Search PubMed⌕ Search

Biomedical subjects

A P Oomen

Publications and source records attributed to A P Oomen.

18 recordsLinked to original sources
PubMed1998

Outcome of machine-perfused non-heart-beating donor kidneys, not allocated within the Eurotransplant area.

UNLABELLED: Eleven non-heart-beating (NHB) donor kidneys considered vital during machine perfusion (MP), could not be allocated inside Eurotransplant (ET). With the help of ET, five kidneys were transplanted in Karachi and six in Basel. Our goal was to prove that NHB kidneys successfully passing MP viability tests can be transplanted safely. METHODS: Donor age, serum creatinine (some post-mortem) and warm ischaemic time were, respectively, (mean and range): 44 (14-70) years, 137 mumol/l, and 44 (9-80) min. Reasons for refusal were: bold ureter (one), suboptimal flush (one), relatively long hypotensive phase (seven), and donor age of 70 years (two). After 8 h of MP, mean lactate dehydrogenase, intrarenal resistance and alpha glutathione S-transferase were (including range): 556 U/l (range 366-819 U/l), 0.86 mmHg/ml per min (0.41-1.15 mmHg/ml per min) and 1188 micrograms/l (575-2677 micrograms/l), respectively. Mean cold ischaemic time was 45 (range 28-72) h. RESULTS: Two kidneys showed immediate function, and nine showed delayed function. Mean creatinine levels after 1, 3 and 6 months were 295, 200 and 206 mumol/l, respectively. Four patients died for reasons not related to their kidney transplantation. CONCLUSIONS: We claim that MP can successfully assess viability of NHB donor kidneys. The reluctance to accept MP, and judged vital, NHB donor kidneys is not longer justified.

Adolescent↗
PubMed1997

Glutathione S-transferase as predictor of functional outcome in transplantation of machine-preserved non-heart-beating donor kidneys.

Non-heart-beating (NHB) donors are a valuable source of kidneys for transplantation. The organs, however, sustain substantial warm ischemic damage that may jeopardize the transplantability and result in nonfunction of the grafts. Quantification of warm ischemic time (WIT) and prediction of transplant outcome are essential for the use of NHB donor organs. During machine preservation (MP) the viability of NHB donor kidneys was evaluated through calculating intrarenal vascular resistance and determining lactate dehydrogenase and alpha-glutathione S-transferase (alphaGST) in the perfusate. Thirty-seven functioning (F) and nine nonfunctioning kidneys (NF) were compared. WIT was longer in NF; serum creatinine, donor age, and preservation time were not different. WIT correlated well with alphaGST after 4 and 8 hr of MP (r=0.353, P=0.009, and r=0.346, P=0.011, respectively). When compared with F, intrarenal vascular resistance was increased in NF after 4 and 8 hr of perfusion (P<0.05); at all time points, alphaGST levels were elevated in NF (P<0.05). Lactate dehydrogenase activity was not different between the groups, but could identify immediate functioning grafts within the F group. In conclusion, alphaGST levels correlated strongly with WIT and were also able to distinguish NF from F grafts. alphaGST can adequately predict the functional outcome of NHB donor grafts before transplantation; levels of alphaGST can be used to define reliable safety margins for viability. Therefore, MP is useful in evaluating the viability of NHB donor kidneys, and the parameters discussed will help to select nonviable grafts from this valuable pool of kidneys for transplantation.

Adult↗
PubMed1997

Effect of machine perfusion preservation on delayed graft function in non-heart-beating donor kidneys--early results.

The functioning of non-heart-beating (NHB) donor kidneys upon transplantation is often delayed. To evaluate the effect of preservation by machine perfusion (MP) on early post-transplant function, 37 NHB donor kidneys were compared to 74 matched heart-beating (HB) donor kidneys preserved by cold storage (CS). The NHB donor kidneys were subject to 49 +/- 34 min of warm ischemia. Delayed function (DF) and primary nonfunction (PNF) rates were significantly higher for NHB than for HB donor kidneys (49% and 19% vs 34% and 7%, respectively). Consequently, renal function was impaired but recovered within 6 months. MP could not eliminate the differences in DF rate between NHB and HB donor kidneys. However, NHB donor kidneys preserved by MP showed less DF than that reported in kidneys preserved by CS. This suggests that MP has a beneficial effect on ischemically damaged kidneys. The similar results observed with category 2 and category 3 NHB donors also suggest this effect. The high PNF rate emphasizes the need for viability tests that prevent the transplantation of nonviable organs. We conclude that MP alone is not sufficient to reduce DF and PNF rates in NHB donor kidneys.

Adult↗
PubMed1997

The potential pool of non-heart-beating kidney donors.

One of the ways to fight the growing organ shortage in transplantation is by procuring organs from non-heart-beating (NHB) donors. In order to determine the NHB kidney donor pool and evaluate its significance for renal transplantation, the potential is estimated in this study by retrospective death chart review. All 200 in-hospital deaths aged 3-65 yr reported at the University Hospital Maastricht in 1994, including 25 deaths at the Emergency Department (ED), were analyzed. After exclusion of deaths by computerized ICD-9-CM codes, 109 charts were abstracted and reviewed by experts. As a result a potential of eight brain dead, heart-beating (HB) donors and 56 NHB donors were identified. Medical suitability and logistic availability were scored in an attempt to quantify the likelihood of the donation to proceed towards successful organ procurement. These scores resulted in a range of potential NHB donors from 4.5 to 9.2 per 100 in-hospital deaths. Including rates of refusal to consent, as well as rates of technical failures, 24.0-49.6 kidneys were calculated to be realistically available annually, 2-4.5 times the projected number of kidneys from HB donors. With this increase of available grafts, at least growth of the renal waiting list would be prevented. This estimate shows that the potential of NHB kidney donors is large, and its impact on organ shortage would be considerable. Since 68% of potential NHB kidney donors, and also 70% of the medically most suitable donors, were found in ED, ICU, and CCU, focusing on these hospital units for implementation of routine procurement of kidneys from NHB donors is probably most effective. We therefore plead for the introduction of NHB kidney procurement protocols in EDs, ICUs, and CCUs.

Adolescent↗
PubMed1971

[Metastases?].

Explore the source record for details and available documents.

Aged↗
PubMedDate not supplied

The importance of non-heart-beating donor kidneys in reducing the organ shortage.

For over two decades kidney transplantation has been the treatment of choice for end-stage renal disease. Better immunosuppressive drugs with less side effects, superior infection control and sensitive methods detecting rejection episodes in an early phase are to be credited for these transplantation results. Besides improving quality of life of the recipient, kidney transplantation compared to dialysis is cost-effective.

Cost-Benefit Analysis↗