Document Detail


Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.
MedLine Citation:
PMID:  20334741     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs. METHODS: We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors. RESULTS: The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%. CONCLUSION: Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.
Authors:
Roberto Hernandez-Alejandro; Yves Caumartin; Cameron Chent; Mark A Levstik; Douglas Quan; Norman Muirhead; Andrew A House; Vivian McAlister; Anthony M Jevnikar; Patrick P W Luke; William Wall
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  53     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-05-04     Revised Date:  2010-09-30    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  93-102     Citation Subset:  IM    
Affiliation:
The Multi-Organ Transplant Program, London Health Sciences Centre, the Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Death*
Female
Follow-Up Studies
Heart Arrest*
Humans
Kidney Transplantation*
Length of Stay / statistics & numerical data
Life Support Care
Liver Transplantation*
Male
Middle Aged
Ontario
Postoperative Complications
Retrospective Studies
Time Factors
Tissue Donors*
Tissue and Organ Procurement
Treatment Outcome
Withholding Treatment
Young Adult
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