Improving pancreas graft utilization through importation

Background

We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.

Methods

This is an observational retrospective cohort of 26 recipients who received either a locally procured (n = 16) or an imported pancreas graft (n = 10) at our center between January 2014 and May 2017. Wait list times of this cohort were compared to UNOS Region 9 (New York State and Western Vermont). Hospital financial data were also reviewed to analyze the cost‐effectiveness of this strategy.

Results

Imported pancreas grafts had significantly increased cold ischemia times (CIT) and peak lipase (PL) levels compared to locally procured grafts (CIT 827 vs 497 minutes; P = .001, PL 563 vs 157 u/L; P = .023, respectively). There were no differences in graft or patient survival. The median wait time was significantly lower for simultaneous kidney‐pancreas transplants at our center (518 days, n = 21) compared to Region 9 (1001 days, n = 65) P = .038. Despite financial concerns, the cost of transport for imported grafts was offset by lower standard acquisition costs.

Conclusions

Imported pancreas grafts may be a cost‐effective strategy to increase organ utilization and shorten wait times in regions with longer waiting times.     

快速供肝切取与修整的外科技巧

目的总结肝脏移植供肝的快速切取和修整经验。方法分析2004年共186例快速供肝的切取和修整的资料。快速切取技术采用原位腹主动脉、肠系膜上静脉灌注附加下腔静脉引流，快速切取供肝，4℃UW液中保存和修整肝脏。结果供肝热缺血时间为3～10min，平均4．5min；冷缺血时间平均为3-16h，平均7h。供肝的修整时间为26～90min，平均46min。供肝修整时发现肝动脉解剖变异20例。结论快速供肝切取法要求术者技术娴熟、动作迅速和准确，可最大限度地减少供肝热缺血时间。快速切取法能保证供肝的质量和确保供肝切取的成功。     

Personal experience with the procurement of 132 liver allografts

Abstract. A single donor surgeon's experience procuring the livers from 132 donors is described. Thirty-seven grafts (28. 9%) had hepatic arterial anomalies, 19 (14. 4%) of which required arterial reconstruction prior to transplantation. Of the 121 grafts evaluated for early function, 103 grafts (85. 2%) functioned well, whereas 14 grafts (11. 6%) functioned poorly and 4 grafts (3. 3%) failed to function at all. The variables associated with less than optimal function of the graft consisted of donor age ( P <0. 05), duration of donor's stay in the intensive care unit ( P < 0. 005), abnormal graft appearance ( P < 0. 05), and such recipient problems as vascular thromboses during or immediately following transplantation ( P < 0. 005). A new preservation fluid, University of Wisconsin solution, allowed safe and longer cold storage of the liver allograft than did Euro-Collins' solution ( P < 0. 0001). A parameter of liver allograft viability, which is simple and predictive of allograft function prior to the actual transplant procedure, is urgently needed.     

Program‐specific transplant rate ratios: Association with allocation priority at listing and posttransplant outcomes

The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program‐specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. We evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low‐priority candidates. Despite a strong association with unadjusted TRRs, we found no candidate‐level association between the components of allocation priority and adjusted TRRs. We found a strong program‐level association between median laboratory Model for End‐stage Liver Disease (MELD) score at listing and program‐specific adjusted TRRs (r = .37; P < .001). The program‐level association was likely confounded by regional differences in donor supply/demand and listing practices. In kidney transplantation, higher program‐specific adjusted TRRs were weakly associated with better adjusted posttransplant outcomes (r = ?.14; P = .035) and lower adjusted waitlist mortality rate ratios (r = ?.15; P = .022), but these associations were absent in liver, lung, and heart transplantation. Program‐specific adjusted TRRs were unlikely to be improved by listing candidates with high allocation priority and can provide useful information for transplant candidates and programs.     

Update on Causes of Family Refusal for Organ Donation and the Related Factors: Reporting the Changes Over 6 Years

Introduction

After significant improvement of the family consent rate to organ donation (OD) in recent years, owing to an increase in cultural activities and social awareness, a plateau has been reached. This study was performed to detect the causes for this plateau.

猪原位肝移植快速供肝切取方法与修整技术研究

目的总结肝脏移植供肝的快速切取和修整经验．方法分析2008年1～6月快速26例供肝的切取和修整的资料．快速切取技术采用原位腹主动脉、肠系膜上静脉灌注附加下腔静脉引流,快速切取供肝,4℃UW液中保存和修整肝脏．结果供肝切取时间平均为10min,无热缺血时间;冷缺血时间（2．11±0．26）h;供肝的修整时间为26～90min,平均46min．结论快速供肝切取法要求术者技术娴熟、动作迅速和准确,可最大限度地减少供肝热缺血时间．快速切取法能保证供肝的质量和确保供肝切取的成功．     

香港特区药物采购策略与内地基本药物采购机制比较

目的:借鉴香港特区成功经验,为完善内地基本药物集中采购工作提供参考。方法:通过对香港特区医院管理局药物采购政策和策略与内地基本药物采购机制的分析比较,发掘可借鉴的经验,并提出内地需改进的建议。结果与结论:信息化建设是实现基本药物招采结合、量价挂钩采购模式的基础。建议建立全国范围的规范、统一、科学的药品分类方法和系统药物采购政策,采取多种采购方式和途径,保证基本药物供应,实现基本药物可及性要求。     

Multi-Center Analysis of Liver Transplantation for Combined Hepatocellular Carcinoma-Cholangiocarcinoma Liver Tumors

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