Using livers from donation after cardiac death donors—A proposal to protect the true Achilles heel

Fung, John J.; Eghtesad, Bijan; Patel-Tom, Kusum

doi:10.1002/lt.21388

Cited by 43 publications

(42 citation statements)

References 21 publications

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“…6 Alternative preservation solutions also have been suggested as a modifiable variable to improve DCD outcomes. 11 Histidine-tryptophanketoglutarate has been used increasingly during the past decade, although UW solution remains the standard abdominal organ preservation solution for transplant. 24 Because HTK has a lower viscosity that allows better perfusion of the hepatic microcirculation, it is believed to decrease aggregation and improve elimination of blood cells, hypothetically leading to better preservation of the biliary tree and reduced complications.…”

Section: Discussionmentioning

confidence: 99%

“…Recommendations to manipulate these dynamics have included donor management with vasodilators, limits to warm and cold ischemia times, tissue plasminogen activator, and the use of lower viscosity preservation solutions like histamine-tryptophanketoglutarate (HTK) solution. [8][9][10][11] Despite the series of studies finding poorer outcomes with DCD as compared with DBD donors, several single-center studies have demonstrated that similar results can be achieved in recipients regardless of the donor source. [12][13][14] If concerns regarding DCD donors can be resolved, they could remain a resource to help address the growing demand for liver allografts.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death

Vanatta

Dean

Hathaway³

et al. 2013

Exp Clin Transplant

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Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P = .444 and P = .295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P = .107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death

Vanatta

Dean

Hathaway³

et al. 2013

Exp Clin Transplant

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“…Several strategies have been suggested to reduce the incidence and severity of ITBL [108][109][110][111] . The relative importance of portal venous blood flow in developing ITBL was outlined by Farid et al [108] because these lesions were diagnosed in patients with a normal arterial flow but with portal thrombosis.…”

Section: Itblmentioning

confidence: 99%

“…Simultaneous graft revascularization seems to be associated with a lower incidence of ITBL than sequential revascularization [109,110] . Viscous preservation solutions may negatively impact on efficacy of flushing of the bile ducts capillaries, resulting in residual bile crystallization and obstruction [111][112][113] . Use of less viscous solutions, like HTK, seems to provide better results in reducing the incidence of biliary tract injuries, despite the recent results of the European liver transplant registry data [67,112] .…”

Section: Itblmentioning

confidence: 99%

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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“…There is evidence that although unilateral and easily approachable strictures may be managed endoscopically (with > 85% long-term survival), most DCD patients have diffuse intrahepatic structuring disease, due to global organ ischemia, which negatively impacts their long-term survival [95] .…”

mentioning

confidence: 99%

Endoscopic management of post-liver transplant biliary complications

Girotra¹,

Soota²,

Klair³

et al. 2015

WJGE

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Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. Core tip: Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques which have proved ERCP with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also deliberate the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.

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Using livers from donation after cardiac death donors—A proposal to protect the true Achilles heel

Cited by 43 publications

References 21 publications

Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death

Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death

Strategies to optimize the use of marginal donors in liver transplantation

Endoscopic management of post-liver transplant biliary complications

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