Reference : Extending Donor Pool with Donation after Cardiac Death in Kidney and Liver Transplant...
Dissertations and theses : Doctoral thesis
Human health sciences : Surgery
Extending Donor Pool with Donation after Cardiac Death in Kidney and Liver Transplantation:What is the Price to Pay?
Le Dinh, Hieu mailto [Université de Liège - ULiège > > > Doct. sc. médicales (Bologne)]
université de Liège, ​Liège, ​​Belgique
Docteur en sciences médicales
Meurisse, Michel mailto
DETRY, Olivier mailto
SQUIFFLET, Jean-Paul mailto
[en] transplantation ; donation after cardiac death ; transplant outcomes
[en] Through a series of clinical studies, this thesis aims to clarify the contribution of donation after cardiac death (DCD) to the deceased donor (DD) pool and results of kidney and liver transplantation coming from this donor source in Liège and Belgium. Additionally, an adapted DCD Maastricht classification is also discussed.
Chapters 2.1 and 2.2 summarize the DCD procurement and transplant activity in Liège and Belgium from 2000 to 2009 with an update on data up to 2011. In Liège, DCD really contributes to the DD pool and boosts the transplant activity of the center in both kidneys and livers by on average 30%. By contrast, the steady rise in DCD activity in Belgium does not lead to major increase in the DD donation and transplantation. In other words, some kind of donor-type redistribution within the DD pool might occur.
Chapters 2.2, 3.1, and 3.2 discuss the results of kidney transplantation (KT) from DCD. We demonstrate that Liège‟s experience is comparable to the national level in Belgium and does not differ from the general results in the world with regard to early graft dysfunction, medium-term graft function, graft and patient survival. The excellent results of DCD-KT are attributed to the relatively short warm and cold ischemia, favorable donor factors, and the role of hypothermic machine perfusion (in Belgian series).
Chapters 4.1, and 4.2 discuss the results of liver transplantation (LT) from DCD. Liège‟s results are encouraging and apparently as good as those from donation-after-brain-death LT because of short warm and cold ischemia times. Belgian results show an increased incidence of primary non-function and ischemic cholangiopathy which is in agreement with previously published data.
Chapter 5 proposes an adapted DCD Maastricht classification which maintains the original categories 1 to 4 that are now well-known and widely accepted, and adds a fifth category, so-called „DCD after euthanasia‟. Each category is divided into two or three sub-categories: sub-category A is linked to longer warm ischemia (and worse results) than sub-category B; and B versus C, respectively. In addition, sub-categories A (2A, 3A, 4A, and 5A) are mostly linked to DCD processes occurring in the ICU, which helps to understand and memorize this classification. By keeping the original skeleton of the 1995 Maastricht classification, room is left to add new sub-categories in the future, if deemed clinically relevant.
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