Liver damage during organ donor procurement in donation after circulatory death compared with donation after brain death

Ausania, Fabio; White, Steven A.; Coates, R; Hulme, William; Manas, Derek

doi:10.1002/bjs.9009

Cited by 31 publications

(36 citation statements)

References 16 publications

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“…Alternatively, the small numbers of organs removed en bloc may have reduced the ability of this analysis to detect a truly reduced injury rate. Deceased donor type was not a risk factor for pancreas damage, unlike kidney or liver procurement where DCD donors appear to have higher rates of injuries (10,13). This finding is difficult to explain, but it is reassuring given the high proportion of DCD pancreas donors in the UK and their acceptable short-term outcomes (4,19).…”

Section: Discussionmentioning

confidence: 89%

“…Where data on damage were available, just over half of pancreata procured for solid organ or islet transplantation had one or more injuries, most commonly a shortened portal vein (21.5%) or capsular injury (13.6%). These rates of damage are higher than in other abdominal organs, for example, 7.1% of kidneys (13), and 14% of livers (10). Moreover, damage was given as a primary or secondary reason for discard in 12% of procured pancreata that were subsequently not implanted.…”

Section: Discussionmentioning

confidence: 99%

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A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p ¼ 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p ¼ 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p ¼ 0.04) and in those with parenchymal damage (p ¼ 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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“…Arterial injuries occur in 1.6% DBD and 1% DCD grafts. 6 Arterial injuries may be more frequent (12%) in grafts that have aberrant anatomy and may cause HAT after transplant. 1 The present cases suggest a possible strategy to address graft damage, especially presence of dHAT.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Scalera

Perera²,

Muiesan³

2015

Exp Clin Transplant

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Arterial injuries in graft organs may be recognized during procurement and may contribute to organ waste. These injuries may be more likely in the presence of abnormal anatomy. We observed 2 liver grafts that had hepatic artery thrombosis in the donor vessels. The graft from a 64-year-old woman who had circulatory death was discarded because of potential decreased perfusion of the lobe and risk of thrombosis extending to the main hepatic artery after transplant. The graft from a 68-year-old woman donor who had brain death was used successfully as a reduced-size liver graft that included the caudate lobe. In summary, donor grafts that have hepatic artery thrombosis may or may not be used in transplant, depending on the cause of donor death, graft quality, and anatomic location of donor hepatic artery thrombosis.

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“…The increasing demand for transplantation has created a need for additional organ sources, and acceptance criteria have been widened, not only for kidney retrieval but increasingly for other organs with a lower tolerance of warm ischemia, such as the liver, pancreas, and lungs [18,19]. This expansion of donor criteria to include the use of grafts from elderly donors, DCD, or organs from donors with other medical conditions has underlined the need for a technique that prevents any further damage during the preservation period.…”

Section: Discussionmentioning

confidence: 99%

Development of a preclinical model of donation after circulatory determination of death for translational application

Allain¹,

Kerforne²,

Thuret³

et al. 2014

Transplant Res

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BackgroundExtracorporeal membranous oxygenation is proposed for abdominal organ procurement from donation after circulatory determination of death (DCD). In France, the national Agency of Biomedicine supervises the procurement of kidneys from DCD, specifying the durations of tolerated warm and cold ischemia. However, no study has determined the optimal conditions of this technique. The aim of this work was to develop a preclinical model of DCD using abdominal normothermic oxygenated recirculation (ANOR). In short, our objectives are to characterize the mechanisms involved during ANOR and its impact on abdominal organs.MethodsWe used Large White pigs weighing between 45 and 55 kg. After 30 minutes of potassium-induced cardiac arrest, the descending thoracic aorta was clamped and ANOR set up between the inferior vena cava and the abdominal aorta for 4 hours. Hemodynamic, respiratory and biochemical parameters were collected. Blood gasometry and biochemistry analysis were performed during the ANOR procedure.ResultsSix ANOR procedures were performed. The surgical procedure is described and intraoperative parameters and biological data are presented. Pump flow rates were between 2.5 and 3 l/min. Hemodynamic, respiratory, and biochemical objectives were achieved under reproducible conditions. Interestingly, animals remained hemodynamically stable following the targeted protocol. Arterial pH was controlled, and natremia and renal function remained stable 4 hours after the procedure was started. Decreased hemoglobin and serum proteins levels, concomitant with increased lactate dehydrogenase activity, were observed as a consequence of the surgery. The serum potassium level was increased, owing to the extracorporeal circulation circuit.ConclusionsOur ANOR model is the closest to clinical conditions reported in the literature and will allow the study of the systemic and abdominal organ impact of this technique. The translational relevance of the pig will permit the determination of new biomarkers and protocols to improve DCD donor management.

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Liver damage during organ donor procurement in donation after circulatory death compared with donation after brain death

Cited by 31 publications

References 16 publications

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Untitled

Development of a preclinical model of donation after circulatory determination of death for translational application

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