Kidney Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Kidney Transplant, including details on risks, prognosis, procedure, surgery, organ donation.

Effect of multiorgan donation after cardiac death retrieval on lung performance.

Snell GI, Levvey B, Oto T, McEgan R, Mennan M, Eriksson L, Williams T, Rosenfeldt F

Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia. g.snell@alfred.org.au

AIM: For donation after cardiac death (DCD) transplantation to achieve its full potential, multiorgan retrieval is desirable. Although there are several novel individual techniques recently described for DCD lung donation, they have not been evaluated or compared in a DCD multiorgan scenario. DESCRIPTION: This study describes (i) the technical aspects and (ii) early lung and abdominal organ performance of several combinations of DCD donor liver, kidney and lung retrieval techniques that would mimic common DCD clinical scenarios. EVALUATION: Lung oxygenation, urine production, bile production and biochemical measures were assessed as the outcome of a complex ex vivo lung, liver and kidney perfusion DCD model. CONCLUSION: Successful ex vivo multiorgan perfusion was possible following the three retrieval techniques tested, with excellent oxygenation over a 2-h assessment period, identical to prior studies where the lungs were tested alone. Multiorgan DCD retrieval, including lungs of good quality, is possible from a variety of clinical scenarios and should therefore be considered with all DCD retrieval opportunities.

Published 27 March 2008 in ANZ J Surg, 78(4): 262-5.
Full-text of this article is available online (may require subscription).

Articles on Kidney Transplant published 17 March 2008:

Laparoscopic living donor nephrectomy: a look at current trends and practice patterns at major transplant centers across the United States.   J Urol, 179(4): 1488-92.

PURPOSE: Laparoscopic living donor nephrectomy is now the preferred technique for living donor renal transplantation. To our knowledge we provide the first published multi-institutional consensus describing practice patterns, technical considerations and interesting controversies involved in laparoscopic living donor nephrectomy. MATERIALS AND METHODS: We designed a survey with 33 multiple choice questions looking at demographics, patient selection, technical considerations, postoperative care ... [Abstract] [Full-text]

Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation.   Br J Anaesth, 100(4): 504-8.

BACKGROUND: The renal effect of hydroxyethylstarch (HES) solutions remains controversial. We hypothesized that the use of HES with a mean molecular weight of 130 kDa would reduce renal dysfunctions in the recipients. Our study was aimed at comparing the effects of two fluid regimens (HES 130/0.4 or HES 200/0.6) used for the resuscitation of brain-dead donors on the rate of delayed graft function (DGF) and the serum creatinine levels post-transplantation. METHODS: This retrospective ... [Abstract] [Full-text]

Articles on Kidney Transplant published 7 March 2008:

Pharmacokinetics and pharmacodynamics of cinacalcet in patients with hyperparathyroidism after renal transplantation.   Am J Transplant, 8(4): 803-10.

Cinacalcet is a calcimimetic drug for the treatment of secondary hyperparathyroidism (HPT). In a sequential open-label study, ten patients with persistent HPT after renal transplantation received first 30 and then 60 mg oral cinacalcet once daily over 2 weeks each. Cinacalcet steady state oral clearance was 131.1 +/- 20.9 l/h and 92.8 +/- 9.5 l/h (mean +/- SE) after 30 and 60 mg, respectively. Cinacalcet and parathyroid hormone (PTH) concentrations showed an inverse correlation and were fitted ... [Abstract] [Full-text]

Last resort for renal transplant recipients, 'restored kidneys' from living donors/patients.   Am J Transplant, 8(4): 811-8.

Because of the grave shortage of deceased kidney allografts in Japan, we have embarked on a new source of organs, 'Restored kidneys' from living patients. From January 1991 through September 2006, 42 kidneys (eight benign pathology, eight small renal cancers, eight ureteral cancers, six aneurysms, eight severe nephrotic syndrome from four patients and four ureteral stenosis) were obtained from 38 patients/donors after extensive discussion of treatment modalities and risks. All patients/donors ... [Abstract] [Full-text]

Fatal graft-versus-host disease presenting as fever of unknown origin in a pancreas-after-kidney transplant recipient.   Am J Transplant, 8(4): 881-3.

Acute graft-versus-host disease (GVHD) is a rare complication of pancreas transplantation. We describe a 54-year-old male with type 1 diabetes who received a zero-antigen mismatched pancreas-after-kidney transplant from a pancreas donor who was homozygous at the HLA-B, -Cw, -DR, and -DQ alleles. Starting on postoperative day (POD) #22, the patient developed persistent fevers. Workup was notable only for low-grade cytomegalovirus viremia, which was treated. The fevers eventually disappeared. On ... [Abstract] [Full-text]

Didactic lessons from the serum lactate dehydrogenase posttransplant: a clinical vignette.   Am J Transplant, 8(4): 862-5.

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. An elevated serum lactate dehydrogenase (LDH) is a marker of PTLD activity. We report the case of a 58-year-old female renal transplant patient with a prior history of extranodal PTLD, which developed 19 years after a second transplant. She was successfully treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and maintained subsequently on ... [Abstract] [Full-text]

Life-threatening coagulopathy associated with use of Campath (alemtuzumab) in maintenance steroid-free renal transplant given before surgery.   Am J Transplant, 8(4): 884-6.

We report a case in which an alarming coagulopathy occurred during the operation in a patient receiving a kidney from his spouse. Campath was used for induction of immunosuppression immediately before surgery. There was catastrophic intra-abdominal bleeding associated with severe hypotension, respiratory failure, prolonged partial thrombin time (PTT), normal prothrombin time (PT) and absence of signs of disseminated intravascular coagulation. Multiple tranfusions of blood and blood products ... [Abstract] [Full-text]

Banff 07 classification of renal allograft pathology: updates and future directions.   Am J Transplant, 8(4): 753-60.

The 9th Banff Conference on Allograft Pathology was held in La Coruna, Spain on June 23-29, 2007. A total of 235 pathologists, clinicians and scientists met to address unsolved issues in transplantation and adapt the Banff schema for renal allograft rejection in response to emerging data and technologies. The outcome of the consensus discussions on renal pathology is provided in this article. Major updates from the 2007 Banff Conference were: inclusion of peritubular capillaritis grading, C4d ... [Abstract] [Full-text]

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