Technik der Multiorganentnahme

Zusammenfassung

Der Mangel an verfügbaren Organen zwingt zu einer Liberalisierung der Spenderkriterien und Verpflanzung von Organen marginaler Spender. Da gerade für die Beurteilung der Organqualität von Leber und Pankreas der makroskopische und palpatorische Aspekt eines erfahrenen Chirurgen Ausschlag gebend ist, sollte diese verantwortungsvolle Tätigkeit nicht unerfahrenen Kollegen überlassen werden. Eine Minimierung des chirurgischen Traumas durch Beschränkung der präparatorischen Schritte vor In-situ-Perfusion verbessert die Perfusionsqualität und gewährleistet eine möglichst uneingeschränkte initiale Organfunktion und besseres Langzeitüberleben des Transplantates.

Abstract

The decrease in the number of organ donors resulting in organ shortage has led to increasingly liberal selection criteria for organ donation and utilization of “marginal donors”. Because gross appearance seems to be the crucial criterion for quality assessment of abdominal organs, personal experience of the surgeon is essential. In addition, a safe, atraumatic and easy-to-perform procurement technique is a prerequisite for successful transplantation. Minimizing the surgical trauma prior to in-situ perfusion results in improved organ quality and subsequently in immediate initial function and improved long term graft survival.

Schlüsselwörter

Organentnahme - Technik - marginale Spender - Spenderauswahl

Key words

Abdominal organ procurement - technique - marginal donors - donor selection

Literatur

• 1 Cohen B, D'Amaro J, De Meester J, Persijn G. Changing patterns in organ transplantation in Eurotransplant.  Transpl Int. 1997;  10 1
• 2 Van der Werf W, D'Alessandro A, Hoffmann R, Knechtle S. Procurement, preservation, and transport of cadaver kidneys.  Surg Clin North Am. 1998;  78 41
• 3 Vanormelingen P, Dumont V, Lecomte C. et al . Eight grafts in seven patients from a single cadavar donor: a case report.  Transplant Proc. 1997;  29 3313
• 4 Strasberg S. Preservation injury and donor selection: it all starts here.  Liver Transpl Surg 1997. 1997;  3 (Suppl 1) 1
• 5 Sola R, Guirado L, Lopez Navidad A. et al . Renal transplantation with limit donors: to what should the good results obtained be attributed?.  Transplantation. 1998;  66 1159
• 6 Gruessner R, Sutherland D, Troppmann C. et al . The surgical risk of pancreas transplantation in the cyclosporine era: an overview.  Am Coll Surg. 1997;  185 128
• 7 Kapur S, Bonham C, Dodson S, Dvorchik I, Corry R. Strategies to expand the donor pool for pancreas transplantation.  Transplantation. 1999;  67 284
• 8 Malago M, Rogiers X, Hertl M, Bassas A, Burdelski M, Broelsch C. Optimization of the use of the cadaveric liver.  Transplant Proc. 1998;  30 3902
• 9 Glanemann M, Bechstein W, Muller A. et al . A liver with polycystic liver disease as graft for orthotopic liver transplantation.  Clin Transplant. 1998;  12 281
• 10 Stangou A, Heaton N, Rela M, Pepys M, Hawkins P, Williams R. Domino hepatic transplantation using the liver from a patient with familial amyloid polyneuropathy.  Transplantation. 1998;  65 1496
• 11 Lowell J, Taranto S, Singer G. et al . Transplant recipients as organ donors: the domino transplant.  Transplant Proc. 1997;  29 3392
• 12 Starzl T, Hakala T, Shaw B. et al . A flexible procedure for multiple cadaveric organ procurement.  Surg Gynecol Obstet. 1984;  158 223
• 13 Starzl T, Miller C, Broznick B, Makowka L. An improved technique for multiple organ harvesting.  Surg Gynecol Obstet. 1987;  165 343
• 14 Gubernatis G, Abendroth D, Haverich A. et al . Technique of multiple organ procurement.  Chirurg. 1988;  59 461
• 15 Margreiter R, Königsrainer A, Schmid T, Takahashi N, Pernthaler O, Öfner D. Multiple organ procurement - a simple and safe procedure.  Transplant Proc. 1991;  23 2307
• 16 Squifflet J, de Hemptinne B, Gianello P, Balladur P, Otte J, Alexandre G. A new technique for en block liver and pancreas removal.  Transplant Proc. 1990;  22 2070
• 17 Schemmer P, Schoonhoven R, Swenberg J, Bunzendahl H, Thurman R. Gentle in situ liver manipulation during organ harvest decreases survival after rat liver transplantation: role of Kupffer cells.  Transplantation. 1998;  65 1015
• 18 Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. Transplantation of one donor liver to two recipients (splitting transplantation) - a new method for further development of segmental liver transplantation.  Langenbecks Arch Chir. 1988;  373 127
• 19 Rogiers X, Malago M, Habib N. et al . In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients.  Transplantation. 1995;  59 1081
• 20 Collins G. What solutions are best? Overview of flush solutions.  Transplant Proc. 1997;  29 3543
• 21 Porte R, Ploeg R, Hansen B. et al . Long-term grafat survival after liver transplantation in the UW era: late effects of cold ischemia and primary dysfunction. European Multicentre Study Group.  Transplant Int. 1998;  11 (Suppl 1) 164
• 22 Hesse U, Troisi R, Jacobs B. et al . Cold preservation of the porcine pancreas with histidine-tryptophan-ketoglutarate solution.  Transplantation. 1998;  66 1137
• 23 Roels L, Coosemans W, Donck J. et al . Inferior outcome of cadaveric kidneys preserved for more than 24 hr in histidine-tryptophan-ketoglutarate solution. Leuven Collaborative Group for Transplantation.  Transplantation. 1998;  66 1660
• 24 Cavallari A, Cillo U, Nardo B. et al . A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation.  Liver Transpl. 2003;  9 814
• 25 Brandhorst H, Hering B J, Brandhorst D. et al . Comparison of histidine-tryptophane-ketoglutarate (HTK) and University of Wisconsin (UW) solution for pancreas perfusion prior to islet isolation, culture and transplantation.  Transplant Proc. 1995;  27 3175
• 26 Kotulski M, Pawlak J, Hevelke P, Krawczyk M. Assessment of early graft function in relation to different preservation fluids - preliminary results.  Ann Transplant. 2003;  8 31
• 27 D'Alessandro A M, Stratta R J, Sollinger H W, Kalayoglu M, Pirsch J D, Belzer F O. Use of UW solution in pancreas transplantation.  Diabetes. 1989;  38 (Suppl 1) 7
• 28 Mueller A R, Pascher A, Schulz R J. et al . Clinical small bowel transplantation: focus on mucosal barrier function.  Transplant Proc. 2002;  34 926
• 29 Mueller A R, Pascher A, Platz K P. et al . Modified surgical technique in clinical small bowel transplantation: donor and recipient management.  Transplant Proc. 2002;  34 2265
• 30 Furukawa H, Todo S, Reyes J, Abu-Elmagd K, Starzl T. Technical aspects of small bowel transplantation.  Current Opin Organ Transplant. 1998;  3 279