M. Aycart, M. Alhefzi, G. Sharma, N. Krezdorn, E. Bueno, S. Talbot, M. Carty, S. Tullius, B. Pomahac
{"title":"2560:同时获得实体器官和带血管的复合同种异体移植后实体器官移植的结果:一项全国性分析","authors":"M. Aycart, M. Alhefzi, G. Sharma, N. Krezdorn, E. Bueno, S. Talbot, M. Carty, S. Tullius, B. Pomahac","doi":"10.1080/23723505.2016.1234221","DOIUrl":null,"url":null,"abstract":"2560: Outcomes of solid organ transplants following simultaneous solid organ and vascularized composite allograft procurements: A nationwide analysis Mario A. Aycart, MD, Muayyad Alhefzi, MD, Gaurav Sharma, MD, Nicco Krezdorn, MD, Ericka M. Bueno, PhD, Simon G. Talbot, MD, Matthew J. Carty, MD, Stefan G. Tullius, MD, PhD, and Bohdan Pomahac, MD Brigham and Women’s Hospital, Boston, MA, USA Background Current knowledge of the impact of facial vascularized composite allograft (VCA) procurement on the transplantation outcomes of the concomitantly recovered solid organs is limited to isolated case reports and short-term results. Here we report on a nationwide analysis of facial allograft donor surgery experience and long-term outcomes of the concomitantly recovered solid organs and their recipients. Methods There were 10 facial VCA procurements between December 2008 and October 2014. We identified the population of subjects who received solid organs from these 10 donors using the Scientific Registry of Transplant Recipients. We retrospectively reviewed operative characteristics, intra-operative parameters, and postoperative outcomes. Results Six of 10 donor surgeries were performed at outside institutions, all on brain-dead donors. Mean operative duration for facial VCA recovery was 69 hours (range 4 – 1325 hours). A total of 36 solid organs were recovered and transplanted into 35 recipients. Survival rates for kidney and liver recipients were 100 and 90% at a median follow-up of 33 and 275 months, respectively (range, 6–72 months). Graft survival rates for kidneys and livers were 15/16 (94%) and 9/10 (90%), respectively. Recipient and graft survival rates for hearts and lungs were 75% (nD 4) and 100% (nD 3) at mean follow-up time of 1475 and 16 months, respectively. Conclusions The advent and continued progress of vascularized composite allotransplantation has ushered in a new clinical arena in the field of transplantation. Critical to its advancement is the planning and safe execution of the donor procurement. Despite logistical and technical variation, we show that the procurement of facial VCA and simultaneous upper extremities does not appear to adversely affect the outcomes of transplant recipients of concomitantly recovered solid organs. Excellent coordination and communication between the organ recovery teams remains paramount with guidance and support from the respective organ procurement organization. CONTACT Mario A. Aycart maycart@partners.org © 2016 Mario A. Aycart, Muayyad Alhefzi, Gaurav Sharma, Nicco Krezdorn, Ericka M. Bueno, Simon G. Talbot, Matthew J. Carty, Stefan G. Tullius, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. 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Aycart, MD, Muayyad Alhefzi, MD, Gaurav Sharma, MD, Nicco Krezdorn, MD, Ericka M. Bueno, PhD, Simon G. Talbot, MD, Matthew J. Carty, MD, Stefan G. Tullius, MD, PhD, and Bohdan Pomahac, MD Brigham and Women’s Hospital, Boston, MA, USA Background Current knowledge of the impact of facial vascularized composite allograft (VCA) procurement on the transplantation outcomes of the concomitantly recovered solid organs is limited to isolated case reports and short-term results. Here we report on a nationwide analysis of facial allograft donor surgery experience and long-term outcomes of the concomitantly recovered solid organs and their recipients. Methods There were 10 facial VCA procurements between December 2008 and October 2014. We identified the population of subjects who received solid organs from these 10 donors using the Scientific Registry of Transplant Recipients. We retrospectively reviewed operative characteristics, intra-operative parameters, and postoperative outcomes. Results Six of 10 donor surgeries were performed at outside institutions, all on brain-dead donors. Mean operative duration for facial VCA recovery was 69 hours (range 4 – 1325 hours). A total of 36 solid organs were recovered and transplanted into 35 recipients. Survival rates for kidney and liver recipients were 100 and 90% at a median follow-up of 33 and 275 months, respectively (range, 6–72 months). Graft survival rates for kidneys and livers were 15/16 (94%) and 9/10 (90%), respectively. Recipient and graft survival rates for hearts and lungs were 75% (nD 4) and 100% (nD 3) at mean follow-up time of 1475 and 16 months, respectively. Conclusions The advent and continued progress of vascularized composite allotransplantation has ushered in a new clinical arena in the field of transplantation. Critical to its advancement is the planning and safe execution of the donor procurement. Despite logistical and technical variation, we show that the procurement of facial VCA and simultaneous upper extremities does not appear to adversely affect the outcomes of transplant recipients of concomitantly recovered solid organs. Excellent coordination and communication between the organ recovery teams remains paramount with guidance and support from the respective organ procurement organization. CONTACT Mario A. Aycart maycart@partners.org © 2016 Mario A. Aycart, Muayyad Alhefzi, Gaurav Sharma, Nicco Krezdorn, Ericka M. Bueno, Simon G. Talbot, Matthew J. Carty, Stefan G. Tullius, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. 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引用次数: 0
摘要
2560:同时获得实体器官和带血管的复合同种异体移植后实体器官移植的结果:全国范围的分析Mario A. Aycart, MD, Muayyad Alhefzi, Gaurav Sharma, MD, Nicco Krezdorn, MD, Ericka M. Bueno,博士,Simon G. Talbot, MD, Matthew J. Carty, MD, Stefan G. Tullius, MD, MD Brigham and Women 's Hospital, Boston, MA。目前关于面部血管化复合同种异体移植物(VCA)获取对伴随实体器官恢复的移植结果的影响的知识仅限于个别病例报告和短期结果。在这里,我们报告了一项全国范围内的面部异体移植供体手术经验和伴随恢复的实体器官及其受体的长期结果分析。方法2008年12月至2014年10月共10例面部VCA采购。我们使用移植受者科学登记系统确定了从这10位捐赠者那里接受实体器官的受试者群体。我们回顾性地回顾了手术特点、术中参数和术后结果。结果10例供体手术中6例在境外机构进行,均为脑死亡供体。面部VCA恢复的平均手术时间为69小时(范围4 - 1325小时)。共有36个实体器官被恢复并移植到35个受者身上。肾脏和肝脏受体的存活率分别为100%和90%,中位随访时间为33个月和275个月(范围6-72个月)。移植肾和肝的存活率分别为15/16(94%)和9/10(90%)。在平均随访1475个月和16个月时,心脏和肺的受体和移植物存活率分别为75% (nD 4)和100% (nD 3)。结论带血管复合异体移植的出现和不断发展,为移植领域开辟了一个新的临床领域。对其推进至关重要的是捐助者采购的规划和安全执行。尽管在后勤和技术上存在差异,但我们表明,面部VCA和同时上肢的获取似乎不会对同时恢复实体器官的移植受者的结果产生不利影响。在各自器官采购组织的指导和支持下,器官回收小组之间的良好协调和沟通仍然至关重要。联系Mario A. Aycart maycart@partners.org©2016 Mario A. Aycart, Muayyad Alhefzi, Gaurav Sharma, Nicco Krezdorn, Ericka M. Bueno, Simon G. Talbot, Matthew J. Carty, Stefan G. Tullius和Bohdan Pomahac。由Taylor & Francis授权出版。这是一篇在知识共享署名-非商业许可(http://creativecommons.org/licenses/by-nc/3.0/)条款下发布的开放获取文章,该许可允许在任何媒体上不受限制的非商业使用、分发和复制,前提是正确引用原始作品。指定作者的精神权利得到了维护。血管化复合异体移植,2016,VOL. 3, no . 1-2, 51 http://dx.doi.org/10.1080/23723505.2016.1234221
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2560: Outcomes of solid organ transplants following simultaneous solid organ and vascularized composite allograft procurements: A nationwide analysis
2560: Outcomes of solid organ transplants following simultaneous solid organ and vascularized composite allograft procurements: A nationwide analysis Mario A. Aycart, MD, Muayyad Alhefzi, MD, Gaurav Sharma, MD, Nicco Krezdorn, MD, Ericka M. Bueno, PhD, Simon G. Talbot, MD, Matthew J. Carty, MD, Stefan G. Tullius, MD, PhD, and Bohdan Pomahac, MD Brigham and Women’s Hospital, Boston, MA, USA Background Current knowledge of the impact of facial vascularized composite allograft (VCA) procurement on the transplantation outcomes of the concomitantly recovered solid organs is limited to isolated case reports and short-term results. Here we report on a nationwide analysis of facial allograft donor surgery experience and long-term outcomes of the concomitantly recovered solid organs and their recipients. Methods There were 10 facial VCA procurements between December 2008 and October 2014. We identified the population of subjects who received solid organs from these 10 donors using the Scientific Registry of Transplant Recipients. We retrospectively reviewed operative characteristics, intra-operative parameters, and postoperative outcomes. Results Six of 10 donor surgeries were performed at outside institutions, all on brain-dead donors. Mean operative duration for facial VCA recovery was 69 hours (range 4 – 1325 hours). A total of 36 solid organs were recovered and transplanted into 35 recipients. Survival rates for kidney and liver recipients were 100 and 90% at a median follow-up of 33 and 275 months, respectively (range, 6–72 months). Graft survival rates for kidneys and livers were 15/16 (94%) and 9/10 (90%), respectively. Recipient and graft survival rates for hearts and lungs were 75% (nD 4) and 100% (nD 3) at mean follow-up time of 1475 and 16 months, respectively. Conclusions The advent and continued progress of vascularized composite allotransplantation has ushered in a new clinical arena in the field of transplantation. Critical to its advancement is the planning and safe execution of the donor procurement. Despite logistical and technical variation, we show that the procurement of facial VCA and simultaneous upper extremities does not appear to adversely affect the outcomes of transplant recipients of concomitantly recovered solid organs. Excellent coordination and communication between the organ recovery teams remains paramount with guidance and support from the respective organ procurement organization. CONTACT Mario A. Aycart maycart@partners.org © 2016 Mario A. Aycart, Muayyad Alhefzi, Gaurav Sharma, Nicco Krezdorn, Ericka M. Bueno, Simon G. Talbot, Matthew J. Carty, Stefan G. Tullius, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. VASCULARIZED COMPOSITE ALLOTRANSPLANTATION 2016, VOL. 3, NOS. 1–2, 51 http://dx.doi.org/10.1080/23723505.2016.1234221