Treating the Donor: Strategies to Prolong VCA Preservation

AbstractPurpose of ReviewIn this review, we summarized the latest advances in vascularized composite allografts (VCAs) preservation along with future directions to improve graft viability before transplantation.Recent FindingsAt present, VCAs are preserved using static cold storage methods prior to transplantation. This approach ensures reasonable viability up to 6  h. Beyond this time, ischemia and reperfusion result in substantial graft dysfunction. Ex situ VCA perfusion can potentially improve the graft survival and function and can help spread the procurement to a larger geographic area.SummaryNew strategies to minimize ischemia and reperfusion injury can prolong VCA preservation.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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We describe a case of successfully ex vivo treated and transplanted human lung allografts.MethodsDonor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery.ResultsWe successfully implanted our ex vivo treated organs.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: NEW TECHNOLOGIES Source Type: research
Conclusions: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.
Source: Annals of Surgery - Category: Surgery Tags: ESA PAPERS Source Type: research
Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant. Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes, the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al present 10-year outcomes of the Toronto Lung Transplant Group &rs...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
In this study, we investigated the long-term effects of the HESP on skeletal muscle metabolism, structure, and force generation and compared it with the current standard of preservation. Methods. Forty male Lewis rats (250 ± 25 g) were divided into 5 groups, including naive control, sciatic nerve transection or repair, immediate transplantation, SCS, and HESP. For the SCS group, limbs were preserved at 4°C for 6 hours. In the HESP group, limbs were continuously perfused with oxygenated histidine-tryptophan-ketoglutarate (HTK) solution at 10–15°C for 6 hours. Hemodynamic and biochemical parame...
Source: Transplantation - Category: Transplant Surgery Tags: Original Basic Science–General Source Type: research
This study shows that quantitative perfusion of kidney transplants can be evaluated safely during kidney transplantation. DGF being defined as one or more dialyses after kidney transplantation can only be detected postoperatively, however, it may be predicted intraoperatively. PMID: 31559620 [PubMed - as supplied by publisher]
Source: Zentralblatt fur Chirurgie - Category: Surgery Authors: Tags: Zentralbl Chir Source Type: research
This study describes a simple, reproducible, human model that allows for interrogation of flow effects during ex vivo organ perfusion. MATERIALS AND METHODS: Gonadal veins from deceased human renal allografts were subjected to either static cold storage or hypothermic machine perfusion for up to 24 hours. Caspase-3, Krüppel-like factor 2 expression and electron microscopic analysis were compared between 'flow' and 'no-flow' conditions, with living donor gonadal vein sections serving as negative controls. RESULTS: The increase in caspase-3 expression was less pronounced for hypothermic machine-perfused veins ...
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Conclusions. Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
CONCLUSIONS Non-invasive investigations of the liver microcirculation and hemoglobin oxygenation were shown to be predictive factors for EAD following liver transplantation. PMID: 31417074 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
Abstract BACKGROUND AND OBJECTIVES: Recent developments indicated that functional magnetic resonance imaging (MRI) could potentially provide noninvasive assessment of kidney interstitial fibrosis in patients with kidney diseases, but direct evidence from histopathology is scarce. We aimed to explore the diagnostic utilities of functional MRI for the evaluation of kidney allograft interstitial fibrosis. DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS: We prospectively examined 103 kidney transplant recipients who underwent for-cause biopsies and 20 biopsy-proven normal subjects with functional MRI. Histomorph...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Publication date: Available online 12 July 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Prafulla V. Jadhav, Sunil Raviraj Kothakota, Madhu Sasidharan, Harish Kareem, Ajith K. NairIntroductionIschemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.AimThe aim of this study was to determine the effect of type and grade of donor liv...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
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