The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD g...The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusionmodels, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.展开更多
BACKGROUND:There is a constant and global shortage of deceased-donor organs for transplantation.Ways to identify areas for securing potential deceased-donor organs may improve the supply and hence benefit more patient...BACKGROUND:There is a constant and global shortage of deceased-donor organs for transplantation.Ways to identify areas for securing potential deceased-donor organs may improve the supply and hence benefit more patients in need of transplantation. METHODS:We looked into the disparity of the number of deceased-donor liver transplantation(DDLT)performed at our hospital on different days of the weeks from January 2000 to the end of December 2009(237 DDLTs).The number of DDLT performed on each day was compared with the other days of the week. RESULTS:It was apparent that there were fewer DDLTs on Mondays,as shown by the numbers of DDLT performed on different days of the week in an ascending order:Monday 18(7.6%),Sunday 30(12.7%),Thursday 34(14.3%),Friday 36(15.2%),Wednesday 38(16.0%),Tuesday 40(16.9%), and Saturday 41(17.3%).The difference reached statistical significance when Monday was compared with Tuesday (P=0.019),Wednesday(P=0.010),Friday(P=0.021),and Saturday(P=0.007).It was twice as unlikely a DDLT would be performed on Monday as compared with other days.Such a trend did not change even with an increase in the number of deceased-donor liver grafts in the last year.As consent to donation was obtained from the donor family the day before DDLT,fewer consents were thus obtained on Sundays.CONCLUSION:These findings suggested that deceased-donor organ donation activities were less active on Sundays and could be improved.This further raises the concern of possible wastage of potential cases of organ donation.展开更多
目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation at er cardiac death,DCD)肾移植手术术中、术后管理的认识。方法:2例供肾来自于诊断为脑死亡的2例低龄儿童供者,年龄分别为11个月和1岁7个月,脑死亡的原因分别是重症婴儿肝综合...目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation at er cardiac death,DCD)肾移植手术术中、术后管理的认识。方法:2例供肾来自于诊断为脑死亡的2例低龄儿童供者,年龄分别为11个月和1岁7个月,脑死亡的原因分别是重症婴儿肝综合征和重症颅脑外伤。2例供者出现心死亡后,切取双肾整块,并分别整块移植给了2位受者。2例受者的年龄分别是37岁和41岁。结果:术后随访6个月,2例受者移植肾功能基本正常。2例受者术后都出现大量血性引流液,在给予相应治疗后停止,未出现急性排斥反应和其他手术并发症。结论:采用改进的技术可以安全采用年龄<3岁的婴幼儿DCD供肾;手术后短期效果满意,有助于扩大供体池,但血管并发症值得重视。展开更多
Background Organ transplantation represents an important advance in modern medical science,and it has benefited many patients with organ failure; however,the severe deficiency of organ sources has been a bottleneck th...Background Organ transplantation represents an important advance in modern medical science,and it has benefited many patients with organ failure; however,the severe deficiency of organ sources has been a bottleneck that has limited the benefits -this technology can bring.The aim of this study was to show the results of a survey on Chinese people＇s awareness and attitudes toward organ donation.Methods We designed a questionnaire regarding organ donation consisting of 20 short questions,which were distributed to 10 groups.Most of the questions were multiple-choice; the core question related to people＇s attitudes to organ donation and the development of organ donation.The survey was held in the outpatient hall of Beijing Chao-Yang Hospital,a commercial district,and four professional colleges.Participants were randomly selected,and answered questions about gender,age,educational background,profession,and study major.Results In all,2930 valid responses were received.Male：female ratio was nearly 1：1.2 （mean age 38 years）.Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation,but the time they had been aware of it varied.Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem.Participants who knew more about organ failure and organ transplantation were more likely to support organ donation.College students were very positive about organ donation,though as they gain professional knowledge their attitudes may change.Altogether,65.3% of participants approved of living organ donation,which was obviously lower than the figure for deceased organ donation （P 〈0.05）.In all,85.7% of participants approved of compensation to the deceased donor＇s family.To promote organ donation in China,62.9% of participants indicated that the public＇s knowledge about organ donation should be increased via the media and various kinds of education.Only 20.0% of the participants believed that legislation was required.Conclusions We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation.The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.展开更多
In 1953, the pioneer of human orthotopic liver transplantation(LT), Thomas E Starzl, was the first to attempt an orthotopic liver transplant into a 3 years old patient suffering from biliary atresia. Thus, the first L...In 1953, the pioneer of human orthotopic liver transplantation(LT), Thomas E Starzl, was the first to attempt an orthotopic liver transplant into a 3 years old patient suffering from biliary atresia. Thus, the first LT in humans was attempted in a disease, which, up until today, remains the main indication for pediatric LT(p LT). During the last sixty years, refinements in diagnostics and surgical technique, the introduction of new immunosuppressive medications and improvements in perioperative pediatric care have established LT as routine procedure for childhood acute and chronic liver failure as well as inherited liver diseases. In contrast to adult recipients, p LT differs greatly in indications for LT, allocation practice, surgical technique, immunosuppression and postoperative life-long aftercare. Many aspects are focus of ongoing preclinical and clinical research. The present review gives an overview of current developments and the clinical outcome of p LT, with a focus on alternatives to full-size deceased-donor organ transplantation.展开更多
文摘The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusionmodels, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.
文摘BACKGROUND:There is a constant and global shortage of deceased-donor organs for transplantation.Ways to identify areas for securing potential deceased-donor organs may improve the supply and hence benefit more patients in need of transplantation. METHODS:We looked into the disparity of the number of deceased-donor liver transplantation(DDLT)performed at our hospital on different days of the weeks from January 2000 to the end of December 2009(237 DDLTs).The number of DDLT performed on each day was compared with the other days of the week. RESULTS:It was apparent that there were fewer DDLTs on Mondays,as shown by the numbers of DDLT performed on different days of the week in an ascending order:Monday 18(7.6%),Sunday 30(12.7%),Thursday 34(14.3%),Friday 36(15.2%),Wednesday 38(16.0%),Tuesday 40(16.9%), and Saturday 41(17.3%).The difference reached statistical significance when Monday was compared with Tuesday (P=0.019),Wednesday(P=0.010),Friday(P=0.021),and Saturday(P=0.007).It was twice as unlikely a DDLT would be performed on Monday as compared with other days.Such a trend did not change even with an increase in the number of deceased-donor liver grafts in the last year.As consent to donation was obtained from the donor family the day before DDLT,fewer consents were thus obtained on Sundays.CONCLUSION:These findings suggested that deceased-donor organ donation activities were less active on Sundays and could be improved.This further raises the concern of possible wastage of potential cases of organ donation.
文摘目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation at er cardiac death,DCD)肾移植手术术中、术后管理的认识。方法:2例供肾来自于诊断为脑死亡的2例低龄儿童供者,年龄分别为11个月和1岁7个月,脑死亡的原因分别是重症婴儿肝综合征和重症颅脑外伤。2例供者出现心死亡后,切取双肾整块,并分别整块移植给了2位受者。2例受者的年龄分别是37岁和41岁。结果:术后随访6个月,2例受者移植肾功能基本正常。2例受者术后都出现大量血性引流液,在给予相应治疗后停止,未出现急性排斥反应和其他手术并发症。结论:采用改进的技术可以安全采用年龄<3岁的婴幼儿DCD供肾;手术后短期效果满意,有助于扩大供体池,但血管并发症值得重视。
文摘Background Organ transplantation represents an important advance in modern medical science,and it has benefited many patients with organ failure; however,the severe deficiency of organ sources has been a bottleneck that has limited the benefits -this technology can bring.The aim of this study was to show the results of a survey on Chinese people＇s awareness and attitudes toward organ donation.Methods We designed a questionnaire regarding organ donation consisting of 20 short questions,which were distributed to 10 groups.Most of the questions were multiple-choice; the core question related to people＇s attitudes to organ donation and the development of organ donation.The survey was held in the outpatient hall of Beijing Chao-Yang Hospital,a commercial district,and four professional colleges.Participants were randomly selected,and answered questions about gender,age,educational background,profession,and study major.Results In all,2930 valid responses were received.Male：female ratio was nearly 1：1.2 （mean age 38 years）.Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation,but the time they had been aware of it varied.Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem.Participants who knew more about organ failure and organ transplantation were more likely to support organ donation.College students were very positive about organ donation,though as they gain professional knowledge their attitudes may change.Altogether,65.3% of participants approved of living organ donation,which was obviously lower than the figure for deceased organ donation （P 〈0.05）.In all,85.7% of participants approved of compensation to the deceased donor＇s family.To promote organ donation in China,62.9% of participants indicated that the public＇s knowledge about organ donation should be increased via the media and various kinds of education.Only 20.0% of the participants believed that legislation was required.Conclusions We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation.The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.
文摘In 1953, the pioneer of human orthotopic liver transplantation(LT), Thomas E Starzl, was the first to attempt an orthotopic liver transplant into a 3 years old patient suffering from biliary atresia. Thus, the first LT in humans was attempted in a disease, which, up until today, remains the main indication for pediatric LT(p LT). During the last sixty years, refinements in diagnostics and surgical technique, the introduction of new immunosuppressive medications and improvements in perioperative pediatric care have established LT as routine procedure for childhood acute and chronic liver failure as well as inherited liver diseases. In contrast to adult recipients, p LT differs greatly in indications for LT, allocation practice, surgical technique, immunosuppression and postoperative life-long aftercare. Many aspects are focus of ongoing preclinical and clinical research. The present review gives an overview of current developments and the clinical outcome of p LT, with a focus on alternatives to full-size deceased-donor organ transplantation.
