Brain Death and Its Influence on Donor Organ Quality and Outcome After Transplantation1

Pratschke, Johann; Wilhelm, Markus J.; Kusaka, Mamoru; Basker, M.; Cooper, D. K. C.; Hancock, Wayne W.; Tilney, Nicholas L.

doi:10.1097/00007890-199902150-00001

Cited by 292 publications

(177 citation statements)

References 41 publications

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“…These processes are believed to be responsible (30) for the divergence in clinical results between kidney allografts from cadaver donors and those from living donors (5). Experimentally, kidneys and hearts transplanted from BD animals show accelerated acute rejection in comparison to grafts from living donors (2). This is thought to be triggered by an increased release of proinflammatory cytokines (2,5,31), an up-regulation of major histocompatibility complex (MHC/HLA class I and II) antigens and co-stimulating B7 in peripheral organs (5,32).…”

Section: Discussionmentioning

confidence: 99%

“…The observation that living donor organs show a better outcome than organs from cadaveric donors (1) cannot be fully attributed to shorter cold ischemia time and better immunological conditions, thus indicating that BD can cause relevant pathopysiological changes. This central catastrophe (2) appears to be a primary injury proceeding the secondary effects of ischemia/reperfusion (3). A combination of these effects leads to enhanced immunogenicity, which, after engraftment, can accelerate the recipient's immune response (4).…”

Section: Introductionmentioning

confidence: 99%

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Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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Brain death (BD) influences the quality of donor grafts in transplantation. To evaluate the impact of BD on pancreas grafts, we investigated the influence of BD on the microcirculation and histology of the pancreas in a rat model of explosive BD. A group of Wistar rats (n = = 7), rendered brain dead by inflating an intracranially inserted Fogarty catheter was compared with controls (CO) using intravital epifluorescence-microscopy over 4 h after BD induction; functional capillary density (FCD), leukocyte adherence (AL) in post-capillary venules, histology and pancreatic enzymes were investigated. Four hours after BD, FCD decreased (333 ± 11 vs. baseline 444 cm/cm 2 ± 5 SEM; p < 0.01) and showed lower values than CO (388 ± 9 p < 0.01). In BD, AL was increased (628 cells/mm 2 ± 110 SEM vs. baseline 123 ± 32, and vs. CO 180 ± 33; p < 0.001). BD caused increased histological damage (CO 1.6 scorepoints ± 0.7 SD vs. BD 8.3 ± 7.1; p < 0.05). Amylase was higher in BD (p < 0.05) but did not reach pathological values. We show for the first time that BD causes relevant changes in pancreatic microcirculation, histology and leukocyte endothelial interaction which might have a serious impact on the function of grafts. New strategies for preventing this damage are therefore highly desirable in order to improve the outcome of pancreas transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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“…After enormous progress in handling problems concerning immunocompatibility, factors like brain death [2] and ischemia/reperfusion injury (IRI) [ 3 , 41 are becoming the center of interest of many investigations with the aim to improve outcome after solid-organ transplantation. IRI plays an important role in the development of graft pancreatitis [5], which is still an unsolved problem in pancreas transplantation.…”

Section: Introductionmentioning

confidence: 99%

Influence of nitric oxide on microcirculation in pancreatic ischemia/reperfusion injury: an intravital microscopic study

Obermaier¹,

Dobschuetz²,

Muhs³

et al. 2004

Transplant International

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“…Inherent to graft outcome are donor demographics, hemodynamics, and ischemic times, which vary with the utilization of LDs or cadaveric donors, both whole and segmental. 5 Ultimately, many mitigating factors impact outcomes. Among these, discerning the relative importance of graft type to graft and patient outcome would influence decisions regarding graft selection.…”

mentioning

confidence: 99%

Survival among pediatric liver transplant recipients: Impact of segmental grafts

et al. 2004

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Segmental liver transplantation with living donor (LD), reduced cadaveric (Reduced), and split cadaveric (Split) allografts has expanded the availability of size-appropriate organs for pediatric recipients. The relevance of recipient age to the selection of graft type has not been fully explored, but could offer the potential to maximize recipient outcome and donor utilization. We conducted a retrospective cohort study among children 12 years of age or less utilizing the United Network of Organ Sharing (UNOS) database. Cox proportional-hazards analysis was used to explore the association of recipient age and graft type to graft and patient survival. Among children <1 year of age and those 1 to 2 years of age, 3-year LD graft survival was superior to whole cadaveric (CAD) organs, Split grafts, and Reduced grafts (for children <1 year of age: 79.4 vs. 61.5, 66.0, and 61.1%, respectively, P ‫؍‬ .0003; and for children 1-2 years of age: 79.2 vs 66.9, 57.1, and 63.9%, respectively, P ‫؍‬ .02). However, in children 3 to 12 years of age, after controlling for multiple donor and recipient factors, LD grafts failed to offer a survival advantage (hazard ratio ‫؍‬ .61; 95% confidence interval ‫؍‬ .37-1.02) compared to CAD organs. In an adjusted analysis examining patient survival, there appeared to be minimal association between recipient age and graft type. Much of the difference in graft survival could be attributed to events in the perioperative period. In conclusion, LD liver transplantation provides improved graft survival in children 2 years of age or less.

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Brain Death and Its Influence on Donor Organ Quality and Outcome After Transplantation1

Cited by 292 publications

References 41 publications

Brain Death Impairs Pancreatic Microcirculation

Brain Death Impairs Pancreatic Microcirculation

Influence of nitric oxide on microcirculation in pancreatic ischemia/reperfusion injury: an intravital microscopic study

Survival among pediatric liver transplant recipients: Impact of segmental grafts

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