Construction and validation of a prediction model for public acceptance of kidney xenotransplantation in China / 器官移植

Objective To explore the public attitude towards kidney xenotransplantation in China by constructing and validating the prediction model based on xenotransplantation questionnaire. Methods A convenient sampling survey was conducted among the public in China with the platform of Wenjuanxing to analyze public acceptance of kidney xenotransplantation and influencing factors. Using random distribution method, all included questionnaires (n=2 280) were divided into the training and validation sets according to a ratio of 7:3. A prediction model was constructed and validated. Results A total of 2 280 questionnaires were included. The public acceptance rate of xenotransplantation was 71.3%. Multivariate analysis showed that gender, marital status, resident area, medical insurance coverage, religious belief, vegetarianism, awareness of kidney xenotransplantation and whether on the waiting list for kidney transplantation were the independent influencing factors for public acceptance of kidney xenotransplantation (all P<0.05). The area under the curve (AUC) of receiver operating characteristic (ROC) of the prediction model in the training set was 0.773, and 0.785 in the validation set. The calibration curves in the training and validation sets indicated that the prediction models yielded good prediction value. Decision curve analysis (DCA) suggested that the prediction efficiency of the model was high. Conclusions In China, public acceptance of kidney xenotransplantation is relatively high, whereas it remains to be significantly enhanced. The prediction model based on questionnaire survey has favorable prediction efficiency, which provides reference for subsequent research.

Ethical construction of recipients’ rights and interests protection in organ transplantation from expanded criteria donors / 器官移植

Under the background of severe shortage of donor organs and organ donation after citizen's death becoming the main source of donor organs in China, expanded criteria donor (ECD) has been widely applied in clinical practice. However, ECD has the disadvantages of basic diseases, old age, trauma, shock or infection, which will affect the quality of donor organs to varying degrees and become one of critical factors affecting clinical efficacy of organ transplantation. The recipients of ECD organ transplantation will also bear the additional risk and uncertainty of efficacy brought by ECD organs. Hence, it is necessary to pay attention to the protection of the recipients’ rights and interests. In this article, ethical issues faced by ECD organ transplantation in recipient protection and the shortcomings in the ethical review of organ ethics committee were reviewed, and suggestions on the ethical review institution and system construction of the rights and interests of organ transplantation recipients were elucidated, aiming to provide reference for promoting the advancement of ECD organ transplantation.

The past, present and future of heart transplantation / 器官移植

Heart transplantation is one of the most effective strategies to treat end-stage heart failure. Multiple challenges, such as difficulty in preservation of heart allograft, rejection and postoperative complications, emerge in heart allotransplantation. After decades of research and practice, most problems have been resolved. Nevertheless, the shortage of donor organs has become increasingly prominent. To alleviate the shortage of donor organs, artificial heart and heart xenotransplantation have captivated attention, and obtained significant progress in recent years. The application of artificial heart in clinical practice has significantly enhanced the survival rate of patients with end-stage heart failure, which is expected to become the standard treatment for end-stage heart failure. Heart xenotransplantation still faces many challenges, which is still far from clinical application. In this article, the history of heart transplantation, development of heart allotransplantation, use of artificial heart and research progress on heart xenotransplantation were reviewed, and the future development direction of heart transplantation was predicted.

Transmission of porcine endogenous retrovirus in xenotransplantation / 器官移植

Organ transplantation is the most effective treatment for various types of end-stage diseases. To resolve the problem of donor shortage in organ transplantation, the possibility of xenotransplantation has been gradually explored by surgeons. Pig is one of the common donor sources for xenotransplantation. As a bridge between two species, the viruses carried by pig organs may be transmitted between species and cause the risk of zoonosis. Porcine endogenous retrovirus (PERV) is integrated into the genome, which is a category of retrovirus featuring cross-species transmission. In this article, the influencing factors of transmission characteristics of PERV, the transmission risk of PERV and its recombinant virus, and the detection and transmission risk assessment of PERV in xenotransplantation test were reviewed, aiming to provide reference for alleviating severe shortage of donor organs and driving the advancement of xenotransplantation technologies.

Attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation / 器官移植

Objective To investigate the attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation. Methods From June 2022 to January 2023, stratified random sampling was performed from patients awaiting kidney transplantation, patients after kidney transplantation, patients' relatives and medical students. Four hundred subjects were collected from each population and 1600 subjects were investigated using a self-designed questionnaire. Baseline data of the respondents, their attitudes towards kidney xenotransplantation and the reasons of rejecting kidney xenotransplantation were analyzed. The influencing factors of attitudes towards kidney xenotransplantation were also identified. Results A total of 1 493 valid questionnaires were collected, and the questionnaire retrieval rate was 93.31%. About 93.10% of the respondents accepted allogeneic kidney transplantation, and 66.78% had heard of kidney xenotransplantation. Seven hundred and ninety-five respondents suggested that they could accept kidney xenotransplantation "when kidney xenotransplantation and allogeneic kidney transplantation yielded the same results and risks". Six hundred and ninety-eight respondents indicated that they were "unable" or "uncertain" whether they could accept kidney xenotransplantation (χ2=16.409，P=0.001). Among these 698 respondents, the proportion of them who were willing to accept kidney xenotransplantation when they did not meet the conditions of allogeneic kidney transplantation was 10.9%. About 35.8% of respondents were willing to accept kidney xenotransplantation if it yielded less risk and better prognosis compared with allogeneic kidney transplantation. If the time of awaiting kidney xenotransplantation was shorter than that of allogeneic kidney transplantation, 21.2% were willing to accept kidney xenotransplantation. If the cost of kidney xenotransplantation was less than that of allogeneic kidney transplantation, 24.5% of them were willing to accept kidney xenotransplantation. The main reasons of rejecting kidney xenotransplantation included surgical risk and other unknown risks. Multivariate analysis showed that respondents residing in cities and towns for a long period of time, those who accept allogeneic kidney transplantation and those who have heard of kidney xenotransplantation showed more positive attitudes towards kidney xenotransplantation. Conclusions Different transplantation-related populations have different attitudes towards kidney xenotransplantation, and the overall attitudes are positive. Active promotion of kidney xenotransplantation research and carrying out relevant popular science education contribute to improving public attitudes towards the acceptance of kidney xenotransplantation.

The latest progress on donation after the circulatory determination of death at home and abroad / 器官移植

Organ shortage is a common problem in the field of transplantation worldwide. It is urgent to expand the donor pool via different effective and safe approaches. Recently, "the statement from international collaborative on expanding controlled donation after the circulatory determination of death (cDCDD)" has attracted widespread attention from scholars. The statement aims to promote cDCDD in order to increase organ donation rates, with the ultimate goal of achieving self-sufficiency in transplantation. In this article, the key contents mentioned in the statement were summarized, the terminology update and relevant discussion of donation after the circulatory determination of death (DCDD), the development trend of DCDD, the basic part of the clinical pathway of cDCDD and the key factors affecting the implementation of cDCDD were illustrated, and the inspiration drew from this statement to the sustainable development of organ donation program in China was reflected.

Extra corporeal membrane oxygenation (ECMO) in deceased donors after brain death with severe hemodynamic instability allows to optimize the viability of livers and kidneys procured for transplantation / 中华器官移植杂志

Objective To observe the clinical effect of the maintenance for the liver and kidney function by extra corporeal membrane oxygenation (ECMO) in brain death donor with severe hemodynamic instability.Methods Ninety-nine brain death donors maintained by ECMO were followed up.The criteria for using the ECMO to protect the organ function were as follow:cardiopulmonary resuscitation history (cardiac compression ＞ 20 min);mean arterial pressure (MAP),for Adult ＜60-70 mmHg,for child ＜50-60 mmHg,and for infant ＜40-50 mmHg;cardiac index ＜2 L/(m2 ·min) (3 h);Large doses of vasoactive drugs,for doparnine 20μg/(kg·min),for (norepinephrine) epinephrine 1.0 μg/(kg· min) (3 h),and for oliguria ＜0.5 mL/(kg · h);blood biochemical indexes,moderate,severe impairment on acute hepatic and renal function;others,ST-T significant changes in electrocardiogram,and difficult to correct the metabolic acidosis (3 h).The organs were evaluated during their retrieval and as well their evolution after transplantation was evaluated.Results ECMO allowed for the maintenance of hemodynamic stability before organ procurement.A total of 99 cases receiving ECMO maintenance were collected,equal to100 ％ of the total donation cases (100％).198 kidneys,and 99 livers were procured from these donors meanwhile 15 kidneys and 42 livers respectively were discarded as theywere shown in a macroscopic evaluation.177 of the procured kidneys were transplanted.DGF of kidney transplantation was observed in 20.9％of the cases.Acute rejection incidence was 12.99％.Transplanted kidneys and recipient survival rate was 96.1％/99.3％ for one year,94.7％/97.8％ for 3 years,and 93.6/97.8％ for 4 years,respectively.There was no significant difference in patient or graft survival between the group with ECMO and the group without ECMO.Conclusion ECMO in the brain dead donors with severe circulatory dysfunction allows to avoid organ donors loss and obtain good quality kidneys and livers with excellent graft survival after transplantation.

Desafíos actuales en trasplante hepático / Current challenges in liver transplantation

Nowadays liver transplantation (LT) is a routine procedure for many patients with malignant and nonmalignant liver diseases, usually with excellent outcomes. However, organ shortage remains a critical issue worldwide. In this review, we address the ‘current challenges in liver transplantation’ by answering three main questions: a) How do we get more organs in order to have more and better grafts? b) How do we prevent “wasting” organs because of futile transplants? and c) Is it possible to improve the quality of the organs we currently get, thus having better results? We focus our answers in maximizing all the strategies that might increase the donor pool, emphasizing that living donor liver transplantation perhaps offers the highest potential for increasing the number of donors. We also describe how to optimize indications and better select patients undergoing LT in the scenario of hepatocellular carcinoma, and finally we discuss the new paradigm of liver preservation and perfusion and how we can improve the quality of the grafts in order to perform more and better transplants.

Actualmente el trasplante hepático (TH) es un procedimiento de rutina para pacientes con enfermedades hepáticas terminales neoplásicas y no neoplásicas, usualmente con muy buenos resultados. Sin embargo, la escasez de órganos representa un problema crítico en todo el mundo. En esta revisión abordamos el tema ‘desafíos actuales en trasplante hepático’, tratando de responder 3 preguntas: a) ¿Cómo podemos incrementar el pool de donantes para obtener más y mejores injertos? b) ¿Cómo podemos prevenir “gastar o malgastar” órganos en trasplantes fútiles? c) ¿Es posible mejorar la calidad de los órganos que procuramos actualmente y así conseguir mejores resultados? Enfocamos las respuestas en maximizar todas las estrategias que puedan aumentar la cantidad de trasplantes, destacando que la utilización de donantes vivos quizás tenga el mayor potencial de expansión. También indagamos en cómo optimizar las indicaciones y seleccionar mejor los pacientes que se trasplantan por carcinoma hepatocelular y, finalmente, discutimos el nuevo paradigma de preservación y perfusión hepática y cómo podemos mejorar la calidad de los injertos con la idea de hacer más y mejores trasplantes.

Activation Policy for Brain-dead Organ Donation / 이화의대지

Organ transplantation has become the standard of care for treatment of end stage organ failure patients medically suitable for transplantation. Unfortunately, the availability of transplantable organs has not been able to meet the high demand. The organ shortage of transplantation has become worldwide and a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues. This article reviews methods to increase the number of potential deceased organ donor and the number of organs per donor by aggressive donor management protocol.

The Role of NGO in Deceased Organ Transplantation / 대한이식학회지

Solid organ transplantations give end stage organ failure patients new, healthy and normal lives and have them return to their families, friends and communities. But, there has been a donor organ shortage and it has been considered a major obstacle. A national report in 2009 showed a severe disparity between the annual numbers of organ donors (1,787) and the number of patients (12,235) on the deceased donor waiting list. In terms of donor action, and to meet the demands of organs for transplantation, we need to educate the public on the need for organs, eye and tissue donations, and we need to motivate the public to make an actionable donor designation. The unification of non-governmental organization (NGO) is necessary to educate the public about organ, eye and tissue donations and to avoid duplication of effort.