Current situation of donation after circulatory death in European countries

The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000–2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000–2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short‐term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short‐term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed.     

Magnesium-enriched hydroxyapatite at immediate implants: a histomorphometric study in dogs

Aim: To evaluate the influence of magnesium‐enriched hydroxyapatite (MHA) (SintLife^®) on bone contour preservation and osseointegration at implants placed immediately into extraction sockets. Material and methods: In the mandibular pre‐molar region, implants were installed immediately into extraction sockets of six Labrador dogs. MHA was placed at test sites, while the control sites did not receive augmentation materials. Implants were intended to heal in a submerged mode. After 4 months of healing, the animals were sacrificed, and ground sections were obtained for histomorphometric evaluation. Results: After 4 months of healing, one control implant was not integrated leaving n=5 test and control implants for evaluation. Both at the test and the control sites, bone resorption occurred. While the most coronal bone‐to‐implant contact was similar between test and control sites, the alveolar bony crest outline was maintained to a higher degree at the buccal aspect of the test sites (loss: 0.7 mm) compared with the control sites (loss: 1.2 mm), even though this difference did not reach statistical significance. Conclusions: The use of MHA to fill the defect around implants placed into the alveolus immediately after tooth extraction did not contribute significantly to the maintenance of the contours of the buccal alveolar bone crest. To cite this article:
Caneva M, Botticelli D, Stellini E, Souza SLS, Salata LA, Lang NP. Magnesium‐enriched hydroxyapatite at immediate implants: a histomorphometric study in dogs.
Clin. Oral Impl. Res. 22 , 2011; 512–517
doi: 10.1111/j.1600‐0501.2010.02040.x     

Borrelidin介导静脉畸形模型小鼠脾窦内皮细胞凋亡实验研究

目的评价巯螺旋体素（Borrelidin）对小鼠脾窦内皮细胞凋亡的诱导作用,为静脉畸形的研究和治疗探索新的药物。方法 180只10周龄雄性SPF小鼠（specific pathogen free muose,无特定病原体小鼠）,质量25-30g随机分为3组：空白对照组、生理盐水组、Borrelidin组,每组60只。每组又随机分四个日程组（3、7、14、21d组）,每组15只。小鼠脾脏直接注射生理盐水、Borrelidin后分别在3、7、14、21d四个时间点处死该组小鼠取其脾脏为标本：①石蜡切片光镜观察;②超薄切片电镜观察;③末端转移酶介导的缺口末端标记法（TUNEL法）标记凋亡细胞;④免疫组化（SABC法）检测细胞凋亡因子半胱氨酸天冬氨酸蛋白酶-3（Caspase-3）的表达;⑤图像分析技术比较Borrelidin不同时段的凋亡率。结果空白对照组和盐水组未发现脾脏萎缩和脾窦组织结构破坏。Borrelidin3天组脾脏有不同程度肿胀,7天肿胀基本消失,14天有不同程度萎缩,21天有肉眼可见的明显萎缩;电镜显示Borrelidin组各时段均可见凋亡细胞,随药物作用时间延长凋亡细胞逐渐增多;TUNEL标记显示Borrelidin作用后3、7天组就有阳性表达,14天后凋亡广泛表达于脾窦内皮细胞;免疫组化显示Caspase-3的表达与凋亡的阳性表达趋势一致。显微图像及统计学分析Borrelidin组凋亡指数及Caspase-3的表达阳性率高,其统计学差异显著。结论 Borrelidin可通过Caspase-3途径诱导小鼠脾窦内皮细胞凋亡,可用于对静脉畸形治疗的进一步研究。     

Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion

Cantafio AW, Dick AAS, Halldorson JB, Bakthavatsalam R, Reyes JD, Perkins JD. Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion.
Clin Transplant 2011: 25: E530–E540. © 2011 John Wiley & Sons A/S. Abstract: There has been a dramatic increase in the utilization of kidneys from donors after cardiac death (DCD). While these organs represent an opportunity to expand the donor pool, the assessment of risk and optimal perioperative management remains unclear. Our primary aim was to identify risk factors for objective outcomes, and secondarily, we sought to determine what impact pulsatile machine perfusion (PMP) had on these outcomes. From 1993 to November 2008, 6057 DCD kidney transplants were reported to the Organ Procurement and Transplantation Network database, with complete endpoints for delayed graft function (DGF) and graft survival (GS). Risk factors were identified using a multivariable regression analysis adjusted for recipient factors. Age (50 yr) [OR 1.81, p < 0.0001] and cold ischemia time (CIT) (>30 h) [OR 3.22, p < 0.0001] were the strongest predictors of DGF. The use of PMP decreased the incidence of DGF only when donor age was >60 yr and improved long‐term graft survival when donor age was >50 yr. Donor warm ischemia time >20 min was also found to correlate with increased DGF. While the incidence of DGF in DCD kidneys is significantly higher, the only factors the transplant surgeon can control are CIT and the use of PMP. The data suggest that the use of PMP in DCD kidneys <50 yr old provides little clinical benefit and may increase CIT.     

Trimetazidine： Is it a promising drug for use in steatotic grafts？

AIM:Chronic organ-donor shortage has led to theacceptance of steatotic livers for transplantation,despitethe higher risk of graft dysfunction or nonfunctionassociated with the ischemic preservation period ofthese organs.The present study evaluates the effects oftrimetazidine(TMZ)on an isolated perfused liver model.METHODS:Steatotic and non-steatotic livers werepreserved for 24 h in the University of Wisconsin(UW)solution with or without TMZ.Hepatic injury and function(transaminases,bile production and sulfobromophthalein(BSP)clearance)and factors potentially involved in thesusceptibility of steatotic livers to ischemia-reperfusion(I/R)injury,including oxidative stress,mitochondrialdamage,microcirculatory diseases,and ATP depletionwere evaluated.RESULTS:Steatotic livers preserved in UW solutionshowed higher transaminase levels,lower bile productionand BSP clearance compared with non-steatotic livers.Alterations in perfusion flow rate and vascular resistance,mitochondrial damage,and reduced ATP content weremore evident in steatotic livers.TMZ addition to UWsolution reduced hepatic injury and ameliorated hepaticfunctionality in both types of the liver and protectedagainst the mechanisms potentially responsible for thepoor tolerance of steatotic livers to I/R.CONCLUSION:TMZ may constitute a useful approachin fatty liver surgery,limiting the inherent risk of steatoticliver failure following transplantation.     

Use of fibrin glue (Tissucol) as a hemostatic in laparoscopic conservative treatment of spleen trauma

Background This study aimed to evaluate the effect of fibrin glue in laparoscopic spleen-preserving procedures for traumatic rupture. Methods From January 2002 to December 2005, six laparoscopic spleen-preserving procedures were performed for traumatic rupture using fibrin glue. Two of the cases had previous middle and lower abdominal surgery. Survey of the abdominal cavity was performed by inserting two 5- to 12-mm trocars, one 5-mm trocar, and a 30° scope. A complete survey of all the patients was performed. Results None of the patients required laparotomy, and no postoperative bleeding occurred. The fibrin sealant achieved immediate hemostasis, and all the patients recovered without further splenic bleeding. The mean postoperative stay was 4.3 days (range, 4–5 days). All the patients were followed up for 3 to 12 months. Postoperative immunoglobulin scanning, ultrasonography, and computed tomography (CT) results were normal. Conclusions Laparoscopic management of spleen trauma can be used once a positive diagnosis has been made. It is useful for assessing the degree of splenic injury. A laparoscopic spleen-preserving procedure can be used safely for patients with stable vital data. It is an effective procedure for the evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial. The topical application of a fibrin sealant in splenic trauma achieves definitive hemostasis safely, rapidly, and reliably. It also is simple to use in either laparoscopic or open procedures. An erratum to this article can be found at     

白花前胡丙素对心肌缺血再灌注损伤的影响

目的观察白花前胡丙素（Pra—C）对抗大鼠心肌缺血再灌注损伤（MI／R）的机制及其保护作用。方法48只健康雄性SD大鼠随机分为6组：假手术组（A组）、缺血再灌注组（B组）、溶剂±缺血再灌组（C组）、Pra—C5mg／kg组（D组）、Pra—C15mg／kg组（E组）和Pra—C30mg／kg组（F组）。Pra—C各剂量组分别于实验前3d腹腔注射,每天2次,于实验前2h加强1次;A组给予等量的生理盐水腹腔注射;B组采用冠状动脉左前降支结扎40min,再灌120min建立;C组给予等量的50％PEG400,10ml／kg溶剂腹腔注射。分光光度计法检测心肌组织SOD活性和MDA含量。苏木素-伊红（HE）染色观察心肌组织病理改变,透射电镜观察心肌超微结构的变化,并比较各组之间的差异。结果六组SOD值（U／mgprot）分别为154．78±10．94、78．16±7．13、79．15±7．12、88．77±8．53、115．80±7．09和145．07±7．24;MDA值（nmol／mgprot）分别为2．70±0．26、6．77±0．23、6．48±0．64、5．07±0．38、3．41±0．32和2．72±0．32。B组和C组心肌组织SOD活性和MDA含量差异无统计学意义（P〉0．05）;与它们相比较,D、E、F组SOD活性显着增加（P〈0．05或P〈0．01）,MDA含量显著降低（P〈0．01）。D、E、F组心肌组织的病理改变有不同程度的减轻。结论Pra—C可以减轻MI／R对心肌组织的损伤作用。其机制可能与对抗氧自由基、对抗脂质过氧化有关。     

不同保存液对自体静脉移植后血管内膜增生的影响

目的:探讨晶、胶体保存液对自体静脉移植后血管内膜增生的影响,以筛选出优良的移植血管保存液.方法:建立大鼠自体静脉移植模型,分为2组:晶体液保存组,术中移植静脉以晶体液保存;胶体液保存组, 术中移植静脉以胶体液保存.分别于术后第1 天、3天、1周、2周、4周、6周取材.对移植血管应用苏木精-伊红染色,进行组织形态学观察;应用免疫组织化学法观察增殖细胞核抗原(PCNA)、P21在移植后不同时期的表达情况.结果:晶体液保存组的静脉较胶体液保存组增厚明显;PCNA表达高峰在1～2周,晶体液保存的静脉表达较胶体液保存的静脉明显;P21在1～2周时表达水平较低,其后逐渐升高,至4周时达高峰,在同一时点,胶体液保存的静脉较晶体液保存的静脉表达明显.结论:自体静脉移植血管保存中,胶体保存液优于晶体保存液.     

输血样本ALT活性在保存过程中的变化规律及其重要意义

目的：探讨输血样本不同保存形式丙氨酸氨基转移酶（ALT）活性的变化规律。方法：将输血样本以全血及血浆形式分别在22℃（仅全血）、4℃、-20℃（仅血浆）保存,在不同保存时间检测ALT活性。结果：以全血形式保存的输血样本随保存时间延长ALT活性逐步升高,并且22℃比4℃保存升高快;以血浆形式保存的输血样本随保存时间延长ALT活性逐步下降,并且-20℃比4℃下降慢。结论：认识全血、血浆样本ALT活性在保存过程中的变化规律,有助于血液检测的准确性,避免宝贵血液的无故报废,也说明长时间保存输血样本-20℃保存血浆（血清）为较好。