342 research outputs found
Orgaantransplantatie in Leiden: over Identiteit en Innovatie
Rede uitgesproken door prof.dr. I.P.J. Alwayn op 1 oktober 2018 bij de aanvaarding van het ambt van hoogleraar met als leeropdracht Heelkunde, in het bijzonder Transplantatiechirurgie.LUMC / Geneeskund
Induction of immunological tolerance in the pig-to-baboon xenotransplantation model : studies aimed at achieving mixed hematopoietic chimerism and preventing associated thrombotic complications
The outcome of clinical organ transplantation has dramatically improved since the
introduction of cyclosporine (CyA) in 1979 and of other, more recently introduced,
immunosuppressive agents such as azathioprine, mycophenolate mofetil, tacrolimus
and sirolimus. Furthermore, due to more refined surgical techniques and peri operative
management, prolonged survival of allografts is achieved. Due to its relative success,
the inclusion criteria for potential organ transplant recipients have been broadened,
resulting in an even greater shortage of donor organs. The number of patients with
end-stage organ failure that die awaiting organ transplantatio
Reply to:Balancing Cost and Efficiency in Screening Potential Organ Donors With Whole Body CT
Transplant surger
Biological effects of fucoidan isolated from Fucus vesiculosus on thrombosis and vascular cells
Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial
Factors Associated With Prolonged Warm Ischemia Time Among Deceased Donor Kidney Transplant Recipients
Transplant surger
Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation
Perioperative Medicine: Efficacy, Safety and Outcom
Complement Is Activated During Normothermic Machine Perfusion of Porcine and Human Discarded Kidneys
Background: The gap between demand and supply of kidneys for transplantation
necessitates the use of kidneys from extended criteria donors. Transplantation of these
donor kidneys is associated with inferior results, reflected by an increased risk of delayed
graft function. Inferior results might be explained by the higher immunogenicity of
extended criteria donor kidneys. Normothermic machine perfusion (NMP) could be
used as a platform to assess the quality and function of donor kidneys. In addition, it
could be useful to evaluate and possibly alter the immunological response of donor
kidneys. In this study, we first evaluated whether complement was activated during NMP
of porcine and human discarded kidneys. Second, we examined the relationship between
complement activation and pro-inflammatory cytokines during NMP. Third, we assessed
the effect of complement activation on renal function and injury during NMP of porcine
kidneys. Lastly, we examined local complement C3d deposition in human renal biopsies
after NMP.
Methods: NMP with a blood-based perfusion was performed with both porcine and
discarded human kidneys for 4 and 6 h, respectively. Perfusate samples were taken every
hour to assess complement activation, pro-inflammatory cytokines and renal function.
Biopsies were taken to assess histological injury and complement deposition.
Results: Complement activation products C3a, C3d, and soluble C5b-9 (sC5b-9) were
found in perfusate samples taken during NMP of both porcine and human kidneys. In
addition, complement perfusate levels positively correlated with the cytokine perfusate
levels of IL-6, IL-8, and TNF during NMP of porcine kidneys. Porcine kidneys with high
sC5b-9 perfusate levels had significantly lower creatinine clearance after 4 h of NMP. In line with these findings, high complement perfusate levels were seen during NMP of
human discarded kidneys. In addition, kidneys retrieved from brain-dead donors had
significantly higher complement perfusate levels during NMP than kidneys retrieved from
donors after circulatory death.
Conclusion: Normothermic kidney machine perfusion induces complement activation in
porcine and human kidneys, which is associated with the release of pro-inflammatory
cytokines and in porcine kidneys with lower creatinine clearance. Complement inhibition
during NMP might be a promising strategy to reduce renal graft injury and improve graft
function prior to transplantation
Quality assessment of donor liver procurement surgery using an unadjusted CUSUM prediction model: a practical nationwide evaluation
BackgroundThe aim of this study was to analyze the value of the unadjusted CUSUM graph of liver surgical injury and discard rates in organ procurement in the Netherlands. MethodsUnadjusted CUSUM graphs were plotted for surgical injury (C event) and discard rate (C2 event) from procured livers accepted for transplantation for each local procurement team compared with the total national cohort. The average incidence for each outcome was used as benchmark based on procurement quality forms (Sep 2010-Oct 2018). The data from the five Dutch procuring teams were blind-coded. ResultsThe C and C2 event rate were 17% and 1.9%, respectively (n = 1265). A total of 12 CUSUM charts were plotted for the national cohort and the five local teams. National CUSUM charts showed an overlapping "alarm signal." This overlapping signal for both C and C2, albeit a different time period, was only found in one local team. The other CUSUM alarm signal went off for two separate local teams, but only for C events or C2 events respectively, and at different points in time. The other remaining CUSUM charts showed no alarm signaling. ConclusionThe unadjusted CUSUM chart is a simple and effective monitoring tool in following performance quality of organ procurement for liver transplantation. Both national and local recorded CUSUMs are useful to see the implication of national and local effects on organ procurement injury. Both procurement injury and organ discard are equally important in this analysis and need to be separately CUSUM charted.Transplant surger
Joint modeling of liver transplant candidates outperforms the model for end-stage liver disease: the effect of disease development over time on patient outcome
Liver function is measured regularly in liver transplantation (LT) candidates. Currently, these previous disease development data are not used for survival prediction. By constructing and validating joint models (JMs), we aimed to predict the outcome based on all available data, using both disease severity and its rate of change over time. Adult LT candidates listed in Eurotransplant between 2007 and 2018 (n = 16 283) and UNOS between 2016 and 2019 (n = 30 533) were included. Patients with acute liver failure, exception points, or priority status were excluded. Longitudinal MELD(-Na) data were modeled using spline-based mixed effects. Waiting list survival was modeled with Cox proportional hazards models. The JMs combined the longitudinal and survival analysis. JM 90-day mortality prediction performance was compared to MELD(-Na) in the validation cohorts. MELD(-Na) score and its rate of change over time significantly influenced patient survival. The JMs significantly outperformed the MELD(-Na) score at baseline and during follow-up. At baseline, MELD-JM AUC and MELD AUC were 0.94 (0.92-0.95) and 0.87 (0.85-0.89), respectively. MELDNa-JM AUC was 0.91 (0.89-0.93) and MELD-Na AUC was 0.84 (0.81-0.87). The JMs were significantly (p < .001) more accurate than MELD(-Na). After 90 days, we ranked patients for LT based on their MELD-Na and MELDNa-JM survival rates, showing that MELDNa-JM-prioritized patients had three times higher waiting list mortality.Transplant surger
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