Infusion of third party mesenchymal stem cells (MSC) after kidney and liver transplantation: a phase I-II, open-label, clinical study

Conference (2012, October 19)

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC ... [more ▼]

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC infusion after cadaveric kidney and liver transplantation in a prospective phase I-II study, taking advantage of our centre expertise and experience in MSC use in graft-versus-host disease (GVHD) after bone marrow transplantation and using an already functioning GMP-compliant laboratory producing clinical-grade MSC. Secondary end-points will help to evaluate the immunosuppressive potential of MSC after organ transplantation, and the opportunity to develop larger randomised, controlled, phase III trials. After successful transplantation, 10 liver and 10 kidney transplant recipients under standard immunosuppression (tacrolimus, MMF, steroids) will receive an intravenous infusion of 1.5-3x106/kg of third-party MSC on post-operative day 3±2. These patients will be prospectively compared to 10 liver and 10 kidney recipients who meet the inclusion criteria but deny MSC infusion. Safety will be assessed by recording side effects, including opportunistic infections and cancers. Immunosuppressive potential will be evaluated by rejection episode rates, by graft/patient survivals, by immunohistology of 3-months kidney and 6-month liver graft biopsies and by in vitro evaluation of the immunity profile of the recipients. In a second step, reduction (kidney) and progressive weaning (liver) of immunosuppression will be attempted in recipients who received MSC. This ongoing study is supported by research grants from the CHU of Liège, University of Liège, and by the Senior Clinical Research Grant from ESOT. The first patients were included and treated in early 2012, and final results expected in late 2013. [less ▲]

Do dead from cardiovascular death donors experience end-of-life shortening?

Conference (2011, March 24)

End of life care in the operating room for non-heart-beating donors: organization at the University Hospital of Liege.

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 ▲]

Les prélèvements à coeur arrêté: une source d'organes trop souvent oubliée?

in Hospitals.be (2010), 8(1), 7-12

La transplantation est aujourd’hui victime de son succès. Les procédures de prélèvement à coeur arrêté se doivent de respecter les règles d’éthique et les dispositions légales en la matière. La pénurie ... [more ▼]

La transplantation est aujourd’hui victime de son succès. Les procédures de prélèvement à coeur arrêté se doivent de respecter les règles d’éthique et les dispositions légales en la matière. La pénurie relative d’organes sera partiellement comblée lorsqu’elles seront appliquées dans une majorité d'hôpitaux du pays. [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 ▲]

An 11 - Year Overview of the belgian donor and transplant statistics bsed on a consecutive yearly data follow-up and comparing two periods : 1997 to 2005 versus 2006 to 2007

in Transplantation Proceedings (2009), 41

Background. The Belgian Transplant Coordinators Section is responsible for the yearly data follow-up concerning donor and transplantation statistics in Belgium and presents herein a 10-year overview ... [more ▼]

Background. The Belgian Transplant Coordinators Section is responsible for the yearly data follow-up concerning donor and transplantation statistics in Belgium and presents herein a 10-year overview. Methods. The procurement and transplant statistics were compared between 2 periods: Period 1 (P1, 1997–2005) versus Period 2 (P2, 2006–2007). Results. The kidney and liver waiting lists (P1 vs P2) showed an overall decrease for a period of 2 consecutive years in P2; kidney ( 170 patients; 18%), and liver ( 83 patients; 34%). All other waiting lists (heart, lung, pancreas) remained stable. Mean ED further increased (P1 vs P2); 229 (P1) versus 280 (P2, 22.27%). Non–heart-beating donors were significantly ( 288%) more often procured in P2. Mean donor age was 37.9 17.8 years (P1) versus 46.5 19.9 years (P2), and mean organ yield per donor was 3.48 1.7 (P1) versus 3.38 1.8 (P2). Overall transplant activity per million inhabitants increased 21.1%. Conclusion. For 2 consecutive years, the Belgian statistics showed significantly increased donor activity with an impact on waiting list dynamics and transplantation. The mean organ yield per donor was not influenced despite an increased average age and change in reason for death. [less ▲]

La transplantation hépatique après prélèvement à cœur non battant : expérience de l’Université de Liège

Conference (2008, October 10)

Overview of the Belgian Donor and Transplant Statistics 2006: Results of Consecutive Yearly Data Follow-up by the Belgian Section of Transplant Coordinators

in Transplantation Proceedings (2007), 39

Background. The Belgian Section of Transplant Coordinators, created in 1997 under the auspices of the Belgian Transplant Society, is in charge of the collection of the national data about donor ... [more ▼]

Background. The Belgian Section of Transplant Coordinators, created in 1997 under the auspices of the Belgian Transplant Society, is in charge of the collection of the national data about donor/procurement activities. Methods. Data are collected in all Belgian transplant centers. An annual report is finalized by combining these data with data from the Eurotransplant database. Results. An increase of both potential donors (n 501, 14.4%) and effective donors (n 273, 16.7%) was observed in 2006 versus 2005. Among effective donors, 28 were non–heart-beating donors (10.25%). Overall donor ratio was 26.26 donors per million inhabitants. Within potential donors, absence of organ harvesting was due to medical contraindications (28%), family refusal (13%), or legal refusal (2%). Donor mean age was 46.4 years and mean organs/donor was 3.21 1.7. An overall reduction of Belgian waiting lists was observed in 2006 as compared with 2005 ( 5.7% for kidney, 25.7% for liver, 9.4% for heart, 6.7% for lung, and 11.7% for pancreas), while waiting list mortality was 18% for liver, 11% for heart, and 7% for lung. As compared with 2005, transplant activities increased for kidney (n 485, 24.3%), heart lungs (n 73, 7.3%), and lungs (n 83, 39.4%) but decreased for liver (n 236, 2.1%). Living donation represented 8.45% for kidney ( 28.1% vs 2005) and 8% for liver transplantation ( 29.6%). Conclusion. Globally, a marked increase of procurement and transplant activities was observed in 2006, allowing to limit waiting list and waiting list mortality. Further increase of living donor activity and non–heart-beating donation remains necessary to extend the donor pool. [less ▲]

Cadaveric whole liver transplantation for non-acetaminophen fulminant hepatic failure: A 20-year experience

in Journal of Hepatology (2007), 46(Suppl. 1), 66-67

Bloodless cadaveric liver transplantation: Experience with Jehovah's witness recipients

in Journal of Hepatology (2007), 46(Suppl. 1), 67