raffinose and Cadaver

This article discusses the guidelines for brain death determination, the criteria for donor selection, the management of the cadaveric donor, the surgical techniques of isolated renal and multiorgan retrieval, methods of organ preservation, and proper transport of organs to the recipient.

Topics: Adenosine; Allopurinol; Brain Death; Cadaver; Cryopreservation; Glutathione; Humans; Insulin; Kidney Transplantation; Nephrectomy; Organ Preservation; Organ Preservation Solutions; Organ Transplantation; Patient Selection; Perfusion; Raffinose; Tissue and Organ Procurement; Tissue Donors

Cold storage is the most common method of preservation in renal transplantation, but pulsatile machine perfusion (MP) is increasingly used for purposes of ex vivo assessment and resuscitation of high risk allografts. Vasosol (VSL) MP solution (MPS) (Pike Laboratories Inc, Eagle, PA) is a novel perfusate with enhanced vasodilatory and antioxidant capacity. We report our experience with VSL in machine preservation of renal allografts.. Locally procured cadaver kidney pairs undergoing MP were randomized to VSL or control solution (Belzer MPS; Trans-Med, Elk River, MN). En bloc perfusion was performed according to standard MP procedures. Transplantation was performed at 1 of 12 local transplant centers. Donor and recipient data were collected prospectively.. Data from 162 transplanted kidneys were analyzed. A total of 82 renal grafts were perfused with VSL, and 80 were perfused with control solution. No organs were lost secondary to the technique of MP. There was no difference in donor or recipient age between groups. Kidneys perfused with VSL exhibited significantly higher rates of immediate function and significantly less delayed graft function (12.2% vs. 21.2%). Discharge creatinine and length of stay were also significantly improved in the VSL group. One-year graft and patient survivals were equivalent (95%) in both groups.. VSL improved early graft function and shortened the length of stay compared with Belzer MPS. Further improvement in preservation solutions in conjunction with pulsatile perfusion shows promise in improving early outcomes after renal transplantation, especially for extended criteria donor kidneys.

Topics: Adenosine; Adult; Aged; Allopurinol; Cadaver; Glutathione; Graft Survival; Humans; In Vitro Techniques; Insulin; Kidney; Kidney Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Perfusion; Pulsatile Flow; Raffinose

Topics: 6-Ketoprostaglandin F1 alpha; Adenosine; Allopurinol; Analysis of Variance; Biomarkers; Cadaver; Cyclic AMP; Eicosanoids; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Leukotriene E4; Organ Preservation; Organ Preservation Solutions; Postoperative Period; Raffinose; Renal Circulation; Thromboxane B2; Time Factors; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Glutathione; Humans; Insulin; Kidney; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Perfusion; Postoperative Complications; Pressure; Prospective Studies; Raffinose; Tissue and Organ Harvesting; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Cold Temperature; Glucose; Glutathione; Graft Survival; Histocompatibility Testing; Humans; Hypertonic Solutions; Insulin; Ischemia; Kidney Transplantation; Mannitol; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Retrospective Studies; Time Factors

Topics: Adenosine; Adult; Allopurinol; Cadaver; Cause of Death; Female; Glutathione; Histocompatibility Testing; Humans; Hypertonic Solutions; Immunosuppression Therapy; Incidence; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Organ Preservation; Organ Preservation Solutions; Raffinose; Tissue Donors; Transplantation, Homologous

High-sodium as opposed to high-potassium lactobionate/raffinose preservation solution offers potential advantages in improving the quality of liver storage by reducing potassium-induced vasoconstriction and preventing hyperkalaemia on reperfusion. In our study we evaluated in a prospective trial (encompassing 40 consecutive cadaver donor hepatic retrievals and subsequent transplants) the efficacy of a high-sodium formulation versus the standard high-potassium solution. Quality of preservation was assessed by clinical indices of liver function in the intraoperative and early postoperative phases, including measurements of requirements for blood and blood products and potassium, circulating liver enzymes and bilirubin. Frequencies of acute rejection episodes and primary non-function were also recorded. No significant differences were evident in any of the measured parameters. Thus a sodium-based solution can be used for hepatic preservation, advancing the possibility that it may be possible to develop a single storage solution for clinical multi-organ donor operations.

Topics: Adult; Cadaver; Disaccharides; Female; Graft Rejection; Humans; Intraoperative Period; Liver; Liver Function Tests; Liver Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Postoperative Period; Potassium; Prospective Studies; Raffinose; Reperfusion Injury; Tissue Donors

University of Wisconsin (UW) solution is now commonly used as a single-flush solution during multiorgan procurement for effective preservation of all intraabdominal organs including the kidney. Many kidneys from single kidney donors are still preserved in Eurocollins solution and the question is whether preservation in UW solution is more cost-effective. A European randomized multicenter trial was organized by the Department of Surgery of Leiden University in close cooperation with Eurotransplant to study the efficacy of UW solution as compared with EC solution. On the basis of this trial we found that at three months after transplant 92.4% of the patients in the UW group had a functioning graft in comparison with 88.4% in the EC group (similar figures after one year were 88.2% and 82.5%, P approximately 0.04), while health care expenditure during these first three months was on average US$ 700 lower for the UW group than for the EC group, taking into account the price difference in the preservation fluids. The long-term benefits of using UW solution as compared with EC solution were conservatively estimated at US$ 7000 per patient reflecting the additional expenses for dialysis in the EC group. We concluded that the extra costs of using UW solution instead of EC solution (US$ 230 per kidney) can be easily earned back within three months and that the long-term savings of such a strategy are considerable. Moreover, the health status of patients in the UW group is expected to be better on the average than in the EC group. Simply reacting to the price tag of the UW solution may be penny-wise but pound-foolish.

Topics: Adenosine; Allopurinol; Cadaver; Cost-Benefit Analysis; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Netherlands; Organ Preservation; Organ Preservation Solutions; Peritoneal Dialysis, Continuous Ambulatory; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Cold Temperature; Glutathione; Graft Survival; Heart Arrest; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Perfusion; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Adult; Allopurinol; Cadaver; Female; Follow-Up Studies; Glucose; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Adult; Allopurinol; Animals; Cadaver; Chlorpromazine; Creatinine; Disaccharides; Dogs; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Raffinose; Solutions; Sucrose; Time Factors; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Perfusion; Raffinose; Retrospective Studies; Solutions; Time Factors

Topics: Adenosine; Adult; Allopurinol; Cadaver; Creatinine; Glutathione; Humans; Hypertonic Solutions; Immunosuppression Therapy; Insulin; Kidney Function Tests; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Raffinose; Retrospective Studies; Solutions

Orthotopic liver transplantation (OLT) is today the gold standard treatment of the end-stage liver disease. Different solutions are used for graft preservation. Our objective was to compare the results of cadaveric donor OLT, preserved with the University of Wisconsin (UW) or Celsior solutions in the portal vein and Euro-Collins in the aorta.. We evaluated retrospectively 72 OLT recipients, including 36 with UW solution (group UW) and 36 with Celsior (group CS). Donors were perfused in situ with 1000 mL UW or Celsior in the portal vein of and 3000 mL of Euro-Collins in the aortia and on the back table managed with 500 mL UW or Celsior in the portal vein, 250 mL in the hepatic artery, and 250 mL in the biliary duct. We evaluated the following variables: donor characteristics, recipient features, intraoperative details, reperfusion injury, and steatosis via a biopsy after reperfusion. We noted grafts with primary nonfunction (PNF), initial poor function (IPF), rejection episodes, biliary duct complications, hepatic artery complications, re-OLT, and recipient death in the first year after OLT.. The average age was 33.6 years in the UW group versus 41 years in the CS group (P = .048). There was a longer duration of surgery in the UW group (P = .001). The other recipient characteristics, ischemia-reperfusion injury, steatosis, PNF, IPF, rejection, re-OLT, and recipient survival were not different. Stenosis of the biliary duct occured in 3 (8.3%) cases in the UW group and 8 (22.2%) in the CS (P = .19) with hepatic artery thrombosis in 4 (11.1%) CS versus none in the UW group (P = .11).. Cadaveric donor OLT showed similar results with organs preserved with UW or Celsior in the portal vein and Euro-Collins in the aorta.

Topics: Adenosine; Adolescent; Adult; Aged; Allopurinol; Aorta, Abdominal; Cadaver; Child; Child, Preschool; Disaccharides; Electrolytes; Female; Glutamates; Glutathione; Histidine; Humans; Hypertonic Solutions; Immunosuppressive Agents; Insulin; Liver Failure; Liver Transplantation; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Portal Vein; Postoperative Complications; Prospective Studies; Raffinose; Reperfusion Injury; Retrospective Studies; Tissue Donors

Recent studies demonstrated that prolactin (PRL) has beneficial effects on beta cells for islet transplantation. We examined the effect of human recombinant PRL (rhPRL) supplementation to the culture media to determine its potential use in the context of clinical islet transplantation.. Each human islet isolated from 14 deceased multiorgan donors was cultured in Miami modified media-1 supplemented with or without rhPRL (500 microg/L) for 48 hr. beta-Cell survival and proliferation (BrdU and Ki-67) were determined by laser scanning cytometry. The cytoprotective effects of rhPRL against noxious stimuli were assessed by flow cytometry (tetramethylrhodamine ethyl ester). Cytokine/chemokine and tissue factor productions were measured in vitro, and islet potency was assessed in vivo in diabetic immunodeficient mice.. beta-Cell survival during culture was 37% higher in the rhPRL group than in control (P=0.029). rhPRL protected beta cells in vitro from cytokines, Nitric oxide donor, and H2O2. The exposure to rhPRL did not affect human beta-cell proliferation with our protocol. rhPRL treatment did not alter cytokine/chemokine and tissue factor production in vitro or affected human islet functionality in vivo: recipient mice achieved normoglycemia with a comparable tempo, whereas loss of graft function was observed in two of the seven mice in the control group and in none of the rhPRL group (p=n.s.).. rhPRL supplementation to islet culture media improved human beta-cell-specific survival without altering islet quality. Addition of rhPRL to cultured islets may grant a more viable beta-cell mass in culture. The development of beta-cell cytoprotective strategies will be of assistance in improving islet transplantation outcomes.

Topics: Adenosine; Allopurinol; Animals; Apoptosis; Cadaver; Cell Culture Techniques; Cell Division; Cell Survival; Chemokines; Culture Media; Cytokines; Glutathione; Humans; Insulin; Insulin-Secreting Cells; Islets of Langerhans Transplantation; Mice; Organ Preservation Solutions; Prolactin; Raffinose; Recombinant Proteins; Tissue Donors; Transplantation, Heterologous

Kidneys obtained from donors after cardiac death are damaged by the combination of warm and cold ischemia. Although the parenchymal damage of these kidneys is well studied, little is known about the functional effects of warm and cold ischemia on the renal vascular bed. We compared kidney preservation using the new extracellular-type cold storage solution from Institut Georges Lopez (IGL-1) with the University of Wisconsin solution (UW) and focused on vasomotor functions.. The influence of warm and cold ischemia on vasomotor functions was studied in an isolated perfused kidney model. Six groups of donation after cardiac death donor kidneys were studied with warm ischemia of 0, 15, and 30 min followed by 0 or 24 h cold storage preservation in IGL-1 or UW at 4 degrees C. Endothelial dependent vasodilation was studied using acetylcholine, smooth muscle cell (SMC) constriction was assessed using phenylephrine, and finally endothelial independent relaxation was tested using papaverine-sulfate.. SMCs were significantly affected by cold ischemia showing a 50% reduction of phenylephrine mediated constriction after preservation. Additional warm ischemia did not affect SMCs. After UW preservation endothelial dependent vasodilation was only significantly reduced when the combination of warm and cold ischemia was present. IGL-1 preserved kidneys showed a reduction in endothelial dependent vasodilation after isolated warm ischemia. Both preservation solutions rendered equal results after 24 h preservation.. Vasomotor functions are negatively influenced by the combination of warm and cold ischemia. Both IGL-1 and UW performed equally in preserving vasomotor functions. The interesting finding of the rapid decline of SMC function might point at the first step toward intimal hyperplasia as seen in late transplant dysfunction.

Topics: Adenosine; Allopurinol; Animals; Cadaver; Cold Temperature; Endothelium, Vascular; Glutathione; Insulin; Ischemia; Kidney; Male; Muscle, Smooth, Vascular; Organ Preservation Solutions; Raffinose; Rats; Rats, Inbred F344; Renal Circulation; Reperfusion; Tissue and Organ Harvesting; Tissue Donors; Vasoconstriction

Single-center studies have reported that liver allograft survival is not affected by preservation in histidine-tryptophan-ketoglutarate (HTK) versus University of Wisconsin (UW) solution. We analyzed the UNOS database of liver transplants performed from July, 2004, through February, 2008, to determine if preservation with HTK (n = 4755) versus UW (n = 12 673) impacted graft survival. HTK preservation of allografts increased from 16.8% in 2004 to 26.9% in 2008; this was particularly striking among donor after cardiac death (DCD) allografts, rising from 20.7% in 2004 to 40.9% in 2008. After adjusting for donor, recipient and graft factors that affect graft survival, HTK preservation was associated with an increased risk of graft loss (HR 1.14, p = 0.002), especially with DCD allografts (HR 1.44, P = 0.025) and those with cold ischemia time over 8 h (HR 1.16, P = 0.009). Furthermore, HTK preservation was associated with a 1.2-fold higher odds of early (< 30 days) graft loss as compared to UW preservation (OR 1.20, p = 0.012), with a more pronounced effect on allografts with cold ischemia time over 8 h (OR 1.31, p = 0.007), DCD allografts (OR 1.63, p = 0.09) and donors over 70 years (OR 1.67, p = 0.081). These results suggest that the increasing use of HTK for abdominal organ preservation should be reexamined.

Topics: Adenosine; Adolescent; Adult; Aged; Allopurinol; Cadaver; Cold Ischemia; Cryopreservation; Death; Female; Glucose; Glutathione; Graft Survival; Humans; Insulin; Liver Transplantation; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Time Factors; Tissue Donors; Transplantation, Homologous; Young Adult

Single-center studies have reported equivalent outcomes of kidney allografts recovered with histidine-tryptophan-ketoglutarate (HTK) or University of Wisconsin (UW) solution. However, these studies were likely underpowered and often unadjusted, and multicenter studies have suggested HTK preservation might increase delayed graft function (DGF) and reduce graft survival of renal allografts. To further inform clinical practice, we analyzed the United Network for Organ Sharing (UNOS) database of deceased donor kidney transplants performed from July 2004 to February 2008 to determine if HTK (n = 5728) versus UW (n = 15 898) preservation impacted DGF or death-censored graft survival. On adjusted analyses, HTK preservation had no effect on DGF (odds ratio [OR] 0.99, p = 0.7) but was associated with an increased risk of death-censored graft loss (hazard ratio [HR] 1.20, p = 0.008). The detrimental effect of HTK was a relatively late one, with a strong association between HTK and subsequent graft loss in those surviving beyond 12 months (HR 1.43, p = 0.007). Interestingly, a much stronger effect was seen in African-American recipients (HR 1.55, p = 0.024) than in Caucasian recipients (HR 1.18, p = 0.5). Given recent studies that also demonstrate that HTK preservation reduces liver and pancreas allograft survival, we suggest that the use of HTK for abdominal organ recovery should be reconsidered.

Topics: Adenosine; Adult; Allopurinol; Black People; Cadaver; Cause of Death; Ethnicity; Female; Glucose; Glutathione; Graft Survival; Humans; Insulin; Kidney Transplantation; Male; Mannitol; Middle Aged; Nephrectomy; Organ Preservation Solutions; Potassium Chloride; Procaine; Racial Groups; Raffinose; Retrospective Studies; Tissue and Organ Harvesting; Tissue Donors; Transplantation, Homologous; Treatment Outcome; White People

The double piggyback technique has been proposed for domino liver transplantation. To make this possible, it is necessary to reconstruct the venous outflow of the domino liver graft on the back table. We describe an alternative method of reconstruction of hepatic venous outflow, in which a neocaval segment is obtained using both common iliac veins from the cadaveric donor.

Topics: Adenosine; Adult; Allopurinol; Cadaver; Female; Glutathione; Hepatic Artery; Hepatic Veins; Humans; Iliac Vein; Insulin; Liver Transplantation; Male; Middle Aged; Organ Preservation Solutions; Perfusion; Plastic Surgery Procedures; Raffinose; Tissue Donors; Treatment Outcome

Histidine-Tryptophan-Ketoglutarate (HTK) solution is increasingly used to flush and preserve organ donor kidneys, with efficacy claimed equivalent to University of Wisconsin (UW) solution. We observed and reported increased graft pancreatitis in pancreata flushed with HTK solution, which prompted this review of transplanting HTK-flushed kidneys. We analyzed outcomes of deceased-donor kidneys flushed with HTK and UW solutions with a minimum of 12 months follow-up, excluding pediatric and multi-organ recipients. We evaluated patient and graft survival and rejection rates, variables that might constitute hazards to graft survival and renal function. Two-year patient survival, rejection, renal function and graft survival were not different, but early graft loss (<6 months) was worse in HTK-flushed kidneys (p < 0.03). A Cox analysis of donor grade, cold ischemic time, panel reactive antibodies (PRA), donor race, first vs. repeat transplant, rejection and flush solution showed that only HTK use predicted early graft loss (p < 0.04; relative risk = 3.24), almost exclusively attributable to primary non-function (HTK, n = 5 (6.30%); UW, n = 1 (0.65%); p = 0.02). Delayed graft function and early graft loss with HTK occurred only in lesser grade kidneys, suggesting it should be used with caution in marginal donors.

Topics: Adenosine; Adult; Aged; Allopurinol; Cadaver; Delayed Graft Function; Female; Glucose; Glutathione; Humans; Insulin; Kidney Function Tests; Kidney Transplantation; Male; Mannitol; Middle Aged; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Renal Dialysis; Tissue Donors

Due to the organ shortage, there is increased use of organs harvested from non-heart-beating donors (NHBD). These organs have been subjected to a period of warm ischemia that is most deleterious to functional recovery. We have designed a new preservation solution, "Solution de Conservation des Organes et des Tissus" (SCOT 15; Macopharma, Tourcoing, France) which contains an extracellular ionic composition including PEG 20 kD (15 g/L) as a colloid.. Our objective was to compare SCOT 15 with University of Wisconsin (UW) solution or islet culture medium CMRL 1066 + 1% of Bovine Serum Albumin (BSA), as the working and preservation solution for islet isolation from pancreata subjected to warm ischemia using a murine model.. Warm ischemia decreased the islet yield and cellular viability regardless of the preservation solution. Either when the pancreas was or was not subjected to warm ischemia, the best islet yield was obtained with SCOT 15 (P < .05 vs UW or CMRL 1066). The same results were observed for islet viability as assessed using the 3,(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test; namely, better viability with SCOT 15 as compared with UW or CMRL 1066 (P < .01).. In a murine model SCOT 15 was a better preservation solution for islet isolation than UW solution or culture medium (CMRL 1066).

Topics: Adenosine; Allopurinol; Animals; Cadaver; Cell Survival; Culture Media; Glutathione; Heart Rate; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Mice; Mice, Inbred C3H; Models, Animal; Organ Preservation; Organ Preservation Solutions; Oxygen Consumption; Pancreas; Raffinose; Serum Albumin, Bovine; Specific Pathogen-Free Organisms

Pancreas preservation using an oxygenated two-layer method (TLM) has been reported to improve islet yields, as has supplementation of Liberase with Pefabloc. We hypothesized that using both TLM and Pefabloc could enhance islet yield as compared with preservation in University of Wisconsin (UW) or Histidine-Tryptophan Ketoglutarate (HTK) solution.. Ninety-eight pancreata with no significant differences of age, body mass index, or cold ischemia time preserved randomly with UW (n = 40), TLM (n = 48), or HTK (n = 10) were processed with (n = 36) or without (n = 66) Pefabloc.. The total islet equivalent (IEQ) from TLM-preserved pancreata processed with Pefabloc (n = 12) showed lower yields versus those processed without Pefabloc (n = 36): 216,120 +/- 27,906 vs. 301,427 +/- 21,447 IEQ (P < .05). Islets from 1 of 12 (8.33%) pancreata processed with Pefabloc in TLM were transplanted, in contrast with 15/36 TLM (41.67%) pancreata processed without it. Islet yields were not significantly different among pancreata preserved in UW and processed with Pefabloc (n = 17) versus without Pefabloc (n = 23): 342,693 +/- 45,588 versus 266,609 +/- 29,006 IEQ (P = .149). The number of transplants from UW-preserved pancreata was 3/17 (17.65%) when processed with Pefabloc and 4/23 (17.39%) without. Among the HTK group, there was no significant difference in islet yields between pancreata processed with (n = 7) versus without Pefabloc (n = 3): 248,227 +/- 65,294 versus 483,555 +/- 144,070 IEQ (P = .118).. Pefabloc showed no benefit to improve islet yields. Pancreata preserved in TLM provided better transplant quality islets when processed in the absence of Pefabloc.

Topics: Adenosine; Allopurinol; Cadaver; Cell Count; Female; Glucose; Glutathione; Humans; Insulin; Islets of Langerhans; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Organ Size; Oxygen Consumption; Pancreas; Potassium Chloride; Procaine; Protease Inhibitors; Raffinose; Tissue Donors

We sought to compare the efficacy of Celsior and University of Wisconsin (UW) solutions on the perfusion and cold storage of renal grafts for human transplantation.. Retrospective analyses of 313 kidney transplants were performed between 2002 and 2005; group A (n = 160), UW solution and group B (n = 153), Celsior solution were used in the preservation of the organs. The mean donor age was lower in group B (group A = 42.67 years vs group B = 38.96 years; P < .05), living donors were more frequent in the UW group (group A = 10% vs group B = 0.9%; P < .001). Multiorgan procurement procedures were more common in the Celsior group (group A = 75% vs group B = 81.7%; P < .001). Recipients with no associated comorbidities were more frequent in the UW group (group A = 50% vs group B = 36%; P < .001). Recipient mean age, cold ischemia time, and HLA matches were comparable.. Delayed graft function (group A = 22.7% vs group B = 20.6%), acute rejections (group A = 21.4% vs group B = 18.4%), and serum creatinine at 6 months (group A = 1.75 vs group B = 1.67 mg/dL), 1 year (group A = 1.47 vs group B = 1.74 mg/dL), and 2 years (group A = 1.43 vs group B = 1.58 mg/dL) showed no differences (P = NS). Graft (group A = 82.23% vs group B = 84.11%) and patient (group A = 93% vs group B = 93.69%) survivals at 3 years were similar (P = NS). There were no differences in the causes of graft loss.. The efficacy of UW and Celsior solutions is equivalent in the cold storage and renal preservation for transplantation.

Topics: Adenosine; Allopurinol; Cadaver; Disaccharides; Electrolytes; Follow-Up Studies; Glutamates; Glutathione; Graft Survival; Histidine; Humans; Insulin; Kidney; Kidney Transplantation; Mannitol; Organ Preservation Solutions; Raffinose; Retrospective Studies; Tissue Donors; Treatment Outcome

Redox-active iron, catalyzing the generation of reactive oxygen species, has been implicated in experimental renal ischemia-reperfusion injury. However, in clinical transplantation, it is unknown whether redox-active iron is involved in the pathophysiology of ischemic injury of non-heart-beating (NHB) donor kidneys. We measured redox-active iron concentrations in perfusate samples of 231 deceased donor kidneys that were preserved by machine pulsatile perfusion at our institution between May 1998 and November 2002 using the bleomycin detectable iron assay. During machine pulsatile perfusion, redox-active iron was released into the preservation solution. Ischemically injured NHB donor kidneys had significantly higher perfusate redox-active iron concentrations than heart-beating (HB) donor kidneys that were not subjected to warm ischemia (3.9 +/- 1.1 vs. 2.8 +/- 1.0 micromol/L, p = 0.001). Moreover, redox-active iron concentration was an independent predictor of post-transplant graft viability (odds ratio 1.68, p = 0.01) and added predictive value to currently available donor and graft characteristics. This was particularly evident in uncontrolled NHB donor kidneys for which there is the greatest uncertainty about transplant outcomes. Therefore, perfusate redox-active iron concentration shows promise as a novel viability marker of NHB donor kidneys.

Topics: Adenosine; Allopurinol; Cadaver; Cell Survival; Glutathione; Graft Survival; Heart Arrest; Humans; Hypothermia; Insulin; Iron; Ischemia; Kidney; Kidney Transplantation; Organ Preservation Solutions; Oxidation-Reduction; Perfusion; Predictive Value of Tests; Raffinose; Reactive Oxygen Species; Tissue Donors; Treatment Outcome

Previous small clinical trials indicate that the two-layer method (TLM) for pancreas preservation improves islet isolation outcome. However, the effect of TLM has not been evaluated in large-scale study. In addition, a direct benefit of TLM on islet transplantation outcome has not been addressed in the setting of any randomized controlled trials.. Between April 2003 and October 2005, human pancreata from brain-dead donors were preserved by TLM using preoxygenated perfluorocarbon (n = 75) or in University of Wisconsin (UW) solution (n = 91) prior to islet isolation. Islet isolation and transplantation outcomes were compared between the two groups.. We did not find any significant differences in adenosine triphosphate content in pancreatic tissue after preservation, pre and postpurification islet yields, in vitro insulin secretory function, or utilization ratio of transplantation between the two groups. Transplanted mass and functional viability of islet isolated from TLM-preserved pancreas were similar to those from UW-preserved pancreas. Patients receiving the TLM-islet or the UW-islet showed a marked decrease in insulin requirement after transplantation. However, no significant difference was observed in a decrease in insulin requirement between patients receiving the TLM-islet and the UW-islet.. No beneficial effect of TLM on islet isolation and transplantation outcomes was observed. Our findings bring into question the true merit of routine use of TLM prior to islet isolation.

Topics: Adenosine; Adenosine Triphosphate; Adult; Allopurinol; Brain Death; Cadaver; Cell Separation; Female; Glutathione; Humans; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas; Partial Pressure; Raffinose; Tissue Donors

This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx).. A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics.. After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS).. Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.

Topics: Adenosine; Adult; Allopurinol; Blood Group Incompatibility; Cadaver; Cause of Death; Disaccharides; Electrolytes; Female; Glutamates; Glutathione; Histidine; Humans; Insulin; Italy; Male; Mannitol; Organ Preservation Solutions; Pancreas Transplantation; Postoperative Complications; Raffinose; Retrospective Studies; Tissue Donors; Treatment Failure

Machine pulsatile perfusion for whole pancreas preservation might improve yield, viability, and function of human islets recovered after prolonged cold ischemia times. Four human pancreata were procured from cadaver donors (1 non-heart-beating donor) and stored in cold University of Wisconsin (UW) solution for a mean 13 hours prior to placement on a machine pulsatile perfusion device. The four pancreata were perfused for 4 hours with UW solution before undergoing islet isolation. Islets were quantified, viability was assessed, and insulin secretion was measured. Results were compared with nonpumped islet isolations stratified for cold ischemia time (CIT) <8 hours or cold ischemia time >8 hours. The islet yield for the four pumped pancreata was 3435 (+/-1951) islet equivalents/gram pancreas tissue (IEQ/g), compared with a mean yield of 5134 (+/-2700) IEQ/g and 2640 (+/-1000) IEQ/g from pancreas with <8 hours and >8 hours CIT, respectively. The mean viability after machine pulsatile perfusion was 86% (vs 74% and 74% for the <8 hour and >8 hour CIT groups). The mean viable yield (total yield x viability) was 2937 IEQ/g for machine perfusion, compared with 3799 IEQ/g and 1937 IEQ/g from pancreata with <8 hours and >8 hours CIT, respectively. The insulin secretion index of islets after machine perfusion was 6.4, compared with indices of 1.9 and 1.8 for the <8 hour and >8 hour CIT groups. This preliminary data indicates that low-flow machine pulsatile perfusion of pancreata with prolonged cold ischemia time can result in excellent yield, viability, and function.

Topics: Adenosine; Allopurinol; Cadaver; Glutathione; Humans; Insulin; Islets of Langerhans Transplantation; Organ Preservation Solutions; Pancreas; Perfusion; Raffinose; Tissue Donors; Treatment Outcome

Kidney transplant surgery can be complicated by short, attenuated, or injured renal vessels which are now more frequently encountered with laparoscopic right donor nephrectomy. We describe a technique to overcome this problem in seven recipients (2 cadaveric and 5 living donors) by constructing third-party "vascular extenders" using cadaveric iliac vessels retrieved previously and preserved at 4 degrees C in University of Wisconsin solution. Mean vessel cold storage time was 25.7 days (range, 2-56 days). Immunosuppression consisted of sirolimus, mycophenolate mofetil, and steroids. Prompt reperfusion of all allografts was observed, and there were no surgical complications. Integrity of the extenders was confirmed using serial MAG3 renal scans and magnetic resonance angiography. Mean serum creatinine was 1.44 mg/dl at 19.2 months (range, 0.7-2 mg/dl at 3-31 months). Each recipient had a negative posttransplant kidney donor specific flow cytometry crossmatch. Two recipients developed HLA antibodies, one to DR7 and another DR13 (mismatched to the vessel donor) at 4 and 11 months posttransplant, respectively.

Topics: Adenosine; Allopurinol; Cadaver; Cryopreservation; Glutathione; Humans; Immunosuppressive Agents; Insulin; Kidney Transplantation; Nephrectomy; Organ Preservation; Organ Preservation Solutions; Raffinose; Renal Artery; Renal Veins; Time Factors; Tissue and Organ Harvesting; Tissue Donors

Human pancreas preservation for islet transplantation holds additional challenges and considerations compared with whole pancreas transplantation. The purpose of this study was to clarify the limitations of the University of Wisconsin (UW) solution and the potentials of the two-layer method (TLM) for pancreas preservation before human islet isolation.. We retrospectively evaluated human islet isolation records between January 2001 and February 2003. One hundred forty-two human pancreata were procured from cadaveric donors and preserved by means of the UW solution (n=112) or TLM (n=30). Human islet isolations were performed using a standard protocol and assessed by islet recovery and in vitro function of islets.. Eight to ten hours of cold ischemia in the UW solution is a critical point for successful islet isolations. It is difficult to recover a sufficient number of viable islets for transplantation from human pancreata with more than 10 hours of cold storage in the UW solution. The overall islet recovery in the TLM group was significantly higher than in the UW group. With 10 to 16 hours of cold storage, the success rates of islet isolations remained at 62% in the TLM group but decreased to 22% in the UW group. Transplanted islets in the TLM group worked well in the recipients.. There are time limitations for using the UW solution for pancreas preservation before human islet isolation. The TLM is a potential method to prolong the optimal cold storage time for successful islet isolations.

Topics: Adenosine; Adult; Aged; Allopurinol; Cadaver; Fluorocarbons; Glutathione; Graft Survival; Humans; Insulin; Ischemia; Islets of Langerhans Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Recovery of Function; Retrospective Studies

A two-layer cold storage method (TLM) allows sufficient oxygen delivery to pancreata during preservation and resuscitates the viability of ischemically damaged pancreata. This study determined the effect of additional preservation of ischemically damaged human pancreata by the TLM before islet isolation. Human pancreata were procured from cadaveric organ donors and preserved by the TLM for 3.2 +/- 0.5 hours (mean +/- SEM) at 4 degrees C after 11.1 +/- 0.9 hours of cold storage in University of Wisconsin solution (UW) (TLM group), or by cold UW alone for 11.0 +/- 0.3 hours (UW group). Islet isolations of all pancreata were performed using the Edmonton protocol. Islet recovery and in vitro function of isolated islets were significantly increased in the TLM group compared with the UW group. In the metabolic assessment of human pancreata, ATP levels were significantly increased after the TLM preservation. This study showed that additional short-term preservation by the TLM resuscitates the viability of ischemically damaged human pancreata before islet isolation, leading to improvements in islet recovery and in vitro function of isolated islets.

Topics: Adenosine; Allopurinol; Cadaver; Cell Separation; Glutathione; Humans; Insulin; Ischemia; Islets of Langerhans; Organ Preservation; Organ Preservation Solutions; Pancreas; Raffinose; Resuscitation; Tissue and Organ Harvesting; Tissue Donors

Reperfusion injury is a vital problem in non-heart-beating donor (NHBD) organs. The sodium-hydrogen inhibitor cariporide is thought to improve cellular integrity after ischemia and reperfusion. Recently, we demonstrated the possibility of preserving hearts with in situ perfusion after circulatory death. The purpose of this study was to determine whether cariporide improves in situ heart protection.. We studied 20 pigs (18 +/- 2 kg). Hearts in the conventional group (CON, n = 6) underwent cardioplegic arrest with University of Wisconsin solution and then were explanted and stored for 150 minutes on ice. In the other groups, a catheter was placed in each ascending aorta and right atrium. After disconnecting the ventilator, hypoxia caused circulatory arrest within 7 +/- 2 minutes. The aorta was endoclamped, and continuous in situ perfusion of the aortic root was maintained for 60 minutes with University of Wisconsin solution (UW, n = 7) or with UW solution and cariporide (CAR, n = 7). After explantation, the hearts were stored on ice for 90 minutes. In all groups, hearts were reperfused with homologous, whole pig blood in an isolated working heart model for 45 minutes. We monitored stroke-work index on-line, intermittently measured troponin I and malondialdehyde, and compared light microscopic examinations among the groups.. Stroke-work index was higher in the CAR group compared with the UW group during the last 20 minutes of reperfusion (10(3)dynes x cm x beats(-1)x gm(-1), 6.6 +/- 1.4 vs 4.5 +/- 2.0, p < 0.05), troponin I was lower in the CAR group compared with the UW group (161 +/- 32 ng/ml vs 277 +/- 35 ng/ml, p < 0.05). Results of malondialdehyde and light microscopic examinations were slightly better in the CAR group, without reaching statistical significance.. Cariporide as an additive to UW solution improves functional recovery and decreases myocardial damage in hearts from NHBDs protected with an in situ perfusion technique.

Topics: Adenosine; Allopurinol; Animals; Cadaver; Glutathione; Guanidines; Heart; Heart Transplantation; Insulin; Models, Animal; Organ Preservation; Organ Preservation Solutions; Perfusion; Raffinose; Sodium-Hydrogen Exchangers; Sulfones; Swine

Topics: Adenosine; Allopurinol; Cadaver; Cell Separation; Glutathione; Humans; Insulin; Islets of Langerhans; Organ Preservation Solutions; Raffinose; Tissue Donors; Tissue Preservation

Topics: Adenosine; Adult; Age Factors; Allopurinol; Body Mass Index; Cadaver; Cause of Death; Cell Separation; Female; Glutathione; Humans; Insulin; Ischemia; Islets of Langerhans; Male; Middle Aged; Organ Preservation Solutions; Raffinose; Retrospective Studies; Tissue and Organ Harvesting; Tissue Donors; Tissue Preservation

Topics: Adenosine; Allopurinol; Cadaver; Disaccharides; Electrolytes; Glutamates; Glutathione; Histidine; Humans; Insulin; Intestine, Small; Liver; Mannitol; Organ Preservation Solutions; Pancreas; Raffinose; Tissue and Organ Harvesting; Tissue Donors

Early immunologic and non-immunologic injury of renal allografts adversely affects long-term graft survival. Some degree of preservation injury is inevitable in cadaveric renal transplantation, and, with the reduction in early acute rejection, this non-immunologic injury has assumed a greater relative importance. Optimal graft preservation will maximize the chances of early graft function and long-term graft survival, but the best method of preservation pulsatile perfusion (PP) versus cold storage (CS) is debated.. Primary cadaveric kidney recipients from January 1990 through December 1995 were evaluated. The effects of implantation warm ischemic time (WIT) ( < or = 20 min, 21-40 min, or > 40 min) and total ischemic time (TIT) ( < or > or = 20 h) on death-censored graft survival were compared between kidneys preserved by PP versus those preserved by CS. The effect of preservation method on delayed graft function (DGF) was also examined.. There were 568 PP kidneys and 268 CS kidneys. Overall death-censored graft survival was not significantly different between groups, despite worse donor and recipient characteristics in the PP group. CS kidneys with an implantation WIT > 40 min had worse graft survival than those with < 40 min (p = 0.0004). Survival of PP kidneys and those transplanted into 2 DR-matched recipients was not affected by longer implantation WIT. Longer TIT did not impact survival. DGF was more likely after CS preservation (20.2% versus 8.8%, p = 0.001).. Preservation with PP improves early graft function and lessens the adverse effect of increased warm ischemia in cadaveric renal transplantation. This method is likely associated with less preservation injury and/or increases the threshold for injury from other sources and is superior to CS.

Topics: Adenosine; Adult; Allopurinol; Cadaver; Cardioplegic Solutions; Cold Temperature; Follow-Up Studies; Glutathione; Graft Survival; Humans; Insulin; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Pulsatile Flow; Raffinose

During recent years, an increasing number of transplant centers within the Eurotransplant organization have used histidine-tryptophan-ketoglutarate (HTK) solution instead of University of Wisconsin (UW) solution as their preferred cold storage solution for abdominal organ preservation. We report on our single-center experience on the outcome of imported kidneys preserved with either HTK or UW solution in relation to the duration of cold ischemia time (CIT).. Between July 1989 and July 1997, 323 cadaveric kidneys preserved with UW or HTK and imported as a result of an exchange within the Eurotransplant organization were transplanted at our institution. CIT was <24 hr in 216 kidneys (UW: n=174, HTK: n=42) and > or =24 hr in 107 kidneys (UW: n=67, HTK: n=40). Renal functional outcome was evaluated by comparing delayed graft function and initial non-function rates, daily urinary output, the evolution of serum creatinine, and creatinine clearance at 1, 3, 5, 7, and 14 days and at 1, 3, 6 and 12 months, and graft survival at 1 year after transplantation in relation to the type of cold storage solution and CIT < or > or =24 hr.. Whereas the incidence of delayed graft function did not differ significantly between kidneys preserved for less than 24 hr in UW (18.6%) or HTK (26.2%), this rate increased to 50% in HTK kidneys compared to 23.9% in UW kidneys when CIT exceeded 24 hr (P=0.006). Mean serum creatinine and creatinine clearance values were better at 1 and 5 days postoperatively in kidneys preserved <24 hr with UW as compared to HTK (P<0.05). After 24 hr of CIT, HTK-preserved kidneys showed an impaired renal function, not only in the immediate postoperative phase but also at 1, 3, 6, and 12 months after transplantation (P<0.05). Graft survival at 1 year was 92.9% in UW vs. 87.5% in HTK kidneys preserved for <24 hr (NS), and 91% vs. 77.4% when CIT exceeded 24 hr (P=0.059).. From these single-center findings, it can be concluded that UW is superior to HTK in kidney preservation, particularly when CIT exceeds 24 hr.

Topics: Adenosine; Adult; Aged; Allopurinol; Cadaver; Creatinine; Female; Glucose; Glutathione; Humans; Insulin; Kidney Transplantation; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Time Factors

Topics: Adenosine; Age Factors; Allopurinol; Biopsy; Brain Death; Cadaver; Creatinine; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Patient Selection; Prognosis; Raffinose; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Digestive System Surgical Procedures; Dissection; Glutathione; Hepatectomy; Humans; Insulin; Nephrectomy; Organ Preservation; Organ Preservation Solutions; Pancreatectomy; Raffinose; Tissue Donors

Topics: Actuarial Analysis; Adenosine; Adult; Age Factors; Allopurinol; Cadaver; Cyclosporine; Female; Glucose; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Immunosuppressive Agents; Insulin; Kidney Transplantation; Male; Mannitol; Middle Aged; Multivariate Analysis; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Regression Analysis; Sex Factors; Time Factors; Tissue Donors; Treatment Outcome

Topics: Adenosine; Allopurinol; Animals; Blood Glucose; Cadaver; Dogs; Female; Glutathione; Graft Survival; Heart Arrest; Insulin; Male; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Raffinose; Temperature; Time Factors; Tissue Donors; Transplantation, Autologous

We have previously studied the time course of pulmonary cell viability, ultrastructural damage, and adenine nucleotide metabolites after circulatory arrest in a rat model to investigate the feasibility of lung retrieval for transplantation from cadavers. This study was designed to investigate the effect of hypothermic flush and subsequent 4-hour storage with either modified Euro-Collins or University of Wisconsin solution on lungs retrieved 4 hours after death.. Ninety-six Sprague-Dawley rats were sacrificed by intraperitoneal injection of pentobarbital. Control lungs were flushed immediately after sacrifice and stored for 4 hours. Rats in the experimental groups were sacrificed, and then their lungs were either ventilated with 100% oxygen or not ventilated for 4 hours before flushing with either Euro-Collins or University of Wisconsin solution followed by 4-hour hypothermic storage. At the end of the storage period, all right lungs were maintained at -70 degrees C and used to determine wet-to-dry weight ratios and adenine nucleotide levels with high-pressure liquid chromatography. Left lungs were assessed for viability with trypan blue dye exclusion. The effect on viability of flushing with Carolina rinse solution after storage was also assessed.. The percentage of viable cells in the control group after 4-hour hypothermic storage was 74% +/- 2% in Euro-Collins solution-flushed lungs and 78% +/- 2% in University of Wisconsin solution-flushed lungs. This result was virtually identical to that of lungs retrieved after 4 hours of in situ oxygen ventilation followed by 4 hours of hypothermic storage. Nonventilated cadaver lungs had substantially less viability. Adenosine triphosphate levels were significantly higher in the control group than in the oxygen-ventilated group, which were higher still than those in the nonventilated group. Adenosine triphosphate levels were consistently higher in University of Wisconsin solution-flushed lungs compared with Euro-Collins solution-flushed lungs in all groups. Total adenine nucleotide levels had a similar pattern. Wet-to-dry ratios were significantly lower in the control group (Euro-Collins = 6.27 +/- 0.46, University of Wisconsin = 4.63 +/- 0.07) compared with the oxygen-ventilated (Euro-Collins = 9.80 +/- 0.44, University of Wisconsin = 10.96 +/- 0.60) and nonventilated (Euro-Collins = 9.44 +/- 0.26, University of Wisconsin = 11.54 +/- 1.16; p < 0.0001) groups.. Four hours of circulatory arrest before 4 hours of hypothermic storage had no additional adverse impact on lung viability compared with lungs subjected to 4 hours of hypothermic storage alone, provided nonperfused lungs were ventilated with 100% oxygen. Adenine nucleotide levels were well maintained in oxygen-ventilated cadaver lungs, more so in University of Wisconsin solution-flushed lungs compared with Euro-Collins solution-flushed lungs.

Topics: Adenine Nucleotides; Adenosine; Adenosine Triphosphate; Allopurinol; Animals; Cadaver; Cardioplegic Solutions; Cell Survival; Chromatography, High Pressure Liquid; Cryopreservation; Feasibility Studies; Glutathione; Heart Arrest; Hypertonic Solutions; Insulin; Lung; Lung Transplantation; Organ Preservation; Organ Preservation Solutions; Organ Size; Oxygen; Raffinose; Rats; Rats, Sprague-Dawley; Respiration, Artificial; Solutions; Tissue and Organ Procurement; Tissue Survival

From 1988 to 1994, 15356 renal cadaveric transplantations have been performed within the Eurotransplant area (Austria, Belgium, Germany, Luxembourg and The Netherlands); 8746 kidneys were obtained from multiorgan donors and 6610 from kidney only donors. To evaluate the impact of the procurement policy, multiorgan donor (MOD) versus kidney only donor (KOD), on renal graft survival, an observational study has been performed. Multivariate analysis using Cox's proportional hazards model served to quantify the role of the procurement policy on renal graft survival after adjustment for other prognostic factors. The kidneys obtained from MODs had a significantly better graft survival at 1, 3, and 5 years after transplantation than the kidneys obtained from KODs (85%, 75%, and 58% versus 78%, 68%, and 46% (P=0.0001). In the Cox model, patients transplanted with a KOD kidney had a 1.28 times higher risk of losing their graft than patients transplanted with a MOD kidney. This benefit in graft survival for MOD kidneys could not be explained by the fact that the MODs were younger and male, and that UW was used as preservation solution. A plausible explanation is that MODs, on average, because of the nonrenal transplants, are better supervised. We expect that optimal donor management will contribute to a better outcome of all renal grafts.

Topics: Adenosine; Adult; Allopurinol; Cadaver; Cyclosporine; Europe; Female; Glutathione; Graft Rejection; Graft Survival; Histocompatibility; Humans; Immunosuppressive Agents; Insulin; Kidney Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Prognosis; Proportional Hazards Models; Public Policy; Raffinose; Solutions; Tissue and Organ Procurement; Tissue Donors; Treatment Outcome

During a 1-yr period between September 1993 and September 1994, 74 patients received cadaveric kidney transplants at our institution. Thirty nine (39) kidneys were cold stored (CS), while 35 received pulsatile preservation (PP) on the Water's Mox system using U.W. Machine Preservation Solution. A perfusionist maintained pressure, flows, pH, and osmolality, within accepted ranges. Vasodilators (Regitine, Stelazine, Verapamil) were routinely added to the machine preservation solution. Most kidneys on PP were from marginal donors, or were imported and had associated long ice storage times. The CS kidneys, however, were from "ideal donors" where immediate function (IF) was expected. The kidneys were transplanted using a common protocol by a variety of surgeons. PP was associated with higher IF rates, shorter hospital stay and decreased overall costs. The function of those kidneys was also compared with the mate kidneys, obtained through a telephone survey of the various transplant centers throughout the country. PP was again associated with higher immediate function rates.

Topics: Adenosine; Adolescent; Adult; Aged; Allopurinol; Cadaver; Child; Cold Temperature; Costs and Cost Analysis; Glutathione; Humans; Insulin; Kidney; Kidney Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pulsatile Flow; Raffinose

Topics: Adenosine; Adolescent; Adult; Allopurinol; Cadaver; Child; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Middle Aged; Organ Preservation Solutions; Postoperative Complications; Potassium; Raffinose; Retrospective Studies; Safety; Statistics, Nonparametric; Tissue Donors

The recovery of pancreatic islet cells from cadaveric donors for allotransplantation may depend on the functional condition of the pancreas of the donor prior to organ harvesting. We examined donor hemodynamic and biochemical parameters and their effects on the subsequent yield of islet cells after harvesting. All pancreata were flushed and preserved in University of Wisconsin (UW) solution and digested using automated method within 8 hours. In the first analysis, digestions were divided into high-yield (> 2000 IEQ/g pancreas), and low-yield (< 2000 IEQ/g) groups and donor variables were averaged for each group. Donors whose pancreata yielded > 2000 IEQ/g received significantly greater amounts of Dopamine (14.43 micrograms/kg/min vs 9.35 mg/kg/min, p = 0.05). The daily urine output between groups was also significantly different. Maximum systolic blood pressure (SBP), minimum systolic blood pressure, use of vasopressin, length of hospitalization, and maximum base deficit were compared between the two groups. Less severe hypoglycemia (lowest blood glucose 143 mg/dL vs 107 mg/dL, p = 0.02) and lower amylase levels (36.2 U vs 80.7, p = 0.07 were noted in the high-yield group. A trend towards higher islet yields was associated with lowest hourly urine output > 60 (2040 IEQ/g vs 1649 IEQ/g p = 0.09), maximum SBP > 200 (2097 vs 1673, p = 0.07, and surprisingly, lowest SBP below 80 (2013 vs 1742, p < 0.1). Amount of fluids administered prior to procurement had no influence on islet yield. In conclusion, hemodynamic variables such as urine output, systolic blood pressure, and degree of pressor support were modestly associated with successful islet isolation. The preliminary data suggest that better multifactor donor analysis is imperative for standardization and monitoring of multiorgan donors. The association of higher blood glucose levels with successful isolation may also be related to resuscitation with dextrose-containing fluids.

Topics: Adenosine; Adolescent; Adult; Allopurinol; Animals; Cadaver; Cell Separation; Diabetes Mellitus, Experimental; Glutathione; Hemodynamics; Humans; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Middle Aged; Organ Preservation Solutions; Raffinose; Rats; Tissue Donors; Tissue Preservation; Transplantation, Heterologous; Transplantation, Homologous

Topics: Adenosine; Allopurinol; Animals; Cadaver; Glutathione; Humans; Insulin; Liver Transplantation; Male; Organ Preservation Solutions; Raffinose; Rats; Rats, Wistar

Topics: Adenosine; Allopurinol; Cadaver; Drug Contamination; Drug Therapy, Combination; Europe; Glucose; Glutathione; Humans; Hypertonic Solutions; Immunosuppression Therapy; Immunosuppressive Agents; Insulin; Kidney; Kidney Transplantation; Mannitol; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Retrospective Studies; Streptococcus pneumoniae; Tissue Donors; Turkey

Topics: Adenosine; Adolescent; Adult; Allopurinol; Cadaver; Female; Glutathione; Graft Rejection; Humans; Insulin; Ischemia; Isotonic Solutions; Kidney; Kidney Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Perfusion; Raffinose; Ringer's Solution; Therapeutic Irrigation; Thrombosis; Tissue and Organ Procurement; Tissue Donors

Topics: Adenosine; Adult; Allopurinol; Blood Grouping and Crossmatching; Cadaver; Child; Glutathione; Humans; Insulin; Intestine, Small; Liver Transplantation; Organ Preservation; Organ Preservation Solutions; Raffinose; Tissue and Organ Procurement

Topics: Adenosine; Allopurinol; Apoptosis; Biopsy, Needle; Cadaver; Epithelium; Family; Glutathione; Graft Rejection; Humans; Insulin; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Kidney Tubules; Organ Preservation; Organ Preservation Solutions; Raffinose; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Cyclosporine; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Ischemia; Kidney; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Organ Preservation; Organ Preservation Solutions; Raffinose; Time Factors; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Glutathione; Heart Arrest; Humans; Insulin; Kidney; Kidney Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Renal Dialysis; Tissue Donors

Topics: Adenosine; Adolescent; Adult; Allopurinol; Brain Death; Cadaver; Glucose; Glutathione; Humans; Hypertonic Solutions; Insulin; Intensive Care Units; Korea; Length of Stay; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Raffinose; Retrospective Studies; Tissue and Organ Procurement; Tissue Donors

Topics: Adenosine; Allopurinol; Cadaver; Cell Separation; Centrifugation, Density Gradient; Cold Temperature; Ficoll; Glutathione; Humans; Hypertonic Solutions; Insulin; Islets of Langerhans; Organ Preservation Solutions; Pancreas; Raffinose; Time Factors; Tissue Donors; Tissue Preservation

Topics: Adenosine; Adult; Allopurinol; Cadaver; Cell Separation; Cell Survival; Centrifugation, Zonal; Glucose; Glutathione; Humans; In Vitro Techniques; Insulin; Insulin Secretion; Islets of Langerhans; Organ Preservation; Organ Preservation Solutions; Pancreas; Raffinose; Solutions

Topics: Adenosine; Adult; Allopurinol; Cadaver; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Raffinose; Solutions; Tissue Donors

From November 1985 to March 1990, 55 cadaveric kidney transplants were performed under cyclosporine therapy. All kidneys were harvested from non-heart beating donors and cold stored after being flushed with EC solution (Group I, n = 27) or UW solution (Group II, n = 28). Warm ischemic time (min) in groups I and II were 7.1 +/- 3.3 and 6.9 +/- 2.3, respectively. Cold ischemic times (hr) in groups I and II were 6.9 +/- 2.4 and 8.4 +/- 2.8, respectively. Mean numbers of days for postoperative dialysis were 14.0 +/- 7.9 in group I and 7.9 +/- 5.8 in group II (p less than 0.05). One-month creatinine (mg/dl) was 2.9 +/- 2.8 in group I and 1.75 +/- 1.0 in group II (NS). One-month graft survivals (%) in groups I and II were 81.4% and 92.8%, respectively. In conclusion, UW solution has provided beneficial effect of preservation on ischemic damaged kidney and appears to be method of choice in non-heart beating cadaveric kidney transplantation.

Topics: Adenosine; Adult; Allopurinol; Cadaver; Female; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney; Kidney Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Postoperative Period; Raffinose; Retrospective Studies; Solutions

Topics: Adenosine; Allopurinol; Cadaver; Glutathione; Graft Survival; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Raffinose; Solutions

The efficacy of Belzer UW solution was compared to Collins' solution in the preservation of asphyxiated cadaver hearts in a canine model. Donor hearts were stored for 24 h: 2 h of in situ hypothermic (15 degrees C) coronary perfusion plus 22 h of simple immersion in ice-cold solution. Verapamil, propranolol and prostacyclin were used for myocytoprotection in both groups. After orthotopic transplantation, all animals were weaned off bypass without inotropic support. After 1 h, however, the cardiac output was significantly higher in the Belzer UW solution group (128 +/- 28 vs. 67 +/- 13 ml/kg/min, p less than 0.01).

Topics: Adenosine; Allopurinol; Animals; Asphyxia; Cadaver; Dogs; Glutathione; Heart; Heart Transplantation; Insulin; Microscopy, Electron; Myocardium; Organ Preservation; Organ Preservation Solutions; Postoperative Period; Raffinose; Solutions; Time Factors