brain-death-induction-mice-using-intra-arterial-blood-pressure

Brain Death Induction in Mice Using Intra-Arterial Blood Pressure Monitoring and Ventilation via Tracheostomy

While both living donation and donation after circulatory death provide alternative opportunities for organ transplantation, donation after donor brain ...

Charité - Universitätsmedizin Berlin

Medical university of innsbruck

Berlin Institute of Health

 Although prone to a higher degree of ischemia reperfusion injury (IRI), the use of extended criteria donor (ECD) organs has become reality in transplantation. We therefore postulated that peri-operative perfusion of renal transplants with anti-human T-lymphocyte globulin (ATLG) ameliorates IRI and results in improved graft function.  We performed a randomized, single-blinded, placebo-controlled trial involving 50 kidneys (KTx). Prior to implantation organs were perfused and incubated with ATLG (AP) ( = 24 kidney). Control organs (CP) were perfused with saline only ( = 26 kidney). Primary endpoint was defined as graft function reflected by serum creatinine at day 7 post transplantation (post-tx).  AP-KTx recipients illustrated significantly better graft function at day 7 post-tx as reflected by lower creatinine levels, whereas no treatment effect was observed after 12 months surveillance. During the early hospitalization phase, 16 of the 26 CP-KTx patients required dialysis during the first 7 days post-tx, whereas only 10 of the 24 AP-KTx patients underwent dialysis. No treatment-specific differences were detected for various lymphocytes subsets in the peripheral blood of patients. Additionally, mRNA analysis of 0-h biopsies post incubation with ATLG revealed no changes of intragraft inflammatory expression patterns between AP and CP organs.  We here present the first clinical study on peri-operative organ perfusion with ATLG illustrating improved graft function in the early period post kidney transplantation.  www.ClinicalTrials.gov, NCT03377283.

Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantation Period-a Prospective, Randomized Placebo-Controlled Trial.

Due to the shortage of liver allografts and the rising prevalence of fatty liver disease in the general population, steatotic liver grafts are considered for transplantation. This condition is an important risk factor for the outcome after transplantation. We here analyze the characteristics of the donor pool offered to the  from 2010 to 2016 with respect to liver allograft nonacceptance and steatosis hepatis. Of the 2653 organs offered to our center, 19.9% (n=527) were accepted for transplantation, 58.8% (n=1561) were allocated to other centers, and 21.3% (n = 565) were eventually discarded from transplantation. In parallel to an increase of the incidence of steatosis hepatis in the donor pool from 20% in 2010 to 30% in 2016, the acceptance rates for steatotic organs increased in our center from 22.3% to 51.5% in 2016 (p < 0.001), with the majority (86.9%; p > 0.001) having less than 30% macrovesicular steatosis hepatis. However, by 2016, the number of canceled transplantations due to higher grades of steatosis hepatis had significantly increased from 14.7% (n = 15) to 63.6% (42; p < 0.001). The rising prevalence of steatosis hepatis in the donor pool has led to higher acceptance rates of steatotic allografts. Nonetheless, steatosis hepatis remains a predominant phenomenon in discarded organs necessitating future concepts such as organ reconditioning to increase graft utilization.

Prevalence of Steatosis Hepatis in the  Region: Impact on Graft Acceptance Rates.

In contrast to donor factors predicting outcomes of liver transplantation (LT), few suitable recipient parameters have been identified. To this end we performed an in-depth analysis of hospitalization status and duration prior to LT as a potential risk factor for post-transplant outcome. The pre-transplant hospitalization status of all patients undergoing LT between 2005 and 2016 at the Charité-Berlin was analyzed retrospectively using Propensity Score Matching. At the time of organ acceptance 226 of 1134 (19.9%) recipients were hospitalized on an intensive care unit, 146 (12.9%) on a regular ward and 762 patients (67.2%) were at home. Hospitalized patients (regular ward and intensive care unit) showed a dramatically shorter 3-month, 1- and 3-year survival compared to patients from home (78.7% vs. 94.4%; 66.3% vs. 87.3%; 61.7% vs. 81.7%; all p<0.001) while no significant difference was detected between intensive care unit and regular ward patients (3-year survival: 61.5% vs. 62.3%; p=0.60) These results remained significant after Propensity Score Matching. Furthermore, in intensive care unit patients, but not regular ward patients, survival correlated with days spent on intensive care unit before LT (1-year survival: 1-6 days vs. 7-14 days vs. > 14 days: 73.7% vs. 60.5% vs. 51.0%; p=0.04; p=0.006). In conclusion, hospitalization status before transplantation is a valuable predictor of patient survival following LT.

Article	Year
Graft Pre-conditioning by Peri-Operative Perfusion of Kidney Allografts With Rabbit Anti-human T-lymphocyte Globulin Results in Improved Kidney Graft Function in the Early Post-transplantati... Frontiers in immunology\| PubMed ID: 30197644	2018
Prevalence of Steatosis Hepatis in the Region: Impact on Graft Acceptance Rates. HPB surgery : a world journal of hepatic, pancreatic and biliary surgery\| PubMed ID: 30515073	2018
Hospitalization before liver transplantation predicts post-transplant patient survival - a propensity-score matched analysis. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society\| PubMed ID: 32159923	2020

Paul V. Ritschl

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