Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Extended criteria brain-dead organ donors:Prevalence and impact on the utilisation of livers for transplantation in Brazil

BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AIM To investigate the prevalence of ECD in donation after brain death(DBD)and its impact on organ acceptance for transplantation.METHODS Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre.The incidence of the Eurotransplant risk factors to define an ECD(ET-ECD)among DBD donors and the likelihood of organ acceptance over the years were analysed.The relationship between organ refusal for transplantation,the occurrence,and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.RESULTS A total of 1619 organ donors were evaluated.Of these,78.31%(n=1268)had at least one ET-ECD criterion.There was an increase in the acceptance of ECD DBD organs for transplantation(1 criterion:from 23.40%to 31.60%;2 criteria:from 13.10%to 27.70%;3 criteria:From 6.30%to 13.60%).For each addition of one ETECD variable,the estimated chance of organ refusal was 64.4%higher(OR 1.644,95%CI 1.469-1.839,P<0.001).Except for the donor serum sodium>165 mmol/L(P=0.310),all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.CONCLUSION A high prevalence of ECD DBD was observed.Despite the increase in their utilisation,the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.

Attitudes toward organ donation in China

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.

Marginal donor liver versus standard donor liver: A single-center observational study

Background:The effectiveness and safety of marginal donor livers remain controversial.This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation(LT).Methods:This study included 199 liver donors(including 16 split donors)and 206 liver recipients from January 1,2018 to January 27,2020,with case follow-up until July 31,2021.Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers.Indices of liver and kidney functions,complications,and survival curves of the two groups were compared.Results:Compared with the standard donor group,the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation(P<0.05);there were no significant differences in alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels after LT(all P>0.05);there was no significant difference in the incidence of complications after LT(P>0.05);there was also no significant difference in the survival curve(P=0.335).Conclusions:There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups.The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.

Monday blues of deceased-donor liver transplantation

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.

病原体宏基因检测在器官捐献患者中的应用

目的探讨病原体宏基因组二代测序(metagenomic next-generation sequencing,mNGS)应用于器官捐献者病原微生物的检测,为器官移植后的抗感染药物靶向治疗提供依据。方法回顾性分析了武汉大学中南医院于2021年8月至2023年6月142例器官捐献者的临床病例,收集捐献者的血液样本的mNGS检测和病原微生物培养检测结果,对其进行分析比较。结果142例捐献者中98例在mNGS中检测到病原微生物,阳性检出率为69.01%。其中,59例(60.20%)为单纯病毒感染,12例(12.24%)为单纯细菌感染,4例(4.08%)为单纯真菌感染,混合感染23例(23.47%)。共检测出病原微生物173株。其中,病毒125株(72.25%),细菌40株(23.12%),真菌8株(4.62%)。对捐献者血液样本送检mNGS同时送检微生物培养检测,142例捐献者中20例(14.08%)血培养检测到病原微生物,共检测出21株病原微生物,其中20例(95.24%)为细菌,1例(4.76%)为真菌。器官保存液中培养出病原微生物2例(1.40%)。结论mNGS对病原微生物的检出率高于微生物血培养检测。mNGS检测和血培养病原微生物检测在细菌的诊断上差异不明显,而在检测真菌及病毒阳性时有统计学意义,且mNGS检测比血培养病原微生物检测能大幅度缩短检验时长。

机器人辅助肾移植术单中心初步经验

目的 探索机器人辅助肾移植(RAKT)的安全性、有效性及可行性。方法 收集行肾移植术的16例患者资料,其中8例采用RAKT(RAKT组),接受同一供者对侧肾脏的8例患者采用开放肾移植术(OKT组)。对比两组受者围手术期结果及移植肾功能恢复情况。结果 所有患者均成功完成手术,RAKT组无患者在术中转开放手术。RAKT组手术时间长于OKT组(P=0.015)。两组受者术前血清肌酐及出院时血清肌酐差异无统计学意义(均为P>0.05)。OKT组1例受者出现移植物功能延迟恢复(DGF),其余患者均未出现围手术期并发症。两组术后短期肾功能恢复差异无统计学意义(P>0.05)。结论 RAKT术后恢复与OKT相当,对于肾移植手术经验丰富的团队而言,RAKT是一种安全有效的手术方式,可以尝试开展。

国外捐献器官获取质量管理与控制进展

器官移植是二十世纪以来有效挽救终末期器官衰竭患者生命的一项突破性技术,显著改善了患者生存质量。器官捐献作为器官移植的重要来源,提升捐献器官获取质量是促进捐献器官转化、改善器官移植预后的关键。美国、西班牙等国家在捐献器官获取质量管理与控制方面提出了系列政策和标准,并取得了积极成果。本文通过探讨医疗质量管理与控制有关概念、国际捐献器官获取质量管理先进策略及模式,研究器官获取组织、捐献者、捐献器官质控举措,以期为形成具有“中国特色”的捐献器官获取质量管理与控制体系、推进捐献器官获取高速度高质量发展提供参考。

遗体器官捐献协调工作指南

遗体器官捐献和移植工作坚持人民至上、生命至上原则。国家鼓励遗体器官捐献,建立了遗体器官捐献和移植工作体系,推动遗体器官捐献,规范遗体捐献器官获取和分配,提升遗体器官移植服务能力。器官捐献协调是遗体器官捐献实施过程中最重要的环节,决定着捐献能否成功实施的关键。协调员作为连接器官捐献者与移植等待者之间的桥梁,在遗体器官捐献工作中发挥着极其重要的作用。为进一步规范我国遗体器官捐献协调工作的实施,由中华医学会器官移植学分会、中国医师协会器官移植医师分会组织制定《遗体器官捐献协调工作指南》。针对捐献协调和见证工作中主要的16个问题,依据国家相关法律法规、政策规定、国际通则、专家共识和实际工作经验,总结形成了20条推荐意见,以指导协调员依法依规、科学规范开展捐献的协调和见证工作,推动遗体器官捐献工作高质量发展。

中国遗体器官捐献供肾体外低温机械灌注保存指南

为促进遗体器官捐献供肾体外低温机械灌注保存技术的规范应用,中华医学会器官移植学分会组织制定了《中国遗体器官捐献供肾体外低温机械灌注保存指南》。该指南整合了肾脏移植学和遗体器官捐献学领域的专家共识,依据现有的临床指南、系统评价、病例研究、专家共识等资料,并结合近年国内外遗体器官捐献供肾体外低温机械灌注保存技术的临床问题。在多次专家研讨和达成一致意见后,完成了该指南的撰写。该指南共包含11个临床问题,14条推荐意见,并按照2009版牛津大学循证医学中心的证据分级与推荐强度标准,对每个临床问题的推荐意见强度与证据级别进行了分级。该指南旨在为临床实践提供指导,提高我国遗体器官捐献供肾保存水平,减少器官弃用率,缓解器官短缺问题。

脑死亡器官捐献供体评估和供心选择临床分析

目的总结73例脑死亡器官捐献供体评估和供心选择的临床经验。方法回顾73对脑死亡器官捐献心脏移植供受者临床资料,评估供体,选择供心,分析心脏移植受者生存情况和边缘供心使用情况。结果发现潜在供体,在判定脑死亡状态后,明确供体家属同意器官捐献后,评估供体,选择供心,使供受体最大限度匹配。73例心脏移植受者手术成功率为94.5%(69/73),围手术期死亡4例,术后随访1年死亡4例。边缘供心使用情况:供体年龄≥45岁17例,供受体体质量不匹配2例,供体中毒1例,供心冷缺血时间≥4 h 43例,大部分心脏移植受者予主动脉内球囊反搏和(或)体外膜肺氧合辅助,最终顺利出院。结论供受体最大限度匹配可使心脏移植患者获益最大;同时,适当放宽供心选择标准,增加供心数量,将为众多等待心脏移植患者带来希望。

伴急性肾损伤的DBD供肾肾移植的临床结局

目的探讨伴急性肾损伤(AKI)的脑死亡器官捐献(DBD)供者供肾肾移植的临床结局。方法回顾性分析216例DBD供者的资料,按照改善全球肾脏病预后组织(KDIGO)标准将分为AKI组(69例)与正常组(147例),AKI组进一步分为KDIGO 1期和2~3期两组,AKI组受者135例,正常组受者288例。总结受者术后肾功能恢复情况及临床结局。分析移植物功能延迟恢复(DGF)发生的危险因素。结果AKI组供者血清肌酐(Scr)最高值、获取前Scr值、血钠最高值、获取前血钠值均高于正常组,升压药物应用时间长于正常组,48 h内液体复苏用量高于正常组,入院HCO3−值低于正常组,尿崩症、低血压发生率高于对照组;KDIGO 2~3期供者Scr最高值、获取前Scr值较KDIGO 1期供者高(均为P<0.05)。与正常组比较,AKI组受者DGF、急性排斥反应发生率较高,行连续性肾脏替代治疗的比例较高,术后90 d内Scr水平较高,术后3 d尿量较少;与KDIGO 1期受者比较,KDIGO 2~3期受者术后3、4、5、15 d Scr水平较高,术后2 d尿量较少(均为P<0.05)。单因素分析结果显示供者年龄、Scr最高值、血钠最高值、48 h内液体复苏用量是肾移植术后受者发生DGF的危险因素,多因素分析结果显示,供者年龄是肾移植术后受者发生DGF的独立危险因素(均为P<0.05)。结论伴AKI的DBD供者供肾用于肾移植,经过积极的器官维护可纠正AKI,对术后6个月移植物功能和存活率没有影响,可达到与非AKI供肾同样的效果,可作为扩大供肾来源。

遗体器官捐献的激励机制之伦理思辨

我国当前的低捐献率处境之下,完全的无偿机制不足以提高捐献率,需要引入遗体器官捐献的激励机制。然而,遗体器官捐献的激励机制本身仍存在着一些伦理争议,不能被公众普遍接受,因而其仍未被普遍推广。此背景之下,为遗体器官捐献的激励机制提供伦理可辩护性至关重要。同时,通过建立坚持以无偿为原则,有偿为辅佐,多种激励机制相结合的遗体器官捐献体系,借助社会力量、创新科普载体、推进医院的协调员队伍的完善与优化等方式或能成为改善公众对遗体器官捐献及其激励机制的看法、营造合适的伦理环境、提高捐献率的有效路径。

儿童潜在器官捐献者亲属捐献意愿调查及影响因素分析

目的探讨儿童潜在器官捐献者亲属对于器官捐献的认知和了解程度,并分析其器官捐献意愿的影响因素。方法回顾性分析联勤保障部队第九〇〇医院2017—2021年57例符合器官捐献条件的儿童亲属资料,根据最终是否同意器官捐献分为同意组(n=14)和不同意组(n=43),调查患儿亲属对器官捐献的认知情况和了解程度,并分析器官捐献意愿的影响因素。结果14例器官捐献的患儿中,脑外伤、胶质瘤、脑膜炎是主要病因,分别为5例(35.71%)、4例(28.57%)、3例(21.43%),有3例患儿家属初次沟通即同意器官捐献,6例患儿家属进行两次沟通,5例患儿家属沟通次数超过2次。14例器官捐献患儿共捐献肝脏11个、肾脏10对、心脏3个、眼角膜11对、1具大体。单因素和Logistic多因素分析发现宗教信仰(OR=2.916,95%CI=2.546~9.646)、独生子女(OR=2.246,95%CI=1.536~6.347)、不了解器官捐献(OR=2.578,95%CI=1.864~5.346)、不愿意放弃救治(OR=3.635,95%CI=2.835~11.536)是患儿家属拒绝器官捐献的独立影响因素。结论儿童潜在器官捐献者亲属对于器官捐献决策往往受多方面因素影响,在日常公益宣传中应加强宣教,提高民众对器官捐献认知和了解水平,有利于提高儿童器官捐献成功率。

76例器官捐献供体临床维护效果分析

目的从重症医学科角度对供体维护手段进行分析,得出供体治疗前后的临床指标差异,总结捐献供体临床维护的治疗经验及效果,为器官捐献供体维护治疗提供更多临床证据。方法回顾性分析陆军军医大学第三附属医院(陆军特色医学中心)重症医学科2014年1月至2021年12月76例器官捐献供体,收集供体维护治疗方式,包括机械通气、连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)、肠内营养、肠外营养、肠内及肠外联合营养、血浆置换,同时利用配对t检验对供体治疗前后脏器功能进行对比分析。结果对76例供体的肺、肝脏、肾脏治疗前后进行评估以判定符合捐献的人数,其中肾脏、肝脏治疗前后符合捐献人数比较,差异有统计学意义(P<0.05);肺评估差异无统计学意义(P>0.05)。结论对器官移植供体采取及时有效的脏器维护支持治疗,有利于供体脏器功能恢复,提高供体脏器利用率。

《移植器官质量与安全指南(第6版)》解读——器官的获取、保存和运输

捐献器官的获取、保存与运输直接影响着器官移植受者的预后。针对器官的获取、保存与运输的流程优化及质量控制标准的建立有利于提高捐献器官的质量和利用率,并降低医疗风险。本文根据2016年欧盟《移植器官质量与安全指南(第6版)》对其中第11章器官获取、保存和运输进行解读并综述。

大连市2011～2015年无偿献血人群的分布特点及变化趋势

目的分析大连市2011~2015年无偿献血人群的性别、年龄以及街头和团体献血人次的分布特点及变化趋势,为制订和改进无偿献血者招募策略提供参考。方法采用唐山启奥软件信息管理系统,以2011~2015年在大连市血液中心献血的无偿献血者为研究对象,对无偿献血人群的性别、年龄以及街头和团体献血人次的分布及变化趋势进行分析。结果大连地区献血人数逐年增加,男性献血者始终多于女性,且男女献血比例差距进一步拉大(63.2%VS 36.8%),差异有统计学意义(P<0.01)。献血者平均年龄增加2.5岁(P<0.01)。在2011~2015年,18~25岁年龄段献血者比例呈逐渐降低趋势(49.2%VS 38.7%,P<0.01);>25~35岁年龄段献血者比例变化不大,差异无统计学意义(26.1%VS25.9%,P>0.05);>35~45岁和>45岁2个年龄段献血者比例均逐渐升高(17.2%VS 21.6%,P<0.01;7.5%VS 13.8%,P<0.01)。街头献血者比例逐年下降(82.4%V S 72.8%,P<0.01),团体献血者比例逐年上升(17.6%V S 27.2%,P<0.01)。结论大连地区无偿献血人群的性别、年龄以及街头和团体献血人次的分布,有其自身特点,所占比例也在不断变化。应根据无偿献血人群的特征,加强对不同群体的宣传教育,制定合理的献血者招募策略,满足临床用血需求。

关于中国器官捐献协调员的职业化建设

背景:器官捐献协调员是开展器官捐献工作的骨干力量,是提高中国器官捐献率的重要保证,而加快器官捐献协调员队伍建设的核心问题是实现职业化。目的:通过器官捐献协调员职业化建设的重大意义、内涵探析、现状总结以及建议对策等4个方面进行了尝试性探索。方法:以"器官捐献/器官移植/协调员/职业化,遗体捐献,心死亡"为中文捡索词,以"organ donation/organ transplantation/coordinator/profession/occupation/,body donation,cardiac death"为英文检索词,检索维普和中国知网(CNKI)期刊全文数据库、万方、Pubmed,Medline,Highwire和外文生物医学期刊全文数据库(Foreign Journals Integration System)2003年1月至2013年8月有关器官捐献报告中主要涉及器官捐献协调员的相关报道。然后二次人工检索器官捐献协调员后,纳入有关器官捐献协调员,以及器官捐献移植相关政策法规的文献,排除临床研究和基础研究性的文章,通过对文献归纳,总结分析目前中国器官捐献协调员的现况,提出器官捐献协调员职业化建设的对策。结果与结论:文章详细阐述了器官捐献协调员的深刻内涵、职业要求和社会定位,系统分析了国内目前器官捐献协调员队伍建设中存在的问题,粗略构建了中国器官捐献协调员职业化建设的基本框架,总结探索了器官捐献协调员职业化建设应采取的路径和方法。

供者来源性感染对肝移植受者预后的影响

目的探讨供者来源性感染对肝移植受者预后的影响。方法分析75例行肝移植供、受者临床资料。根据供者器官灌洗液培养结果,将受者分为阳性组(26例)和阴性组(49例)。观察阳性组和阴性组受者围手术期相关临床指标,对肝移植受者痰液、腹腔引流液进行培养,观察受者术后感染情况。采用Kaplan-Meier法分析受者术后1.5年的生存曲线。结果阳性组受者门静脉狭窄和门静脉血栓的发生率明显高于阴性组受者(P<0.05)。75例肝移植受者中,发生术后感染者33例(44%),受者发生感染的部位以肺部和腹腔为主,阳性组和阴性组的感染率分别为77%、27%,差异有统计学意义(P<0.05)。阳性组中,痰液、腹腔引流液培养阳性分别为10例、11例,其中4例受者痰培养结果与其供者器官灌洗液培养结果一致,6例受者腹腔引流液培养结果与其供者器官灌洗液培养结果一致。经过抗感染治疗后,阳性组中2例受者分别于术后5、12 d死亡,其余受者的培养结果均转阴。阴性组中,痰液、腹腔引流液培养阳性分别为7例、6例,经抗感染治疗后培养结果均转阴,2例受者因移植物肝衰竭分别于术后1个月、1年死亡。阳性组和阴性组受者移植术后1.5年生存率比较,差异无统计学意义(P>0.05)。结论供者来源性感染对肝移植受者早期预后的影响不可忽视,但对中晚期预后影响不大。

2006年至2016年遗体器官捐献领域研究热点与前沿的可视化分析

目的对2006年至2016年遗体器官捐献领域英文文献数据进行可视化分析,探讨遗体器官捐献领域的研究热点及发展趋势。方法使用Cite Space对Web of Science核心数据库中遗体器官捐献领域的研究力量、高影响力作者、核心期刊、高频关键词以及突变词进行统计分析。结果1 278条文献数据显示,研究力量主要集中在美国,论文产量达497篇,占10年发文总量的28%;高产作者Ploeg RJ和Parrilla P发文量均为14篇,高被引作者Kootstra G论文被引192次;高被引期刊《Am J Transplant》的论文被引达917次;高频关键词依次为organ donation、transplantation、donation等,突变词包括waiting-list、beating donor、donor-kidneys等。结论遗体器官捐献领域近10年研究热点主要包括心脏死亡捐献移植手术存活率、遗体器官捐献移植手术预后、遗体器官捐献供体器官保存技术等方面,研究前沿集中于遗体器官捐献率、器官供体来源、遗体器官捐献供体标准及扩展标准等方面。