Abdominal organ procurement in the Netherlands - an analysis of quality and clinical impact

Abstract

Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume is associated with fewer injuries.

Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?

“…However, when donor surgeons avoid in situ portal flush, for example, as in other countries, portal perfusion is immediately applied on the bench after hepatectomy, and a randomized comparison between in situ portal flush and bench portal flush has not yet been performed . Next, the 27.1% rate of liver injuries in our study paralleled recent results from the Netherlands, where de Boer et al demonstrated a higher risk of liver injuries in the setting of DCD donation surgery compared with DBD liver donation . Despite the relatively high rate of liver injuries, the authors found a low discard rate and no impact on graft survival .…”

“…(25) Next, the 27.1% rate of liver injuries in our study paralleled recent results from the Netherlands, where de Boer et al demonstrated a higher risk of liver injuries in the setting of DCD donation surgery compared with DBD liver donation. (26) Despite the relatively high rate of liver injuries, the authors found a low discard rate and no impact on graft survival. (26) In contrast, in our DCD cohort, injured livers had a higher risk for graft loss in high-risk and futile donor-recipient combinations.…”

“…Next, we found large differences in the total number of DCD livers retrieved by the 9 centers, ranging between 9 and 85 retrievals, where potentially some risk factors are underestimated given the low overall number in some centers. In addition, high‐volume centers were previously shown to have a lower graft injury rate at retrieval . Further national or international assessments would be of interest to analyze the size and volume of a center as an impact factor.…”

Influence of the procurement surgeon on transplanted abdominal organ outcomes: An SRTR analysis to evaluate regional organ procurement collaboration

“…for pancreas, 34 but the rate of discard resulting from surgical injury for these organs is 0.8-1.4% for kidney, 32,35 .8-6.6% for liver, 33,35 and 10-13% for pancreas. 35,36 Thus, these data indicate that albeit common, procurement-related injury is rarely irremediable or transplant-defining.…”

Donation after cardiac death in the hepatocellular carcinoma patient: Same indication?

“…Additionally, once procured, a fibrinolytic preflush such as tissue plasminogen activator (tPA) can be employed to decrease ischemic‐type biliary lesions, which is hypothesized to function by reducing peribiliary microvasculature microthrombi . In an analysis of organ procurement in the Netherlands, it was found that both higher BMI and procurement from a DCD donor were risk factors for increased procurement injury, further suggesting the need for experienced transplant surgeons . Finally, the cold ischemia time should be minimized with expedited graft allocation and transportation.…”