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See detailExtending Donor Pool with Donation after Cardiac Death in Kidney and Liver Transplantation:What is the Price to Pay?
Le Dinh, Hieu ULg

Doctoral thesis (2012)

Through a series of clinical studies, this thesis aims to clarify the contribution of donation after cardiac death (DCD) to the deceased donor (DD) pool and results of kidney and liver transplantation ... [more ▼]

Through a series of clinical studies, this thesis aims to clarify the contribution of donation after cardiac death (DCD) to the deceased donor (DD) pool and results of kidney and liver transplantation coming from this donor source in Liège and Belgium. Additionally, an adapted DCD Maastricht classification is also discussed. Chapters 2.1 and 2.2 summarize the DCD procurement and transplant activity in Liège and Belgium from 2000 to 2009 with an update on data up to 2011. In Liège, DCD really contributes to the DD pool and boosts the transplant activity of the center in both kidneys and livers by on average 30%. By contrast, the steady rise in DCD activity in Belgium does not lead to major increase in the DD donation and transplantation. In other words, some kind of donor-type redistribution within the DD pool might occur. Chapters 2.2, 3.1, and 3.2 discuss the results of kidney transplantation (KT) from DCD. We demonstrate that Liège‟s experience is comparable to the national level in Belgium and does not differ from the general results in the world with regard to early graft dysfunction, medium-term graft function, graft and patient survival. The excellent results of DCD-KT are attributed to the relatively short warm and cold ischemia, favorable donor factors, and the role of hypothermic machine perfusion (in Belgian series). Chapters 4.1, and 4.2 discuss the results of liver transplantation (LT) from DCD. Liège‟s results are encouraging and apparently as good as those from donation-after-brain-death LT because of short warm and cold ischemia times. Belgian results show an increased incidence of primary non-function and ischemic cholangiopathy which is in agreement with previously published data. Chapter 5 proposes an adapted DCD Maastricht classification which maintains the original categories 1 to 4 that are now well-known and widely accepted, and adds a fifth category, so-called „DCD after euthanasia‟. Each category is divided into two or three sub-categories: sub-category A is linked to longer warm ischemia (and worse results) than sub-category B; and B versus C, respectively. In addition, sub-categories A (2A, 3A, 4A, and 5A) are mostly linked to DCD processes occurring in the ICU, which helps to understand and memorize this classification. By keeping the original skeleton of the 1995 Maastricht classification, room is left to add new sub-categories in the future, if deemed clinically relevant. [less ▲]

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See detailCategories of donation after cardiocirculatory death.
DETRY, Olivier ULg; Le Dinh, Hieu ULg; NOTERDAEME, Timothée et al

in Transplantation Proceedings (2012), 44(5), 1189-95

The interest in donation after cardiocirculatory death (DCD) was renewed in the early 1990s, as a means to partially overcome the shortage of donations after brain death. In some European countries and in ... [more ▼]

The interest in donation after cardiocirculatory death (DCD) was renewed in the early 1990s, as a means to partially overcome the shortage of donations after brain death. In some European countries and in the United States, DCD has become an increasingly frequent procedure over the last decade. To improve the results of DCD transplantation, it is important to compare practices, experiences, and results of various teams involved in this field. It is therefore crucial to accurately define the different types of DCD. However, in the literature, various DCD terminologies and classifications have been used, rendering it difficult to compare reported experiences. The authors have presented herein an overview of the various DCD descriptions in the literature, and have proposed an adapted DCD classification to better define the DCD processes, seeking to provide a better tool to compare the results of published reports and to improve current practices. This modified classification may be modified in the future according to ongoing experiences in this field. [less ▲]

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See detailLiège experience in donation after cardiac death liver transplantation: 2003-2011
Le Dinh, Hieu ULg; DELWAIDE, Jean ULg; MONARD, Josée ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 6811

Objectives: Results of DCD-LT at the University Hospital of Liège were evaluated from 2003 to 2011. Methods: Medical records of 56 DCD liver recipients were retrospectively reviewed with regard to patient ... [more ▼]

Objectives: Results of DCD-LT at the University Hospital of Liège were evaluated from 2003 to 2011. Methods: Medical records of 56 DCD liver recipients were retrospectively reviewed with regard to patient and graft survivals and biliary complications. Mean follow-up was 26.4 months. Mean donor age was 56.3±14.5 years (25 - 83). Donor causes of death were due to anoxia (51.8%), stroke (32.1%) and head trauma (14.3%). Mean WIT, CIT and suture time were 20.5±7.1min (10 – 39), 265.6±85.1min (105 – 576), and 40.8±7.8 min (25 – 61), respectively. 95% of liver grafts were locally shared. HTK was the most commonly used perfusion solution (86%). Mean recipient age was 56.6±10.5 years (29 – 73). Indications for LT included ESLD (53.6%) and HCC (46.6%). Mean MELD score at transplant was 15.6±6.1points (6 – 40). Results: No primary non-function grafts. Mean peak serum AST and bilirubin levels were 2520±3621UI/L and 50.2±49.2mg/L, respectively. Eight patients (14.3%) developed biliary complications. No intra-hepatic bile duct strictures or re-transplantation. Global patient and graft survival was 92.6% at 3 months, 92.6% at 1 year, 73.8% at 3 years and 60% at 5 years. Death-censored patient and graft survival at the corresponding time points was 92.6%, 92.6%, 87.7% and 87.7%. Thirteen liver grafts were lost during follow-up exclusively due to recipient deaths. The rate of HCC recurrence was 33.3%. Conclusions: Controlled DCD donors are a valuable source of transplantable liver grafts. Primary results are encouraging and apparently as good as those from brain-dead donation LT essentially due to short WIT and CIT. [less ▲]

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience
Le Dinh, Hieu ULg; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 667

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival ... [more ▼]

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. Methods: This is a retrospective mono-center review of a consecutive series of 80 DCD-KT performed at the University Hospital of Sart Tilman, University of Liège, between Jan 2005 and Dec 2011. Mean patient follow-up was 28.5 months. Results: Overall graft survival was 93.7%, 89.5%, 85% and 81.3% at 3 months, 1 year, 3 and 5 years, respectively. Death-censored graft survival at the corresponding time points was 93.7%, 93.7%, 90.8% and 90.8%. Main cause of graft loss was patient’s death with a functioning graft. No primary non-function grafts were encountered. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 36% of all DCD-KT. DGF significantly increased post-operative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index (BMI) ≥30 kg/m2, recipient BMI ≥30 kg/m2 and pre-transplant dialysis duration significantly increased the risk of DGF in a multivariate logistic regression analysis (p < 0.05). Conclusions: Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailLIVER TRANSPLANTATION FROM DONATION AFTER CARDIOCIRCULATORY DEATH (DCD) DONORS: BELGIAN EXPERIENCE 2003-2009
DE ROOVER, Arnaud ULg; Le Dinh, Hieu ULg; Cicarelli, Olga et al

in Transplant International (2011, September), 24(2), 84-84

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