Strategies to optimize the use of marginal donors in liver transplantation

Pezzati, Daniele; Ghinolfi, Davide; Simone, Paolo De; Balzano, E; Filipponi, Franco

doi:10.4254/wjh.v7.i26.2636

Cited by 35 publications

(36 citation statements)

References 119 publications

(187 reference statements)

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“…3 In consideration of the prolonged time required for arterial reconstruction at back table, every effort should be made to minimize cold ischemia time, since a time > 12 hours is associated with a 2-fold higher risk of graft failure. 5 …”

Section: Discussionmentioning

confidence: 99%

Successful Transplant of a Nonagenarian Liver Graft With Fully Replaced Right Hepatic Artery Reconstruction

Ghinolfi

Gianardi²,

Cirillo³

et al. 2019

Exp Clin Transplant

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Organ shortage and increasing donor age in liver transplant are stimulating transplant centers to accept otherwise discarded grafts due to donor age or vascular abnormalities; nevertheless, the use of nonagenarian donor grafts is uncommon because advanced age is associated with a higher risk of ischemic-type biliary lesions and worse long-term graft survival. We herein report the case of a 90-yearold donor with fully replaced right hepatic artery. After back-table vascular assessment, the donor right hepatic artery was anastomosed end-to-end with the gastroduodenal artery with 2 polypropylene 8/0 running sutures. Even if the back-table reconstruction of a replaced right hepatic artery is not associated with an enhanced risk of posttransplant vascular complications, vascular abnormalities might discourage the use of otherwise acceptable elderly grafts. The present case underscores that elderly liver grafts should not be discarded per se even in the presence of vascular variants.

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Section: Discussionmentioning

confidence: 99%

Successful Transplant of a Nonagenarian Liver Graft With Fully Replaced Right Hepatic Artery Reconstruction

Ghinolfi

Gianardi²,

Cirillo³

et al. 2019

Exp Clin Transplant

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“…In agreement with the previous study findings, Pezzatiet al (2015) revealed that the implementation of transplant intervention educational program, lead to significant improvements in their performance related to measuring vital signs. [41] In addition, Neuberger and colleagues (2009) mentioned that there was significant improvement observed liver function and body weight of liver transplant recipients after liver transplantation due to reduced ascites. [42] Similar for these results study done by Feng et al [43] Majority of the studied sample reported pain pre transplantation are improved after implementation of program.…”

Section: Discussionmentioning

confidence: 99%

The effects of educational intervention on self-care behavior and expected clinical outcome in patient undergoing liver transplantation

Mohamed

Mostafa²

2018

JNEP

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Background: Organ transplantation has the potential to rapidly restore the health and wellbeing of individuals experiencing end stage liver disease (ESLD). The aim of the research was to evaluate effects of educational intervention on self-care behaviors and expected clinical outcome in patient undergoing liver transplantation. Methods: A convenience sample of 60 liver patients was assigned for transplantation. The study was conducted in the transplanted Unit in Ain Shams University Hospitals. A quasi-experimental design with pre-post and follow up assessment has been used for this study. Tools were utilized to collect data such a) Self-care practice assessment tool, b) Patient physiological assessment sheet, and c) Demographic and medical health history tool. Results: Improvement in knowledge and self-care behaviors at the post and follow-up tests (p < .0001) after implementation of program compared by pretest evaluation. There are significant improvements in blood pressure (BP) and laboratory results through study stage (p < .001). The pain level improved after intervention and follow up (p < .0001). There are statistically significant between age, job and self-care behaviors at follow up phase. Conclusions: Liver transplantation patients showed a positive improvement in their knowledge, self-care and physiological outcomes after implementing of program. Replication of the study on larger probability sample from different geographical areas to achieve more generalizable results.

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“…(12) Therefore, extended criteria donors (ECDs), previously known as marginal donors, are more often accepted to augment the donor pool. (17) Living Donor Liver Transplantation in Germany LT from living related donors is a relatively common procedure in Germany for pediatric patients. (18) Overall, LDLTs account for far less than 10% of all LTs in adults (Fig.…”

Section: Referral and Assessment For Transplantation: Selection And Amentioning

confidence: 99%

Liver transplantation in Germany

Tacke¹,

Kroy²,

Barreiros

et al. 2016

Liver Transpl

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Liver transplantation (LT) is a well‐accepted procedure for end‐stage liver disease in Germany. In 2015, 1489 patients were admitted to the waiting list (including 1308 new admissions), with the leading etiologies being fibrosis and cirrhosis (n = 349), alcoholic liver disease (n = 302), and hepatobiliary malignancies (n = 220). Organ allocation in Germany is regulated within the Eurotransplant system based on urgency as expressed by the Model for End‐Stage Liver Disease score. In 2015, only 894 LTs (n = 48 from living donors) were performed at 23 German transplant centers, reflecting a shortage of organs. Several factors may contribute to the low number of organ donations. The German transplant legislation only accepts donation after brain death (not cardiac death), whereas advances in neurosurgery and a more frequently requested “palliative care” approach render fewer patients suitable as potential donors. The legislation further requires the active consent of the donor or first‐degree relatives before donation. Ongoing debates within the German transplant field address the optimal management of patients with alcoholic liver cirrhosis, hepatocellular carcinoma (HCC), and cholangiocarcinoma and measures to increase living donor transplantations. As a result of irregularities at mainly 4 German transplant centers that were exposed in 2012, guiding principles updated by the German authorities have since implemented strict rules (including internal and external auditing, the 8‐eyes principle, mandatory repeated testing for alcohol consumption) to prohibit any manipulations in organ allocation. In conclusion, we will summarize important aspects on the management of LT in Germany, discuss legal and organizational aspects, and highlight challenges mainly related to the relative lack of organ donations, increasing numbers of extended criteria donors, and the peculiarities of the recipient patients. Liver Transplantation 22 1136–1142 2016 AASLD

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Strategies to optimize the use of marginal donors in liver transplantation

Cited by 35 publications

References 119 publications

Successful Transplant of a Nonagenarian Liver Graft With Fully Replaced Right Hepatic Artery Reconstruction

Successful Transplant of a Nonagenarian Liver Graft With Fully Replaced Right Hepatic Artery Reconstruction

The effects of educational intervention on self-care behavior and expected clinical outcome in patient undergoing liver transplantation

Liver transplantation in Germany

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