ABSTRACT
We previously reported that subnormothermic machine perfusion (sMP; 20°C) is able to improve the preservation of livers obtained from non-heart-beating donors (NHBDs) in rats. We have compared sMP and standard cold storage (CS) to preserve pig livers after 60 minutes of cardiac arrest. In the sMP group livers were perfused for 6 hours with Celsior at 20°C. In the CS group they were stored in Celsior at 4°C for 6 hours as usual. To simulate liver transplantation, both sMP- and CS-preserved livers were reperfused using a mechanical continuous perfusion system with autologus blood for 2 hours at 37°C. At 120 min after reperfusion aspartate aminotransferase levels in sMP versus CS were 499 ± 198 versus 7648 ± 2806 U/L (P < .01); lactate dehydrogenase 1685 ± 418 versus 12998 ± 3039 U/L (P < .01); and lactic acid 4.78 ± 3.02 versus 10.46 ± 1.79 mmol/L (P < .01) respectively. The sMP group showed better histopathologic results with significantly less hepatic damage. This study confirmed that sMP was able to resuscitate liver grafts from large NHBD animals.
Subject(s)
Body Temperature , Liver Transplantation , Models, Animal , Perfusion/methods , Tissue Donors , Animals , Aspartate Aminotransferases/metabolism , Disaccharides , Electrolytes , Glutamates , Glutathione , Histidine , L-Lactate Dehydrogenase/metabolism , Mannitol , Myocardial Contraction , Organ Preservation Solutions , Perfusion/instrumentation , SwineABSTRACT
BACKGROUND: The system that controls the waiting list (WL) and organ allocation for liver transplantation (OLT) seeks to achieve 3 main goals: objectivity, low dropout risks and good post-OLT results. We sought to prospectively validate a priority allocation model that is believed to achieve objectivity without penalizing dropout risk and post-OLT results. METHODS: We evaluated a study group of 272 patients enrolled in 2006-2007. WL candidates were divided into 2 categories: cirrhotic patients classified according to Model for End-Stage Liver Disease (MELD) score (MELD list and patients with hepatocellular carcinoma (HCC) organized according to a specific score (non-MELD list). The allocation algorithm for donor-recipient match assigned an optimal graft to the first MELD candidate with a MELD score of >or=20; a suboptimal graft, to the first non-MELD patient. A respective control group of 327 patients transplanted from 2003-2006 was characterized by a unique WL with a free allocation policy. We performed an interim analysis of this prospectively controlled study. RESULTS: Although the study group showed a lower percentage of OLT (P < .05) than the control group (37% vs 45%), it selected patients for OLT based on a higher MELD score (P < .05), thus obtaining similar dropout, post-OLT survivals, and intention-to-treat (ITT) survival probabilities as the controls. Among MELD patients, we observed a significantly reduced dropout and better ITT survival profiles than those of the control group (P = .02), whereas the similar results were delivered among non-MELD patients (P > .05). Among patients with a MELD score of >or=20, the prevalences of suboptimal grafts (0% vs 48%) and of early graft losses (0% vs 21%) were lower in the study than in the control group (P < .05). CONCLUSIONS: We prospectively validated a priority allocation model based on objective criteria that achieved high ITT survival rates.
Subject(s)
End Stage Liver Disease/surgery , Liver Transplantation , Severity of Illness Index , Waiting Lists , Adult , Aged , Carcinoma, Hepatocellular/surgery , Female , Humans , Liver Neoplasms/surgery , Liver Transplantation/mortality , Male , Middle Aged , Prospective Studies , Tissue Donors , Tissue and Organ Procurement , Young AdultABSTRACT
A survey on the perceived severity and criteria for defining the nursing shortage was made by interviewing with a semistructured questionnaire 11 nurses responsible for nursing services of 11 Italian hospitals and districts. The questionnaire was administered by interview. Ten hospitals suffer a medium-severe nursing shortage. The main solutions adopted to overcome the nursing shortage are: the closure of wards, the merge of wards, with comparable patients; the employment of support personnel; the mobility of nursing personnel, whereby nurses change wards and are move where they are most needed; modification of shifts. Interestingly, criteria for defining the nursing shortage vary from hospital to hospital, but they are not based on objective data (c.g. number of "missing" nurses). The payment of overtime hours is also different, ranging from 20 to 35 dollars/hour. Since the shortage of nurses will last for the next 5-8 years, a study of criteria for assessing it, of solutions adopted and of their effectiveness is pivotal for gaining a better understanding of the problem.
