Abstract:Donor organs are exposed to sequential temperature changes during the transplantation process. The role of donor warm ischemia and cold ischemia times on post‐transplant outcomes has been extensively studied. Much less attention has been paid to the transient ischemia occurring during donor organ removal and implantation. Recently, it has become clear that prolonged donor nephrectomy and implantation time are independently associated with delayed graft function after kidney transplantation. In addition, implan… Show more
“…Our finding that the duration of AT negatively affects short-term outcomes after LTx is consistent with recent studies in kidney and liver transplantation. 19 revealed AT as an independent risk factor for decreased allograft function, reflected by an increased need for dialysis in the first 7 days post-transplant (OR 1.05, 95% CI [1.02-1.07], p = .001).…”
Section: Discussionmentioning
confidence: 99%
“…The most common indication for transplantation was emphysema, accounting for 271 cases ). The total length of in-hospital stay was 28 days (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). One, 3-, and 5-year patient survival was 94%, 87%, and 82%, respectively, and graft survival was 94%, 86%, and 80%, respectively.…”
Section: Recipient and Donor Demographicsmentioning
confidence: 99%
“…In liver and kidney transplantation, however, it has been shown that the time to create the vascular anastomoses is an independent risk factor for short-and long-term outcome. 19 Prolonged anastomosis time (AT) in liver transplantation is associated with an increased risk of early allograft dysfunction and graft loss in the early post-transplant period (<3 months). 20,21 In kidney transplantation, AT is correlated with delayed graft function and long-term graft failure.…”
Primary graft dysfunction (PGD) is a major obstacle after lung transplantation (LTx), associated with increased early morbidity and mortality. Studies in liver and kidney transplantation revealed prolonged anastomosis time (AT) as an independent risk factor for impaired short‐ and long‐term outcomes. We investigated if AT during LTx is a risk factor for PGD. In this retrospective single‐center cohort study, we included all first double lung transplantations between 2008 and 2016. The association of AT with any PGD grade 3 (PGD3) within the first 72 h post‐transplant was analyzed by univariable and multivariable logistic regression analysis. Data on AT and PGD was available for 427 patients of which 130 (30.2%) developed PGD3. AT was independently associated with the development of any PGD3 ≤72 h in uni‐ (odds ratio [OR] per 10 min 1.293, 95% confidence interval [CI 1.136–1.471], p < .0001) and multivariable (OR 1.205, 95% CI [1.022–1.421], p = .03) logistic regression analysis. There was no evidence that the relation between AT and PGD3 differed between lung recipients from donation after brain death versus donation after circulatory death donors. This study identified AT as an independent risk factor for the development of PGD3 post‐LTx. We suggest that the implantation time should be kept short and the lung cooled to decrease PGD‐related morbidity and mortality post‐LTx.
“…Our finding that the duration of AT negatively affects short-term outcomes after LTx is consistent with recent studies in kidney and liver transplantation. 19 revealed AT as an independent risk factor for decreased allograft function, reflected by an increased need for dialysis in the first 7 days post-transplant (OR 1.05, 95% CI [1.02-1.07], p = .001).…”
Section: Discussionmentioning
confidence: 99%
“…The most common indication for transplantation was emphysema, accounting for 271 cases ). The total length of in-hospital stay was 28 days (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). One, 3-, and 5-year patient survival was 94%, 87%, and 82%, respectively, and graft survival was 94%, 86%, and 80%, respectively.…”
Section: Recipient and Donor Demographicsmentioning
confidence: 99%
“…In liver and kidney transplantation, however, it has been shown that the time to create the vascular anastomoses is an independent risk factor for short-and long-term outcome. 19 Prolonged anastomosis time (AT) in liver transplantation is associated with an increased risk of early allograft dysfunction and graft loss in the early post-transplant period (<3 months). 20,21 In kidney transplantation, AT is correlated with delayed graft function and long-term graft failure.…”
Primary graft dysfunction (PGD) is a major obstacle after lung transplantation (LTx), associated with increased early morbidity and mortality. Studies in liver and kidney transplantation revealed prolonged anastomosis time (AT) as an independent risk factor for impaired short‐ and long‐term outcomes. We investigated if AT during LTx is a risk factor for PGD. In this retrospective single‐center cohort study, we included all first double lung transplantations between 2008 and 2016. The association of AT with any PGD grade 3 (PGD3) within the first 72 h post‐transplant was analyzed by univariable and multivariable logistic regression analysis. Data on AT and PGD was available for 427 patients of which 130 (30.2%) developed PGD3. AT was independently associated with the development of any PGD3 ≤72 h in uni‐ (odds ratio [OR] per 10 min 1.293, 95% confidence interval [CI 1.136–1.471], p < .0001) and multivariable (OR 1.205, 95% CI [1.022–1.421], p = .03) logistic regression analysis. There was no evidence that the relation between AT and PGD3 differed between lung recipients from donation after brain death versus donation after circulatory death donors. This study identified AT as an independent risk factor for the development of PGD3 post‐LTx. We suggest that the implantation time should be kept short and the lung cooled to decrease PGD‐related morbidity and mortality post‐LTx.
“…Similar to DBD and ISP DCD procedures, colloid‐containing solutions are preferred in most countries for abdominal organ (UW and IGL‐1) and lung preservation (Perfadex). Abdominal organs are removed as quickly as possible, either sequentially or en bloc , following the onset of cold preservation [63]. We recommend special consideration for thoracic organ recovery in DCD donors with NRP (not graded).…”
Section: Minimal Basic Technical Requirements For Nrpmentioning
Summary
Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence‐based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.
“…Hepatic IRI is a common but thorny problem in different clinical settings such as LT, LR, trauma surgery, and shock. As essential procedures during LT, cold preservation of liver graft and subsequent warm reperfusion when implanted into the recipients result in hepatic IRI, which can be stratified into warm IRI and cold IRI ( 15 ). The severity of IRI and subsequent inflammation is positively correlated with ischemia time, which can also be partitioned into warm ischemia time (WIT) and cold ischemia time (CIT) ( 16 ).…”
Section: Hepatic Iri Promotes the Recurrence Of Hcc: Clinical Evidenc...mentioning
Inflammation is crucial to tumorigenesis and the development of metastasis. Hepatic ischemia/reperfusion injury (IRI) is an unresolved problem in liver resection and transplantation which often establishes and remodels the inflammatory microenvironment in liver. More and more experimental and clinical evidence unmasks the role of hepatic IRI and associated inflammation in promoting the recurrence of hepatocellular carcinoma (HCC). Meanwhile, approaches aimed at alleviating hepatic IRI, such as machine perfusion, regulating the gut-liver axis, and targeting key inflammatory components, have been proved to prevent HCC recurrence. This review article highlights the underlying mechanisms and promising therapeutic strategies to reduce tumor recurrence through alleviating inflammation induced by hepatic IRI.
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