Pre-donation evaluation of organ donors is important.Organ quality directly affects both short-and long-term survival rates of transplanted organs and recipients after transplantation.Contraindications to donation are...Pre-donation evaluation of organ donors is important.Organ quality directly affects both short-and long-term survival rates of transplanted organs and recipients after transplantation.Contraindications to donation are directly related to recipient survival and medical ethics.The following information is included in this organ donation case report:detailed medical history(primary disease and surgical history),blood type,infectious diseases,coagulation function,biochemical function,tumor biomarker,indicators related to tuberculosis infection,microbial culture indicators,lung computed tomography(CT)scan,and abdominal ultrasound(heart,liver,gallbladder,pancreas,spleen,kidneys,ureters,bladder,adnexa).We found a 10 cm×10 cm space-occupying lesion in the abdominal cavity in this donor organ retrieval surgery.Frozen or paraffin sections showed that the space-occupying lesion was malignant.The organ donor was not suitable due to the malignant tumor,and the transplantation surgery was canceled.We analyzed this case of organ donation to provide a reference for the follow-up donation evaluation process.This case study reveals the limitations of preoperative non-invasive assessment,the necessity of preoperative multi-dimensional assessment of organ function,and the exclusion of donation contraindications.展开更多
Objective Delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased donor.As“non-traditional”risk factors,serum biomarkers of donors,such as lipid...Objective Delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased donor.As“non-traditional”risk factors,serum biomarkers of donors,such as lipids and electrolytes,have drawn increasing attention due to their effects on the postoperative outcomes of renal grafts.This study aimed to examine the value of these serum biomarkers for prediction of renal graft function.Methods The present study consecutively collected 306 patients who underwent their first single kidney transplantation(KT)from adult deceased donors in our center from January 1,2018 to December 31,2019.The correlation between postoperative outcomes[DGF and abnormal serum creatinine(SCr)after 6 and 12 months]and risk factors of donors,including gender,age,body mass index(BMI),past histories,serum lipid biomarkers[cholesterol,triglyceride,high-density lipoprotein(HDL)and low-density lipoprotein(DL)],and serum electrolytes(calcium and sodium)were analyzed and evaluated.Results(1)Donor age and pre-existing hypertension were significantly correlated with the incidence rate of DGF and high SCr level(≥2 mg/dL)at 6 and 12 months after KT(P<0.05);(2)The donor’s BMI was significantly correlated with the incidence rate of DGF after KT(P<0.05);(3)For serum lipids,merely the low level of serum HDL of the donor was correlated with the reduced incidence rate of high SCr level at 12 months after KT[P<0.05,OR(95%CI):0.425(0.202–0.97)];(4)The serum calcium of the donor was associated with the reduced incidence rate of high SCr level at 6 and 12 months after KT[P<0.05,OR(95%CI):0.184(0.045–0.747)and P<0.05,OR(95%CI):0.114(0.014–0.948),respectively].Conclusion The serum HDL and calcium of the donor may serve as predictive factors for the postoperative outcomes of renal grafts after KT,in addition to the donor’s age,BMI and pre-existing hypertension.展开更多
BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting a...BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.METHODS A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1,2022,and May 31,2023.The study included 25 SLT cases and 81 whole liver transplantation(WLT)cases.Total ex-vivo liver splitting was employed for SLT graft procurement in three steps.Patient outcomes were determined,including liver function parameters,postoperative complications,and perioperative mortality.Group comparisons for categorical variables were performed using theχ²-test.RESULTS In the study,postoperative complications in the 25 SLT cases included hepatic artery thrombosis(n=1)and pulmonary infections(n=3),with no perioperative mortality.In contrast,among the 81 patients who underwent WLT,complications included perioperative mortality(n=1),postoperative pulmonary infections(n=8),abdominal infection(n=1),hepatic artery thromboses(n=3),portal vein thrombosis(n=1),and intra-abdominal bleeding(n=5).Comparative analysis demonstrated significant differences in alanine aminotransferase(176.0 vs 73.5,P=0.000)and aspartate aminotransferase(AST)(42.0 vs 29.0,P=0.004)at 1 wk postoperatively,and in total bilirubin(11.8 vs 20.8,P=0.003)and AST(41.5 vs 26.0,P=0.014)at 2 wk postoperatively.However,the overall incidence of complications was comparable between the two groups(P>0.05).CONCLUSION Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach,especially under the expertise of an experienced transplant center.The approach developed by our center can serve as a valuable reference for other transplantation centers.展开更多
AIM: To evaluate donation after circulatory death(DCD) orthotopic liver transplant outcomes [hypoxic cholangiopathy(HC) and patient/graft survival] and donor risk-conditions.METHODS: From 2003-2013, 45 DCD donor trans...AIM: To evaluate donation after circulatory death(DCD) orthotopic liver transplant outcomes [hypoxic cholangiopathy(HC) and patient/graft survival] and donor risk-conditions.METHODS: From 2003-2013, 45 DCD donor transplants were performed. Predonation physiologic data from UNOS Donor Net included preoperative systolic and diastolic blood pressure, heart rate, p H, SpO_(2), PaO_(2), FiO_(2), and hemoglobin. Mean arterial bloodpressure was computed from the systolic and diastolic blood pressures. Donor preoperative arterial O_(2) content was computed as [hemoglobin(gm/d L) × 1.37(m L O_(2)/gm) × SpO_(2)%) +(0.003 × PaO_(2))]. The amount of preoperative donor red blood cell transfusions given and vasopressor use during the intensive care unit stay were documented. Donors who were transfused ≥ 1 unit of red-cells or received ≥ 2 vasopressors in the preoperative period were categorized as the red-cell/multi-pressor group. Following withdrawal of life support, donor ischemia time was computed as the number-of-minutes from onset of diastolic blood pressure < 60 mm Hg until aortic cross clamping. Donor hypoxemia time was the number-of-minutes from onset of pulse oximetry < 80% until clamping. Donor hypoxia score was(ischemia time + hypoxemia time) ÷ donor preoperative hemoglobin.RESULTS: The 1, 3, and 5 year graft and patient survival rates were 83%, 77%, 60%; and 92%, 84%, and 72%, respectively. HC occurred in 49% with 16% requiring retransplant. HC occurred in donors with increased age(33.0 ± 10.6 years vs 25.6 ± 8.4 years, P = 0.014), less preoperative multiple vasopressors or red-cell transfusion(9.5% vs 54.6%, P = 0.002), lower preoperative hemoglobin(10.7 ± 2.2 gm/d L vs 12.3 ± 2.1 gm/d L, P = 0.017), lower preoperative arterial oxygen content(14.8 ± 2.8 m L O_(2)/100 m L blood vs 16.8 ± 3.3 m L O_(2)/100 m L blood, P = 0.049), greater hypoxia score >2.0(69.6% vs 25.0%, P = 0.006), and increased preoperative mean arterial pressure(92.7 ± 16.2 mm Hg vs 83.8 ± 18.5 mm Hg, P = 0.10). HC was independently associated with age, multi-pressor/redcell transfusion status, arterial oxygen content, hypoxia score, and mean arterial pressure(r^2 = 0.6197). The transplantation rate was greater for the later period with more liberal donor selection [era 2(7.1/year)], compared to our early experience [era 1(2.5/year)]. HC occurred in 63.0% during era 2 and in 29.4% during era 1(P = 0.03). Era 2 donors had longer times for extubation-to-asystole(14.4 ± 4.7 m vs 9.3 ± 4.5 m, P = 0.001), ischemia(13.9 ± 5.9 m vs 9.7 ± 5.6 m, P = 0.03), and hypoxemia(16.0 ± 5.1 m vs 11.1 ± 6.7 m, P = 0.013) and a higher hypoxia score > 2.0 rate(73.1% vs 28.6%, P = 0.006).CONCLUSION: Easily measured donor indices, including a hypoxia score, provide an objective measure of DCD liver transplantation risk for recipient HC. Donor selection criteria influence HC rates.展开更多
Background:Enhanced Recovery After Surgery(ERAS)is a multimodal approach for almost all types of surgical procedures,including liver transplantation(LTx).We developed an ERAS protocol for LTx based on previous experie...Background:Enhanced Recovery After Surgery(ERAS)is a multimodal approach for almost all types of surgical procedures,including liver transplantation(LTx).We developed an ERAS protocol for LTx based on previous experience and assessed it using benchmarks from the German Institute for Quality Management and Transparency in Healthcare(IQTIG).Methods:An ERAS protocol was developed and implemented in our center since 2018 for LTx,including preoperative,intraoperative,and postoperative procedures.From January 2021 to December 31st 2022,we conducted a prospective analysis including donor and recipient demographics,Model for End-Stage Liver Disease(MELD)score and medical history.Perioperative management,such as operative time,anhepatic phase time,intensive care unit(ICU)stay,morbidity and mortality as well as postoperative hospitalization,readmission and 1-year patient survival,were collected as outcome measures.Results:Sixty-eight consecutive liver transplant recipients were included.Mean age of the donors was 47(36-55.5)years old,type of donation was in 41 donation after brain death(DBD),26 donation after controlled circulatory death(DCD)and 1 donation after brain and cardiac death(DBCD).Mean age of the patients was 49.6 years(range,26-68 years),81%were male.The mean body mass index(BMI)of the recipients was 24 kg/m^(2)(range,15-37 kg/m^(2)),mean MELD score was 15(range,6-39),3 patients had a MELD score higher than 30.Fifty-three patients suffered from hepatitis B virus(HBV)related cirrhosis.Twenty-eight patients had hepatocellular carcinoma(HCC);5 patients were diagnosed with alcohol related cirrhosis and primary biliary cirrhosis,autoimmune disease and drug induced cirrhosis,undefined cirrhosis,respectively.The mean operation time in our cohort was 6.73 hours,and the average anhepatic phase time was 68 minutes.No patient had intraoperative hypothermia.Tracheal extubation was performed in the ICU department within 6 hours post operation and the average ICU/intermediate care(IMC)unit stay was 4.5 days(range,2-14 days).None of the patients required re-intubation.Postoperative complications with a CDC classification>II were seen in 16 patients(23.5%).Mean hospital stay was 21.7 days and readmission rate was 13(19%).Neither acute rejection nor postoperative mortality during the hospital stay was recorded.One patient died from acute myocardial infarction after discharge.Conclusions:We developed an ERAS protocol in LTx,consisting of preoperative,perioperative and postoperative management and assessed the quality using benchmarks from IQTIG.Our study revealed that the proposed ERAS approach in LTx is feasible offering the opportunities of enhanced recovery and quality management.展开更多
基金Supported by grants from the National Natural Sciences Foundation of China(No.81800580)Wuhan Federation of Social Sciences(No.WHSKL2020140)the Sichuan Medical Law Research Center(No.YF20-Y05)。
文摘Pre-donation evaluation of organ donors is important.Organ quality directly affects both short-and long-term survival rates of transplanted organs and recipients after transplantation.Contraindications to donation are directly related to recipient survival and medical ethics.The following information is included in this organ donation case report:detailed medical history(primary disease and surgical history),blood type,infectious diseases,coagulation function,biochemical function,tumor biomarker,indicators related to tuberculosis infection,microbial culture indicators,lung computed tomography(CT)scan,and abdominal ultrasound(heart,liver,gallbladder,pancreas,spleen,kidneys,ureters,bladder,adnexa).We found a 10 cm×10 cm space-occupying lesion in the abdominal cavity in this donor organ retrieval surgery.Frozen or paraffin sections showed that the space-occupying lesion was malignant.The organ donor was not suitable due to the malignant tumor,and the transplantation surgery was canceled.We analyzed this case of organ donation to provide a reference for the follow-up donation evaluation process.This case study reveals the limitations of preoperative non-invasive assessment,the necessity of preoperative multi-dimensional assessment of organ function,and the exclusion of donation contraindications.
基金The study was supported by the Innovation Team Fund Project of Hubei Province(No.WJ2021C001)the Key Research and Development Plan of Hubei Province(No.2022BCA015).
文摘Objective Delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased donor.As“non-traditional”risk factors,serum biomarkers of donors,such as lipids and electrolytes,have drawn increasing attention due to their effects on the postoperative outcomes of renal grafts.This study aimed to examine the value of these serum biomarkers for prediction of renal graft function.Methods The present study consecutively collected 306 patients who underwent their first single kidney transplantation(KT)from adult deceased donors in our center from January 1,2018 to December 31,2019.The correlation between postoperative outcomes[DGF and abnormal serum creatinine(SCr)after 6 and 12 months]and risk factors of donors,including gender,age,body mass index(BMI),past histories,serum lipid biomarkers[cholesterol,triglyceride,high-density lipoprotein(HDL)and low-density lipoprotein(DL)],and serum electrolytes(calcium and sodium)were analyzed and evaluated.Results(1)Donor age and pre-existing hypertension were significantly correlated with the incidence rate of DGF and high SCr level(≥2 mg/dL)at 6 and 12 months after KT(P<0.05);(2)The donor’s BMI was significantly correlated with the incidence rate of DGF after KT(P<0.05);(3)For serum lipids,merely the low level of serum HDL of the donor was correlated with the reduced incidence rate of high SCr level at 12 months after KT[P<0.05,OR(95%CI):0.425(0.202–0.97)];(4)The serum calcium of the donor was associated with the reduced incidence rate of high SCr level at 6 and 12 months after KT[P<0.05,OR(95%CI):0.184(0.045–0.747)and P<0.05,OR(95%CI):0.114(0.014–0.948),respectively].Conclusion The serum HDL and calcium of the donor may serve as predictive factors for the postoperative outcomes of renal grafts after KT,in addition to the donor’s age,BMI and pre-existing hypertension.
基金Supported by the Shenzhen Science and Technology Research and Development Fund,No.JCYJ20220530163011026.
文摘BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.METHODS A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1,2022,and May 31,2023.The study included 25 SLT cases and 81 whole liver transplantation(WLT)cases.Total ex-vivo liver splitting was employed for SLT graft procurement in three steps.Patient outcomes were determined,including liver function parameters,postoperative complications,and perioperative mortality.Group comparisons for categorical variables were performed using theχ²-test.RESULTS In the study,postoperative complications in the 25 SLT cases included hepatic artery thrombosis(n=1)and pulmonary infections(n=3),with no perioperative mortality.In contrast,among the 81 patients who underwent WLT,complications included perioperative mortality(n=1),postoperative pulmonary infections(n=8),abdominal infection(n=1),hepatic artery thromboses(n=3),portal vein thrombosis(n=1),and intra-abdominal bleeding(n=5).Comparative analysis demonstrated significant differences in alanine aminotransferase(176.0 vs 73.5,P=0.000)and aspartate aminotransferase(AST)(42.0 vs 29.0,P=0.004)at 1 wk postoperatively,and in total bilirubin(11.8 vs 20.8,P=0.003)and AST(41.5 vs 26.0,P=0.014)at 2 wk postoperatively.However,the overall incidence of complications was comparable between the two groups(P>0.05).CONCLUSION Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach,especially under the expertise of an experienced transplant center.The approach developed by our center can serve as a valuable reference for other transplantation centers.
文摘AIM: To evaluate donation after circulatory death(DCD) orthotopic liver transplant outcomes [hypoxic cholangiopathy(HC) and patient/graft survival] and donor risk-conditions.METHODS: From 2003-2013, 45 DCD donor transplants were performed. Predonation physiologic data from UNOS Donor Net included preoperative systolic and diastolic blood pressure, heart rate, p H, SpO_(2), PaO_(2), FiO_(2), and hemoglobin. Mean arterial bloodpressure was computed from the systolic and diastolic blood pressures. Donor preoperative arterial O_(2) content was computed as [hemoglobin(gm/d L) × 1.37(m L O_(2)/gm) × SpO_(2)%) +(0.003 × PaO_(2))]. The amount of preoperative donor red blood cell transfusions given and vasopressor use during the intensive care unit stay were documented. Donors who were transfused ≥ 1 unit of red-cells or received ≥ 2 vasopressors in the preoperative period were categorized as the red-cell/multi-pressor group. Following withdrawal of life support, donor ischemia time was computed as the number-of-minutes from onset of diastolic blood pressure < 60 mm Hg until aortic cross clamping. Donor hypoxemia time was the number-of-minutes from onset of pulse oximetry < 80% until clamping. Donor hypoxia score was(ischemia time + hypoxemia time) ÷ donor preoperative hemoglobin.RESULTS: The 1, 3, and 5 year graft and patient survival rates were 83%, 77%, 60%; and 92%, 84%, and 72%, respectively. HC occurred in 49% with 16% requiring retransplant. HC occurred in donors with increased age(33.0 ± 10.6 years vs 25.6 ± 8.4 years, P = 0.014), less preoperative multiple vasopressors or red-cell transfusion(9.5% vs 54.6%, P = 0.002), lower preoperative hemoglobin(10.7 ± 2.2 gm/d L vs 12.3 ± 2.1 gm/d L, P = 0.017), lower preoperative arterial oxygen content(14.8 ± 2.8 m L O_(2)/100 m L blood vs 16.8 ± 3.3 m L O_(2)/100 m L blood, P = 0.049), greater hypoxia score >2.0(69.6% vs 25.0%, P = 0.006), and increased preoperative mean arterial pressure(92.7 ± 16.2 mm Hg vs 83.8 ± 18.5 mm Hg, P = 0.10). HC was independently associated with age, multi-pressor/redcell transfusion status, arterial oxygen content, hypoxia score, and mean arterial pressure(r^2 = 0.6197). The transplantation rate was greater for the later period with more liberal donor selection [era 2(7.1/year)], compared to our early experience [era 1(2.5/year)]. HC occurred in 63.0% during era 2 and in 29.4% during era 1(P = 0.03). Era 2 donors had longer times for extubation-to-asystole(14.4 ± 4.7 m vs 9.3 ± 4.5 m, P = 0.001), ischemia(13.9 ± 5.9 m vs 9.7 ± 5.6 m, P = 0.03), and hypoxemia(16.0 ± 5.1 m vs 11.1 ± 6.7 m, P = 0.013) and a higher hypoxia score > 2.0 rate(73.1% vs 28.6%, P = 0.006).CONCLUSION: Easily measured donor indices, including a hypoxia score, provide an objective measure of DCD liver transplantation risk for recipient HC. Donor selection criteria influence HC rates.
基金supported by the Anhui Provincial Natural Science Foundation(No.2108085MH256 to X.Y.)the Fundamental Research Funds for the Central Universities(No.WK9110000055 to B.N.,No.WK9110000131 to X.Y.).
文摘Background:Enhanced Recovery After Surgery(ERAS)is a multimodal approach for almost all types of surgical procedures,including liver transplantation(LTx).We developed an ERAS protocol for LTx based on previous experience and assessed it using benchmarks from the German Institute for Quality Management and Transparency in Healthcare(IQTIG).Methods:An ERAS protocol was developed and implemented in our center since 2018 for LTx,including preoperative,intraoperative,and postoperative procedures.From January 2021 to December 31st 2022,we conducted a prospective analysis including donor and recipient demographics,Model for End-Stage Liver Disease(MELD)score and medical history.Perioperative management,such as operative time,anhepatic phase time,intensive care unit(ICU)stay,morbidity and mortality as well as postoperative hospitalization,readmission and 1-year patient survival,were collected as outcome measures.Results:Sixty-eight consecutive liver transplant recipients were included.Mean age of the donors was 47(36-55.5)years old,type of donation was in 41 donation after brain death(DBD),26 donation after controlled circulatory death(DCD)and 1 donation after brain and cardiac death(DBCD).Mean age of the patients was 49.6 years(range,26-68 years),81%were male.The mean body mass index(BMI)of the recipients was 24 kg/m^(2)(range,15-37 kg/m^(2)),mean MELD score was 15(range,6-39),3 patients had a MELD score higher than 30.Fifty-three patients suffered from hepatitis B virus(HBV)related cirrhosis.Twenty-eight patients had hepatocellular carcinoma(HCC);5 patients were diagnosed with alcohol related cirrhosis and primary biliary cirrhosis,autoimmune disease and drug induced cirrhosis,undefined cirrhosis,respectively.The mean operation time in our cohort was 6.73 hours,and the average anhepatic phase time was 68 minutes.No patient had intraoperative hypothermia.Tracheal extubation was performed in the ICU department within 6 hours post operation and the average ICU/intermediate care(IMC)unit stay was 4.5 days(range,2-14 days).None of the patients required re-intubation.Postoperative complications with a CDC classification>II were seen in 16 patients(23.5%).Mean hospital stay was 21.7 days and readmission rate was 13(19%).Neither acute rejection nor postoperative mortality during the hospital stay was recorded.One patient died from acute myocardial infarction after discharge.Conclusions:We developed an ERAS protocol in LTx,consisting of preoperative,perioperative and postoperative management and assessed the quality using benchmarks from IQTIG.Our study revealed that the proposed ERAS approach in LTx is feasible offering the opportunities of enhanced recovery and quality management.
