Transplantation proceedings
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Most donors in Japan have been non-heart-beating donors (NHBD), so-called "marginal donors." In Western countries kidney transplants from NHBD have also been increasing. We analyzed 120 kidneys harvested from NHBD with regard to organ procurement, renal function, graft survival, and the donor factors that affected graft survival. ⋯ Organ procurement without cannulation prior to cardiac arrest entailed a long WIT and a high DGF rate. However, the graft survival was good. It has been necessary to use grafts from NHBD despite the inherent risk factors. It is important to reduce kidney damage both at the organ procurement and during the posttransplant management.
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As the great majority of the population in Saudi Arabia is Muslim, the Islamic views about organ donation and transplantation have been the focus of interest to the transplant community in this and other Muslim countries. The first resolution of the Islamic council in Saudi Arabia (Senior Ulama Commission) about organ donation and transplantation was issued in 1982. It permitted tissue and organ transplantation from both living and cadaveric donors. ⋯ In addition, there have been many tissue donations of bone marrow, heart valves (264 hearts), skin, and bone. Despite the success of the Saudi program, there have been public and medical obstacles that have obviated the full benefit of cadaver donors. We suggest increasing the awareness of the medical community and the public at large to the importance of organ donation and transplantation.
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In the year 2001, cadaveric kidney and liver transplant rates (CadTx) in countries with well-established transplant programs such as the United States and Spain ranged from 51 to 61.9 and 18.7 to 31.3 per million population (pmp), respectively. However, overall kidney and liver transplant rates in Asia are significantly lower at 4.3 and 0.3 pmp, respectively. Improving CadTx rates to meet the needs of organ failure patients poses several unique challenges in Asia. ⋯ Broadening donor criteria as with the use of expanded criteria donors, including non-heart-beating and older donors, may further improve cadaveric donation rates by as much as 20%. Finally, ethical transplant practices that prohibit trade in organs will promote an environment conducive to cadaveric donation. Together with efforts to increase living donor TX transplant rates, it is hoped that these measures will increase the supply of organs so as to meet the needs of organ failure patients in Asia.
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Ischemia-reperfusion (I/R) injury is unavoidable in cadaveric renal transplantation. It contributes to acute rejection and chronic allograft dysfunction. Studies have shown that Ligustrazine, a purified and chemically identified component of a Chinese herbal remedy, is a potent blocker of vasoconstriction and has strong effects to scavenge oxygen free radicals. Since warm I/R is potentially more damaging than cold storage, we investigated the possible protective effect of Ligustrazine on warm I/R in mice. ⋯ These findings suggest that Ligustrazine reduces the renal dysfunction associated with warm I/R of the kidney.
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Some groups have reported early extubation post-liver transplantation in patients with previously defined criteria, in an attempt to shorten the ICU stay and decrease costs. We review our experience with trends in mechanical ventilation and resource utilization. ⋯ We demonstrate improved results, decreased length of mechanical ventilation, ICU, and hospital stay, and costs. The immediate postoperative extubation may be feasible for patients who meet previously defined criteria.