Initial outcomes of using allografts from donation after cardiac death donors for liver transplantation in New South Wales

Objectives: To report the early outcomes of the initial selection and use of donation after cardiac death (DCD) donor livers for transplantation in New South Wales, following a guidelines implementation process. Design and setting: Review of database and medical records from the Australian National Liver Transplantation Unit and the NSW Organ and Tissue Donation Service for DCD activity including organ donor offers and retrievals, from 1 July 2007 to 31 December 2010. Main outcome measures: Acceptance and utilisation rates of livers from DCD donors, and patient and graft outcomes after liver transplantation. Results: Of the potential 84 DCD donor offers, 45 were declined, and 15 of the 39 attempted retrievals provided livers for transplantation. The most common reason for non-retrieval of the liver was the time to declaration of death exceeding 30 minutes after withdrawal of treatment (14 donors), followed by abnormality in the donor liver (eight donors). Data on early outcomes for liver transplant recipients showed a median peak aspartate aminotransferase of 3667 U/L (range, 919-11264 U/L), but no delayed graft function. Four patients developed biliary complications (two within 3 months and two later). Patient and graft survival were 100% at a median follow-up of 15 months. Conclusions: As a result of the re-establishment of multiorgan donation through the DCD pathway, 15 (18%) of the selected DCD donors provided livers for transplantation. Patient and graft survival rates were excellent, and the rate of intra- and postoperative complications was acceptable. Hence, the selective transplantation of DCD donor liver allografts will continue to be pursued and the outcomes followed

Cleanability of soiled stainless steel as studied by atomic force microscopy and time of flight secondary ion mass spectrometry.

The hygienic status of food contact surfaces can deteriorate with wear. Effective cleaning regimes must remove any adsorbed organic material as well as microorganisms. Previous work has determined the extent of surface wear occurring on a stainless steel surface within the food industry, and we have reproduced representative samples in vitro. Two surface analytical techniques, atomic force microscopy and time of flight secondary ion mass spectrometry were combined with fluorescence microscopy to give detailed analysis of stainless steel surfaces fouled with starch and milk powder, then cleaned with water either by a spray or brushing method. It was found that the surface cleanability is affected by the cleaning regime and the surface roughness, not only the average vertical roughness but also by the shape of the surface defects, with sharp scratches more difficult to clean than wider surface defects. Spray cleaning with distilled water was found to be a selective method by preferentially removing proteinaceous material more easily than fatty acid ester material. The analytical techniques employed provided information on selective cleanability and surface topography at a hitherto unexplored level, and the information gained may be of value in the design and investigation of novel cleaning regimes and hygienic surfaces

Surface characterization of glass and poly(methyl methacrylate) soiled with a mixture of fat, oil, and starch

Micro-organisms on food contact surfaces provide a 'biotransfer potential', i.e. the ability to contaminate foods during processing or preparation. Surfaces coated with organic materials can act as sites for microbial attachment. This investigation into the surface properties of glass and poly(methyl methacrylate) substrates soiled with a milk powder, oil, and starch composite has found that fatty acid esters dominate the surface chemistry. A lower concentration of proteinaceous material was also detected, with the concentration dependent on both the underlying substrate and the thickness of the soiling material. The physical surface structure of the fouled surfaces showed a complicated surface topography with features of the order of tens of micrometres wide and up to 2 μm high, which increased in size with increasing thickness of the soiling layer. The features reflect bulk incompatibilities between the components of the soiling material and demonstrate the heterogeneity of the surface as presented to micro-organisms

Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index

Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes. Methods: Areview of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist. Results: Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P <0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75-19.05], P = 0.000) and 1 year (P = 0.000). Conclusions: MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI

Poorer survival in patients whose explanted hepatocellular carcinoma (HCC) exceeds Milan or UCSF Criteria. An analysis of liver transplantation in HCC in Australia and New Zealand

AbstractBackgroundMilan and University of California San Francisco (UCSF) Criteria have been used for selection of patients with hepatocellular carcinoma (HCC) for liver transplantation (LTx). The aims of this study were to analyse the results of LTx for HCC in Australia and New Zealand with emphasis on the effects of discordance between pre-LTx radiological and post-LTx pathological staging.MethodsA total of 186 LTx for HCC carried out between July 1985 and August 2003 were included. Patients were categorized according to the Milan and UCSF Criteria.ResultsThe median follow-up was 6.55 years (range 2.96–20.93 years). Pre-LTx factors associated with better survival include tumour size ≤5cm, number of tumours ≤3, staging within Milan and UCSF Criteria and more recent transplantation (1996–2003). In all, 14 patients had a pre-LTx stage outside the Milan but within the UCSF Criteria. One- and 5-year patient survival rates were, respectively, 88% and 74% within the Milan Criteria, and 87% and 73% within the UCSF Criteria. Vascular invasion, capsular invasion, lymph node invasion and pathological stage outside UCSF Criteria were associated with poor outcome. Of patients within the Milan and UCSF Criteria pre-LTx, 24% and 18%, respectively, were outside the same criteria post-LTx. These patients had poorer survival rates.ConclusionsThe use of the UCSF Criteria in this cohort increased the number of patients eligible for LTx without compromising 5-year survival rates. Patients whose explant tumours were outside the Milan or UCSF Criteria had poorer outcomes compared with those whose explants remained within these criteria