjectivesOur aim was to analyze the prevalence of multidrug-resistant bacterial infections in lung transplant donors and to evaluate its influence on donor-derived bacterial infections. MethodsWe conducted a retrospective study of adult patients who underwent lung transplantation (2013–2016) at our hospital. Donor-derived bacterial infection was defined as the isolation of the same bacteria with identical antibiotic susceptibility patterns in the recipient and the perioperative cultures from the donor during the first month posttransplantation. We utilized a preventive antibiotic strategy adapted to the bacteria identified in donor cultures using systemic and nebulized antibiotics. Results252 lung transplant recipients and 243 donors were included. In 138/243 (56.8%) donors, one bacterial species was isolated from at least one sample; graft colonization (118/243; 48.6%), blood cultures (5/243; 2.1%) and the contamination of preservation fluids (56/243; 23%). Multidrug-resistant bacteria were isolated from 12/243 (4.9%) donors; four Enterobacterales, four Stenotrophomonas maltophilia, three Pseudomonas aeruginosa and one methicillin-resistant Staphylococcus aureus. There was no transmission of these multidrug-resistant bacteria. Donor-derived infections, primarily tracheobronchitis due to non-MDR bacteria, were diagnosed in 7/253 (2.9%) recipients, with good clinical outcomes. ConclusionsThe lungs of donors colonized with multidrug-resistant bacteria may be safely used when recipients receive prompt tailored antibiotic treatment.

A standardized European trapping protocol – perspectives for long-term studies

Pitfall traps have a long tradition in carabidology and have been used for more than a century (e.g. over a century ago by Reitter). However, different trap designs were and are often used (e.g. preservative liquids, trap diameters, with or without roof). The resulting lack of comparability undermines the suitability of the catches, as for many modern ecological and conservation biological questions, the compilation of data across large geographical scales is important. This applies in particular to long-term studies, which are currently debated in Central Europe to mitigate insect decline. Therefore, standardization of the trapping protocol is urgently needed. Here we propose a trapping method protocol based on the protocols for long-term research in North America and Great Britain. In an open discussion the design and further research approaches have been debated with the participants of the 19th ECM in Rennes. A pilot study using two trap diameters and two preservation fluids allowed us to test the suitability of the new trap design. The aim of this contribution is the standardization of the trapping protocol and to stimulate discussions about joint projects which help us to understand and conserve the structure and function of ground beetle communities in Europe.

Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study

ObjectivesKidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. MethodsWe performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. ResultsOf 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1–9.1), multiorgan procurement (OR 1.4, 95% CI 1.1–1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3–4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3–0.5 and OR 0.6, 95% CI 0.5–0.7, respectively). ConclusionIn conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.

Toward safer thanatopraxy cares: formaldehyde-releasers use.

Human cadavers constitute very useful educational tools to teach anatomy in medical scholarship and related disciplines such as physiology, for example. However, as biological material, human body is subjected to decay. Thanatopraxy cares such as embalming have been developed to slow down and inhibit this decay, but the formula used for the preservation fluids are mainly formaldehyde (FA)-based. Very recently, other formulas were developed in order to replace FA, and to avoid its toxicity leading to important environmental and professional exposure concerns. However, these alternative FA-free fluids are still not validated or commercialized, and their efficiency is still under discussion. In this context, the use of FA-releasing substances, already used in the cosmetics industry, may offer interesting alternatives in order to reduce professional exposures to FA. Simultaneously, the preservation of the body is still guaranteed by FA generated over time from FA-releasers. The aim of this review is to revaluate the use of FA in thanatopraxy cares, to present its benefits and disadvantages, and finally to propose an alternative to reduce FA professional exposure during thanatopraxy cares thanks to FA-releasers use.

Compared efficacy of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions in ex-situ liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis patients

BackgroundThe University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). MethodsA total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW (n = 48) and HTK groups (n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. ResultsDemographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. ConclusionsThis is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.

Donor to Host Transmission of Infection in Lung Transplantation

Purpose To evaluate the incidence and etiology of donor infection and donor to host transmission of infections in lung transplantation. Methods We performed a retrospective cohort study of lung transplant patients at Hospital Italiano de Buenos Aires from January 2010 to March 2017. We analyzed data from electronic medical records. Donor infection was classified as bacteremia, graft colonization or isolated contamination of preservation fluids. Donor-to-host transmission of infection was defined as any infection in the recipient due to at least one microorganism also isolated from the donor and with identical antimicrobial susceptibility pattern. Results We included 55 lung transplant patients. Mean age was 48 years (SD 16), Single lung transplantation was performed in 75% of the cases. Cause of transplantation was chronic obstructive pulmonary disease (n=19), interstitial lung disease (n= 15), cystic fibrosis (n= 16) and others (n=5). Incidence of donor infection was 92.7% (n=51, 95%CI 82-98). Isolated contamination of preservation fluids was determined in 76.4% of cases (n= 42), graft colonization in 83.6% (n= 46) and bacteremia in 12.7% (n=7). The most common microorganisms isolated were gram positive coccus. Incidence of donor to host transmission of infection was 12.7% (n= 7, 95% CI 5-24). All cases were related to graft colonization. 40% (n=3) of recipients that developed infection had inadequate antibiotic prophylaxis. The microbiological etiologies were Acinetobacter baumannii (n=2), Klebsiella pneumoniae (n=2), Citrobacter koseri (n=1), Aspergillus fumigatus (n=1) and Methicillin-Sensitive Staphylococcus Aureus (n=1). Types of host infection were pneumonia (n=5), tracheobronchitis (n=1) and empyema (n=1). Infection-related death occurred in one patient. Conclusion The incidence of donor infection was high but donor to host transmission of infection after lung transplantation was an uncommon event. Inadequate antibiotic prophylaxis was high in those with donor to host transmission of infection. The most frequent etiology for donor infection was gram positive cocci. Gram negative bacteria was the most frequent cause of donor to host transmission of infection.

The Effect of Histidine-tryptophan-ketoglutarate Solution and University of Wisconsin Solution: An Analysis of the Eurotransplant Registry

Both University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are currently used in the Eurotransplant region for preservation of liver allografts. Previous studies on their effect have led to a lot of discussion. This study aims to compare the effect of HTK and UW on graft survival. First liver transplantations in recipients 18 years or older from January 1, 2007, until December 31, 2016, were included. Graft survival was compared for livers preserved with HTK and UW at 30 days, 1, 3, and 5 years. Multivariable analysis of risk factors was performed and outcome was adjusted for important confounders. Of all 10 628 first liver transplantations, 8176 (77%) and 2452 (23%) were performed with livers preserved with HTK and UW, respectively. Kaplan-Meier curves showed significant differences in graft survival between HTK and UW at 30 days (89% vs 93%, P=<0.001), 1 year (75% vs 82%, P=<0.001), 3 years (67% vs 72%, P<0.001), and at 5 years (60% vs 67%, P<0.001). No significant differences in outcome were observed in separate analyses of Germany or non-German countries. In multivariable analysis, UW was associated with a decreased risk of graft loss at 30 days (HR 0.772, P=0.002) and at 1 year (0.847 (0.757-0.947). When adjusted for risk factors, no differences in long term outcome could be detected. Because the use of preservation fluids is clustered geographically, differences in outcome by preservation fluids are strongly affected by regional differences in donor and recipient characteristics. When adjusted for risk factors, no differences in graft survival exist between transplantations performed with livers preserved with either HTK or UW.