Livers transplanted from donors after cardiac death occurring in the ICU or the operating room have excellent outcomes.

BACKGROUND: Increasing donor hospital cooperation with donation after cardiac death (DCD) requires the organ procurement organization (OPO) to use current withdrawal of life support (WLS) protocols. Hospital ICU nurses/physicians are comfortable performing the emotionally draining procedure of WLS in the ICU while OPOs are reluctant to accept these donors due to increased warm ischemia (WI). In our area, several hospitals will only allow WLS to occur in the ICU. This study compares liver outcomes from DCD donors where death occurred in the ICU (DCDICU) vs the OR (DCDOR). METHODS: From March 2003 to June 2004, 34 DCD donors were recovered by our OPO. WLS occurred in the ICU for 26 donors (76%) and in the OR for 8 donors (24%). Thirteen of 26 DCDICU and 5 of 8 DCDOR livers were transplanted. Donor demographics, warm ischemic time, cold ischemic time, distance shipped, and recipient functions were analyzed. RESULTS: Eighteen livers were transplanted both locally and at distant transplant centers. Results are outlined in the . CONCLUSIONS: Although DCDICU donors averaged approximately 4 minutes longer WI than DCDOR donors, short-term results for both groups were equivalent. These findings support using DCDICU livers. DCDICU donors have the potential to significantly improve donor hospital cooperation.

In vivo 125I-erythropoietin pharmacokinetics are unchanged after anesthesia, nephrectomy and hepatectomy in sheep.

Knowledge regarding the in vivo metabolic fate of the glycoprotein erythropoietin (EPO) is incomplete. To determine whether EPO pharmacokinetics are perturbed by ablation of the kidneys or liver or by anesthesia, EPO pharmacokinetic parameters were determined in adult sheep. Animals were studied in a paired manner, with and without deep barbiturate anesthesia and before and immediately after nephrectomy or hepatectomy accompanied by deep barbiturate anesthesia. Hepatectomy was accomplished with the liver left in situ, by occlusion of the arterial hepatic blood supply and diversion of portal venous flow to the jugular vein. After i.v. administration of tracer amounts of 125I-labeled recombinant human EPO, multiple blood samples were taken over 6 to 7 hr and analyzed for EPO immunoprecipitable radioactivity. EPO pharmacokinetic parameters were derived using a noncompartmental system analysis applied to the data on EPO immunoprecipitable radioactivity. No significant differences were detected for plasma clearance, distribution volume, mean residence time and alpha and beta half-lives examined under each of the three paired study conditions. Contrary to speculation by others, results of the present study make it highly unlikely that removal of the terminal sialic acid moieties of EPO contributes significantly to the metabolism of EPO. Because removal of the liver and kidney had no effect on EPO elimination, the metabolic degradation of EPO occurs in a tissue compartment that is yet to be defined. We speculate that the bone marrow is the most likely tissue with primary responsibility for the metabolism of EPO.

Successful combined hepatic and pancreatic allograft retrieval in donors with a replaced right hepatic artery.

The parallel development of reconstructive techniques used to retrieve and transplant organs with vascular anomalies, and of techniques used in the multiple organ retrieval process, have facilitated the recovery of the maximal number of transplantable organs from a limited supply of donors. Recent contributions to this effort are descriptions of combined retrieval of both liver and whole organ pancreaticoduodenal allografts from the same multiple organ donor. Suggested contraindications for the retrieval of the latter allograft have included the presence of a replaced right hepatic artery originating from the superior mesenteric artery. We describe herein the techniques used in retrieving both the liver and the whole pancreas from donors with this vascular anomaly.

The effect of warm ischemia and cold-storage preservation on rat pancreas transplantation.

Pancreatic isografts subjected to preharvest warm ischemia as well as cold-storage preservation in Collins' solution were studied after transplantation into diabetic rats to determine whether warm ischemia will limit the ability to preserve pancreas grafts for transplantation. Warm ischemic periods of up to 2 hr did not alter islet function as measured by daily glucose levels and response to intravenous glucose challenge. Likewise, hypothermic preservation of nonischemic pancreata was also well tolerated for up to 24 hr. However, the combination of preharvest warm ischemia and cold storage was deleterious. Whereas 60 min of warm injury coupled with 12 hr of cold storage resulted in successful transplantation in 86% of recipients, lengthening the duration of either warm or cold ischemia uniformly resulted in nonfunctioning grafts. Thus while islet function in the transplanted pancreas is very tolerant of warm ischemia alone, these studies suggest that it should be kept to a minimum if cold storage preservation is to be used.