scholarly journals Combining Donor Characteristics with Immunohistological Data Improves the Prediction of Islet Isolation Success

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Zuzana Berkova ◽  
Frantisek Saudek ◽  
Peter Girman ◽  
Klara Zacharovova ◽  
Jan Kriz ◽  
...  
Keyword(s):  
Pancreatic Tissue ◽  
Islet Isolation ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Immunohistochemical Examination ◽  
Optimal Cutoff ◽  
Factors Associated ◽  
Donor Factors ◽  
Optimal Cutoff Point ◽  
Donor Characteristics

Variability of pancreatic donors may significantly impact the success of islet isolation. The aim of this study was to evaluate donor factors associated with isolation failure and to investigate whether immunohistology could contribute to organ selection. Donor characteristics were evaluated for both successful (n=61) and failed (n=98) islet isolations. Samples of donor pancreatic tissue (n=78) were taken for immunohistochemical examination. Islet isolations with 250000 islet equivalents were considered successful. We confirmed that BMI of less than 25 kg/m2(P<0.001), cold ischemia time more than 8 hours (P<0.01), hospitalization longer than 96 hours (P<0.05), higher catecholamine doses (P<0.05), and edematous pancreases (P<0.01) all unfavorably affected isolation outcome. Subsequent immunohistochemical examination of donor pancreases confirmed significant differences in insulin-positive areas (P<0.001). ROC analyses then established that the insulin-positive area in the pancreas could be used to predict the likely success of islet isolation (P<0.001). At the optimal cutoff point (>1.02%), sensitivity and specificity were 89% and 76%, respectively. To conclude, while the insulin-positive area, determined preislet isolation, as a single variable, is sufficient to predict isolation outcome and helps to improve the success of this procedure, its combination with the established donor scoring system might further improve organ selection.

scholarly journals Perioperative factors associated with delayed graft function in renal transplant patients

2018 ◽  
Vol 40 (4) ◽  
pp. 360-365
Author(s):  
Milton Halyson Benevides de Freitas ◽  
Luciana Cavalcanti Lima ◽  
Tania Cursino de Menezes Couceiro ◽  
Wilton Bernadino da Silva ◽  
João Marcelo de Andrade ◽  
...  
Keyword(s):  
Risk Factor ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Factors Associated ◽  
Combined Anesthesia ◽  
Anesthesia Technique

ABSTRACT Introduction: Successful renal transplant and consequent good graft function depend on a good surgical technique, an anesthetic that ensures the hemodynamic stability of the receiver, and appropriate conditions of graft and recipient. Several factors can interfere with the perfusion of the graft and compromise its viability. The objective of this study was to evaluate perioperative factors associated with delayed graft function (DGF) in renal transplantation patients. Methods: This is a historical cohort study of patients who underwent renal transplantation between 2011 and 2013. Three hundred and ten transplants were analyzed. DGF was defined as the need for dialysis during the first week post-transplant. Logistic regression with a stepwise technique was used to build statistical models. Results: Multivariate analysis revealed the following risk factor for DGF: combined anesthesia technique (OR = 3.81, 95%CI, 1.71 to 9.19), a fluid regimen < 50 mL·kg-1 (OR = 3.71, 95%CI, 1.68 to 8.61), dialysis for more than 60 months (OR = 4.77, 95%CI, 1.93 to 12.80), basiliximab (OR = 3.34, 95%CI, 1.14 to 10.48), cold ischemia time > 12 hour (OR = 5.26, 95%CI, 2.62 to 11.31), living donor (OR = 0.19, 95%CI, 0.02 to 0.65), and early diuresis (OR = 0.02, 95%CI, 0.008 to 0.059). The accuracy of this model was 92.6%, calculated using the area under the ROC curve. The incidence of DGF in the study population was 76.1%. Conclusions: Combined anesthesia technique, dialysis for more than 60 months, basiliximab, and cold ischemia time > 12 hours are risk factor for DGF, while liberal fluid regimens and kidneys from living donors are protective factors.

scholarly journals Successful Islet Outcomes Using Australia-Wide Donors: A National Centre Experience

Metabolites ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 360
Author(s):  
Wayne J. Hawthorne ◽  
Sussan Davies ◽  
Hee-chang Mun ◽  
Yi Vee Chew ◽  
Lindy Williams ◽  
...  
Keyword(s):  
Local Area ◽  
Islet Isolation ◽  
Cold Ischemia ◽  
Transplant Outcomes ◽  
Significant Difference ◽  
Non Local ◽  
The Mean ◽  
Donor Characteristics ◽  
Mean Time ◽  
Isolation Facility

Cold ischemia and hence travel time can adversely affect outcomes of islet isolation. The aim of this study was to compare the isolation and transplant outcomes of donor pancreata according to the distance from islet isolation facility. Principally, those within a 50 km radius of the centre were compared with those from regional areas within the state and those from interstate donors within Australia. Organ donors were categorised according to distance from National Pancreas Transplant Unit Westmead (NPTU). Donor characteristics were analysed statistically against islet isolation outcomes. These were age, BMI, cause and mechanism of death, days in ICU, gender, inotrope and steroid use, cold ischemia time (CIT) and retrieval surgical team. Between March 2007 and December 2020, 297 islet isolations were performed at our centre. A total of 149 donor pancreata were local area, and 148 non-local regions. Mean distance from the isolation facility was 780.05 km. Mean pancreas CIT was 401.07 ± 137.71 min and was significantly different between local and non-local groups (297.2 vs. 487.5 min, p < 0.01). Mean age of donors was 45.22 years, mean BMI was 28.82, sex ratio was 48:52 F:M and mean time in ICU was 3.07 days. There was no significant difference between local and non-local for these characteristics. The mean CIT resulting in islet transplantation was 297.1 ± 91.5 min and longest CIT resulting in transplantation was 676 min. There was no significant difference in islet isolation outcomes between local and non-local donors for characteristics other than CIT. There was also no significant effect of distance from the isolation facility on positive islet transplant outcomes (C-peptide > 0.2 at 1 month post-transplant). Conclusions: Distance from the isolation centre did not impact on isolation or transplant outcomes supporting the ongoing nationwide use of shipping pancreata for islet isolation and transplantation.

Donor Care before Pancreatic Tissue Transplantation

2005 ◽  
Vol 15 (2) ◽  
pp. 129-137 ◽  
Author(s):  
David J. Powner
Keyword(s):  
Islet Cells ◽  
Pancreatic Tissue ◽  
Tissue Transplantation ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time

Publications are reviewed to identify factors related to donor care that may optimize the function of pancreatic tissue (whole or segmental organ or islet cells) after transplantation. Short cold ischemia time, avoidance of hypotension, and treatment of donor hyperglycemia appear to be beneficial, although additional properly designed studies are needed to verify those findings.

scholarly journals Evaluation of Perfluorohexyloctane/Polydimethylsiloxane for Pancreas Preservation for Clinical Islet Isolation and Transplantation

2016 ◽  
Vol 25 (12) ◽  
pp. 2269-2276 ◽  
Author(s):  
Magnus Ståhle ◽  
Aksel Foss ◽  
Bengt Gustafsson ◽  
Marko Lempinen ◽  
Torbjörn Lundgren ◽  
...  
Keyword(s):  
Islet Function ◽  
Islet Isolation ◽  
Clinical Grade ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemic Time ◽  
Cold Ischemic Time ◽  
University Of Wisconsin ◽  
Pancreas Preservation ◽  
Preservation Solutions

This study aimed to evaluate a 50:50 mix of perfluorohexyloctane/polydimethylsiloxane 5 (F6H8S5) preservation of pancreases in a clinical setting compared with standard solutions for 1) cold ischemia time (CIT) <10 h and 2) an extended CIT >20 h. Procured clinical-grade pancreases were shipped in either F6H8S5 or in standard preservation solutions, that is, University of Wisconsin (UW) or Custodiol. F6H5S5 was preoxygenated for at least 15 min. Included clinical-grade pancreases were procured in UW or Custodiol. Upon arrival at the islet isolation laboratory, the duodenum was removed followed by rough trimming while F6H8S5 was oxygenated for 15-20 min. Trimmed pancreases were immersed into oxygenated F6H8S5 and stored at 4°C overnight followed by subsequent islet isolation. Pancreas preservation using F6H8S5 proved as effective as UW and Custadiol when used within CIT up to 10 h, in terms of both isolation outcome and islet functionality. Preservation in F6H8S5 of pancreases with extended CIT gave results similar to controls with CIT <10 h for both isolated islet functionality and isolation outcome. This study of clinically obtained pancreases indicates a clear benefit of using F6H8S5 on pancreases with extended CIT as it seems to allow extended cold ischemic time without affecting islet function and islet numbers.

Islet Isolation From Human Pancreas With Extended Cold Ischemia Time

2010 ◽  
Vol 42 (6) ◽  
pp. 2027-2031 ◽  
Author(s):  
W.M. Kühtreiber ◽  
L.T. Ho ◽  
A. Kamireddy ◽  
J.A.W. Yacoub ◽  
D.W. Scharp
Keyword(s):  
Human Pancreas ◽  
Islet Isolation ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time

Tu1488 The Effect of Cold Ischemia Time on Islet Cell Function in Islet Autotransplant Patients Undergoing Remote Islet Isolation

2015 ◽  
Vol 148 (4) ◽  
pp. S-906-S-907
Author(s):  
Timothy B. Gardner ◽  
Kerrington Smith ◽  
David Axelrod ◽  
Samuel Kesseli ◽  
Richard Freeman ◽  
...  
Keyword(s):  
Islet Cell ◽  
Cell Function ◽  
Islet Isolation ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time ◽  
Islet Autotransplant ◽  
Islet Cell Function

scholarly journals The endogenous capacity to produce proinflammatory mediators by the ex vivo human perfused lung

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Aleksandra Leligdowicz ◽  
James T. Ross ◽  
Nicolas Nesseler ◽  
Michael A. Matthay
Keyword(s):  
Ex Vivo ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Experimental Conditions ◽  
Ischemia Time ◽  
Proinflammatory Mediators ◽  
Donor Lung ◽  
Perfused Lung ◽  
Lung Response ◽  
Percent Weight Gain

Abstract Background The ex vivo human perfused lung model has enabled optimizing donor lungs for transplantation and delineating mechanisms of lung injury. Perfusate and airspace biomarkers are a proxy of the lung response to experimental conditions. However, there is a lack of studies evaluating biomarker kinetics during perfusion and after exposure to stimuli. In this study, we analyzed the ex vivo-perfused lung response to three key perturbations: exposure to the perfusion circuit, exogenous fresh whole blood, and bacteria. Results Ninety-nine lungs rejected for transplantation underwent ex vivo perfusion. One hour after reaching experimental conditions, fresh whole blood was added to the perfusate (n = 55). Two hours after reaching target temperature, Streptococcus pneumoniae was added to the perfusate (n = 42) or to the airspaces (n = 17). Perfusate and airspace samples were collected at baseline (once lungs were equilibrated for 1 h, but before blood or bacteria were added) and 4 h later. Interleukin (IL)-6, IL-8, angiopoietin (Ang)-2, and soluble tumor necrosis factor receptor (sTNFR)-1 were quantified. Baseline perfusate and airspace biomarker levels varied significantly, and this was not related to pre-procurement PaO2:FiO2 ratio, cold ischemia time, and baseline alveolar fluid clearance (AFC). After 4 h of ex vivo perfusion, the lung demonstrated a sustained production of proinflammatory mediators. The change in biomarker levels was not influenced by baseline donor lung characteristics (cold ischemia time, baseline AFC) nor was it associated with measures of experimental epithelial (final AFC) or endothelial (percent weight gain) injury. In the presence of exogenous blood, the rise in biomarkers was attenuated. Lungs exposed to intravenous (IV) bacteria relative to control lungs demonstrated a significantly higher rise in perfusate IL-6. Conclusions The ex vivo-perfused lung has a marked endogenous capacity to produce inflammatory mediators over the course of short-term perfusion that is not significantly influenced by donor lung characteristics or the presence of exogenous blood, and only minimally affected by the introduction of systemic bacteremia. The lack of association between biomarker change and donor lung cold ischemia time, final alveolar fluid clearance, and experimental percent weight gain suggests that the maintained ability of the human lung to produce biomarkers is not merely a marker of lung epithelial or endothelial injury, but may support the function of the lung as an immune cell reservoir.

IMPACT OF COLD ISCHEMIA TIME ON RENAL ALLOGRAFT OUTCOME FROM YOUNG DONORS

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 364
Author(s):  
D Hernández ◽  
S Estupiñán ◽  
G Pérez Suárez ◽  
M Rufino ◽  
J M. González-Posada ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Ischemia Time ◽  
Allograft Outcome
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