Introduction: The utilization of organs from donors following circulatory death, has greatly expanded the donor pool; however, organ preservation strategies for those receiving multiorgan transplantation is not well described in the current DCD era. We present 4 patients who received heart, liver, and kidney transplants from a single center institution utilizing contemporary technology including NRP and organ care systems (OCS).

Objective: Hepatic arterial reconstruction, remains controversial during liver surgery. This study assesses the utility, and safety of hepatic arterial reconstruction during liver resection for malignancy. Methods: 30 patients undergoing liver resection with hepatic arterial reconstruction between 2000 and 2016 were reviewed. Median patient age was 54 years. Resections were carried out for cholangiocarcinoma in 18 patients, gallbladder adenocarcinoma in 9 and recurrent adenocarcinoma and recurrent hepatocellular carcinoma in two and one patient respectively. Resections performed were left trisectionectomy (8) right trisectionectomy (7), left hepatectomy (7) segment 4B, 5 (4) and right hepatectomy (4). Arterial reconstructions performed were : Proper hepatic artery (PHA) to PHA (7), PHA to Right HA (RHA) (6), common HA to PHA (5), Replaced RHA to Replaced RHA (4), RHA to right posterior HA (3), PHA to left HA (1) , left HA to RHA (1) and gastroduodenal to RHA (2) or LHA (1). 27 patients had resection of the extrahepatic bile duct with 8 patients also requiring pancreaticoduodenectomy. Portal vein resection was required in 7 patients. Results: There was a 3 %, 90 day operative mortality with the single death from liver dysfunction. All vascular reconstructions were patent at 30 days. Overall morbidity was 46%. Median survival was 35 months (95% CI, 13–60 months) with a five-year actuarial survival of 21%. Negative margins were achieved in 85% of cases. Conclusion: Resection of the hepatic artery during liver resection can be performed safely. Long term survival is possible.

BACKGROUND: To improve outcomes of expanded criteria donor (ECD) kidneys, prior studies matched donors to recipients according to recipient weight or donor kidney size. This study hypothesizes that matching donors to recipients based on Cockcroft-Gault estimates of creatinine clearance can improve outcomes in ECD kidney transplants compared to predictions based on size matching or donor creatinine clearance alone. METHODS: Recipients of ECD kidneys in the Scientific Registry of Transplant Recipients (SRTR) who were transplanted from October 1, 1987 to August 31, 2011 were included. The estimated creatinine clearance ratio (CCMR) was calculated as the estimated recipient creatinine clearance based on manipulations of the Cockcroft-Gault equation utilizing donor creatinine clearance at the time of transplant. Univariate and multivariate analyses predicted the hazard ratio of graft failure and the odds ratio of requiring dialysis within the first week. The CCMR was compared to the kidney donor risk index (KDRI) and recipient-to-donor weight and age ratios using discrimination analyses. RESULTS: 25,640 ECD kidney transplants were analyzed. On multivariate analysis, higher CCMR was associated with increased graft failure and odds of requiring dialysis within the first week (comparing highest ratio quintile versus lowest ratio quintile: HR 1.53, p<0.001; OR 2.18, p<0.001). CCMR was found to be superior in prediction and discrimination ability as compared to donor creatinine clearance, recipient/donor age ratio, and recipient/donor weight ratio. CONCLUSION: ECD kidneys have improved outcomes when the donor/recipient creatinine clearance match ratio is optimal.

Heilman, R.; Davarapalli, Y.; Chakkera, H.; Mekeel, K.; Moss, A.; Williams, J.; Hamawi, K.; Mazur, M.; Mulligan, D.; Reddy, K. Author Information