移植技術と研究

Static cold storage is currently the most used method of organ preservation worldwide. However, cutting edge technology and dramatic changes in the donor pattern have lately renewed the interest toward hypothermic machine perfusion. Marginal and cardiac death donors show higher rates of primary non function and delayed graft function compared to standard criteria donors. In this setting, machine perfusion may offer several theoretical advantages such as improved organ preservation, continuous graft evaluation, and ex-vivo conditioning of the graft before implantation. These topics have been recently reassessed by several studies. In particular, perfusion characteristics (renal resistance) and perfusate biomarker concentrations (lactate dehydrogenase, aspartate aminotransferase, heart-type fatty acid binding protein, and IL-18) during machine preservation, proved to be reliable tools to rule out graft viability and predict outcomes after transplantation. Treatment strategies acting on tissue repair, cell metabolism, and allorecognition pathway are also under investigation with promising results. Machine perfusion has finally shown its real potential however, stronger evidences and updated cost-effectiveness analysis are needed to fully support its role for the next future.

Introduction: Organ transplantation (OT) is life-saving for patients with failing organs. Shortage of donor organs can be solved by raising the willingness of the population to donate organs. Health-care professionals have a fundamental role in raising the public awareness.

Methods: This is a cross sectional descriptive study in which a specially designed self-administered questionnaire to assess knowledge and attitude towards organ donation (OD) was used to perform a survey on a representative sample of pre-medical students in a local high school whose major is biology science and medical students in Faculty of Medicine, Mansoura University, Egypt.

Results: A total of 359 students completed the questionnaire. 36% of the students had good knowledge about OD; however, 11.7% of them had good knowledge about brainstem death. 66.3% of students found their information resources insufficient. 77.7% of participants didn’t know about the law regulating OD in Egypt. 37% of the students had positive attitude towards organ donation. The most frequent cause for organ donation refusal was lack of confidence in the health care system (31%). There is a significant relation between student knowledge and positive attitude towards OD (P=0.003). Student's knowledge was significantly associated with seniority (P = 0.0001) and Christian religion (P=0.04).

Conclusion: There is lack of sufficient knowledge about the legal aspect criteria and details of organ donation process which directly contributing in reducing the positive attitude among Egyptian medical students. In a religiously and culturally accepted background, educational curriculum must focus on the importance of OD in modern surgical practice. Awareness of regulating law and the concept of brainstem death is crucial for positive attitude from OD.

Introduction: We quantified the potential for organ donation and identified missed opportunities for organ donation in a single institute.

Materials and methods: Data of potential organ donors and the outcome of requests for organ donation in the intensive care unit (ICU) of Ajou University Hospital between January 2013 and July 2015 were collected and reviewed.

Results: Of 1338 deaths that occurred within 2.5 years in our ICU, there were 189 (14.1%) brain-dead patients, with 150 medically suitable potential organ donors (11.2%). 116 requests (request rate of 77.3%) for organ donation resulted in 50consents (consent rate of 33.3%) and 41 transplantations (transplantation rate of 27.3%, 3.1% of total ICU deaths). In 8 cases out of 49 eligible donors, donation failed because of circulatory death (1 case), proven prostate cancer (2 cases), no request from recipient (1 case), poor quality of organs assessed on the operation table (2 cases), hidden active tuberculosis (1 case) and hemophagocytic lymphohistiocytosis (1 case).

Conclusion: An increase in the organ donation rate may be possible through increasing the number of consents, and through optimizing the identification procedures of potential donors.

Introduction

Historically Urata et al. first described a formula, based on donor biometrics, to predict total liver volumes. Many centres have shown that such formulae have different accuracy based on the population studied. To date, no such study has been carried out in a South East Asian population. Our primary aim was to study the accuracy of seven internationally recognized formula. Secondarily we aimed to derive a formula for caluculating the weight of a liver graft using CT derived volume.

Methods

A prospectively held database of adult living donor liver transplants between July 1996 and January 2015 was interrogated. Only entries with complete data were included. Donors’ biometrics were tabulated with corresponding CT based volumetry and actual graft volumes and weight, using seven well recognized formulae derived from international centres. The accuracy of these formulae was compared to the CT generated volume. Finally a correlation formula between CT volume and actual graft weight was described.

Results

In the study period, 100 adult donors underwent donor hepatectomies for the purposes of living donation. 79 of these had complete data allowing downstream analysis. None of the seven formulae were accurate at predicting volume and were similar in accuracy. However, the estimated liver volumes using formulas by FuGui and A. Poovathumkavadil showed the same and closest correlation with CT predicted volumes (r² = 0.55). Finally, we derived a formula to calculate weight of the graft based on predicted CT volumetry (Weight (g) = 0.86 X Vol (cm³) + 72.5) with good accuracy (r² = 0.9).

Conclusion

For the first time to date, we describe here the most reliable formula for predicting liver volume in a South East Asian population. Also, with good accuracy we propose a formula for calculating the weight of a liver graft based on CT volumetry.