Donation after cardio-circulatory death liver transplantation.

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 ▲]

DREAM 2012: DEVELOPMENT OF LAPAROSCOPIC SURGERY AT THE UNIVERSITY HOSPITAL OF KINSHASA, DRC

in Acta Chirurgica Belgica (2012, May), 112(3), 8240

Objectives: The technical nature of laparoscopy, and the required specific laparoscopic tools and medical skills, may render this approach difficult in developing countries. We hypothesized that ... [more ▼]

Objectives: The technical nature of laparoscopy, and the required specific laparoscopic tools and medical skills, may render this approach difficult in developing countries. We hypothesized that laparoscopy may be developed in the Cliniques Universitaires de Kinshasa (CUK), and may be cost-effective. The final aim of this program is to bring the benefits of laparoscopy to the DRC population, by allowance of adequate training on the UNIKIN personnel, including anaesthetists, surgeons and nurses, who in the future will have to locally form the DRC medical and nursery students. Methods: With the financial support from Wallonie-Bruxelles International (WBI), a complete CUK team, including a surgeon (2 years training in Belgium), an anaesthetist and nurses, were trained in Belgium and then afterwards in DRC. The laparoscopic equipment was sent to Kinshasa, and three theoretical and practical missions of Belgian teams were organised. Results: Over a 2 year period, 116 laparoscopic procedure were performed, including 32 appendectomies, 41 cholecystectomies, 11 hernia repairs, 9 laparoscopy explorations for peritoneal carcinoma assessment and biopsy, 8 procedures for catheter of dialysis peritoneal, 5 gynecologics procedures, and 10 other miscellaneous procedures. Conclusions: A joined approach, taking into account on one hand the training of the skills locally trained to adapt itself to some difficulties, on the other hand institutions of scientific support and a real program and local will of development of this new procedure are the wages of development, accessibility and durability of such news approach in developing countries. All University and non-University team willing to join such a project are welcome. [less ▲]

DCD liver transplantation: is donor age an issue?

in Liver Transplantation (2011, July), 17(6S1), 112

DREAM 2020: Development of laparoscopic surgery and endoscopy in the university hospital of Kinshasa, DRC

in Acta Gastro-Enterologica Belgica (2011, March), 74(1), 14

FATAL SMALL FOR SIZE SYNDROME AFTER RIGHT LOBE DONATION

in Transplant International (2011, February), 24(1), 8-8

Contribution of donors after cardiac death to the deceased donor pool: 2002 to 2009 university of liege experience.

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 ▲]

Analgésie après coelioscopie

Conference (2010, March)

Effect of an intravenous infusion of lidocaine on cisatracurium-induced neuromuscular block duration: a randomized-controlled trial.

in Acta Anaesthesiologica Scandinavica (2010), 54(10), 1192-6

BACKGROUND: Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking ... [more ▼]

BACKGROUND: Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking agents. We hypothesized that intravenous lidocaine would prolong the time to recovery of neuromuscular function after cisatracurium. METHODS: Forty-two patients were enrolled in this randomized, double-blind, placebo-controlled study. Before induction, patients were administered either a 1.5 mg/kg bolus of intravenous lidocaine followed by a 2 mg/kg/h infusion or an equal volume of saline. Anaesthesia was induced and maintained using propofol and remifentanil infusions. After loss of consciousness, a 0.15 mg/kg bolus of cisatracurium was administered. No additional cisatracurium injection was allowed. Neuromuscular function was assessed every 20 s using kinemyography. The primary endpoint was the time to spontaneous recovery of a train-of-four (TOF) ratio >/= 0.9. RESULTS: The time to spontaneous recovery of a TOF ratio >/= 0.9 was 94 +/- 15 min in the control group and 98 +/- 16 min in the lidocaine group (P=0.27). CONCLUSIONS: No significant prolongation of spontaneous recovery of a TOF ratio >/= 0.9 after cisatracurium was found in patients receiving intravenous lidocaine. [less ▲]

Liver transplant donation after cardiac death : experience at the University of Liège

in Transplantation Proceedings (2009), 41(2), 582-4

Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher ... [more ▼]

Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher rate of primary non-function and ischemic type biliary lesions. In this study we reviewed the results of DCD liver transplantation at the University of Liège. Patients and Methods: From 2003 to 2007, 13 controlled DCD liver transplantations were consecutively performed. The records of all donors and recipients were retrospectively reviewed, particularly evaluating the outcome and the occurrence of biliary complications. Mean follow-up was 25 months. Results: Mean donor age was 51 years and their mean intensive care stay was 5.4 days. Mean time between ventilation arrest and cardiac arrest was 9.3 min. Mean time between cardiac arrest and arterial flush was 7.7 min. No touch period was 2 to 5 min. Mean graft cold ischemia was 295 min and mean suture warm ischemia was 38 min. Postoperatively there was no primary non-function. Mean peak transaminase was 2,546 UI/ml. Patient and graft survival was 100% at one year. Two patients (15%) developed graft main bile duct stenosis and underwent endoscopic management. No patient developed symptomatic intrahepatic bile duct strictures or needed retransplantation in the follow-up. Conclusions: The experience of the transplantation department of the University of Liege confirms that controlled DCD donors may be a valuable source of transplantable liver grafts, in case of short procurement warm ischemia and short transplant cold ischemia. [less ▲]

Injection intraveineuse d'anesthésiques locaux, lidocaïne: intérêt, limites, utilisation en pratique

in Webanesthésie (2009), 1(3), 090008