  Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: A proof-of-concept study using discarded human livers.; ; et al in Liver Transplantation (2012), 18(12), 1495-507 The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk ... [more ▼] The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured. Liver Transpl, 2012. (c) 2012 AASLD. [less ▲] Detailed reference viewed: 8 (0 ULg) Kidney donation after circulatory death in a country with a high number of brain dead donors: 10 -year experience in Belgium; ; et al in Transplant International (2012), 25 Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its ... [more ▼] Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan–Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused. Transplant International ISSN 0934-0874 ª [less ▲] Detailed reference viewed: 11 (1 ULg)LIVER TRANSPLANTATION FROM DONATION AFTER CARDIOCIRCULATORY DEATH (DCD) DONORS: BELGIAN EXPERIENCE 2003-2009DE ROOVER, Arnaud  ; Le Dinh, Hieu ; et alin Transplant International (2011, September), 24(2), 84-84 Detailed reference viewed: 11 (2 ULg)BELGIAN EXPERIENCE OF DCD KIDNEY TRANSPLANTATION; ; et al in Transplant International (2011, September), 24(2), 43-44 Detailed reference viewed: 33 (1 ULg)MULTICENTER BELGIAN SURVEY ON DONOR MORBIDITY AND MORTALITY IN ADULT-TO-ADULT LIVING DONOR LIVER TRANSPLANTATION; ; et al in Transplant International (2011, September), 24(2), 13-13 Detailed reference viewed: 8 (0 ULg)Liver transplantation (LT) from donation after cardiac death (DCD) donors: Multicenter Belgian experience 2003-2007Detry, Olivier ; ; et alin Transplant International (2009, August), 22(S2), 62-234 Detailed reference viewed: 43 (12 ULg) |
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