Case Report: Organ procurement in a DCD donor with ovarian thecoma: abdominal NRP enabled timely and safe resection, pathological confirmation, and successful kidney transplantation

BackgroundDonation after circulatory death (DCD) may be complicated by incidental findings, including tumor lesions that require urgent diagnosis. Here, we describe the case of a DCD donor with a large adnexal mass. Abdominal normothermic regional perfusion (A-NRP) enabled the safe resection of the mass, real-time pathological analysis, and subsequent kidney transplantation.Case summaryA 60-year-old woman suffered a hypoxic cardiac arrest and subsequently remained in a deep coma with poor neurological prognostic indicators. In accordance with her presumed wishes, life support was withdrawn, and a controlled DCD procedure with A-NRP was initiated. Imaging revealed a 27-cm adnexal mass. Laboratory markers showed elevated cancer antigen 125 (CA 125) but low cancer antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and cytology was negative. Bilateral oophorectomy was performed under A-NRP, and the frozen section excluded malignancy, with final pathology confirming an ovarian thecoma. Both kidneys were procured; only the left kidney was transplanted successfully. The recipient experienced immediate diuresis and regained stable renal function at 1 month.DiscussionThis case illustrates how A-NRP provides oxygenated perfusion while allowing time for surgical excision and a pathological diagnosis of incidental tumors. It prevented unnecessary donor exclusion and enabled transplantation.ConclusionIn selected DCD donors with incidental lesions, A-NRP can safely bridge the diagnostic process, preserve organ viability, and expand the donor pool

Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant

IMPORTANCE Surgical site infections (SSIs) are one of the most common health care-associated infections. Surgical site infections can have harmful effects in liver transplant (LT) recipients. OBJECTIVE To assess the incidence of SSI after LT and identify risk factors associated with SSIs and whether SSIs are associated with death and graft loss. DESIGN, SETTING, AND PARTICIPANTS A multicenter cohort study encompassing data on LT performed at all Swiss transplant centers between May 1, 2008, and September 30, 2020, was conducted. Data analyses were performed in 2023. EXPOSURE Liver transplant. MAIN OUTCOMES AND MEASURES Frequency of SSIs within 90 days after transplant, risk factors associated with SSIs, and association of SSIs with 1-year death or graft loss. Surgical site infections were defined according to Centers for Disease Control and Prevention criteria with SSIs occurring within 90 days after LT. For association with posttransplant outcomes, 1-year follow-up data were analyzed. RESULTS Among 1333 LT recipients in the Swiss Transplant Cohort Study, 1158 adults were included in analyses. Median age was 57.2 (IQR, 49.3-62.8) years and 792 were men (68.4%). Seventy patients (6.0%) had an SSI. Most SSIs were deep incisional (9 [12.8%]) or organ-space infections (54 [77.1%]). In most SSIs (56 [80.0%]), bacteria were detected, most frequently Enterococcus spp (36 of 75 [48.0%]) and Escherichia coli (12 of 75 [16.0%]). In multivariable analysis, prior liver transplant (odds ratio [OR] 4.01; 95% CI, 1.44-11.18; P = .008) and living liver donation (OR, 4.08; 95% CI, 1.37-12.16; P = .01) were independent risk factors associated with SSIs. Surgical site infections were independently associated with graft loss and/or death (hazard ratio [HR], 3.24; 95% CI, 1.82-5.79; P < .001); this association was observed in separate analyses on graft loss (HR, 2.97; 95% CI, 1.32-6.68; P = .02) and death (HR, 3.25; 95% CI, 1.44-7.35; P = .01). CONCLUSIONS AND RELEVANCE The findings of this study suggest that prior liver transplant and living liver donation are independent risk factors associated with SSIs and that SSIs are independently associated with graft loss and/or death, highlighting the relevance of this health care-associated infection

Utilization of livers donated after circulatory death for transplantation - An international comparison.

BACKGROUND AND AIM Liver graft utilization rates are a hot topic due to the worldwide organ shortage and an increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially allow the assessment of livers before use. METHODS Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht-type-III) arising during the past decade in eight countries, including Belgium, France, Italy, the Netherlands, Spain, Switzerland, UK, and US. Initial DCD-type-III liver offers were correlated with accepted, recovered and implanted livers. RESULTS A total number of 34`269 DCD livers were offered, resulting in 9`780 liver transplants (28.5%). The discard rates were highest in UK and US, ranging between 70 and 80%. In contrast, much lower DCD liver discard rates, e.g., between 30-40%, were found in Belgium, France, Italy, Spain and Switzerland. In addition, large differences were recognized in the use of various machine perfusion techniques, and in terms of risk factors in the cohorts of implanted livers. For example, the median donor age and functional donor warm ischemia were highest in Italy, e.g., >40minutes, followed by Switzerland, France, and the Netherlands. Importantly, such varying risk profiles of accepted DCD livers between countries did not translate into large differences in five-year graft survival rates, which ranged between 60-82% in this analysis. CONCLUSIONS We highlight a significant number of discarded and consequently unused DCD liver offers. Countries with more routine use of in- and ex-situ machine perfusion strategies showed better DCD utilization rates without compromised outcome. IMPACT AND IMPLICATIONS A significant number of Maastricht type III DCD livers are discarded across Europe and North America today. The overall utilization rate among eight Western countries is 28.5%, but varies significantly between 18.9% and 74.2%. For example, the median DCD III liver utilization in five countries, e.g., Belgium, France, Italy, Switzerland, and Spain is 65%, in contrast to 24% in the Netherlands, UK and US. Despite this, and despite different rules and strategies for organ acceptance and preservation, the one and five-year graft survival remains currently relatively comparable among all participating countries. Factors which impact on DCD liver acceptance rates include the national pre-selections of donors, before the offer is made, as well as cutoffs for key risk factors, including donor age and donor warm ischemia time. In addition, a highly varying experience with modern machine perfusion technology is noticed. In situ and ex situ liver perfusion concepts, and assessment tools for type III DCD livers before transplantation may be one key part for the observed differences in better DCD III utilization

Long-term outcomes after hypothermic oxygenated machine perfusion and transplantation of 1,202 donor livers in a real-world setting (HOPE-REAL study)

Background &amp; aims: Despite strong evidence for improved preservation of donor livers by machine perfusion, longer post-transplant follow-up data are urgently needed in an unselected patient population. We aimed to assess long-term outcomes after transplantation of hypothermic oxygenated machine perfusion (HOPE)-treated donor livers based on real-world data (i.e., IDEAL-D stage 4). Methods: In this international, multicentre, observational cohort study, we collected data from adult recipients of HOPE-treated livers transplanted between January 2012 and December 2021. Analyses were stratified by donation after brain death (DBD) and donation after circulatory death (DCD), sub-divided by their respective risk categories. The primary outcome was death-censored graft survival. Secondary outcomes included the incidence of primary non-function (PNF) and ischaemic cholangiopathy (IC). Results: We report on 1,202 liver transplantations (64% DBD) performed at 22 European centres. For DBD, a total number of 99 benchmark (8%), 176 standard (15%), and 493 extended-criteria (41%) cases were included. For DCD, 117 transplants were classified as low risk (10%), 186 as high risk (16%), and 131 as futile (11%), with significant risk profile variations among centres. Actuarial 1-, 3-, and 5-year death-censored graft survival rates for DBD and DCD livers were 95%, 92%, and 91%, vs. 92%, 87%, and 81%, respectively (log-rank p&nbsp;= 0.003). Within DBD and DCD strata, death-censored graft survival was similar among risk groups (log-rank p&nbsp;= 0.26, p&nbsp;= 0.99). Graft loss due to PNF or IC was 2.3% and 0.4% (DBD), and 5% and 4.1% (DCD). Conclusions: This study shows excellent 5-year survival after transplantation of HOPE-treated DBD and DCD livers with low rates of graft loss due to PNF or IC, irrespective of their individual risk profile. HOPE treatment has now reached IDEAL-D stage 4, which further supports its implementation in routine clinical practice. Trial registration: ClinicalTrials.gov Identifier: NCT05520320. Impact and implications: This study demonstrates the excellent long-term performance of hypothermic oxygenated machine perfusion (HOPE) treatment of donation after circulatory and donation after brain death liver grafts irrespective of their individual risk profile in a real-world setting, outside the evaluation of randomised-controlled trials. While previous studies have established safety, feasibility, and efficacy against the current standard, according to the IDEAL-D evaluation framework, HOPE treatment has now reached the final IDEAL-D stage 4, which further supports its implementation in routine clinical practice

L’Asie du Sud-Est 2023 : bilan, enjeux et perspectives

Chaque année, l’Institut de recherche sur l’Asie du Sud-Est contemporaine (IRASEC), basé à Bangkok, mobilise une vingtaine de chercheurs et d’experts pour mieux comprendre l’actualité régionale de ce carrefour économique, culturel et religieux, au cœur de l’Indo-Pacifique. Cette collection permet de suivre au fil des ans l’évolution des grands enjeux contemporains de cette région continentale et archipélagique de plus de 680 millions d’habitants, et d’en comprendre les dynamiques d’intégration régionale et de connectivités avec le reste du monde. L’Asie du Sud-Est 2023 propose une analyse synthétique et détaillée des principaux événements politiques et diplomatiques, ainsi que des évolutions économiques, sociales et environnementales de l’année 2022 dans chacun des onze pays de la région. Ce décryptage est complété pour chaque pays par un focus sur deux personnalités de l’année et une actualité marquante en image. L’ouvrage propose également cinq dossiers thématiques qui abordent des sujets traités à l’échelle régionale sud-est asiatique : les ressorts institutionnels de l’approche de santé intégrée One Health, le vieillissement de la population et sa prise en compte par les politiques publiques, les câbles sous-marins au cœur de la connectivité sud-est asiatique, l’aménagement du bassin du Mékong et ses multiples acteurs, et les enjeux politiques et linguistiques des langues transnationales. Des outils pratiques sont également disponibles : une fiche et une chronologie par pays et un cahier des principaux indicateurs démographiques, sociaux, économiques et environnementaux

Transplantation hépato-rénale ou transplantation rénale isolée pour hyperoxalurie primitive de type 1 (étude multicentrique française)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Circuit du médicament et implantation du logiciel GENOIS au centre hospitalier Philippe Pinel

Le circuit du médicament en milieu hospitalier met en relation quatre acteurs : le médecin, le personnel pharmaceutique, le personnel infirmier et le malade. Ce circuit recouvre la prescription, l'analyse et la validation de la prescription, la préparation, la distribution et l'administration du médicament. Les médicaments conçus au départ pour soigner, peuvent être responsables d'accidents liés à leur utilisation. En effet, des études américaines complétées par des études françaises montrent qu'un médicament sur dix n'arrive pas au patient dans les conditions souhaitées par le médecin. Les erreurs de médication sont essentiellement liées à des échecs d'organisation du circuit du médicament. Elles peuvent être corrigées par un système informatique. L'informatisation de ce circuit semble donc incontournable. Une telle solution est proposée avec l'acquisition du logiciel de prescription, dispensation, gestion et administration du médicament. Il est intégré dès 2002 au sein du Centre Hospitalier Philippe PINEL. L'expérience du site pilote sous le mode de délivrance globalisé a montré rapidement ses limites. Des améliorations et des adaptations au quotidien sont apparues indispensables pour évoluer vers une dispensation nominative. Ce mode de distribution des médicaments sera étendu à l'ensemble des unités fonctionnelles.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Selective retransplantation after late hepatic artery thrombosis

Hepatic artery thrombosis (HAT) is a serious and life-threatening complication that can occur any time after liver transplantation. HAT is generally subdivided into 2 categories. Early HAT frequently presents with profound graft dysfunction and sepsis, and requires urgent revascularization or retransplantation. This article is protected by copyright. All rights reserved

Contribution à l'amélioration de la conservation du greffon hépatique

RENNES1-BU Santé (352382103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF