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Predictive Score Model for Delayed Graft Function Based on Easily Available Variables before Kidney donation after cardiac death

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Chinese Medical Journal 2017年第20期130卷 2429-2434页

作者： Chen-Guang Ding Qian-Hui Tai Feng Han Yang Li Xiao-Hui Tian Pu-Xun Tian Xiao-Ming Ding Xiao-Ming Pan Jin Zheng He-Li Xiang Wu-Jun Xue Department of Renal Transplantation Nephropathy Hospital The First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi 710061 China Institute of Organ Transplantation Xi'an Jiaotong University Xi'an Shaanxi 710061 China

Background： How to evaluate the quality of donation after cardiac transplantation in China. Hence, the aim of this study was to develop kidneys before DCD. death （DCD） kidneys has become a critical problem in kidney a simple donor risk score model to evaluate the quality of DCD Methods： A total of 543 qualified kidneys were randomized in a 2：1 manner to create the development and validation cohorts. The donor variables in the development cohort were considered as candidate univariate predictors of delayed graft function （DGF）. Multivariate logistic regression was then used to identify independent predictors of DGF with P 〈 0.05. Date from validation cohort were used to validate the donor scoring model. Results： Based on the odds ratios, eight identified variables were assigned a weighted integer; the sum of the integer was the total risk score for each kidney. The donor risk score, ranging from 0 to 28, demonstrated good discriminative power with a C-statistic of 0.790. Similar results were obtained from validation cohort with C-statistic of 0.783. Based on the obtained frequencies of DGF in relation to different risk scores, we formed tour risk categories of increasing severity （scores 04, 5 9, 10-14, and 15 28）. Conclusions： The scoring model might be a good noninvasive tool for assessing the quality of DCD kidneys before donation and potentially useful for physicians to make optimal decisions about donor organ offers.

关键词： Delayed Graft Function donation after cardiac death Kidney Transplantation Predictive Score

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Current attitudes toward organ donation after cardiac death in northwest China

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Chinese Medical Journal 2014年第5期127卷 835-838页

作者： Pan Xiaoming Liu Linjuan Xiang Heli Ding Chenguang Ren Li Xue Wujun Nephropathy Center First Affiliated Hospital Medical College of Xi&#39 an Jiaotong University Xi&#39 an Shaanxi 710061 China Institute of Organ Transplantation First Affiliated Hospital Medical College of Xi&#39

Background People＇s attitude toward organ donation after cardiac death （DCD） has not come to an agreement in different countries and *** by the local culture in China for thousands of years,the general public has different ideas about this *** purpose of this study was to investigate the current attitudes trend and characteristics of transplantation with organs donated after cardiac death in northwest *** This largest single-center cohort study was performed by an interview or by telephone using a *** family members of potential DCD donors were recruited from the First Affiliated Hospital,medical college of Xi＇an Jiaotong University located in a metropolitan area of northwest *** 12-item attitude questionnaire was specifically developed from the literature review with coordinator,physician,and donor＇s family *** participants were asked to rate the queries on a 5-point Likert intensity *** The 174 participants included 56 （32.2％） women and 118 （67.8％） *** people were aged between 41 and 50 years （n=63,36.2％）,31 and 40 years （n=59,33.9％）,and less than 30 years （n=36,20.7％）.The top five attitudes of participants were the best person to suggest organ donation to a family was ranked as the DCD coordinator of Red Cross Organization （RCO,n=160,92％）,donor is a hero （n=143,82.2％）,honor to be a donor＇s family member （n=136,78.2％）,improved relationship with colleagues （n=124,71.3％）,and with recipient after donation （n=123,70.7％）.The best person to suggest organ donation to a family was ranked as the coordinator of RCO （n=160,92％）,doctor unrelated to transplantation （n=104,59.8％）,social worker （n=36,20.7％）,and doctor related to transplantation （n=25,14.4％）.The top two reasons for non-consent to donation were that the family insisted on intact body after patient death and did not want to have surgery again （n=51,41.5％）,and feared that they would be misunderstood by neighbors,relatives,and friends about do

关键词： donation after cardiac death organ transplantation attitude

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Tauroursodeoxycholic acid and 4-phenyl butyric acid alleviate endoplasmic reticulum stress and improve prognosis of donation after cardiac death liver transplantation in rats

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 586-593页

作者： Hao Lu Ling Lu Zhen-Chao Xu Yun-Jie Lu Bo Zhao Lin Zhuang Bao-Bing Hao Feng Zhang Translation Medicine Research Center Affiliated Jiangning Hospital Department of Liver Surgery First Affiliated Hospital Nanjing Medical University Key Laboratory of Living Donor Liver Transplantation National Health and Family Planning Commission of China School of Chemistry and Materials Science Nanjing Normal University

BACKGROUND： Inevitable warm ischemia time before organ procurement aggravates posttransplantation ischemia- reperfusion injury. Endoplasmic reticulum （ER） stress is involved in ischemia-reperfusion injury, but its role in donation after cardiac death （DCD） liver transplantation is not clear and the effect of ER stress inhibitors, tauroursodeoxycholic acid （TUDCA） and 4-phenyl butyric acid （PBA）, on the prognosis of recipient of DCD liver transplantation remains unclear. METHODS： Male Sprague-Dawley rats （8-10 weeks） were randomly divided into control group： liver grafts without warm ischemia were implanted; DCD group： warm ischemia time of the liver grafts was 60 minutes; TUDCA and PBA groups： based on the DCD group, donors were intraperitoneally injected with TUDCA or PBA 30 minutes before the organ procurements. Serum aminotransferase levels, oxidative stress activation and expression of ER stress signal molecules were evaluated. Pathological examinations were performed. The survivals of the recipients in each group were compared for 14 ***： Compared with the control group, DCD rats had significantly higher levels of serum aminotransferase at 6 hours, 1 day and 3 days after operation （P〈0.01, 0.01 and 0.05, respectively） and oxidative indices （P〈0.01 for both malondialdehyde and 8-hydroxy deoxyguanosine）, more severe liver damage （P〈0.01） and up-regulated ER stress signal expressions （P〈0.01 for GRP78, phos-eIF2al, CHOP, ATF-4, ATF-6, PERK, XBP-1 and pro-caspase-12）. All recipients died within 3 days after liver transplantation. Administration of TUDCA or PBA significantly decreased aminotransferase levels （P〈0.05）, increased superoxide dismutase activities （P〈0.01）, alleviated liver damage （P〈0.01）, down-regulated ER stress signal expressions （P〈0.01） and improved postoperative survivals （P〈0.01）. CONCLUSIONS： ER stress was involved with DCD liver trans- plantation in rats. Preoperative intraperitoneally injection of TUDCA or PBA protected ER stress and

关键词： donation after cardiac death liver transplantation ischemia-reperfusion injury endoplasmic reticulum stress

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Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death

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World Journal of Gastroenterology 2018年第43期24卷 4920-4927页

作者： Liang-Shuo Hu Yi-Chao Chai Jie Zheng Jian-Hua Shi Chun Zhang Min Tian Yi Lv Bo Wang Ai Jia Department of Hepatobiliary Surgery First Affiliated Hospital of Xi’an Jiaotong University Clinical Research Center First Affiliated Hospital of Xi’an Jiaotong University Department of Gastroenterology First Affiliated Hospital of Xi’an Jiaotong University

AIM To describe the prevalence of posttransplant metabolic syndrome(PTMS) after donation after cardiac death(DCD) liver transplantation(LT) and the pre-and postoperative risk *** One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre-and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-Ⅲ criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years *** The prevalence of PTMS after DCD donor orthotopic LT was 20/147(13.6%). Recipient's body mass index(P = 0.024), warm ischemia time(WIT)(P = 0.045), and posttransplant hyperuricemia(P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients(P after the 1 s t mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. after transplantation, the level of serum uric acid in PTMS patients was not associated with renal *** PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

关键词： Posttransplant metabolic syndrome Liver transplantation donation after cardiac death Uric acid Warm ischemia time

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Kidney donation after cardiac death

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World Journal of Nephrology 2012年第3期1卷 79-91页

作者： Jacob A Akoh South West Transplant Centre Plymouth Hospi-tals NHS TrustDerriford HospitalPlymouth PL6 8DHUnited Kingdo

There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

关键词： donation after cardiac death donation after brain death Extended criteria donor Viability assessment Renal transplantation Delayed graft function Graft survival Agonal phase Kidney preservation

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Outcome and Impact of Different Induction Agents in donation after cardiac death Kidney Transplantation

Outcome and Impact of Different Induction Agents in Donation...

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中国中西医结合学会泌尿外科专业委员会第十四次全国学术会议暨2016年广东省中西医结合学会泌尿外科专业委员会学术年会

作者： Dong Zhu Kevin McCague Wei Lin Ruiming Rong Ming Xu Laurence Chan Tongyu Zhu Department of Urology Zhongshan HospitalFudan University Shanghai Key Laboratory of Organ Transplantation Department of Transfusion Zhongshan HospitalFudan University

Background:Kidney transplant is the most successful organ transplantation,while it is limited severely by the current enduring critical shortage of donor kidneys. donation after cardiac death(DCD) has been explored to alleviate such a problem. For better understanding the outcome of DCD kidney transplant and impact of different induction agents in DCD kidney transplantation,we re-analyzed the U.S. MORE Registry(Mycophenolic Renal Transplant Registry). Methods:We compared delayed graft function(DGF),acute rejection(AR),graft loss and patient death between DCD and donation after brain death(DBD) kidney transplants. Recipients were further stratified into depleting induction group and non-depleting induction group for ***:There were 548 patients received kidney transplantations from deceased donor in the MORE Registry. Among them,133 received grafts from DCD donors and 415 received from DBD donors. DGF and AR rates at 12 months post-transplantation were 29.4% and 9.0% in the DCD group,and 23.5% and 9.9% in the DBD group respectively(P=0.1812 and P=0.7713). Grafts from DCD donors were associated with higher one-year graft loss rates(7.5% vs. 3.1%,P= 0.0283) vs. DBD donor grafts. Four-year graft loss rate,one-year and four-year patient death rates were not significantly different between the two groups. DGF,AR,graft loss and patient death were also compared between the non-depleting group and depleting group of DCD kidney transplantation,and no statistically significant differences were observed. Conclusions:The DCD kidney transplant group resulted in acceptable short-term outcomes and good long-term outcomes as compared to the DBD kidney transplant group. And non-depleting induction therapy might be an effective therapeutics in DCD kidney transplantation.

关键词： donation after cardiac death Induction agents Kidney transplantation MORE Outcome

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Cold ischemia time in liver transplantation:An overview

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World Journal of Hepatology 2024年第6期16卷 883-890页

作者： Manuela Cesaretti Alessandro Izzo Roberta Anna Pellegrino Alessandro Galli Orestes Mavrothalassitis Department of HPB and Liver Transplantation Brotzu HospitalCagliari 09122Italy Department of Nanophysic Istituto Italiano di TecnologiaGenova 16163Italy Department of Critical Care Medicine and Anesthesia ASST Papa Giovanni XXIIIBergamo 24100Italy Department of Anesthesia and Perioperative Care University of California San FranciscoSan FranciscoCA 94143United States

The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold ischemia time(CIT).This simple definition reveals a multifactorial time frame that depends on donor hepatectomy time,transit time,and recipient surgery time,and is one of the most important donor-related risk factors which may influence the graft and recipient’s ***,the growing demand for the use of marginal liver grafts has prompted scientific exploration to analyze ischemia time factors and develop different organ preservation *** review details the CIT definition and analyzes its different *** also explores the most recent strategies developed to implement each timestamp of CIT and to protect the graft from ischemic injury.

关键词： Cold ischemia time Liver transplantation Organ donation donation after cardiac death Warm ischemia time Machine perfusion

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Evolution of heart transplant donor characteristics in the 21st century: A United States single center’s experience

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World Journal of Transplantation 2024年第3期14卷 22-29页

作者： Alexander M Spring Christiana Gjelaj Shivank Madan Snehal R Patel Omar Saeed Sandhya Murthy Yogita Rochlani Daniel B Sims Sasha Vukelic Stephen J Forest Jamil F Borgi Daniel J Goldstein Ulrich P Jorde Montefiore-Einstein Center for Heart and Vascular Care Montefiore Medical CenterAlbert Einstein College of MedicineBronxNY 10467United States Division of Cardiothoracic Surgery Tulane UniversityNew OrleansLA 70112United States

Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United *** we describe the barriers to adaptation of numerous“non-traditional”orthotopic heart transplant donor characteristics including donors with hepatitis C virus,those meeting criteria for donation after cardiac death,donors with coronavirus disease 19 infection,donors with the human immunodeficiency virus,and grafts with left ventricular systolic *** center’s objective was to increase our transplant volume by expanding our donor pool from“traditional”donors to these“non-traditional”*** detail how medical advances such as certain laboratory studies,pharmacologic interventions,and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.

关键词： Orthotopic heart transplantation Hepatitis C virus COVID-19 Left ventricular systolic dysfunction Human immunodeficiency virus donation after cardiac death

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Prediction of rat liver transplantation outcomes using energy metabolites measured by microdialysis

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 392-401页

作者： Qi Pan Ying Cheng Zi-Gong Shao An-Yin Wang Yong-Feng Liu Department of Transplantation and Hepatobiliary Surgery First Affiliated Hospital of China Medical University

Background: Warm ischemia jeopardizes graft quality and recipient survival in donation after cardiac death(DCD) transplantation. Currently, there is no system to objectively evaluate the liver quality from DCD. The present study tried to use energy metabolites to evaluate the donor liver quality. Methods: We divided 195 Sprague-Dawley rats into five groups: the control( n = 39), warm ischemic time(WIT) 15 min( n = 39), WIT 30 min( n = 39), WIT 45 min( n = 39), and WIT 60 min( n = 39) groups. Three rats from each group were randomly selected for pretransplant histologic evaluation of warm ischemiarelated damage. The remaining 36 rats were randomly divided into donors and recipients of 18 liver transplantations, and were subjected to postoperative liver function and survival analyses. Between cardiac arrest and cold storage, liver energy metabolites including glucose, lactate, pyruvate, and glycerol were measured by microdialysis. The lactate to pyruvate ratio(LPR) was calculated. Results: The changes in preoperative pathology with warm ischemia were inconspicuous, but the trends in postoperative pathology and aminotransferase levels were consistent with preoperative energy metabolite measurements. The 30-day survival rates of the control and WIT 15, 30, 45, and 60 min groups were 100%, 81.82%, 76.92%, 58.33%, and 25.00%, respectively. The areas under the receiver operating characteristic curves of glucose, lactate, glycerol, and LPR were 0.87, 0.88, 0.88, and 0.92, respectively. Conclusion: Glucose, lactate, glycerol, and LPR are predictors of graft quality and survival outcomes in DCD transplantation.

关键词： Energy metabolites Graft evaluation Warm ischemia Microdialysis donation after cardiac death

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Outcome of kidney transplantation between controlled cardiac death and brain death donors： a meta-analysis

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Chinese Medical Journal 2014年第15期127卷 2829-2836页

作者： Ming Yingzi Shao Mingjie Tian Tingting She Xingguo Liu Hong Ye Shaojun Ye Qifa Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology the Third Affiliated Hospital Central South University Changsha Hunan 410013 China Department of Radiology the Third Affiliated Hospital Central South University Changsha Hunan410013 China

Background Our goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort *** The PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion *** lists of retrieved articles were also *** authors independently extracted information on the designs of the studies,the characteristics of the study participants,and outcome *** Nine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death *** ischemia time was significantly longer for the controlled cardiac death donor *** incidence of delayed graft function was 2.74 times （P 〈0.001） greater in the controlled cardiac death donor *** results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long *** analysis yielded similar *** evidence of publication bias was *** This meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors.

关键词： heart-beating donor donation after cardiac death non-heart-beating donor donation after brain death kidney transplantation

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