Donation after cardio-circulatory death liver transplantation.
; DE ROOVER, Arnaud ; KABA, Abdourahmane et al
in World Journal of Gastroenterology (2012), 18(33), 4491-506
The renewed interest in donation after cardio-circulatory death (DCD) started in the 1990s following the limited success of the transplant community to expand the donation after brain-death (DBD) organ ... [more ▼]
The renewed interest in donation after cardio-circulatory death (DCD) started in the 1990s following the limited success of the transplant community to expand the donation after brain-death (DBD) organ supply and following the request of potential DCD families. Since then, DCD organ procurement and transplantation activities have rapidly expanded, particularly for non-vital organs, like kidneys. In liver transplantation (LT), DCD donors are a valuable organ source that helps to decrease the mortality rate on the waiting lists and to increase the availability of organs for transplantation despite a higher risk of early graft dysfunction, more frequent vascular and ischemia-type biliary lesions, higher rates of re-listing and re-transplantation and lower graft survival, which are obviously due to the inevitable warm ischemia occurring during the declaration of death and organ retrieval process. Experimental strategies intervening in both donors and recipients at different phases of the transplantation process have focused on the attenuation of ischemia-reperfusion injury and already gained encouraging results, and some of them have found their way from pre-clinical success into clinical reality. The future of DCD-LT is promising. Concerted efforts should concentrate on the identification of suitable donors (probably Maastricht category III DCD donors), better donor and recipient matching (high risk donors to low risk recipients), use of advanced organ preservation techniques (oxygenated hypothermic machine perfusion, normothermic machine perfusion, venous systemic oxygen persufflation), and pharmacological modulation (probably a multi-factorial biologic modulation strategy) so that DCD liver allografts could be safely utilized and attain equivalent results as DBD-LT. [less ▲]Detailed reference viewed: 32 (7 ULg)
What is the potential increase of the heart graft pool by cardiac donation after circulatory death?
; HANS, Marie-France ; NELLESSEN, Eric et al
in Acta Chirurgica Belgica (2012, May), 112(3), 668Detailed reference viewed: 13 (2 ULg)
Mechanical Ventilation During Anaesthesia: Pathophysiology and Clinical Implications
; JORIS, Jean ; HANS, Grégory
in Trends in Anaesthesia and Critical Care (2012), 2(2), 71-75Detailed reference viewed: 15 (3 ULg)
Bénéfices démontrés et potentiels de l'administration intraveineuse périopératoire de lidocaïne
; LAUWICK, Séverine ; KABA, Abdourahmane et al
in Revue Médicale de Liège (2012), 67(2), 81-84Detailed reference viewed: 46 (6 ULg)
Cardiac paraganglioma : diagnostic work up and review of the literature.
Sooknunden, Marvyn ; HAMOIR, Etienne ; de Leval, Laurence et al
in Acta Chirurgica Belgica (2012), 112Detailed reference viewed: 51 (3 ULg)
Do dead from cardiovascular death donors experience end-of-life shortening?
LEDOUX, Didier ; DELBOUILLE, Marie-Hélène ; MONARD, Josée et al
Conference (2011, March 24)Detailed reference viewed: 46 (6 ULg)
End of life care in the operating room for non-heart-beating donors: organization at the University Hospital of Liege.
JORIS, Jean ; KABA, Abdourahmane ; LAUWICK, Séverine et al
in Transplantation Proceedings (2011), 43(9), 3441-4
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many ... [more ▼]
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many institutions the end of life care of the NHB donor (NHBD) is terminated in the operating room (OR) to reduce warm ischemia time. Herein we have described the organization of end of life care for these patients in our institution, including the problems addressed, the solution proposed, and the remaining issues. Emphasis is given to our protocol elaborated with the different contributors of the chain of the NHB donation program. This protocol specifies the information mandatory in the medical records, the end of life care procedure, the determination of death, and the issue of organ preservation measures before NHBD death. The persisting malaise associated with NHB donation reported by OR nurses is finally documented using an anonymous questionnaire. [less ▲]Detailed reference viewed: 132 (24 ULg)
Renal transplantation from living related donors: a single center experience in viet nam.
; Detry, Olivier ; et al
in Transplantation Proceedings (2010), 42(10), 4389-91
INTRODUCTION: End-stage renal disease is a major public health problem in Viet Nam. A cooperative project between the University of Liege, Belgium, and the University of Medicine Pham Ngoc Thach, Ho Chi ... [more ▼]
INTRODUCTION: End-stage renal disease is a major public health problem in Viet Nam. A cooperative project between the University of Liege, Belgium, and the University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Viet Nam, has permitted the establishment of an autonomous program of renal transplantation from living-related donors at the Peoples' Hospital No 115. The aim of this paper was to report the primary results of the project and to draw conclusions for the future. PATIENTS AND METHODS: From January 2004 to July 2008, we performed 33 living-related renal transplantations. Mean ages of donors and recipients were 31.8 +/- 9.5 and 41.6 +/- 13.5 years, respectively. Laparoscopic nephrectomy was performed in 6 donors. The immunosuppressive regimen consisted of three drugs associated with induction therapy using anti-interleukin-2 receptor monoclonal antibody. RESULTS: The 33 donors are in good health at follow-up. Four developed major intra- or postoperative hemorrhage necessitating transfusion, with a surgical re-exploration in 1 donor. Wound infection occurred in 2 donors. Posttransplant recipient and graft survivals at 1 versus 3 years were 82% and 73% versus 82% and 65%, respectively. Eight recipients presented 13 biopsy-proven acute rejection episodes that were reversible in 7, but 1 patient lost his graft due to an irreversible rejection. Two recipients developed cancer. CONCLUSIONS: These initial results have encouraged us to continue the program of renal transplantation from living-related donors. However, they also pointed out the need to develop other donor sources. [less ▲]Detailed reference viewed: 39 (9 ULg)
Contribution of donors after cardiac death to the deceased donor pool: 2002 to 2009 university of liege experience.
; Meurisse, Nicolas ; Delbouille, Michèle et al
in Transplantation Proceedings (2010), 42(10), 4369-72
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine ... [more ▼]
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine whether this program influenced transplantation programs, or donation after brain death (DBD) activity. METHODS: We prospectively collected our procurement and transplantation statistics in a database for retrospective review. RESULTS: We observed an increasing trend in potential and actual DCD number. The mean conversion rate turning potential into effective donors was 58.1%. DCD accounted for 16.6% of the deceased donor (DD) pool over 8 years. The mean age for effective DCD donors was 53.9 years (range, 3-79). Among the effective donors, 63.3% (n = 31) came from the transplant center and 36.7% (n = 18) were referred from collaborative hospitals. All donors were Maastricht III category. The number of kidney and liver transplants using DCD sources tended to increase. DCD kidney transplants represented 10.8% of the DD kidney pool and DCD liver transplants made up 13.9% of the DD liver pool over 8 years. The DBD program activity increased in the same time period. In 2009, 17 DCD and 33 DBD procurements were performed in a region with a little >1 million inhabitants. CONCLUSION: The establishment of a DCD program in our institution enlarged the donor pool and did not compromise the development of the DBD program. In our experience, DCD are a valuable source for abdominal organ transplantation. [less ▲]Detailed reference viewed: 41 (16 ULg)
Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation.
Hans, Grégory ; Lauwick, Séverine ; Kaba, Abdourahmane et al
in British Journal of Anaesthesia (2010), 105(4), 471-9
BACKGROUND: I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia. METHODS: A randomized ... [more ▼]
BACKGROUND: I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia. METHODS: A randomized controlled study of 40 patients tested the effect of i.v. lidocaine (1.5 mg kg(-1) then 2 mg kg(-1) h(-1)) on propofol requirements. Anaesthesia was maintained with remifentanil and propofol target-controlled infusions (TCI) to keep the bispectral index (BIS) around 50. Effect-site concentrations of propofol and remifentanil and BIS values were recorded before and after skin incision. Data were analysed using anova and mixed effects analysis with NONMEM. Two dose-response studies were then performed with and without surgical stimulation. Propofol TCI titrated to obtain a BIS around 50 was kept constant. Then patients were randomized into four groups: A, saline; B, 0.75 mg kg(-1) bolus then infusion 1 mg kg(-1) h(-1); C, 1.5 mg kg(-1) bolus and infusion 2 mg kg(-1) h(-1); and D, 3 mg kg(-1) bolus and infusion 4 mg kg(-1) h(-1). Lidocaine administration coincided with skin incision. BIS values and haemodynamic variables were recorded. Data were analysed using linear regression and two-way anova. RESULTS: Lidocaine decreased propofol requirements (P<0.05) only during surgery. In the absence of surgical stimulation, lidocaine did not affect BIS nor haemodynamic variables, whereas it reduced BIS increase (P=0.036) and haemodynamic response (P=0.006) secondary to surgery. CONCLUSIONS: The sparing effect of lidocaine on anaesthetic requirements seems to be mediated by an anti-nociceptive action. [less ▲]Detailed reference viewed: 136 (5 ULg)
Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy
Senard, Marc ; ; Ledoux, Didier et al
in British Journal of Anaesthesia (2010), 105(2), 196-200Detailed reference viewed: 38 (6 ULg)
Norepinephrine and ephedrine do not counteract the increase in cutaneous microcirculation induced by spinal anaesthesia.
Lecoq, Jean-Pierre ; Brichant, Jean-François ; Lamy, Maurice et al
in British Journal of Anaesthesia (2010), 105(2), 214-9
BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive ... [more ▼]
BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive drugs. The use of peripheral vasoconstrictors might counteract the improved tissue perfusion and its potentially beneficial effects. We therefore investigated the effect of i.v. norepinephrine and ephedrine on skin perfusion using laser-Doppler flowmetry (LDF) in patients during spinal anaesthesia. METHODS: /st> Skin blood flow expressed in perfusion units (PU) provided by LDF was measured simultaneously at the foot and the manubrium levels in 44 patients during spinal anaesthesia with a sensory level below T5. Norepinephrine infusion was then titrated to normalize mean arterial pressure (MAP) in 23 patients (Group NOR). Ephedrine (max. 10 mg) was administered in 21 patients (Group EPH). Changes in relative PU were compared between the two sites of measurements in each group during drug administration. The same doses of norepinephrine were assessed in 11 normal volunteers to assure comparable vasoreactivity at the foot and manubrium levels. RESULTS: /st> Spinal anaesthesia resulted in a 10% decrease in MAP (P<0.001), an increase in relative PU values at the foot level (P<0.001), and a decrease at the sternum level (P<0.05). Norepinephrine and ephedrine produced a significant increase in relative PU values at the foot level when compared with the sternum level (NOR: P=0.02; EPH: P=0.0035). In volunteers, norepinephrine decreased cutaneous perfusion similarly at the manubrium and foot levels. CONCLUSIONS: /st> Improved skin perfusion induced by spinal anaesthesia was not counteracted by the use of norepinephrine or ephedrine. [less ▲]Detailed reference viewed: 44 (8 ULg)
Donation after Cardiac Death In Liver Transplantation :is donor age an issue?
Detry, Olivier ; De Roover, Arnaud ; Squifflet, Jean-Paul et al
in Acta Chirurgica Belgica (2010, April), 110Detailed reference viewed: 18 (7 ULg)
Sevrage tabagique en préopératoire: une période propice pour lutter contre l'inertie et le défaut d'observance
; ; Clerdain, Anne-Michèle et al
in Revue Médicale de Liège (2010), 65(5-6), 332-337Detailed reference viewed: 31 (6 ULg)
What is the outcome of intraoperative management? Reply
Hans, Grégory ; ; Joris, Jean
in European Journal of Anaesthesiology (2010), 27Detailed reference viewed: 7 (1 ULg)
Scarless cholecystectomy: laparoscopic surgery by unique umbilical incision
Kohnen, Laurent ; Coimbra Marques, Carla ; De Roover, Arnaud et al
in Revue Médicale de Liège (2010), 65(10), 543-4Detailed reference viewed: 61 (4 ULg)
Effect of the transversus abdominis plane block on pain after laparoscopic inguinal hernia repair
; ; Detry, Olivier et al
in Acta Anaesthesiologica Belgica (2009, September 19), 60(3), 205Detailed reference viewed: 75 (5 ULg)