By Gabriel Oniscu, John Forsythe, John Fung
Presents transplant pros with a step-wise method of stomach organ retrieval and bench surgical procedure, illustrating complicated anatomical events and delivering perform issues and selection algorithms. A go-to reference for transplant surgeons, trainees and fellows, in addition to for different execs serious about stomach organ transplantation.
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Additional resources for Abdominal Organ Retrieval and Transplantation Bench Surgery
Sympathetic cardiovascular hyperactivity precedes brain death. Clin Auton Res 2010; 20(6):363–9. 15 Novitzky D, Cooper DKC, Rosendale JD, et al. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation 2006; 82(11):1396–401. 16 Ilmakunnas M, Höckerstedt K, Mäkiasalo H, et al. Hepatic IL-8 release during graft procurement is associated with impaired graft function after human liver transplantation. Clin Transplant 2010; 24:29–35. 17 Barklin A. Systemic inflammation in the brain-dead organ donor.
7). It is important to realize that we are on the verge of an exciting period during which we will learn how we can better monitor, match and condition donor organs, improving outcome after transplantation. Collaboration of all professionals in the field of donation and transplantation is a must, in order to advance our knowledge and make high quality transplantation sustainable in the future. Summary box Preservation strategies should maintain viability and allow rapid restoration of function: • Hypothermia, prevention of acidosis and oedema and neutralization of ROS are the main principles of organ preservation • Ten percent of the normal metabolic rate is maintained at 10°C • To provide an effective preservation, the solution has to contain macromolecular agents or impermeants, an adequate pH-buffer, a balanced electrolyte composition of Na and K and antioxidants • University of Wisconsin (UW) solution is the most commonly used preservation solution • Less than 10 L of HTK compromises the clinical outcome • Machine perfusion provides a better outcome than static cold perfusion in kidney transplantation • In situ normothermic regional perfusion is showing promising results for organ reconditioning in liver transplantation • Ex situ warm perfusion liver machines are undergoing clinical trials • Organs should be packed in three adequately sized bags 21 Abdominal Organ Retrieval and Transplantation Bench Surgery References 1 Moers C, Leuvenink HG, Ploeg RJ.
Recruitment manoeuvres are particularly important following apnoea testing, endotracheal suction or disconnection from the ventilator [4,5,30]. • Nurse patient 30 degrees head up • Limit tidal volume to 6–8 mL/kg predicted body weight. • Limit ventilatory plateau pressure to < 30 cm H2O • Avoid hyperoxia • Conservative fluid strategy Cardiovascular management Treatment of the rapid and dramatic changes around the time of brainstem death is challenging, and if attempted only short-acting drugs should be used due to the dynamic nature of the circulatory changes.
Abdominal Organ Retrieval and Transplantation Bench Surgery by Gabriel Oniscu, John Forsythe, John Fung