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See detailCinacalcet treatment at the time of transplantation is associated with a significant risk of delayed graft function in kidney transplant recipients
Jouret, François ULg; WEEKERS, Laurent ULg; GROSCH, Stéphanie ULg et al

in Transplant International (2014, May), 27(S1), 167

The calcium-sensing receptor (CaSR) has been implicated in the ischemia/ reperfusion (I/R) cascade in heart, liver and brain. Renal I/R occurs at the time of transplantation (Tx), with a deleterious ... [more ▼]

The calcium-sensing receptor (CaSR) has been implicated in the ischemia/ reperfusion (I/R) cascade in heart, liver and brain. Renal I/R occurs at the time of transplantation (Tx), with a deleterious impact on early graft function. Here, we retrospectively investigated if the use of cinacalcet, a CaSR agonist, in kidney transplant recipients (KTR) influences early graft recovery. All KTR from 2007 to 2012 in our Academic Hospital were prospectively included in a database. Patients actively treated with cinacalcet on the day of Tx were retrospectively identified from this database and matched with controls on (i) type of donor (living [LD], deceased after brain or circulatory death [DCD]); (ii) cold ischemic time (CIT) ` 1 h; (iii) residual diuresis (` 500 ml); and (iv) donor age (` 5 years). Delayed graft function (DGF) was defined as dialysis requirement after Tx. Baseline characteristics were compared between groups with student’s t-test or Chi-2 as appropriate. The endpoint was the percentage of DGF in both groups. Among 337 KTR, 36 (10.7%) were treated with cinacalcet at Tx. Control group included 61 patients. Characteristics of patients and donors are summarized in the table. DGF occurred in 42 and 23% of cinacalcet-treated and control groups, respectively (p = 0.05). These retro- spective observations suggest that CaSR activation at the time of Tx impairs early graft recovery. [less ▲]

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See detailDONATION AFTER CIRCULATORY DEATH INCREASES THE CADAVERIC DONOR POOL
Le Dinh, H.; DE ROOVER, Arnaud ULg; SQUIFFLET, Jean-Paul ULg et al

in Transplant International (2013, December), 26(S2), 54-101

Background: There is a controversy on the possibility to increase the organ donor pool by donation-after-circulatory-death (DCD) and the possible decrease in donation-after-brain-death (DBD) by DCD ... [more ▼]

Background: There is a controversy on the possibility to increase the organ donor pool by donation-after-circulatory-death (DCD) and the possible decrease in donation-after-brain-death (DBD) by DCD programs. Our aim is to report the DCD experience at the University Hospital of Liege, Belgium, from 2002 through 2012, in a donor region of about 1 million inhabitants. Methods: The prospective organ donor and recipient databases were retrospectively reviewed. Results: 94 and 331 procurements were performed from controlled DCD and DBD donors in the time period, respectively. DCD donors contributed to 22.1% of the deceased donor (DD) organ procurement activity from Jan 2002 to Dec 2012, and up to one-third annually since 2009. DCD liver and kidneys contributed 23.7% and 24.2% of the DD liver and kidney transplantation activity, respectively. There was no decrease of the DBD procurement in the study period. In 2012, overall 54 DD were procured in the Liege region, reaching a high procurement activity.Conclusions: Controlled DCD donors are a valuable source of transplantable liver and kidney grafts, and in our experience do not adversely affect DBD organ procurement activity. [less ▲]

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See detailIS ULTRA-SHORT COLD ISCHEMIA THE KEY TO ISCHEMIC CHOLANGIOPATHY AVOIDANCE IN DCD- LT?
DETRY, Olivier ULg; DE ROOVER, Arnaud ULg; Cheham, Samir 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 ▲]

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See detailDONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTATION: IS DONOR AGE AN ISSUE?
DETRY, Olivier ULg; Ledinh, Heu; HONORE, Pierre ULg et al

in Transplant International (2013, December), 26(s2), 112-228

Background: Donation after circulatory death (DCD) donors > 55 years are usually not considered suitable for liver transplantation (LT). At our institute, age is not an absolute exclusion criterion to ... [more ▼]

Background: Donation after circulatory death (DCD) donors > 55 years are usually not considered suitable for liver transplantation (LT). At our institute, age is not an absolute exclusion criterion to refuse DCD liver grafts. We retrospectively compared the transplant outcome of patients receiving older DCD liver grafts to the younger ones. Methods: 70 DCD liver transplants have been performed from 2003 to 2012, which includes 32 liver grafts from younger donors <55y (group A), 20 between 56 and 69 years (group B), and 18 from older donors ≥70 years (group C). The three groups were compared in terms of donor and recipient demographics, procurement and transplantation conditions, peak laboratory values during the first post-transplant week and results at one and three years. Results are expressed as median IQR. Results: No difference other than age in donor and recipient characteristics as well as procurement conditions was noted between both groups. Median donor age of the group A was 44 (38-45) years, in group B 62 (60-64) years and 73 (71-75) in group C. Median primary warm ischemia time (WIT) were 20 (17-22), 21 (19-25) and 19 (16-23) min, respectively (NS). Median cold ischemia time (CIT) was 236 (229-294), 245 (227-290) and 210 (195-277) min, respectively (NS). Peak AST (UI/ml) was 1162 (1072-3971), 1416 (1006-2752), and 1067 (902-4037), respectively (NS). There was no primary nonfunction and one patient needed retransplantation for artery thrombosis. Biliary complications occurred similarly in both groups, without graft loss secondary to ischemic cholangiopathy. Graft and patient survivals were not different at one and three years. Conclusion: This study shows comparable results between DCD liver transplants from younger and older donors. Therefore donor age >55 years should not be a contraindication to DCD liver transplantation if other donor risk factors (such as WIT, CIT) are minimized. [less ▲]

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See detailWhat is the potential increase in the heart graft pool by cardiac donation after circulatory death?
NOTERDAEME, Timothée; DETRY, Olivier ULg; HANS, Marie-France ULg et al

in Transplant International (2013), 26(1), 61-66

Heart transplantation remains the only definite treatment option for end-stage heart diseases. The use of hearts procured after donation after circulatory death (DCD) could help decrease the heart graft ... [more ▼]

Heart transplantation remains the only definite treatment option for end-stage heart diseases. The use of hearts procured after donation after circulatory death (DCD) could help decrease the heart graft shortage. The aim of this study was to evaluate the potential increase in heart graft pool by developing DCD heart transplantation. We retrospectively reviewed our local donor database from 2006 to 2011, and screened the complete controlled DCD donor population for potential heart donors, using the same criteria as for donation after brain death (DBD) heart transplantation. Acceptable donation warm ischemic time (DWIT) was limited to 30 min. During this period 177 DBD and 70 DCD were performed. From the 177 DBD, a total of 70 (39.5%) hearts were procured and transplanted. Of the 70 DCD, eight (11%) donors fulfilled the criteria for heart procurement with a DWIT of under 30 min. Within the same period, 82 patients were newly listed for heart transplantation, of which 53 were transplanted, 20 died or were unlisted, and 9 were waiting. It could be estimated that 11% of the DCD might be heart donors, representing a 15% increase in heart transplant activity, as well as potential reduction in the deaths on the waiting list by 40%. [less ▲]

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

in Transplant International (2012), 25

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 ... [more ▼]

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. This is a retrospective mono-center review of a consecutive series of 59 DCD-KT performed between 2005 and 2010. Overall graft survival was 96.6%, 94.6%, and 90.7% at 3 months, 1 and 3 years, respectively. Main cause of graft loss was patient's death with a functioning graft. No primary nonfunction grafts. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 45.6% of all DCD-KT. DGF significantly increased postoperative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index >/=30 was the only donor factor that was found to significantly increase the risk of DGF (P < 0.05). 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 detailMachine perfusion in clinical trials : "machine vs. solution effects"
Treckmann, Jürgen; Moers, Cyril; Smits, Jacqueline M et al

in Transplant International (2012), 25

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See detailKidney donation after circulatory death in a country with a high number of brain dead donors: 10 -year experience in Belgium
Jochmans, Ina; Darius, Tom; Kuypers, Dirk 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 ▲]

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See detailPRESERVATION OF NORMAL MORPHOLOGY OF HUMAN LIVERS AFTER 24 HOURS OF HYPOTHERMIC MACHINE PERFUSION. A FIRST-IN-MAN STUDY
Monbaliu, D.; Liu, Q.; Libbrecht, L. et al

in Transplant International (2011, September), 24(2), 151-151

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See detailMULTICENTER BELGIAN SURVEY ON DONOR MORBIDITY AND MORTALITY IN ADULT-TO-ADULT LIVING DONOR LIVER TRANSPLANTATION
Troisi, Roberto I; Vogelaers, Dirk; Lerut, Jan et al

in Transplant International (2011, September), 24(2), 13-13

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See detailBELGIAN EXPERIENCE OF DCD KIDNEY TRANSPLANTATION
Darius, Tom; Jochmans, Ina; Ledinh, Hieu et al

in Transplant International (2011, September), 24(2), 43-44

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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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See detailLIVER TRANSPLANTATION FOR ACUTE HEPATIC FAILURE DUE TO CHEMOTHERAPY-INDUCED HEPATITIS B VIRUS REACTIVATION IN LYMPHOMA PATIENTS
Noterdaeme, T.; Longree, L.; Bataille, C. et al

in Transplant International (2011, February), 24(1), 10-10

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See detailFATAL SMALL FOR SIZE SYNDROME AFTER RIGHT LOBE DONATION
DETRY, Olivier ULg; DE ROOVER, Arnaud ULg; LAUWICK, Séverine ULg et al

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

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See detailEFFECTS OF LARGE PORE HEMOFILTRATION IN A SWINE MODEL OF FULMINANT HEPATIC FAILURE
DETRY, Olivier ULg; JANSSEN, Nathalie ULg; CHERAMY-BIEN, Jean-Paul ULg et al

in Transplant International (2011, February), 24(1), 10-10

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See detailMachine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death
Treckmann, Jürgen; Moers, Cyril; Smits, Jacqueline M et al

in Transplant International (2011), 24

The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys ... [more ▼]

The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heartbeating deceased ECDs – defined according to the United Network of Organ Sharing definition – were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P = 0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P = 0.04). One-year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P = 0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1-year graft survival and function in ECD kidneys. [less ▲]

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See detailDonation after Cardiac Death In Liver Transplantation :is donor age an issue?
Detry, Olivier ULg; De Roover, Arnaud ULg; Squifflet, Jean-Paul ULg et al

in Transplant International (2010, July), 23(Suppl. 1), 415

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See detailLiver transplantation from donation after cardiac death donors: initial Belgian experience 2003-2007.
Detry, Olivier ULg; Donckier, Vincent; Lucidi, Valerio et al

in Transplant International (2010), 23(6), 611-618

The Belgian experience with donation after cardiac death (DCD) liver transplantation (LT) was retrospectively reviewed, particularly evaluating patient and graft survivals, and biliary complications. From ... [more ▼]

The Belgian experience with donation after cardiac death (DCD) liver transplantation (LT) was retrospectively reviewed, particularly evaluating patient and graft survivals, and biliary complications. From 2003 to 2007, 58 DCD-LT were performed in Belgium. Mean procurement total warm ischemia time was 25 +/- 2 min (mean +/- SEM). Mean cold ischemia time was 451 +/- 18 min. Mean follow-up was 23 +/- 2.2 months. Post-transplant peak aspartate aminotransminases was 2241 +/- 338 UI/l. Patient survivals at 1 month, 1 and 3 years, were 91.3%, 83.3% and 66.9% respectively. Graft survivals at 1 month, 1 and 3 years, were 84.4%, 72.4% and 48.8% respectively. Two patients (3.4%) developed primary nonfunction. Regarding the biliary complications, seven grafts (12%) were lost because of intrahepatic cholangiopathy, and 12 other patients (20.6%) developed bile duct stenoses requiring endoscopic and/or surgical management. The rate of symptomatic ischemic biliary lesions for grafts surviving more than 3 months was 38% (19/50). Although DCD organ donors may be a source of viable liver grafts, results were inferior to those obtained with donation after brain death LT in this series. Prognostic criteria have to be developed to improve results of DCD-LT. [less ▲]

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