Simultaneous en bloc kidney and pancreas transplantation from pediatric donors: Selection, surgical strategy, management, and outcomes.

Pediatric donors are underutilized for simultaneous pancreas-kidney transplantation due to concerns about technical complications and inadequate islet and/or renal mass. We analyzed our experience with simultaneous en bloc kidney and pancreas transplantation using pediatric donors on 8 consecutive adult patients from 1997-2018. En bloc kidney transplants were implanted intraperitoneally and contralaterally to right-sided pancreas grafts.

Use of preprocurement biopsy in donation after circulatory death liver transplantation.

We perform routine preprocurement image-guided percutaneous liver biopsies on potential donation after circulatory death (DCD) liver donors. The purpose of this study was to examine the impact of preprocurement liver biopsy on the use of livers from DCD donors. We retrospectively reviewed demographics, liver histology, and disposition of DCD liver donors within a single organ procurement organization (OPO) who underwent preprocurement liver biopsy from January 2000 through December 2019.

Association of transplant center market concentration and local organ availability with deceased donor kidney utilization.

Although there is a shortage of kidneys available for transplantation, many transplantable kidneys are not procured or are discarded after procurement. We investigated whether local market competition and/or organ availability impact kidney procurement/utilization. We calculated the Herfindahl-Hirschman Index (HHI) for deceased donor kidney transplants (2015-2019) for 58 US donation service areas (DSAs) and defined 4 groups: HHI ≤ 0.

Organ recovery from deceased donors with prior COVID-19: A case series.

Although guidance documents have been published regarding organ donation from individuals with a prior history of COVID-19 infection, no data exist regarding successful recovery and transplantation from deceased donors with a history of or positive testing suggesting a prior SARS-CoV-2 infection. Here, we report a case series of six deceased donors with a history of COVID-19 from whom 13 organs were recovered and transplanted through several of the nation's organ procurement organizations (OPOs). In addition, at least two potential donors were authorized for donation but with no organs were successfully allocated and did not proceed to recovery.

Understanding the Final Disposition of Livers Declined After the Start of Procurement: A Nationwide Organ Procurement Organization Effort.

Declining a liver offer during organ procurement likely increases the risk of discard, but the specifics around late reallocation remain obscure. This voluntarily submitted, prospectively collected data describe late declines and the ultimate disposition of 893 livers. Once a liver suffered an intraoperative decline, only 49% of recovered livers were transplanted.

Organ Donor Management: Part 1. Toward a Consensus to Guide Anesthesia Services During Donation After Brain Death.

Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage.

Deceased donor organ procurement injuries in the United States.

Aim: To determine the incidence of surgical injury during deceased donor organ procurements.

Methods: Organ damage was classified into three tiers, from 1-3, with the latter rendering the organ non-transplantable. For 12 consecutive months starting in January of 2014, 36 of 58 organ procurement organization's (OPO)'s prospectively submitted quality data regarding organ damage (as reported by the transplanting surgeon and confirmed by the OPO medical director) seen on the procured organ.

Can 'extreme' pancreas donors expand the donor pool?

Purpose Of Review: The present review investigates donor qualities that impact pancreas and islet transplantation, with a focus on donors that have been historically underutilized, including those of extreme age, extreme size, and donors after cardiac death.

Recent Findings: The increasing waiting time caused by the shortage of available pancreata and the growing number of patients with uncontrolled diabetes has led to the expansion of acceptance criteria for transplantable pancreata. The possible increased perioperative risks and/or foreshortened graft survival associated with the use of 'extreme' donors should be weighed against the mortality of uremic diabetics on the waiting list and the risk of dying from a hypoglycemic-unawareness episode.

Hydrolysis of phosphatidylserine-exposing red blood cells by secretory phospholipase A2 generates lysophosphatidic acid and results in vascular dysfunction.

Secretory phospholipase A(2) (sPLA(2)) type IIa, elevated in inflammation, breaks down membrane phospholipids and generates arachidonic acid. We hypothesized that sPLA(2) will hydrolyze red blood cells that expose phosphatidylserine (PS) and generate lysophosphatidic acid (LPA) from phosphatidic acid that is elevated in PS-exposing red blood cells. In turn, LPA, a powerful lipid mediator, could affect vascular endothelial cell function.

Postinjury serum secretory phospholipase A2 correlates with hypoxemia and clinical status at 72 hours.

Background: Although trauma patients often suffer direct lung damage, an equally destructive mechanism of lung injury involves postinjury systemic inflammation. We postulate that secretory phospholipase A(2) (sPLA(2)) release induced by trauma relates to systemic inflammation that compromises both lung function and clinical status after injury. The objectives of this study were: to relate Injury Severity Score to postinjury sPLA(2); to determine whether circulating sPLA(2) relates to pulmonary oxygenation and compliance; and to determine whether early or persistent increases in sPLA(2) are associated with abnormal chest x-ray at 72 hours after injury.

Cardiac thromboemboli complicating a stab wound to the heart.

A 27-year-old man was noted to have neurologic deficit 4 days following cardiorrhaphy to repair a penetrating cardiac injury. Cerebral computed tomography scan showed multiple embolic infarcts and two-dimensional echocardiography revealed the source as thrombus in the left ventricle. Although this entity has been described following blunt chest trauma and cardiac contusion, it has not been noted in association with penetrating injury.