Summary of experience in the establishment of rat models with orthotopic liver transplantation from donation after cardiac death / 器官移植

Objective To explore the skills and summarize the experience in the establishment of orthotopic liver transplantation rat models from donation after cardiac death (DCD). Methods According to the time of warm ischemia, 120 rats were divided into 3 groups: group A (warm ischemia for 0 min, n=40 pairs), group B (warm ischemia for 10 min, n=40 pairs) and group C (warm ischemia for 20 min, n=40 pairs). Orthotopic liver transplantation was performed by the modified two-cuff technique in 3 groups. The time of each stage of surgery was recorded in 3 groups. The survival rate at the end of surgery, 24 h, 72 h and 7 d after surgery was recorded in 3 groups. The dead rats were immediately subject to anatomical examination to identify the cause of death. Results The cold ischemia time of donor liver, anhepatic phase and operation time of the recipients did not significantly differ among three groups (all P>0.05). In groups A, B and C, the survival rate at the end of surgery was 97%, 97%, and 100% respectively. The survival rate at postoperative 24 h was 92%, 90% and 92% respectively. The survival rate at postoperative 72 h was 90%, 80% and 77% respectively. The survival rate at postoperative 7 d was 85%, 70% and 57% respectively. The survival rate at the end of surgery, postoperative 24 h and 72 h did not significantly differ among 3 groups (all P>0.05). At postoperative 7 d, the survival rate in group C was significantly lower than that in group A (P<0.05). Surgical operation was the major cause of intraoperative and postoperative 24 h death. Bile leakage and ischemic hepatic failure were the causes of death at postoperative 72 h. Biliary duct complications were the main causes of death at postoperative 7 d. The quantity of rats developing with biliary duct complications was increased along with the prolongation of warm ischemic time. Conclusions The success of stable establishment of rat models with orthotopic liver transplantation from DCD depends upon the protection of the liver and biliary function. The difficulty lies in the anastomosis of the suprahepatic inferior vena cava and the shortening of anhepatic phase.

Factors and prognosis analysis of graft renal function recovery after DCD donor renal transplantation / 中华器官移植杂志

Objective To analyze the factors and prognosis of graft recovery after donation after citizens death (DCD) donor renal transplantation.Methods A retrospective analysis of 67 cases of DCD renal transplantation from August 2012 to September 2015 in our hospital was carried out.According to the stability of renal function after operation,the patients were divided into group A (51cases) with stable renal function,and 16 cases in group B (delayed graft function after operation).The clinical data of two groups including age,gender,cause of death,warm ischemia time,type of dialysis,and application of norepinephrine before operation were collected and analyzed.The related factors of graft function recovery were analyzed.Logistic regression analysis was used to analyze the risk factors of graft functional recovery after operation.The 3-month,6-month,1-year and 18-month survival rate after operation in the two groups was compared.Results The causes of death,the time of ischemia,the type of dialysis before operation,the application of norepinephrine before operation,infants and young donors were related factors of graft function recovery (P ＜ 0.05).Logistic regression analysis showed that cerebral hemorrhage death donor,the long thermal ischemia time,the preoperative hemodialysis and the application of norepinephrine before operation were the risk factors of delayed graft function recovery (P＜0.05).The 3-month,6-month,1-year and 18-month survival rate after operation in group A was higher than that in group B,with the difference being statistically significant (P＜0.05).Conclusion Cerebral hemorrhage death donor,the long thermal ischemia time,the preoperative hemodialysis and the application of norepinephrine before operation were the independent risk factors of delayed graft function recovery.And the prognosis of patients with delayed graft function was poor.Clinical risk should be eliminated or reduced in clinical practice,which can effectively prevent the delayed graft function and further improve the prognosis of the patients.

The Use of Non-Heart Beating Donors to Expand the Donor Pool / 대한이식학회지

There is a persistent shortage of allografts available for transplantation, so we envisioned using non-heart beating donation to expand the donor pool. Non-heart beating donors (NHBD) were categorized using four definitions. Controlled donors, consisting of categories III and IV, are the most suitable for NHBD. Delayed graft function is associated with the use of kidneys from such donors, but had no difference on graft survival in the long-term results compared with heart beating donors. The proportion of NHBD of deceased donors differs considerably among countries, but national programs in many nations have now been initiated to increase the rate of non-heart beating donation. In most cases, the organs from NHBD are not available for transplantation in Korea because of legal restrictions. The use of controlled NHBD is encouraged to expand available allografts in Korea, due to the shortage of such allografts

Anesthesia for liver transplantation from a maastricht category 4 non-heart-beating donor: A case report / 대한마취과학회지

Great improvements in patient selection, surgical techniques, perioperative care, and immunosuppression have been made for the optimization of liver transplantation. To increase the number of organs available for liver transplantation, transplant centers have used marginal donors, split livers, living donors, or non-heart-beating donors (NHBDs). Despite recent enthusiasm for NHBDs in liver transplantation, warm ischemic injury to recovered organs has been an obstacle for the wide acceptance of NHBD. In the present case, we have conducted a liver transplantation from a Maastricht Category 4 NHBD. Warm ischemic time was 20 minutes and cold ischemic time was 5 hour 43 minutes. Consequently, the liver was successfully transplanted into the recipient.

The Feasibility of Recovered Warm Ischemic Injury on Non-heart-beating Donor Liver by Hepatocyte Growth Factor in Animal Model / 대한이식학회지

PURPOSE: Liver transplantation is the therapy of choice for patients with acute and acute-on-chronic severe liver failure or hepatocellular carcinoma. But a suitable liver is not always available for transplantation due to limited donor numbers. To increase the number of available liver for transplantation, a non-heart-beating donor (NHBD) liver transplant program is started. In NHBD liver transplantation, warm ischemic injury of liver occurs. The duration of warm ischemia is thought to be the most important risk factor for postoperative complications such as primary nonfunction or severe hepatic dysfunction. Recent evidence indicates that hepatocyte growth factor (HGF) plays an important role as a cytoprotector against hepatic injury by anti-apoptotic effect and mitogen in liver regeneration. Therefore studies also were performed to examine whether HGF influenced the viability and regeneration of hepatocytes from rats, subjected to prolonged warm ischemic injury. METHODS: Male Sprague- Dawley rats were subjected to non-heart-beating death by cervical spine fracture. Rats left in room temperature directly after, 30-minutes, 1-hours before surgery and perfusion was performed for isolating hepatocyte. Among three groups, hepatocyte viability was compared by trypan blue stain. And isolated hepatocytes from 30-minutes warm ischemic group were cultured for 24-hours, which were treated with no HGF and addition of various doses (5 ng/mL, 10 ng/mL, 20 ng/ mL, 40 ng/mL, 100 ng/mL) of HGF. Anti-apoptosis and regeneration of hepatocyte were compared by LDH assay, MTS assay, western blot, and immunocyto-chemistry after a 24-hours culture. RESULTS: The results of hepatocyte viability along the prolonged warm ischemic groups in isolated hepatocytes decreased sequentially 74.8+/-12.6%, 45.0+/-5.4%, 37.8+/-10.4% along directly after, 30-minutes, 1-hours in trypan blue stain (P<0.01). And 24-hour-cultured hepatocytes from 30-minutes warm ischemic group were treated with HGF. The results of LDH assay, MTS assay did not have relation with HGF addition. But the results of western blot and immunocytochemistry shown that HGF doses dependent anti-apoptosis and regeneration of hepatocyte increased. That indicates HGF presumably inhibites apoptotic pathway by phosphorylation. And HGF also makes hepatocyte hypertrophy and albumin synthesis. CONCLUSION: HGF was a potent cytoprotector against hepatic injury by anti- apoptotic effect and mitogen of liver regeneration in NHBD liver animal model. HGF facilitates recovery of the liver from prolong warm ischemic injury. If the more clinical studies and large animal studies are performed, NHBD using liver transplantation will be available with more chances by HGF.