Strategies for Expanding the UK Pool of Potential Intestinal Transplant Donors

Rushton, Sally; Hudson, Alex; Collett, David; Neuberger, James; Mirza, Darius F.

doi:10.1097/tp.0b013e318278301b

Cited by 10 publications

(15 citation statements)

References 2 publications

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“…Therefore, the pool of donors who can provide a suitable size‐matched intestinal or multivisceral graft is very small as the median (IQR) weight of pediatric donors in the United Kingdom is 46 (14–62) kg 13 . This is further demonstrated by Rushton et al, who reported only 4 potential small intestine donors were <20 kg over a two‐year period in the United Kingdom 9 . During the same time period, there were up to 10 children on the national waitlist for an intestine‐containing graft 6 .…”

Section: Introductionmentioning

confidence: 81%

“…A higher susceptibility of intestinal failure‐associated liver disease (IFALD) in children has necessitated more than 50% of intestinal grafts to be transplanted in conjunction with the liver 5–8 . Obtaining an adequate size‐matched intestine containing graft for small children is challenging, and many may miss their therapeutic window of opportunity for transplantation because of clinical deterioration during a prolonged wait 9,10 . Age and size‐matched pediatric donors are extremely rare in the United Kingdom and Europe in general.…”

Section: Introductionmentioning

confidence: 99%

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Addressing extreme size mismatch in pediatric intestinal transplantation: Outcomes of intestinal length reduction

Hann

Gupte

Pathanki

et al. 2023

Pediatric Transplantation

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Background: Bench liver reduction, with or without intestinal length reduction (LR) (coupled with delayed closure and abdominal wall prostheses), has been a strategy adopted by our program for small children due to the limited availability of sizematched donors. This report describes the short, medium, and long-term outcomes of this graft reduction strategy.Methods: A single-center, retrospective analysis of children that underwent intestinal transplantation (April 1993 to December 2020) was performed. Patients were grouped according to whether they received an intestinal graft of full length (FL) or following LR.Results: Overall, 105 intestinal transplants were performed. The LR group (n = 10) was younger (14.5 months vs. 40.0 months, p = .012) and smaller (8.7 kg vs. 13.0 kg, p = .032) compared to the FL group (n = 95). Similar abdominal closure rates were achieved after LR, without any increase in abdominal compartment syndrome (1/10 vs. 7/95, p = .806). The 90-day graft and patient survival were similar (9/10, 90% vs. 83/95, 86%; p = .810). Medium and long-term graft survival at 1 year (8/10, 80% vs. 65/90, 71%; p = .599), and 5 years (5/10, 50% vs. 42/84, 50%; p = 1.00) was similar. Conclusion:LR of intestinal grafts appears to be a safe strategy for infants and small children requiring intestinal transplantation. This technique should be considered in the situation of significant size mismatch of intestine containing grafts.

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Section: Introductionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Addressing extreme size mismatch in pediatric intestinal transplantation: Outcomes of intestinal length reduction

Hann

Gupte

Pathanki

et al. 2023

Pediatric Transplantation

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“…When these children are considered for transplant surgery, it is anticipated that there would be significant disproportion of abdominal volume to donor organs even if size‐matched donors are used. In the United Kingdom, there is a shortage of size‐matched donors, and hence, although organ reduction techniques are used, the recipient abdominal cavity of infants is often too small to accommodate the transplanted organs, as has been reported . These children have a higher risk of mortality on the waiting list, and hence, alternative options have to be considered.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are echoed by Rushton et al. , who investigated intestinal utilization rates in the UK, in the year 2011–2012. Forty‐seven percent of non‐utilization by pediatric centers was due to donor size.…”

mentioning

confidence: 88%

Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities

Vidyadharan

Bommel

Kuti

et al. 2013

Pediatric Transplantation

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Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size-matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post-transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re-exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post-transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end-stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process.

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“…Over the past two decades, advances in organ preservation, surgical transplantation techniques, immunosuppressive strategies and postoperative management have brought small bowel transplantation from an experimental technique to the preferred treatment option for intestinal failure [1,2]. Treatment success has led to an increased demand for intestinal donors whilst the number of suitable grafts remained static; therefore, researchers have been trying to seek new sources of donors to alleviate this pressure [3].…”

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confidence: 99%

Characterization of the withdrawal phase in a swine controlled intestinal donation after circulatory death model

Guo¹,

Li²,

Chen³

2014

CIM

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Purpose: Transplantation of donation after cardiac death (DCD) intestine has higher rates of organ failure and complications. Fortunately, this is less grievous in a subclass of DCD called controlled (CDCD), those with irreversible but incomplete brain injury. The aim of the paper is to establish a CDCD porcine model which is closely mimicking human CDCD scenario, and investigate the physiologic changes from withdrawal of ventilatory support to circulatory arrest. Method: Ten domestic crossbred pigs were anesthetized and ventilated with room air. Once all baseline data was taken, atracurium besilate (0.9 mg/kg, 3×ED95) was administered and the ventilator was discontinued while the animal was under deep anesthesia to establish the porcine CDCD model. Meanwhile, heparin (150~200 U/kg) was administered after discontinuation of the ventilator. The time to death and the changes of arterial blood gases and hemodynamic parameters were monitored every 5 minutes until circulatory arrest. In addition, histopathology, ultrastructures (via electron microscope) and expression of tight junction proteins of intestinal mucosa were observed at the baseline and the time of death. Result: The mean time to death was approximately (21.8±3.12 min. Within 5 minutes of removal of the ventilator, there was a hyperdynamic period. Systolic blood pressure and heart rate quickly increased to 118.5±10.4 mmHg and 108.2±4.94 bpm, respectively. Blood pressure and heart rate then reduced rapidly until circulatory arrest. Moreover, the PaO2 quickly dropped to 17.4±3.13 mmHg, the blood gases throughout the apneic time showed a rapid hypercapnia and acidosis. In addition, warm ischemia damaged intestinal mucosa and reduced TJ proteins expression. Conclusion: A new swine CDCD model, simulating three stages of “withdrawal of ventilation, systemic anticoagulation and determination of death”, which closely mimics the human DCD scenario and can thus be used in studies related to organ transplantation, was successfully established.

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Strategies for Expanding the UK Pool of Potential Intestinal Transplant Donors

Cited by 10 publications

References 2 publications

Addressing extreme size mismatch in pediatric intestinal transplantation: Outcomes of intestinal length reduction

Addressing extreme size mismatch in pediatric intestinal transplantation: Outcomes of intestinal length reduction

Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities

Characterization of the withdrawal phase in a swine controlled intestinal donation after circulatory death model

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