Circulating CXCL10 and IL-6 in solid organ donors after brain death predict graft outcomes

We tested the hypothesis that circulating CXCL10 and IL-6 in donor after brain death provide independent additional predictors of graft outcome. From January 1, 2010 to June 30, 2012 all donors after brain death managed by the NITp (n = 1100) were prospectively included in this study. CXCL10 and IL-6 were measured on serum collected for the crossmatch at the beginning of the observation period. Graft outcome in recipients who received kidney (n = 1325, follow-up 4.9 years), liver (n = 815, follow-up 4.3 years) and heart (n = 272, follow-up 5 years) was evaluated. Both CXCL-10 and IL-6 showed increased concentration in donors after brain death. The intensive care unit stay, the hemodynamic instability, the cause of death, the presence of risk factors for cardiovascular disease and the presence of ongoing infection resulted as significant determinants of IL-6 and CXCL10 donor concentrations. Both cytokines resulted as independent predictors of Immediate Graft Function. Donor IL-6 or CXCL10 were associated with graft failure after liver transplant, and acted as predictors of recipient survival after kidney, liver and heart transplantation. Serum donor IL-6 and CXCL10 concentration can provide independent incremental prediction of graft outcome among recipients followed according to standard clinical practice.

A clinical case of the successful VAC therapy in a patient with surgical wound infection after kidney transplantation

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.

Organ Donation after Cardiac Death in the Pediatric Patient

The need for organ transplantation is ever increasing. Currently there are 115,000 people on the waitlist and the number is still growing. Organs that are transplanted may be obtained via a living or deceased donor. The organs may be obtained from a deceased donor after either brain death or after cardiac death. The majority of deceased donor organ transplants occur via deceased donor after brain death; however, deceased donor after cardiac death organ donation is increasing. This concept of organ transplantation can be quite difficult to discuss with families, therefore, the anesthesiologist and the entire care team must be knowledgeable and respectful regarding the patient’s and families wishes. The team should also be familiar with the overall process and organ procurement protocols of the institution. By having respectful, thoughtful, early discussions regarding the potential for organ donation, families will be able to make better informed decisions.

Brain Death and Resuscitation of the Organ Donor

When is a patient brain dead? Under what scenarios in the surgical intensive care unit is brain death a possibility? Who can declare brain death and how? What are the steps after brain death declaration? You will find answers to all of these and more in this review. We will walk you through the principles, prerequisites, and techniques of clinical brain death evaluation using checklists and videos. The role and interpretation of ancillary testing and pitfalls are also discussed. New in this section is a description of the techniques that can be adapted when a patient is on extracorporeal membrane oxygenation. In addition, we have included a section on how to communicate effectively (i.e., what phrases to use) with families while discussing brain death and thereby avoid conflicts. We conclude with a detailed section on the physiology and critical care of the potential organ donor after brain death. This review contains 2 videos, 8 figures, 3 tables and 21 references Key words: Brain death, Apnea testing, ECMO, Organ donation