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Uncontrolled donation after cardiac death kidney transplantation: Opportunity to expand the donor pool?
1/7/2023CONCLUSION: Although initial allograft outcomes are inferior following uDCD, long-term durability of uDCD kidney allografts is on par to cDCD transplantation. Kidney allografts derived by uDCD may be a viable and durable option to increase the donor pool.
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Choledochoduodenostomy continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation
11/18/2022Debate continues as to whether choledochoduodenostomy (CDD) can be used instead of Roux-en-Y choledochojejunostomy (CDJ) when duct-to-duct (DTD) is not an option. We hypothesized that CDD and CDJ had similar rates of complications. All deceased-donor liver transplantations from September 2011 to March 2020 were categorized by biliary reconstruction. Primary outcomes were bleeding, bile leak, anastomotic stricture, and cholangitis. Of the 1,086 patients, 812 (74.8%) received a DTD; 225 (20.7%)...
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Can non-directed living liver donation help improve access to grafts and correct socioeconomic disparities in pediatric liver transplantation?
11/4/2022CONCLUSIONS: ND-LLD allows additional children to receive LTs and may help address some of the socioeconomic disparity in pediatric LDLT, but currently account for only a minority of LDLT and are only performed at a few institutions. Initiatives to improve access to both D-LLD and ND-LLD transplants are needed.
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Viscoelastic Management of Coagulopathy during the Perioperative Period of Liver Transplantation
11/1/2022Viscoelastic testing (VET) in liver transplantation (LT) has been used since its origin, in combination with standard laboratory testing (SLT). There are only a few, small, randomized controlled trials that demonstrated a reduction in transfusion rates using VET to guide coagulation management. Retrospective analyses contrasting VET to SLT have demonstrated mixed results, with a recent concern for overtreatment and the increase in postoperative thrombotic events. An oversight of many studies...
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Fibrinolysis Shutdown and Hypofibrinolysis Are Not Synonymous Terms: The Clinical Significance of Differentiating Low Fibrinolytic States
11/1/2022Low fibrinolytic activity has been associated with pathologic thrombosis and multiple-organ failure. Low fibrinolytic activity has two commonly associated terms, hypofibrinolysis and fibrinolysis shutdown. Hypofibrinolysis is a chronic state of lack of ability to generate an appropriate fibrinolytic response when anticipated. Fibrinolysis shutdown is the shutdown of fibrinolysis after systemic activation of the fibrinolytic system. There has been interchanging of these terms to describe...
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Tissue plasminogen activator resistance is an early predictor of posttraumatic venous thromboembolism: A prospective study from the CLOTT research group
10/27/2022CONCLUSION: Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.
We are a team of researchers led by Dr. Trevor Nydam where we study coagulation and how it can impair or heal organs after an injury.
Our Mission
Our mission is to train the next generation of physician-scientists and conduct high-impact research that improves the lives of organ transplant recipients!
Our research focuses on 3 main areas:
- Global Coagulation
- Ex Vivo Perfusion
- Microfluidics
We have been working on novel solutions to improve organ preservation and graft function while also investigating ways to manage deceased donors to increase availability, and improve organ function and long-term survival.
We are evaluating the mechanisms that drive fibrinolysis dysfunction in both the recipient and donor organ. At the same time, we are developing clinical expertise in advance organ recovery strategies. These include normothermic regional perfusion of the donor (extracorporeal perfusion of abdominal organs) and machine perfusion of the liver after it has been removed from the donor before implant in the donor. These research efforts will not only lead to increasing our graft survival but will also increase the number of organs utilized for transplantation.
Overall, these efforts have the potential to make a large impact on reducing the demand on organs in patients awaiting lifesaving transplants in the setting of end stage liver disease.