Multiphase whole-body CT angiography before multiorgan retrieval in clinically brain dead patients: Role and influence on clinical practice.

GOALS: To evaluate the contribution of multiphase whole-body CT angiography (CTA) for identifying the contra-indications to multiorgan retrieval (MOR) and improving the preoperative organ harvesting strategy. PATIENTS AND METHODS: One hundred and eleven consecutive patients who were clinically brain dead underwent multiphase whole-body CTA to confirm the diagnosis of brain death and for assessment of MOR. The CTA protocol included volumetric acquisitions of the brain and abdominopelvic cavity without IV administration of iodinated contrast material, then images of the thorax-abdomen-pelvis 25s after IV contrast administration, of the brain at 60s and finally an abdominopelvic CT acquisition at 90s. The diagnosis of brain death was based on well-established criteria. The assessment of thorax, abdomen and pelvis was based on a systematic checklist. Post-processing imaging techniques were used in all patients. RESULTS: No organs were retrieved from 21 patients due to patient refusal (19%). Twenty-two potential MOR were denied because of general contra-indications including 12/22 (54%) based on CTA criteria alone. Finally, 68 patients were eligible for MOR and 160 organs were harvested. The exclusion of specific organs was based on CTA alone for 2/16 livers, 4/70 kidneys and 5/55 lungs. Fifty hearts and 58 pancreases were not harvested, none based on CTA results alone. Hepatic abnormalities and vascular anatomical variants were identified in 10% of patients. At least one renal artery variant was found in 28% of patients, 13% presented with a double renal vein and 8% with a hepato-mesenteric artery. CONCLUSION: Multiphase whole-body CTA for MOR is based on the simultaneous association of cerebral CTA to determine brain death with CTA of the thorax, abdomen and pelvis. This rapid, standardized and easily accessible procedure has no harmful effects on harvested kidneys. It makes it possible to select the donors and the organs to be harvested and allows the retrieving surgeon to identify and anticipate technical difficulties.

Bacterial contamination of organ graft preservation solution and infection after transplantation.

Infectious complications represent a major cause of morbidity and mortality in patients with organ transplantation. Contamination of preservation solution (PS) can lead to life-threatening complications in the recipients. For a 3-year period, we investigated the bacterial contamination of both PSs and graft fragments, recipient infections, and explored the link between them. In total 137 organs were transplanted, and 131 organ and perfusate cultures out of 426 tested (30.8%) gave a positive bacterial culture, mainly with coagulase-negative staphylococci. Overall, 80 recipients out of 137 (58.4%) had at least 1 infection during the 4-month post-graft surveillance period. Twelve recipients had an infection with the same bacterial species that was recovered in the corresponding graft. However, based on pulsed-field gel electrophoresis typing results, only 1 case was very likely cross-transmitted via the transplantation.

[Are calorimetric changes in brain injury a prognostic factor?]. / Les variations calorimétriques enregistrées chez le traumatisé crânien peuvent-elles constituer un indice évolutif?

Energy expenditure of 3 neuro-cranial trauma (Glasgow Score 4 +/- 1) are analysed by indirect calorimetry from D1 to D6 and correlated with other conventional modes of control: intracranial pressure, arterial pressure, temperature, urine output and so on... Energy expenditure usually remains close to resting energy expenditure (R.E.E.) but the nitrogen balance remains constantly negative in spite of a regimen consisting of 9 g. of nitrogen and 1,200 kCal per day. Increases in cranial pressure are accompanied by an 20-25% increase of energy expenditure. It appears that analysis of energy expenditure of the neurocranial trauma could be a useful prognostic index.

[Calorimetric study of enteral low-carbohydrate diet in patients with respiratory insufficiency and decompensation]. / Etude calorimétrique d'un mélange nutritif hypoglucidique entéral chez des patients insuffisants respiratoires au décours de la décompensation.

Standard artificial feeding is not suitable for patients with acute respiratory failure due to the increase in CO2 production it entails, effect of carbohydrate metabolism. Randomized use of an enteral diet comprising 55% of fats in 10 patients with chronic pulmonary disease during an acute phase, receiving mechanical ventilatory support, achieved a rapid decrease of VCO2 value, 243 to 215 ml.min-1, while it increased to 250 ml.min-1 with the control diet. These variations are metabolic and not ventilatory in origin for they are not accompanied by changes in plasmatic total CO2 rate.