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Presenter: Mihai, Oltean, Gothenburg, Sweden
Authors: Mihai Oltean, Chiara Zanfi, Laurens Ceulemans, Pablo Farinelli, Jacques Pirenne, Augusto Lauro, Gustaf Herlenius, Gabriel Gondolesi
Mihai Oltean1, Chiara Zanfi2, Laurens J. Ceulemans3, Pablo Farinelli4, Jacques Pirenne3, Augusto Lauro2, Gustaf Herlenius1, Gabriel Gondolesi4.
1The Transplant Center, Sahlgrenska University Hosptal, Gothenburg, Sweden; 2Liver and Multiorgan Transplant Center , St.Orsola University Hospital , Bologna, Italy; 3Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; 4Institute of Multiorgan Transplantation , Favaloro Foundation, Buenos Aires, Argentina
Background: For most organs, the criteria for acceptance as donor have been assessed, revised and expanded over the past decade. In contrast, intestinal donor characteristics are poorly studied and well-defined consensus guidelines for acceptance as intestinal donor are still missing.
M&M: We conducted an analysis of 139 organ donors accepted for intestinal procurement at four middle-sized intestinal transplant centers (Bologna, Gothenburg, Leuven, Buenos Aires-Favaloro). We analyzed donor age, cause of death, size matching, cold ischemia time (CIT) and preservation solution. We also compared if there were any changes in these donor –related variables profile before 2007 (first period, n=65) and from 2007 onwards (second period N=74).
Results: The overall 1 year graft survival was 74% with 75% in the first and 70% in the second period. For the entire cohort, median donor age was 17,5 (range 0,6-56) - median donor age for pediatric recipients (N=40) was 3,2 y whereas for adult recipients it was 25y (N=99). The most frequent cause of death was trauma followed by intracranial bleeding with no significant changes between periods. 35 % of the transplanted grafts contained the liver regardless of the period. We noted a significant decrease in donors’ median BMI (21,6 vs 19,1, p<0,01 ) and donor/recipient weight ratio [1,08 (0,36 -1,81) vs. 0,86 (range 0,28-1,8), p<0,01] after 2006.
Several preservation solutions were used: UW (N=69), Celsior (n=50), Custodiol (n=9), and IGL-1 (n=5). The longest CIT was 720 min for UW, 660 min for Custodiol, 535 min for Celsior and 870 min for IGL-1; all these grafts survived at least 1 year. Overall, median CIT was significantly longer after 2006 [330 min (range 90-705) vs. 422 min (139-870), p<0.01.]. The increase appeared on the expense of liver-free grafts.
Conclusions: The donors selected for intestinal procurement are still represented by “the ideal donors”: very young and lean. Over the past decade CIT increased without an obvious negative impact on the short term survival. A trend towards the use of smaller donors was noted - although this may have been due to changes in the indication spectrum (more recipients having short bowel syndrome and less having tumors or chronic intestinal pseudo-obstruction).
The contributing centers are part of the International Network for Intestinal Graft Monitoring and Analysis (INIGMA).
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