Κυριακή, 22 Απριλίου 2018
Normothermic Ex Vivo Kidney Perfusion Reduces Warm Ischemic Injury of Porcine Kidney Grafts Retrieved After Circulatory Death (DCD)
Background: Cold storage is poorly tolerated by kidney grafts retrieved after Donation after Circulatory Death (DCD). It has been determined that normothermic ex vivo kidney perfusion (NEVKP) preservation decreases injury by minimizing cold ischemic storage. The impact of NEVKP on warm ischemic injury is unknown. Methods We compared pig kidneys retrieved after 30minutes warm ischemia and immediate transplantation (no-preservation) with grafts that were exposed to 30min of warm ischemia plus 8hr NEVKP or plus 8hr SCS. Results Following transplantation, the NEVKP group demonstrated lower daily serum creatinine levels indicating better early graft function compared with no-preservation (p=0.02) or static cold storage group (p
Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement
Background In the United States, 1 in 10 infants and 1 in 20 older children die on the liver transplant waiting list. Increasing split liver transplantation could increase organ availability for these children, without decreasing transplants in adults. Methods Using UNOS STAR data, we identified livers transplanted 2010-2015 that could potentially have been used for split transplant, based on strict criteria. Livers not suitable for pediatric patients or allocated to high-risk recipients were excluded. Number and distribution of potentially "split-able" livers were compared to pediatric waitlist deaths in each region. Results Of 37 333 deceased donor livers transplanted, 6.3% met our strict criteria for utilization in split liver transplant. Only 3.8% of these were actually utilized for split liver transplantation. 96% were utilized for a single adult recipient. Of the 2253 transplanted as whole livers, 82% of their recipients were listed as willing to accept a segmental liver, and only 3% were listed as requiring a cold ischemia time less than 6 hours. Over the same 5 years, 299 children died on the waitlist. In every UNOS region, there were more potentially "split-able" livers than pediatric waitlist deaths. 37% of pediatric waitlist deaths occurred at transplant centers that averaged ≤1 pediatric split liver transplant annually during the study period. Conclusion This comparison, while not conclusive, suggests that we might be missing opportunities to reduce pediatric waitlist mortality without decreasing access for adults—using split liver transplant. Barriers are significant, but further work on strategies to increase split liver transplant is warranted. Corresponding Author: Emily R. Perito, MD MAS, Pediatric Gastroenterology, Hepatology, and Nutrition, 550 16th Street, 5th Floor, Box 0136; San Francisco, CA 94143, Email: firstname.lastname@example.org Authorship: Emily R. Perito, MD MAS: Led study design, IRB approval, data analysis and interpretation, writing and revision of the manuscript. Garrett Roll, MD: Participated in study design, data interpretation, writing and revision of the manuscript. Jennifer L. Dodge, MPH: Participated in study design, led data analysis and interpretation, participated in writing and revision of the manuscript Sue Rhee, MD: Participated in study design, data interpretation, writing and revision of the manuscript. John P. Roberts, MD: Participated in study design, data interpretation, writing and revision of the manuscript. Funding and acknowledgements: This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C (UNOS Data), the NIH-NIDDK (Dr. Perito, K23 DK0990253-A101), the UCSF Liver Center (P30 DK026743), and the UCSF Department of Pediatrics (Clinical/Translational Pilot Study Grant). The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and should not be seen as an official policy of or interpretation by the SRTR or the US Government. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, nor does mention of trades names, commercial products, or organizations imply endorsement by the US Government. Disclosures: The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
One Hundred and Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center
Background The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation. Methods Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods. Results During the initial period, three donors (2.6%) experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 vs 344.4 minutes; P
How Should Social Media Be Used in Transplantation? A Survey of The American Society of Transplant Surgeons
Background Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is growing need to understand how social media-driven communication is perceived by providers in the field of transplantation. Methods We surveyed 299 members of the American Society of Transplant Surgeons (ASTS) about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics. Results Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least one purpose. While most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (p=0.02) and fewer years of experience in the field of transplantation (p=0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (p
Chronic rejection is the Achilles' heel of modern lung transplantation, characterized by a slow, progressive decline in allograft function. Clinically, this manifests as obstructive disease, restrictive disease, or a mixture of the 2 depending on the underlying pathology. The 2 major phenotypes of chronic rejection include bronchiolitis obliterans syndrome and restrictive allograft syndrome. The last decade of research has revealed that each of these phenotypes has a unique underlying pathophysiology which may require a distinct treatment regimen for optimal control. Insights into the intricate alloimmune pathways contributing to chronic rejection have been gained from both large and small animal models, suggesting directions for future research. In this review, we explore the pathological hallmarks of chronic rejection, recent insights gained from both clinical and basic science research, and the current state of animal models of chronic lung rejection. Correspondence information: Daniel Kreisel, M.D., Ph.D. Professor of Surgery, Pathology & Immunology, Campus Box 8234, 660 South Euclid Avenue, Washington University School of Medicine, St. Louis, MO 63110, email@example.com Authorship: Each author participated in the writing of this manuscript and approved the final version for submission Disclosure: DK is on the scientific advisory board of Compass Therapeutics. All other authors have nothing to disclose. Funding: No funding was received for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.