Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme.
DETRY, Olivier ; DE ROOVER, Arnaud ; MEURISSE, Nicolas et al
in The British journal of surgery (2014), 10(7), 784-792
BACKGROUND: Results of donation after circulatory death (DCD) liver transplantation are impaired by graft loss, resulting mainly from non-anastomotic biliary stricture. Donor age is a risk factor in ... [more ▼]
BACKGROUND: Results of donation after circulatory death (DCD) liver transplantation are impaired by graft loss, resulting mainly from non-anastomotic biliary stricture. Donor age is a risk factor in deceased donor liver transplantation, and particularly in DCD liver transplantation. At the authors' institute, age is not an absolute exclusion criterion for discarding DCD liver grafts, DCD donors receive comfort therapy before withdrawal, and cold ischaemia is minimized. METHODS: All consecutive DCD liver transplantations performed from 2003 to 2012 were studied retrospectively. Three age groups were compared in terms of donor and recipient demographics, procurement and transplantation conditions, peak laboratory values during the first post-transplant 72 h, and results at 1 and 3 years. RESULTS: A total of 70 DCD liver transplants were performed, including 32 liver grafts from donors aged 55 years or less, 20 aged 56-69 years, and 18 aged 70 years or more. The overall graft survival rate at 1 month, 1 and 3 years was 99, 91 and 72 per cent respectively, with no graft lost secondary to non-anastomotic stricture. No difference other than age was noted between the three groups for donor or recipient characteristics, or procurement conditions. No primary non-function occurred, but one patient needed retransplantation for artery thrombosis. Biliary complications were similar in the three groups. Graft and patient survival rates were no different at 1 and 3 years between the three groups (P = 0.605). CONCLUSION: Results for DCD liver transplantation from younger and older donors were similar. Donor age above 50 years should not be a contraindication to DCD liver transplantation if other donor risk factors (such as warm and cold ischaemia time) are minimized. [less ▲]Detailed reference viewed: 33 (12 ULg)
A More Than 20% Increase in Deceased-Donor Organ Procurement and Transplantation Activity After the Use of Donation After Circulatory Death.
; MONARD, Josée ; DELBOUILLE, Marie-Hélène et al
in Transplantation proceedings (2014), 46(1), 9-13
BACKGROUND: Organ procurement and transplant activity from controlled donation after circulatory death (DCD) was evaluated over an 11-year period to determine whether this program influenced the ... [more ▼]
BACKGROUND: Organ procurement and transplant activity from controlled donation after circulatory death (DCD) was evaluated over an 11-year period to determine whether this program influenced the transplant and donation after brain death (DBD) activities. MATERIAL AND METHODS: Deceased donor (DD) procurement and transplant data were prospectively collected in a local database for retrospective review. RESULTS: There was an increasing trend in the potential and actual DCD numbers over time. DCD accounted for 21.9% of the DD pool over 11 years, representing 23.7% and 24.2% of the DD kidney and liver pool, respectively. The DBD retrieval and transplant activity increased during the same time period. Mean conversion rate turning potential into effective DCD donors was 47.3%. Mean DCD donor age was 54.6 years (range, 3-83). Donors >/=60 years old made up 44.1% of the DCD pool. Among referred donors, reasons for nondonation were medical contraindications (33.7%) and family refusals (19%). Mean organ yield per DCD donor was 2.3 organs. Mean total procurement warm ischemia time was 19.5 minutes (range, 6-39). In 2012, 17 DCD and 37 DBD procurements were performed in the Liege region, which has slightly >1 million inhabitants. CONCLUSIONS: This DCD program implementation enlarged the DD pool and did not compromise the development of DBD programs. The potential DCD pool might be underused and seems to be a valuable organ donor source. [less ▲]Detailed reference viewed: 37 (15 ULg)
IS ULTRA-SHORT COLD ISCHEMIA THE KEY TO ISCHEMIC CHOLANGIOPATHY AVOIDANCE IN DCD- LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Transplant International (2013, December), 26(S2), 53-98
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic ... [more ▼]
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic cholangiopathy leading to graft loss. The authors retrospectively reviewed a single centre experience with DCD-LT in a 9-year period. Patients and Methods: 70 DCD-LT were performed from 2003 to November 2012. All DCD procedures were performed in operative rooms. Median donor age was 59 years. Most grafts were flushed with HTK solution. Allocation was centre-based. Median total DCD warm ischemia was 19.5 min. Mean follow-up was 36 months. No patient was lost to follow-up. Results: Median MELD score at LT was 15. Median cold ischemia was 235 min. Median peak AST was 1,162 U/L. Median peak bilirubin was 31.2 mg/dL. Patient and graft survivals were 92.8% and 91.3% at one year and 79% and 77.7% at 3 years, respectively. One graft was lost due to hepatic artery thrombosis. No PNF or graft loss due to ischemic cholangiopathy was observed in this series. Causes of death were malignancies in 8 cases. Discussion: In this series, DCD LT appears to provide results equal to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]Detailed reference viewed: 25 (5 ULg)
Is ultra-short cold ischemia the key to ischemic cholangiopathy avoidance in DCD-LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Acta Chirurgica Belgica (2013, May), Supplement 113(3), 6729Detailed reference viewed: 43 (12 ULg)
Feasibility and accessibility to the laparoscopic procedures in University Hospital of Kinshasa
; ; et al
in Surgical Endoscopy (2013), 27Detailed reference viewed: 17 (2 ULg)
Laparoscopic liver resection: a single center experience
SZECEL, Delphine ; DE ROOVER, Arnaud ; DELWAIDE, Jean et al
in Surgical Endoscopy (2013), 27Detailed reference viewed: 21 (5 ULg)
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: 22 (5 ULg)
Laparoscopic liver resection: a single center experience
SZECEL, Delphine ; DE ROOVER, Arnaud ; DELWAIDE, Jean et al
in Acta Chirurgica Belgica (2012, May), 112(3), 631Detailed reference viewed: 66 (5 ULg)
DREAM 2012: DEVELOPMENT OF LAPAROSCOPIC SURGERY AT THE UNIVERSITY HOSPITAL OF KINSHASA, DRC
Nsadi Fwene, Berthier ; ; et al
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 ▲]Detailed reference viewed: 32 (1 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: 41 (6 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: 41 (6 ULg)
DREAM 2020: Development of laparoscopic surgery and endoscopy in the university hospital of Kinshasa, DRC
; ; et al
in Acta Gastro-Enterologica Belgica (2011, March), 74(1), 14Detailed reference viewed: 35 (4 ULg)
Laparoscopic liver resection: monocentric university experience
; ARENAS SANCHEZ, Maria Mara ; DE ROOVER, Arnaud et al
in Acta Gastro-Enterologica Belgica (2011, March), 74(1), 30Detailed reference viewed: 43 (7 ULg)
FATAL SMALL FOR SIZE SYNDROME AFTER RIGHT LOBE DONATION
DETRY, Olivier ; DE ROOVER, Arnaud ; LAUWICK, Séverine et al
in Transplant International (2011, February), 24(1), 8-8Detailed reference viewed: 28 (11 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: 93 (24 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: 37 (15 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: 31 (3 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: 54 (3 ULg)