- Postmortem water contents of major organs with regard to the cause of death. [Journal Article]
- JFJ Forensic Leg Med 2019 May 11; 65:48-54
- The water contents of individual organs are maintained in a narrow range, but altered in morbidity owing to a disturbance of water equilibrium. The present study investigated the tissue water content…
The water contents of individual organs are maintained in a narrow range, but altered in morbidity owing to a disturbance of water equilibrium. The present study investigated the tissue water contents of major organs with regard to the cause of death in serial autopsy cases within 3 days postmortem (n = 329; 223 males, 106 females; age range, 1-100 years). Individual tissue water contents differed markedly across organs, but no significant postmortem or survival-period dependence, gender-related difference, or age dependence was observed. However, the lung water contents were higher in drowning cases, especially in saltwater cases (p < 0.05), and in strangulation among the acute mechanical asphyxiation cases. The brain water contents were higher in hypothermia cases (cold exposure) and tended to be higher in hyperthermia cases (heatstroke). The kidney water contents were higher in drowning and acute cardiac cases than in fatal intoxication and fire fatality cases, but tended to be higher in fresh- and bathwater drowning cases than in saltwater cases (p > 0.05). The spleen water contents were higher in bathwater drowning than in saltwater and freshwater cases, but did not differ among other the causes of death. These findings suggest that the postmortem tissue water content of individual organs, especially the lungs and/or kidney, depends on the cause of death and particularly contributes to differentiation between saltwater and freshwater drowning, respectively. This work therefore provides insight into the investigation of varied tissue water imbalances during the death process. In conclusion, we recommend the measurement of tissue water content because it is easy to perform and appears to be useful for evaluating the pathophysiology of systemic circulatory failure.
- Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function. [Journal Article]
- TPTransplant Proc 2019; 51(4):1226-1230
- CONCLUSIONS: The tick mark pattern of SBP kinetics might help to identify DGF intraoperatively. When detecting this SBP pattern, the excessive fluid therapy should be avoided during the postoperative period to prevent iatrogenic hypervolemia leading to further graft damage.
- Incidence, Risk Factors, and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation. [Journal Article]
- TPTransplant Proc 2019; 51(4):1096-1100
- CONCLUSIONS: Older ages of donors, occurrence of acute kidney injury, its grade just before harvesting, and long duration of CIT are the most important risk factors for DGF. Brain death management, shortening the time between brain death and harvesting, and also shortening the duration of CIT can decrease the risk of DGF and can increase the graft survival.
- Therapeutic Strategies of Kidney Transplant Ischemia Reperfusion Injury: Insight From Mouse Models. [Journal Article]
- BJBiomed J Sci Tech Res 2019; 14(5)
- Ischemia/reperfusion injury (IRI) is inherent to all transplanted organs and is adversely associated with early renal graft function and graft longevity. Despite the progress in immunosuppressive reg…
Ischemia/reperfusion injury (IRI) is inherent to all transplanted organs and is adversely associated with early renal graft function and graft longevity. Despite the progress in immunosuppressive regimens and perioperative care, no FDA-approved treatment for kidney transplant IRI is available to date. In recent years, by utilizing the modified and clinically-relevant mouse models of kidney transplantation (KTx) in which extended IRI is induced by the prolonged warm or cold ischemic time, studies have identified several potential therapeutic approaches for KTx IRI, including the hormone supplement, promoting tubular repair and regeneration, and targeting complement system, inflammation, and necroptosis. This review describes some of the lessons learned from mouse models of KTx with regard to factors that influence the severity of transplant IRI and the potential therapeutic targets.
- Machine perfusion versus cold storage in renal preservation of deceased donors with brain death: systematic review and meta-analysis. [Journal Article]
- RCRev Col Bras Cir 2019 May 09; 46(2):e2079
- With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed…
With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed a systematic review that aimed to evaluate the efficacy of the portable machine perfusion (LifePort Kidney Transporter Machine®), used in Brazil, compared to cold storage, regarding the delayed graft function of deceased donors with brain death. Literature search was carried out in LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, and SciELO, as well as in Google Scholar manually. The systematic review consisted only of randomized clinical trials. For meta-analysis, relative risk and odds ratio were evaluated. Eighty-six documents were identified and two papers from European and Brazilian groups were selected at the end, with eligibility criteria for meta-analysis. In these, 374 kidneys were assigned to machine perfusion and 374 kidneys were assigned to cold storage. Delayed graft function was observed in 84 and 110 patients, respectively. In meta-analysis, a risk ratio of 0.7568 (p=0.0151) and an odds ratio of 0.6665 (p=0.0225) were obtained, both with a 95% confidence interval. Machine perfusion reduced the incidence of delayed graft function of deceased donors with brain death.
- Nonimmunologic Factors Affecting Long-Term Outcomes of Deceased-Donor Kidney Transplant. [Journal Article]
- ECExp Clin Transplant 2019 May 14
- CONCLUSIONS: Donor age, cause of brain death, and acute kidney injury affected graft survival in our study cohort but not donor or recipient sex or posttransplant or donor blood pressure.
- Changes in the metabolic composition of storage solution with prolonged cold ischemia of the uterus. [Journal Article]
- JAJ Assist Reprod Genet 2019 May 12
- CONCLUSIONS: The metabolic results indicate a significant degradation of the uterus during 24 h of CI. Metabolic analysis of the storage solution could be used as a non-invasive tool for evaluating uterine degradation during CI before transplantation.
- Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes. [Journal Article]
- AJAm J Kidney Dis 2019 May 07
- CONCLUSIONS: Potential unmeasured confounding from patient comorbid conditions and organ selection.These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death.
- Oxygen Consumption by Warm Ischemia-Injured Porcine Kidneys in Hypothermic Static and Machine Preservation. [Journal Article]
- JSJ Surg Res 2019 May 06; 242:78-86
- Static cold storage (SCS) and hypothermic machine perfusion (HMP) are currently standard methods for renal grafts clinical preservation. Both methods are predominantly implemented without the active …
Static cold storage (SCS) and hypothermic machine perfusion (HMP) are currently standard methods for renal grafts clinical preservation. Both methods are predominantly implemented without the active delivery of oxygen, even for donation after circulatory death-like kidneys. However, even under severe hypothermia (4°C-6°C), kidneys can consume oxygen and produce ATP. What is not established, though, is to what extent and how SCS and HMP compare in terms of oxygen. Using a porcine preclinical model of renal warm ischemia (WI) to compare SCS and HMP methods, we continuously monitored and quantified oxygen level and consumption along preservation; we also determined prepreservation and postpreservation cortical ATP level; values were given as median and [min; max] range. One-hour WI reduced ATP by ∼90% (from 3.3 [1.7; 4.5] mmol/L tissue in Controls). Oxygen consumption (QO2, μmol/min per 100 g) was determined from initial solution PO2 decrease (SCS and HMP) and from arterio-venous difference (HMP). In SCS and HMP, PO2 decreased rapidly (t1/2 ∼1 h) from atmospheric levels to 52.9 [38.0; 65.9] and 8.2 [3.0, 16.0] mmHg, respectively. In HMP, QO2 was 2.7 [0.4; 3.9] versus 0.5 [0.0; 1.3] in SCS (P < 0.05); postpreservation ATP amounted to 5.8 [3.2; 6.5] in HMP versus 0.1 [0.0; 0.2] in SCS. Despite hypothermic conditions in SCS or HMP, donation after circulatory death-like renal grafts require oxygen. Increased oxygen consumption, restored ATP level, and improved histological profile in HMP might explain the established HMP superiority over SCS. These results establish a rational basis for the use of oxygen in hypothermic preservation. Optimal levels required for preservation and graft-type variants remain to be determined.
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- [D-Ala2, D-Leu5] Enkephalin Improves Liver Preservation During Normothermic Ex Vivo Perfusion. [Journal Article]
- JSJ Surg Res 2019 May 06; 241:323-335
- CONCLUSIONS: DADLE confers protection against oxidative stress in hepatocytes and during NEVLP. These data suggest that the mechanism of protection involved the prevention of mitochondrial dysfunction by opioid receptor signaling and subsequent increased expression of prosurvival/antiapoptotic signaling pathways. Altogether, data suggest that opioid receptor agonism may serve as therapeutic target for improved liver protection during NEVLP.