RESUMEN
Liver transplantation (LT) is one of the most effective treatments for end-stage liver diseases. The number of LT in China currently ranks as the second worldwide. Extended criteria donor (ECD) reconditioning and functional improvement is an important research direction at present in order to address the bottleneck of donor graft shortage. In the future, it is pivotal to explore the original breakthroughs in basic theories of stem cell fates regulation, organ restoration and tissue regeneration, and to conduct national-wide, multicenter clinical investigations on the basis of innovative platform of medical, engineering and information technology. Therefore, the authors summarize evidence-based medical proof, latest research achievements and clinical experi-ences with novel concept of "machine perfusion plus" to explore the most updated mode that inte-grates traditional machine perfusion with cutting edge technologies such as multi-omics, molecular biology, information technology, automation technology and nanoparticle targeted delivery tech-nology. This aims to achieve real-time, non-invasive, intelligent quality assessment and monitoring of donor graft, and finally to establish a new technology system of ECD reconditioning and functional improvement, which can safely and effectively expand the donor pool, decrease the risk of post-transplant complications, and improve the prognosis of recipients, thus promoting the higher quality development of LT in China.
RESUMEN
With the increasing quantity of organ donors and the continual expansion of the definition of extended criteria donor (ECD) livers, the quality of donor liver has become a prominent issue affecting the high-quality development of liver transplantation, which is also the study focus in related fields. Resolving the shortage of organs to the maximal extent and promoting the high-quality development of organ transplantation lead the development direction of organ donation and transplantation in China. In recent years, the application of mechanical perfusion (MP) for the perfusion, preservation, evaluation and repair of donor liver has become a hot topic to improve the quality of liver transplantation within the international community. In this article, according to different conditions of the application of ECD livers in liver transplantation at home and abroad in combination with the research progress on MP in the international community and relevant research experience of our center, the feasibility of establishing an organ intensive care unit (ICU) with integrated organ protection techniques was discussed, aiming to promote the high-quality development of organ transplantation in China and further expand the technical connotation of the "Chinese model" of organ donation and transplantation.
RESUMEN
Though achieved great success as the only curative treatment for end-stage liver diseases, liver transplantation has been severely restricted by the shortage of donors. The adoption of extended criteria donor (ECD) tackles the donor shortage problem to some extent, thus became an issue we must face in China at present stage. As the transplantation effect and recipient safety is largely decided by the quality of liver graft, ECD graft should be cautiously selected and adopted because of its inherent defects. This relies on individualized decisions made for recipients by transplant surgeons who have a good understanding of the risk factors and evaluation criteria of ECD. In this article, we investigate the risk factors, evaluation criteriaand allocation of ECD liver grafts as well as the application of mechanic perfusion, and we discuss the fundamental issues and prospects of ECD study.
RESUMEN
Though achieved great success as the only curative treatment for end-stage liver diseases, liver transplantation has been severely restricted by the shortage of donors. The adoption of extended criteria donor (ECD) tackles the donor shortage problem to some extent, thus became an issue we must face in China at present stage. As the transplantation effect and recipient safety is largely decided by the quality of liver graft, ECD graft should be cautiously selected and adopted because of its inherent defects. This relies on individualized decisions made for recipients by transplant surgeons who have a good understanding of the risk factors and evaluation criteria of ECD. In this article, we investigate the risk factors, evaluation criteriaand allocation of ECD liver grafts as well as the application of mechanic perfusion, and we discuss the fundamental issues and prospects of ECD study.
RESUMEN
Objective To compare the early clinical efficacy of renal transplantation between extended criteria donor (ECD) and standard criteria donor (SCD). Methods Clinical data of 85 recipients undergoing renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the types of donors, all recipients were divided into the ECD group (n=31) and SCD group (n=54). The level of serum creatinine (Scr), incidence of early complications and clinical prognosis within 3 months after renal transplantation were compared between 2 groups. Results No statistical significance was observed in the levels of Scr within 1 month after renal transplantation between the ECD group and SCD group (all P>0.05). At postoperative 60 and 90 d, the level of Scr in the ECD group was (189±97) and (175± 69) μmol/L respectively, significantly higher than (142±49) and (135±41) μmol/L in the SCD group (P=0.005 and 0.002). In the ECD group and SCD group, the incidence of acute rejection (AR) was 6% and 15%, the incidence of delayed graft function (DGF) was 23% and 19%, the incidence of pulmonary infection was 10% and 6%, the incidence of other early complications was 32% and 15%, respectively, no statistical significance was identified (all P>0.05). In the ECD group and SCD group, the survival rate of the recipient was 97% and 94%, the survival rate of the renal was 84% and 91%, no statistical significance was identified (all P>0.05). Conclusions Compared with the SCD, renal transplantation from ECD can achieve equivalent early clinical efficacy. In the present condition of serious deficiency of donor kidney, the application of ECD can enlarge the supply of the donor kidney.
RESUMEN
Este artigo tem como objetivo revisar a nomenclatura, a classificação e a utilização dos doadores limítrofes no transplante de fígado. O rápido crescimento do número de transplantes hepáticos tem sido desacelerado por falta de doadores, e existe aumento de doentes em listas de espera. A escassez de órgãos tem levado muitos programas de transplante a estender seus critérios de aceitação de doadores. Esses doadores limítrofes ou marginais provêem imediata expansão do número de órgãos para transplante. Tal desequilíbrio entre doador e disponibilidade de órgãos em cotejo com o número de receptores é um problema internacional. O uso de doadores marginais é estratégia sobremodo usada em bem qualificadas unidades de transplantes. Este artigo tem como objetivo revisar a nomenclatura, a classificação e a utilização dos doadores limítrofes no transplante de fígado. O aumento do número de transplante de fígado acima de 20% foi obtido nos últimos anos graças à crescente aceitação e utilização dos enxertos limítrofes também conhecidos como marginais. Assim, a utilização sistemática de enxertos limítrofes maximiza o uso de doadores, aumenta o acesso ao transplante de fígado e reduz a mortalidade na lista de espera e apresenta resultados satisfatórios em pacientes selecionados.
The rapid growth of the number of liver transplantation has been curtailed by the lack of donors and has an increase of patients on the waiting list. This lack of organs has led a number of transplantation programs to expand its criteria of donors acceptance. These borderline or marginal donors provide immediate expansion of the number of available organs for transplantation. This imbalance between organ donors availability and the number of recipients is an international problem. The use of marginal donor is a strategy used mostly in large liver transplantation units. This paper reports a review of nomenclature, classification and utilization of borderline donors for liver transplantations. The number of liver transplantation rose over 20% in the last past years due to the growing acceptance and utilization of borderline transplanted organs known as marginal grafts. Thus, systematical marginal grafts utilization maximizes. The donor use, increases access to liver transplantation and reduces waiting-list mortality, still provides satisfactory outcomes to selected recipients.