Transcript Prof. Dr Milana Popović

TRANSPLANTACIJA BUBREGA KOD DECE
Centar za dijalizu i transplantaciju
“Prof. dr Milana Popović-Rolović”
Pedijatrijska nefrologija i
urologija
Univerzitetska dečja klinika
Cenatr za hemodijalizu i transplantaciju
“Prof. Dr Milana Popović-Rolović”
31 godina
hemodijalize
25 godina
transplantacije
30 godina Centra za hemodijalizu i transplantaciju
“Prof. Dr Milana Popović-Rolović”
Prva hemodijaliza 10. januar 1980. godine
30 godina Centra za hemodijalizu i transplantaciju
“Prof. Dr Milana Popović-Rolović”




Prva bikarbonatna
hemodijaliza 1986. godine
Prva hemodijafiltracija 2002.
godine
Prva hemofiltracija 2004.
godine
Prva kontinuirana terapija
zamene bubrežne funkcije
2004. godine
30 godina Centra za hemodijalizu i
transplantaciju
“Prof. Dr Milana Popović-Rolović”
Broj hemodijaliza: 116 293
468 505 sati dijalize
53 godine dijalize

Broj dijaliziranih bolesnika: 331
Broj transplantiranih bolesnika: 120
36,3% ukupnog broja dece lečene dijalizom
 U inostranstvu transplantirano 50,1%
 U zemlji transplantirano 49,9% (od čega 91,5% na UDK)
Danas




Broj mesta za hemodijalizu: 7
Broj aparata za hemodijalizu: 9
Aparata za kontinuiranu
zamenu bubrežne funkcije i
plazmaferezu (Prizma): 2
Aparata za albuminsku dijalizu
(MARS): 1
30 godina Centra za hemodijalizu i transplantaciju
“Prof. Dr Milana Popović-Rolović”
Prva transplantacija bubrega na UDK 1986. godine
21. mart 1986. godine
30 godina Centra za hemodijalizu i transplantaciju
“Prof. Dr Milana Popović-Rolović”


Transplantacija bubrega postaje rutinska metoda lečenja
na UDK 2001. godine
Prva kadaverična transplantacija bubrega na UDK 2004.
godine


Mortalitet dece na dijalizi je 30-150 puta veći
nego u opštoj dečjoj populaciji
Procenjena dužina života dece uzrasta od 0-14
god. je dvadeset godina od započinjanja dijalize
(US renal data system 2004)

Preživljavanje dece svih uzrasta nakon transplantacije
je značajno bolje nego na dijalizi
preživljavanje 5 god.
 transplantiranih bolesnika je 94%-97%
 na dijalizi 75%-87%
Transplantacije bubrega učinjene na UDK od 2001-2011 godine
Godina
živi srodni davaoci
kadaverični davaoc
Svega
2001
3
0
3
2002
4
0
4
2003
3
0
3
2004
2
1
3
2005
7
1
8
2006
4
1
5
2007
3
1
4
2008
8
1
9
2009
4
1
5
2010
0
6
6
2011
5
1
6
ukupno
43
13
56
Napomena: navedeni podaci se odnose na transplantacije koje su urađene samo na UDK od 2001. godine
do danas. Dopunjeni podaci.

preemptivna transplantacija čini 24% (2003, US)
76,5%
80,0%
70,0%
60,0%
50,0%
40,0%
30,0%
23,4%
preemptivna
D 3g1m
20,0%
10,0%
0,0%
UDK
2001-2008
Children's Hospital of Wisconsin in Milwaukee,
serving Wisconsin, Northern Illinois and
Michigan's Upper Peninsula and beyond through
nationally-recognized programs
Hospital locations: Milwaukee and Fox Valley
Report any problems or comments about this Web site to [email protected].
Terms of Use and Privacy Policies. © 2011 Children's Hospital and Health System
eHealthcare Leadership Award
Median time on wait list
Why we measure it –

Generally, shorter wait times to transplant result
in better outcomes. Shorter wait times mean
patients generally are healthier, have fewer
complications and experience fewer deaths
while waiting.
What this means - Children's Hospital has shorter median wait times to transplant for
heart and kidney transplants than the national median.
About the data - These data reflect the number of months patients waited for
pediatric kidney transplants and pediatric heart transplants
compared to the national median. The national comparison data include all adult
and pediatric transplant centers.
uzrast bolesnika u vreme transplantacije
50,0%
Distribucija transplantiranih bolesnika po
uzrastu u vreme transplantacije
50,0%
43,3%
45,0%
6
40,0%
Broj bolesnika
5
35,0%
>12 g.
4
30,0%
6-12 g.
3
25,0%
2
20,0%
1
15,0%
0
10,0%
1
3
5
7
9
11
13
Uzrast (godine)
15
17
19
5,0%
2-5 g.
<2 g.
6,7%
0,0%
0,0%
UDK2001-2008
Transplant by age

Why we measure it - Pediatric transplant
programs should be able to care for
children of all ages from the smallest
infants to full-grown young adults.
What this means - Our talents and resources allow us to take care of any age child,
which shows the breadth and depth of our program.
About the data - These data show the breakdown of pediatric kidney transplant and pediatric heart transplant
patients by age from 2001 through 2008.
P rež ivljavanje trans plantiranih boles nika na U D K
K um ulativno
prež ivljavanje
(4 3 b o le s n ik a , 2 0 0 1 -2 0 0 9 )
1
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0
0,96
0
12
24
36
48
Me se c i
60
72
84
96
Survival - kidney transplant

Why we measure it - Overwhelmingly,
survival is the first and most
important statistic parents and others ask
about. In general, centers that have high
survival rates for the most complex cases,
including transplants, generally have high
survival rates for all types of kidney
transplants.
What this means - Survival at one month, one year and three years is 100 percent for
kidney transplant patients from 2002 through 2009.
About the data - These data reflect survival rates for pediatric kidney transplant patients
from 2002 through 2009 for the first 1,200 days after transplant.
These data are publicly reported to the Scientific Registry of Transplant Recipients for benchmarking purposes.
Preživljavanje grafta
1 god-87%
5 god-78%
C um . S urvival
G raft s urvival
1
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0
0
10
20
30
40
50
Months
C umulative s urvival probability

5 god. za sve graftove 78%


1 god. je 95% a 5 god. 83% za graftove sa živih donora
1 god. je 91% a 5 god. 73% za kadaverične graftove
60
Graft survival - kidney transplant
Children's Hospital of Wisconsin in Milwaukee,
serving Wisconsin, Northern Illinois and
Michigan's Upper Peninsula and beyond through
nationally-recognized programs
Hospital locations: Milwaukee and Fox Valley
Report any problems or comments about this Web site to [email protected].
Terms of Use and Privacy Policies. © 2011 Children's Hospital and Health System
eHealthcare Leadership Award

Why we measure it - Graft survival
indicates the proportion of transplanted
kidneys that continue to function well
enough that the patient does not need
dialysis.
AWhat this means - Graft survival is 100 percent for one month and one year post transplant
and 85 percent for three years post transplant for patients transplanted from 2003 to 2005.
Children's Hospital consistently has a higher graft survival than that reported for children nationally.
About the data - The graft survival data table reflects the graft survival for pediatric kidney transplant patients
from 2003 through June 2008, as specified in the table, for the timeframes of one month,
one year and three years post transplant.
These data are publicly reported to the United Network for Organ Sharing
and Scientific Registry of Transplant Recipients for benchmarking purposes.
P rež ivljavanje g rafta kod boles nika s a T T < 20 kg
K um ulativno
prež ivljavanje
u v re m e tra n s p la n ta c ije
1
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0
0,90
0
12
24
36
48
Me se c i
60
72
84
Preživljavanje grafta kod bolesnika sa TT > 20 kg u vreme
K u m u lativn o
p rež ivljavan j
e
tr a n s p la n ta c ije
1
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,10
0,87
0
12
0,76
24
36
48
Meseci
60
72
84
96
Aktuelne prosečne vrednosti sCr
140
Aktuelna prosečna vrednost ClCr
124
90
80
77
63
100
70
ClCr (ml/min/1.73m2)
80
80
60
40
20
0
<20 kg
60
50
40
30
20
>20 kg
10
Telesna težina (grupe bolesnika)
0
<20 kg
Aktuelne prosečne vrednosti Cys C
1,6
1,49
1,41
1,4
1,2
Cystatin C (mg/l)
Serumski kreatinin (umol/l)
120
1
0,8
0,6
0,4
0,2
0
<20 kg
>20 kg
Telesna tež ina (grupe bolesnika)
>20 kg
Telesna težina (grupe bolesnika)
Children's Hospital of Wisconsin in Milwaukee,
serving Wisconsin, Northern Illinois and
Michigan's Upper Peninsula and beyond through
nationally-recognized programs
Hospital locations: Milwaukee and Fox Valley
Report any problems or comments about this Web site to [email protected].
Terms of Use and Privacy Policies. © 2011 Children's Hospital and Health System
eHealthcare Leadership Award
Why we measure it –
We realize the importance of not having a child
stay in the hospital any longer than necessary.
The time a child is in the hospital depends on
many factors including how serious the illness or
injury. Medical therapies can have a significant
impact on recovery and length of hospital stay.
What this means - Patients receiving a heart transplant typically stay in the hospital less
than one month post-transplant. Patients receiving a kidney transplant stay one week or less.
About the data - These data represent the median number of inpatient days
post transplant stratified by organ type. National standards for length of stay do not
currently exist for pediatric solid organ transplants.
Overview of the Pediatric Kidney Transplant Program

Since 1986, Children's Hospital of Wisconsin has been offering new hope for children with chronic kidney
failure through the Kidney Transplant Program. We have performed more than 165 kidney transplants.

The Kidney Transplant Program strives to provide the best quality of life for children suffering from kidney
diseases. Out goal is to assist you in understanding the care, medical issues and treatment options for
kidney disease and the steps involoved in kidney tranplantation.

Our pediatric kidney transplant team has a track record of performing unique, successful kidney
transplants, such as heart-kidney, liver-kidney, bone marrow-liver-kidney. We perform transplants using
donors who are relatives of the child; living nonrelatives; and deceased donors. We also collaborate with
recipient pairs and highly human leukocyte antigen (HLA) sensitized donors. For some patients this can
alleviate the long wait for a kidney.

An indicator of quality of life for our patients, we are pround to report that 100 percent of patients return
to school about a month after transplant.

The United Network for Organ Sharing (UNOS) is the private, nonprofit organization that manages the
nation's organ transplant system under contract with the federal government. They provide up-to-date
information on transplant trends including the number of children waiting for a liver transplant in the United
States.
bolesnik
Operator dr
anastomoza
komplikacije
Vukašinović S
Krstić, Vukanić
v.r.+ račva VCI TL
a.r.+a.iIiaca int. TT
limfocela
Milovančević A
Xavier, Krstić
v.r.+VCI. TL
a.r.+A
TL
Tešnjak H
Krstić, Borić
v.r.+v.iliaca ext.
a.r.+a.iliacaI ext.
Gugleta M
Krstić, Sretenović
v.r.+v.iliaca.com.
a.r.+a.iliaca int.
Nikolić S
Bretto, Krstić
v.r.+kolater.
TL
a.r.+a.iliaca ext. TL
Alavanja S
El Mekresh, Krstić
v.r.+VCI
a.r.+A
TL
TL
disproporcija
Pekeč N
El Mekresh, Krstić
v.r.+VCI
a.r.+A
TL
TL
limfocela
Jasnić B
Borić, Krstić
v.r.+v. ilca ext. TL
a.r.+ a. hipogas. TT
Miljković V
Krstić, Borić
v.r.+v.iliaca.ext. TL
a.r.+a.iliaca int. TT
TL
TL
limfocela
TL
TT
kinking
period
HD
Tx
zemlja
inostr.
1980-05
236
80
(33,8%)
28
(35%)
52
(65%)
2005
26
9
(34,6%)
7
(77,8%)
2
(22,3%)
2006
18
6
(33,3%)
5
(83,3%)
1
(16,7%)
2007
14
5
(35,7%)
4
(80%)
1
(20%)
2008
14
9
(64,3%)
9
(100%)
0
2009
12
6
(50%)
5
(83%)
1
(17%)
Broj dece koja su transplantirana na UDK od 2001. godine do danas je 55 (kod jednog
deteta na UDK rađena retransplantacija).
Transplantacije bubrega učinjene u inostranim centrima od 2001-2011 godine
Godina
živi srodni davaoci
kadaverični davaoc
Svega
2001
1
1
2
2002
1
1
2
2003
2
3
5
2004
0
2
2
2005
1
2
3
2006
0
1
1
2007
0
3
3
2008
0
0
0
2009
1
1
2
2010
0
2
2
2011
0
1
1
ukupno
6
17
23
Većina transplantacija obavljenih u inostranim centrima su bile kadaverične, najveći
broj u Italiji i to u skladu sa It.8 konvencijom.
Transplantacija jetre
Pediatric Liver Transplant Program





Program inception: May 1988.
First successful liver and lung transplant in the United States in 1995.
Patient mortality and graft survival better than national average.
Youngest patient – 3 weeks old.
Successful transplants for Maple Syrup Urine Disease and other metabolic
liver diseases.
Children's Hospital of Wisconsin in Milwaukee,
serving Wisconsin, Northern Illinois and
Michigan's Upper Peninsula and beyond through
nationally-recognized programs
Hospital locations: Milwaukee and Fox Valley
Report any problems or comments about this Web site to [email protected].
Terms of Use and Privacy Policies. © 2011 Children's Hospital and Health System
eHealthcare Leadership Award
Overview of Pediatric Liver Transplant Program

A liver transplant may be the best and only alternative for children and their families who have
exhausted other approaches to the treatment of severe liver disease.

Children's Hospital of Wisconsin's Pediatric Liver Transplant Program provides medical care to
pediatric patients before and after transplant. As the largest pediatric liver transplant center in
Wisconsin, we follow the most children with liver disease in the state. We have performed 100
liver transplants.

Children's Hospital is the only center in the Midwest with three board-certified or board-eligible
pediatric transplant hepatologists.

Liver transplants offer an acceptable treatment for many forms of end-stage liver disease. Liver
transplants performed include live donor, in which a healthy person donates a part of his or her
liver, deceased donor, and split and reduced liver transplants, which involve use of an organ
from a cadaver. Families dealing with the overwhelming nature of a chronic childhood disease need
innovative care and strong integrated support.

The experts at Children's Hospital of Wisconsin are leaders in the field of pediatric liver
transplantation and will work with your child and entire family to ensure the best outcomes possible.
Our highly skilled multidisciplinary team develops pre- and post-transplant treatment options for our
patients.
The experts at Children's Hospital of Wisconsin are leaders in the field of pediatric liver transplantation and
will work with your child and entire family to ensure the best outcomes possible. Our highly skilled
multidisciplinary team develops pre- and post-transplant treatment options for our patients.

Our specialists includes:

Pediatric transplant surgeons specialize in liver and kidney
transplants and perform the surgery.
Pediatric hepatologists specialize in the care of children with
end-stage liver disease before and after surgery.
Pediatric anesthesiologists play an important role during
transplant surgery. They have a special interest in children
and have special training in pediatrics.
Transplant coordinators are instrumental in the
management of care for these children and the education of
their families before, during and after surgery.
Social workers provide individual as well as family
counseling and support.
Pediatric dietitians help keep patients nourished before a
transplant and during the recovery phase.
Pediatric nurse clinicians experienced in caring for liver
transplant recipients provide excellent care and help parents
understand the daily care of their child, including medication
management and overall well-being.






Children's Hospital of Wisconsin in Milwaukee,
serving Wisconsin, Northern Illinois and
Michigan's Upper Peninsula and beyond through
nationally-recognized programs
Hospital locations: Milwaukee and Fox Valley
Report any problems or comments about this Web site to [email protected].
Terms of Use and Privacy Policies. © 2011 Children's Hospital and Health System
eHealthcare Leadership Award
Transplantacija srca
Highlights and milestones
Pediatric Heart Transplant Program

Program inception – December 1990.

Availability of extracorporal membrane oxygenation (ECMO) and state of the art pulsatile
mechanical support.

Linked to one of the top ten pediatric heart programs in the nation, Children's Hospital of
Wisconsin's Herma Heart Center.

Recent actuarial survival analysis demonstrates excellent results with most patients having no
limitations to normal childhood activities.

Youngest patient – 7 days old. Longest survivor is 12 years old and thriving.

Pioneered the systematic use of the virtual crossmatch for sensitized pediatric heart transplant
recipients.

In 2006, The Pediatric Heart Failure program was developed to promote early recognition and
optimize care of children with advanced pediatric heart failure who may need transplantation
services.
Overview of Pediatric Heart Transplant Program

Decades of experience in mending children's hearts stands behind our heart transplant
program. Children's Hospital of Wisconsin is one of the country's top pediatric
cardiothoracic surgery centers with more than 725 cases per year.

Our surgical programs have consistently demonstrated one of the lowest mortality rates in
the country for children with complex congenital heart disease and have been leading
the world in staged repair strategies for hypoplastic left heart syndrome.

The Heart Transplant Program at Children's Hospital draws on this wealth of knowledge
and experience. Children's Hospital of Wisconsin was ranked as the fourth busiest
hospital in the nation for pediatric heart transplantations (UNOS 2006). Over the past
few years, our pediatric heart transplant program has seen rapid growth in volume with
tremendous success. Since Jan 2004, the pediatric heart transplant program has:

Performed 32 cardiac transplants with 95 percent overall survival.





Performed five ABO incompatible transplants.
Bridged eight recipients to transplant with use of The Berlin Heart ventricular assist
device.
Performed one multi-organ and one cardiac retransplant.
Pioneered the use of the Virtual Crossmatch to decrease wait times in highly sensitized
patients.
Developed a comprehensive program in pediatric heart failure.
A team of pediatric cardiology and transplant experts

Everyone involved in the care of transplant patients, from pharmacy to consultants, is experienced in managing complex heart cases.
This experienced team approach optimizes outcomes.
The heart transplant team members include specialists in:

Cardiothoracic Surgeons.

Cardiology.

Critical Care Intensivists.

Infectious Disease.

Pathology.

Immunology.

Anesthesiology.

Pulmonary Medicine.

Nephrology.

Pharmacy.

Dialysis.

Nursing.

Child Life specialists.

Psychology.

Social Work.

The team is dedicated to ensuring open lines of communication as well as consistent and compassionate care. Referring physicians
and family members have easy access to the entire transplant team.

Surgeons affiliated with the Medical College of Wisconsin collaborate closely on treatment and follow-up with Infectious Disease and
the Herma Heart Center playing major roles. Herma Heart Center's eight board-certified pediatric cardiologists have more experience
with congenital heart defects and heart disease in children than any other pediatric group in the region.

Quality Reports - Solid Organ
Transplant
Volume - overall
Why we measure it - Research shows that
physicians and hospitals that treat a large
number of patients tend to provide‚better
care and have improved outcomes for
treatments and procedures. This is
especially true of transplants.
What this means - Children's Hospital of Wisconsin has had steady numbers of solid organ
transplants from 2004 through 2008.
About the data - These data reflects the number of pediatric kidney transplants and pediatric
heart transplants performed between 2004 and 2008.
Transplant by age

Why we measure it - Pediatric transplant
programs should be able to care for
children of all ages from the smallest
infants to full-grown young adults.
What this means - Our talents and resources allow us to take care of any age child,
which shows the breadth and depth of our program.
About the data - These data show the breakdown of pediatric kidney transplant and pediatric heart transplant
patients by age from 2001 through 2008.
Median time on wait list
Why we measure it –

Generally, shorter wait times to transplant result
in better outcomes. Shorter wait times mean
patients generally are healthier, have fewer
complications and experience fewer deaths
while waiting.
What this means - Children's Hospital has shorter median wait times to transplant for
heart and kidney transplants than the national median.
About the data - These data reflect the number of months patients waited for
pediatric kidney transplants and pediatric heart transplants
compared to the national median. The national comparison data include all adult
and pediatric transplant centers.
Why we measure it –
We realize the importance of not having a child
stay in the hospital any longer than necessary.
The time a child is in the hospital depends on
many factors including how serious the illness or
injury. Medical therapies can have a significant
impact on recovery and length of hospital stay.
What this means - Patients receiving a heart transplant typically stay in the hospital less
than one month post-transplant. Patients receiving a kidney transplant stay one week or less.
About the data - These data represent the median number of inpatient days
post transplant stratified by organ type. National standards for length of stay do not
currently exist for pediatric solid organ transplants.
Survival - heart transplant

Why we measure it - Overwhelmingly,
survival is the first and most important statistic
parents and others ask about. In
general, centers that have high survival rates for
the most complex cases, including transplants,
generally have high survival rates for all types of
heart procedures.
What this means - Children's Hospital's Herma Heart Center
has a consistently high early survival rate for all
children undergoing heart surgery.
About the data - These data reflect survival rates
for pediatric heart transplant patients from 2002 through
2009 for the first 1,200 days after transplant.
These data are publicly reported to the Scientific Registry of
Transplant Recipients for benchmarking purposes.
What we're doing to provide the best care:

Our 72-bed Pediatric Intensive Care Unit is staffed by board-certified and pediatric-trained critical
care specialists and anesthesiologists.

We have a core team of specialists and a dedicated cardiac critical care unit to care for children
undergoing heart transplants.

Each patient has a transplant coordinator who closely manages the care before and after surgery

Children's Hospital's Solid Organ Transplant Program ranks in the top 25 percent of pediatric
transplant programs for volume.

Heart and kidney transplant patients have access to pediatric PT/OT, speech and rehabilitation specialists
to enhance and speed recovery. A dedicated pediatric psychologist, pharmacist, social worker and child
life specialist consistently are involved to help children and families through the transplant process and
facilitate the transition to home, school and work.

Pre-transplant care management is provided by the transplant team and may be
coordinated with the referring physician and treatment program in the child's home
community or at Children's Hospital of Wisconsin depending on the needs and health
status of the child. An interdisciplinary review committee meets regularly to
evaluate all transplant candidates.

Before and after transplant, the hospital's premier pediatric intensive care unit
(PICU) provides 24-hour critical care coverage. The PICU is staffed by Pediatric
Critical Care Intensivists with consultation available in all pediatric specialties. Not all
transplant patients need this level of intensive care post transplant.

Post-transplant care management is essential for good outcomes.
Comprehensive specialty support well equips Children's Hospital of Wisconsin to
meet the long-term challenges of managing transplant patients. Over the years, our
team members have gained invaluable experience in minimizing rejection issues while
maximizing quality of life.
Family Accommodations Program






Children's Hospital of Wisconsin understands that traveling with a sick child to a
new city can be stressful. In order to make your stay at Children's Hospital as easy
as possible, we have developed a program that helps out-of-town families
coordinate their lodging arrangements in Milwaukee.
Lodging
Hotels
Ronald McDonald House information
Transportation
Local attractions
Patients/Families:

Take a virtual tour of Children's Hospital, which will help prepare you and your child for
a hospital stay.

Be an advocate for your child. Participate in daily bedside clinical discussions, and
provide any information about your child that may be helpful to staff.

Follow medical instructions fully and carefully before and after surgery.

Ask questions if you don't understand the plan of care or if you are not sure how to care
for your child at home.

Attend any and all follow-up appointments.
Children's Hospital and Health System Foundation
 Gifts to the foundation support the many programs and services for
children and families provided through Children's Hospital and Health
System member organizations. Your donation can support patient care
programs, professional and community education, advocacy for the
health and safety of children, and pediatric research.
Your gifts support:
 Children's Hospital of Wisconsin.
 Children's Hospital of Wisconsin-Fox Valley.
 Children's Health Education Center.
 Children's Service Society of Wisconsin.
Special fundraising initiatives:
 Child Abuse Prevention Fund.
 Max McGee National Research Center for Juvenile Diabetes.

Children's Hospital of Wisconsin offers the following transplant
programs:

Pediatric Liver Transplant Program.
Pediatric Heart Transplant Program.
Pediatric Kidney Transplant Program.
Pediatric Blood and Marrow Transplant Program.





The solid organ transplant programs at Children's Hospital of
Wisconsin are certified by the United Network for Organ Sharing.
The Blood and Marrow Transplant Program is accredited by the
Foundation for the Accreditation of Cellular Therapy.
Curr Cardiol Rev. 2010 February; 6(1): 46–53.
Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart
Transplantation
Avihu Z Gazit,1,3* Sanjiv K Gandhi,2 and Charles C Canter3
1Division of Pediatric Critical Care, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA
2Division of Pediatric Cardiothoracic Surgery, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA
3Division of Pediatric Cardiology, Saint Louis Children’s Hospital, Washington University School of Medicine, St Louis, Mo., USA



Most pediatric patients listed for heart transplantation eventually require a high level of
cardiac support before transplantation.
Unfortunately, due to the limited availability of donors, only 500 children worldwide undergo
cardiac transplantation yearly, and mortality while awaiting a suitable organ exceeds 20% .
This situation has led to increased interest in mechanical circulatory support (MCS) as a
bridge to transplantation or recovery in the pediatric age group
An artificial heart



mechanical device that replaces the heart.
Artificial hearts are typically used to bridge
the time to heart transplantation, or to
permanently replace the heart in case
transplantation is impossible.
Although other similar inventions preceded
it going back to the late 1940's, some used
successfully on dogs, the first artificial
heart to be successfully implanted in a
human, was the Jarvik-7, designed by
Robert Jarvik and implemented in 1982.
The first two patients to receive these
hearts, Barney Clark and William
Schroeder, survived 112 and 620 days
beyond their surgeries...respectively.
An artificial heart displayed
at the London science museum
Mechanical heart patient on 'revolutionary' treatment
2 AUGUST 2011 LAST UPDATED AT 12:13 GMT
A 40-YEAR-OLD MAN HAS BECOME THE FIRST BRITISH PATIENT TO RECEIVE A COMPLETELY ARTIFICIAL HEART.
MATTHEW GREEN WILL BE ABLE TO TO LEAD A MORE NORMAL LIFE WHILE HE WAITS FOR A LIVE TRANSPLANT.
WHOLE ARTIFICIAL HEARTS HAVE BEEN IMPLANTED IN SEVERAL HUNDRED PEOPLE IN THE UNITED STATES,
BUT THE OPERATION HAS ONLY JUST BEEN LICENSED IN THE UK.
Mechanical Circulatory Support

MCS is utilized in children with acute congestive heart failure associated with congenital
heart disease, cardiomyopathy, and myocarditis, both as a bridge to transplantation and as
a bridge to myocardial recovery.

The current arsenal of mechanical assist devices available for children is limited to:






ECMO,
intra-aortic balloon counterpulsation,
centrifugal pump ventricular assist devices,
the DeBakey ventricular assist device Child;
the Thoratec ventricular assist device;
Berlin Heart VAD (Berlin Heart AG, Berlin, Germany)
Mechanical Circulatory Support

Pediatric MCS in the United States has been limited until recently to:

ECMO,

Bio-pump (Medtronic Bio-Medicus, Minneapolis, Minnesota),

adult systems adapted for pediatric support.
New devices in the United States available for children are the
-implantable MicroMed DeBakey VAD Child (MicroMed Cardiovascular, Inc., Houston, Texas)
-Berlin Heart VAD (Berlin Heart AG, Berlin, Germany)


In the spring of 2004, five contracts were awarded by the National Heart, Lung and Blood Institute
to support preclinical development for a range of pediatric ventricular assist devices and similar
circulatory support systems.
These 5-years programs were awarded on March 30, 2004 and include the:

PediaFlow VAD (University of Pittsburgh),

PediPump (The Cleveland Clinic Foundation),

Pediatric Cardiopulmonary Assist System (Ension, Inc),

Pediatric Jarvik 2000 (Jarvik Heart), and the

Pediatric Ventricular Assist Device (Penn State).
Proc Inst Mech Eng H. 2011 Jul;225(7):648-56.
A simple, economical, and effective portable paediatric mock circulatory system.
Vandenberghe S, Shu F, Arnold DK, Antaki JF.
Source
Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
[email protected]
Abstract
Ventricular assist devices (VADs) and total artificial hearts have been in development for the last 50 years. Since
their inception, simulators of the circulation with different degrees of complexity have been produced to test these
devices in vitro. Currently, a new path has been taken with the extensive efforts to develop paediatric VADs, which
require totally different design constraints. This paper presents the manufacturing details of an economical
simulator of the systemic paediatric circulation. This simulator allows the insertion of a paediatric VAD,
includes a pumping ventricle, and is adjustable within the paediatric range. Rather than focusing on complexity
and physiological simulation, this simulator is designed to be simple and practical for rapid device testing. The
simulator was instrumented with medical sensors and data were acquired under different conditions with and
without the new PediaFlowTM paediatric VAD. The VAD was run at different impeller speeds while simulator
settings such as vascular resistance and stroke volume were varied. The hydraulic performance of the VAD under
pulsatile conditions could be characterized and the magnetic suspension could be tested via manipulations such
as cannula clamping. This compact mock loop has proven to be valuable throughout the PediaFlow development
process and has the advantage that it is uncomplicated and can be manufactured cheaply. It can be produced by
several research groups and the results of different VADs can then be compared easily
SHORT-TERM MCS
1. ECMO


ECMO is an effective rescue device, it is generally limited to short-term use (less than a month), requires the
patient’s immobilization, precludes rehabilitation, and is associated with multiple potential complications including major
bleeding and neurological sequelae.
Based on the 2006 ECLS registry report, the mortality rate in pediatric patients supported by ECMO was
approximately 60%. This rate has been consistent over the last two decades.
2. BioMedicus Centrifugal Pump (BCP)


The BCP (Medtronic BioMedicus, Eden Prairie, MN, USA) is a constant speed, nonpulsatile device which can
be used in children of all ages.
Compared with roller pumps, there is less hemolysis and less significant inflammatory response
ECMO or biventricular BCP are required if right sided failure is observed during this assessment. Advantages of left
BCP over ECMO in those children with pure LV failure is its relative ease of use, fast set-up time, low priming volume,
and low-level anticoagulation
3. Intra-Aortic Balloon Counterpulsation (IABP)



Its clinical efficacy in adults with left ventricular failure was established
Its use in children remains limited due to technical considerations related to small patient and blood vessel size
Biventricular support which cannot be achieved with IABP, leads to its limited use in pediatric patients
LONG TERM MCS

1. Adult Systems Used for Pediatric Support


Heartmate VAD
Thoratec VAD (Thoratec Corp., Pleasanton, CA)

These adult FDA approved extracorporeal MCS devices have been used successfully in older
children whose body surface area is greater than 1.4 m2

A retrospective multicenter study conducted by Reinhartz and colleagues in children and
adolescents supported with the Thoratec VAD (November 1982 until December 1999) revealed
overall favorable outcomes. 58 patients in 27 centers worldwide were studied.




Their mean age was 13.8 years (range, 7-17 years), and mean weight and body surface area were 51.6 kg
(range, 17 to 93 kg) and 1.5 m2 (range, 0.7-2.1 m2), respectively.
Overall survival in this cohort (71%) was similar to survival in adults supported by this device (58%71.6%) with a comparable average duration of support.
Statistical analysis exposed congenital heart disease as a strong independent risk factor for death.
Another concerning finding was that 27% of the subjects had neurologic complications, substantially
higher than the 5-12% neurological complications in adults supported by the Thoratec VAD.
LONG TERM MCS
2.The Micromed DeBakey VAD Child (Micromed Technology Inc., Houston TX,
USA)

The DeBakey VAD Child system consists of four subsystems:

implantable pump system,

external controller system,

external Clinical Data Acquisition System and

external Patient Home Support System.
The blood pump, intended to provide mechanical assistance to the failing left ventricle,

DeBakey VAD Child was authorized by the U.S. FDA (February 2004) for use in

providing temporary left side mechanical circulatory support as a bridge to heart transplantation for
pediatric patients (5-16 yeas old, with BSA > 0.7 m2 and < 1.5 m2) who are in NYHA Class IV end
stage heart failure, are refractory to medical therapy, and who are listed for heart transplantation.

Its use in children has been limited to date.

A recent report by Fraser et al. summarized a single center experience of 6 patients with the DeBakey
VAD Child. The average age of the patients was 11 years (range, 6 to 15 years) with a BSA of 0.8 to
1.7 m2. The average duration of support was 39 days, with 84 days being the longest duration
of support. Three of these patients were successfully transplanted, whereas three died during support
before transplantation.
3. Pneumatic Pulsatile Pediatric VADs-The Berlin Heart EXCOR and Medos HIA




These extracorporeal systems have provided successful MCS in children of all ages.
They provide a long term bridge to heart transplantation while allowing extubation, ambulation, and active physical
therapy, unlike ECMO or centrifugal pump VADs.
The Berlin Heart VAD (Berlin Heart AG, Berlin, Germany) consists of a paracorporeal, pneumatically driven pump. The
available biventricular operating modes are synchronous, where both ventricles are filled and emptied in concert,
asynchronous, where one ventricle is filled while the other is emptied, and separate, where each ventricle is cycling
independently.
While the Berlin Heart EXCOR system has been used successfully in Europe since 1991, the U.S. FDA has only recently
approved the use of the Berlin Heart EXCOR Pediatric VAD under a limited investigational device exemption in the USA.
The Berlin Heart VAD (Berlin Heart AG, Berlin, Germany) consists
of a paracorporeal, pneumatically driven pump.
The pump is made of a translucent, semirigid housing of polyurethane
divided into a blood
chamber and an air chamber by a three layer flexible
This picture illustrates the RVAD and LVAD cannulae. The order of the
cannulae, from right to left, is right atrial outflow,
pulmonary artery inflow, aortic inflow and left ventricular outflow
Pneumatic Pulsatile Pediatric VADs-The Berlin Heart EXCOR

Over 160 childre have now been supported by this device in North America through September
2008. The device has been used in over 30 US medical centers.

According to the Berlin Heart Institute’s results for the Berlin Heart Excor, between January 1990 and
June 2006, 11 children out of 74 were weaned off the device. In the era between October 2000 and June
2006, 8 out of 34 children were weaned and 18 underwent heart transplantation. No child died after
weaning
Liver support systems

Due to the scarcity of donor organs, liver support technologies are being developed to
support patients with severe liver failure until either an organ becomes available for
transplantation or their livers recover from injury.

Early devices including

hemodialysis,

hemoperfusion,

exchange transfusion,

cross-hemodialysis,

cross-circulation and

plasmapheresis
appeared inefficient.
Liver support systems today

Bioartificial liver support systems
use either

porcine hepatocytes or

human hepatoma cell lines housed within a hollow-fiber bioreactor.
The system perfuses the patient's whole blood or separated plasma through the
luminal space in the bioreactor.



Theoretically, these methods should optimally resemble normal hepatic tissue structure
and function.
However, the existing bioartificial systems are far from ideal solution in terms of
immunological, infectological, oncological and financial problems and must still be thought
of as experimental.
The artificial systems are already available for the clinicians in limited quantities.
Liver support systems today

non-cell-based devices
These systems include the

hemodiabsorption (Liver Dialysis Unit) which is commercially available in the United
States,

the albumin dialysis which is available in Europe

The simple method of albumin dialysis is "single pass albumin dialysis" (SPAD), which
evolved into the so-called

"molecular adsorbent recirculating system"(MARS).

and the newly developed fractionated plasma separation and adsorption (FPSA) system.

Prometheus system combines the FPSA method with high-flux hemodialysis.
These non-cell-based devices are intended to remove protein-bound and watersoluble toxins without providing synthetic function, which can be partially replaced
with substitution of the failing substances (plasma proteins, coagulation factors).
MARS: Molecular adsorbent recirculating system;
FPSA: Fractionated plasma separation and adsorption;
SPAD: Single-pass albumin dialysis.
HepaWash: hemodiabsorption
Regenerative therapy

Cell-based regenerative therapy currently emerges as one of the most promising
methods for treating cardiac disease.

Regenerative therapy by the direct injection of dissociated cells has been clinically
performed, and the modest therapeutic efficacies are confirmed.

tissue engineering is viewed as a new generational cell therapy for cardiac disease

Tissue engineering is currently based on concepts that three-dimensional (3D)
scaffolds are used as an alternative for extracellular matrix (ECM), and cells are
seeded into the scaffolds.

Cell sheet-based tissue engineering has been applied for the regenerative medicine of
several tissues including myocardial, corneal epithelial, esophageal, lung, liver, pancreatic,
thyroidal, and periodontal tissue . In some tissues, clinical trials have been started.

The transplantation of engineered myocardial tissue grafts improves damaged
heart functions in animal models, and clinical trials have already started.

The transplantation of myocardial
tissue fabricated by cell sheet-based
tissue engineering is a quite different
cell delivery method from cell injection,
and previous studies show promising and
powerful potentials for curing damaged
heart in several animal models

Scaffold-free cell sheet-based tissue
engineering is realized to be very
useful for fabricating electrically
communicative and pulsatile 3D
myocardial tissue both in vitro and in
vivo.

Cell sheet-based tissue engineering has
promising and enormous potentials to
cure many patients suffering from severe
cardiac disease
Cardiol Res Pract. 2011; 2011: 845170.
Published online 2011 October 6. doi: 10.4061/2011/845170
November 15, 2011

Stem cells give new hope to heart attack
survivors
"There is promising news for people at risk of heart
failure after US researchers found stem cell herapy
in humans has been surprisingly successful in
replacing damaged muscle and getting the heart t
pump better.“





Active Research
We are actively enrolling patients in studies
using stem cells for the treatment of:
Heart Failure
Heart Attacks
Peripheral Vascular Disease
The Stem Cell Center of the Texas Heart Institute at St.
Luke’s Episcopal Hospital in Houston, Texas is actively
recruiting patients for FDA-approved clinical studies
investigating the use of adult stem cells in treating
heart failure

Chronic liver disease (CLD) is increasing worldwide yet there has been no major advance in
effective therapies for almost five decades.

At present orthotopic liver transplantation is the only therapeutic option for patients with
acute and chronic ESLDs.

Liver transplantation, however, has the disadvantage of requiring lifelong
immunosuppression and followup,

10–15% of patients dying whilst on the waiting list due to the shortage of donated
organs.

In 2005, only one-third of patients waiting for a liver transplant were transplanted.

With the number of donor organs likely to decrease over the coming decades, research into
the alternative methods of treatment of whole-organ transplant is essential.





Hepatocyte transplantation (HT) has been performed in patients with liver-based
metabolic disease and acute liver failure as a potential alternative to liver
transplantation.
The results are encouraging in genetic liver conditions where HT can replace
the missing enzyme or protein.
However, there are limitations to the technique, which need to be overcome.
Encapsulation of hepatocytes allows cells to be transplanted intraperitoneally in
acute liver failure with the advantage of avoiding immunosuppression.
Alternative sources of hepatocytes, which could be derived from stem cells,
are needed. Mesenchymal stem cells are currently being investigated
particularly for their hepatotropic effects.
Transplantation. 2011 Nov 11.
Current Status of Hepatocyte Transplantation.
Hughes RD, Mitry RR, Dhawan A.
Source
Institute of Liver Studies, King's College London School
of Medicine at King's College Hospital, London, United Kingdom.
Transplantation. 2009 Mar 15;87(5):636-41.
One liver for four children: first clinical series of liver cell transplantation for severe neonatal urea cycle defects.
Meyburg J, Das AM, Hoerster F, Lindner M, Kriegbaum H, Engelmann G, Schmidt J, Ott M, Pettenazzo A, Luecke T, Bertram H, Hoffmann GF, Burlina A.
Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany. [email protected]
Abstract

BACKGROUND:

Urea cycle disorders (UCD) have a poor prognosis despite dietary and pharmacologic therapy, especially if the
onset of the disease is within the neonatal period. They are promising target diseases for liver cell transplantation
(LCT), which may be a less invasive alternative or supplementation to orthotopic liver transplantation.

METHODS:

Cryopreserved hepatocytes were isolated under good manufacturing practice conditions. Four children with
severe neonatal UCD (age 1 day-3 years) received multiple intraportal infusions of cryopreserved
hepatocytes from that same donor, a 9-day old neonate. Portal vein access was achieved surgically in two
children, whereas the umbilical vein was suitable for interventional catheter placement in two neonates. Cell
applications were carefully monitored by means of Doppler ultrasound and portal vein pressure.

RESULTS:

LCT was feasible in all children. No signs of portal vein thrombosis or extrahepatic shunting were observed. All
children showed metabolic stabilization during observation periods of 4 to 13 months. One child with
prenatally diagnosed ornithine transcarbamylase deficiency died after 4 months from a fatal metabolic
decompensation.

CONCLUSIONS:

Given the poor prognosis of UCD with conservative therapy, LCT caused considerable beneficial effects. Periods
of hyperammonemia and clinically relevant crises could be reduced during an observation period of up to 13
months. Though cell therapy is not a permanent therapeutic option, bridging to liver transplantation may be
substantially improved.

Recently, induced pluripotent stem (iPS) cells, derived from the reprogramming of
somatic fibroblasts, have been shown to resemble embryonic stem (ES) cells in that
they have pluripotent properties and the potential to differentiate into all cell lineages in vitro,
including hepatocytes.

rapid and efficient differentiation protocol that is able to generate functional hepatocyte-like
cells from human iPS cells. This may offer an alternative option for treatment of liver
diseases.
Hepatology. 2011 Nov 16. doi: 10.1002/hep.24790. [Epub ahead of print]
Rapid generation of mature hepatocyte-like cells from human induced
pluripotent stem cells by an efficient three-step protocol.
Chen YF, Tseng CY, Wang HW, Kuo HC, Yang VW, Lee OK.
Department of Medical Research and Education, Taipei Veterans General
Hospital, Taiwan; Stem Cell Research Center, National Yang-Ming University, Taiwan.

This study demonstrated the safety and short-term efficacy of autologous bone
marrow-derived mesenchymal stem cell injection in liver cell failure.
Further study is necessary to standardize the cell dose, determine the life span of the injected cells,
and detect the appearance of long-term complications
Eur J Gastroenterol Hepatol. 2011 Oct;23(10):936-41.
Clinical and laboratory evaluation of patients with end-stage liver cell failure
injected with bone marrow-derived hepatocyte-like cells.
Amer ME, El-Sayed SZ, El-Kheir WA, Gabr H, Gomaa AA, El-Noomani N, Hegazy M.
Department of Tropical Medicine, Al-Azhar University, Domeat, Eygpt.
Handchir Mikrochir Plast Chir. 2010 Dec;42(6):337-41. Epub 2010 Apr 19.
[Hepatic tissue engineering].
Fiegel HC, Kneser U, Kluth D, Rolle U.
Source-Goethe Universität Frankfurt, Kinderchirurgie, Theodor-Stern-Kai
7, Frankfurt.





tissue engineering based cell transplantation is currently under investigation with the
aim to replace liver tissue and function.
The principle of tissue engineering is the notion of an interaction between a cell and a threedimensional matrix.
system for heterotopic hepatocyte transplantation on polymeric matrices was
developed in an animal model.
In this transplantation model a long-term proliferation and function of transplanted
hepatocytes was shown.
The major limitation of matrix-based transplantation systems is the high initial cell loss,
most probably due to an insufficient vascularisation.
regenerative therapy

present study was designed to develop a cell sheet-based hepatocyte co-culture
system that enables cultured hepatocytes to preserve their functions for a longer
period of time.


To achieve this goal, a monolayer cell sheet composed of endothelial cells (EC) was placed on top of
a monolayer of hepatocytes (Hep). In this hybrid cell sheet format, histological examination revealed
that bile canaliculi networks were formed and well developed among the hepatocytes in the layered
Hep-EC sheet group.
this culture system provides a valuable technology to prolong hepatocyte
functionality and enable more efficient development of liver tissue engineering
approaches to create liver-targeted regenerative therapies.
Biomaterials. 2011 Nov 23. [Epub ahead of print]
Preserved liver-specific functions of hepatocytes in 3D co-culture
with endothelial cell sheets.
Kim K, Ohashi K, Utoh R, Kano K, Okano T.
Institute of Advanced Biomedical Engineering and Science, Tokyo
Women's Medical University, Japan.



cell-based liver directed therapies, e.g. liver tissue engineering should permit (i)
expansion of cells in an in vitro phase, (ii) genetic or immunological manipulation of cells for
transplantation, (iii) tissue typing and cryopreservation in a cell bank, and (iv) the ex vivo
genetic modification of patient's own cells prior re-implantation.
Function and differentiation of liver cells are influenced by the three-dimensional organ
architecture.
Based on bioreactor technology, bioartificial liver devices (BAL) are
developed for extracorporeal liver support.
J Cell Mol Med. 2008 Jan-Feb;12(1):56-66. Epub 2007 Nov 16.
Hepatic tissue engineering: from transplantation to customized cell-based liver
directed therapies from the laboratory.
Fiegel HC, Kaufmann PM, Bruns H, Kluth D, Horch RE, Vacanti JP, Kneser U.
Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
Curr Opin Biotechnol. 2009 Oct;20(5):575-92. Epub 2009 Nov 5.
Engineering organs.
Atala A.
Source
Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27157, USA. [email protected]
Abstract




Applications of regenerative medicine technology may offer novel therapies for patients with injuries,
end-stage organ failure, or other clinical problems.
Currently, patients suffering from diseased and injured organs can be treated with transplanted organs.
However, there is a severe shortage of donor organs that is worsening yearly as the population ages and
new cases of organ failure increase.
Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of
cell transplantation, material science, and bioengineering to construct biological substitutes that will restore
and maintain normal function in diseased and injured tissues.
The stem cell field is also advancing rapidly, opening new avenues for this type of therapy. For example,
therapeutic cloning and cellular reprogramming may one day provide a potentially limitless source of
cells for tissue engineering applications. Although stem cells are still in the research phase, some therapies
arising from tissue engineering endeavors have already entered the clinical setting successfully, indicating
the promise regenerative medicine holds for the future.
Transpl Int. 2011 Mar;24(3):223-32. doi: 10.1111/j.1432-2277.2010.01182.x. Epub 2010 Nov 10.
Regenerative medicine as applied to solid organ transplantation: current status and future
challenges.
Orlando G, Baptista P, Birchall M, De Coppi P, Farney A, Guimaraes-Souza NK, Opara E, Rogers J, Seliktar D, Shapira-Schweitzer K, Stratta RJ,
Atala A, Wood KJ, Soker S.
Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
[email protected]
Abstract
In the last two decades, regenerative medicine has shown the potential for "bench-tobedside" translational research in specific clinical settings. Progress made in cell and stem
cell biology, material sciences and tissue engineering enabled researchers to develop
cutting-edge technology which has lead to the creation of monocular tissue constructs
such as skin, bladders, vessels and upper airways. In all cases, autologous cells were
seeded on either artificial or natural supporting scaffolds. However, such constructs were
implanted without the reconstruction of the vascular supply, and the nutrients and oxygen
were supplied by diffusion from adjacent tissues. Engineering of modular organs (namely,
organs organized in functioning units referred to as modules and requiring the reconstruction
of the vascular supply) is more complex and challenging. Models of functioning hearts and
livers have been engineered using "natural tissue" scaffolds and efforts are underway to
produce kidneys, pancreata and small intestine. Creation of custom-made bioengineered
organs, where the cellular component is exquisitely autologous and have an internal vascular
network, will theoretically overcome the two major hurdles in transplantation, namely the
shortage of organs and the toxicity deriving from lifelong immunosuppression. This review
describes recent advances in the engineering of several key tissues and organs
Tissue Eng Part A. 2010 August; 16(8): 2441–2455. Published online
2010 April 27. doi: 10.1089/ten.tea.2009.0548PMCID:
PMC2947461Copyright 2010, Mary Ann Liebert, Inc.
Constructing Kidney-like Tissues from
Cells Based on Programs for Organ
Development: Toward a Method of In
Vitro Tissue Engineering of the Kidney
Eran Rosines, Ph.D.,1,* Kohei Johkura, M.D.,2,* Xing Zhang, Ph.D.,2 Heidi
J. Schmidt, M.S.,1 Marvalyn DeCambre, M.D.,2 Kevin T. Bush,
Ph.D.,2 and Sanjay K. Nigam, M.D.2,3,4,5
1Department of Bioengineering, University of California, San Diego, La
Jolla, California.
2Department of Medicine, University of California, San Diego, La Jolla,
California.
3Department of Pediatrics, University of California, San Diego, La Jolla,
California.
4Department of Cellular and Molecular Medicine, University of California,
San Diego, La Jolla, California.
5Department of John and Rebecca Moores UCSD Cancer Center,
University of California, San Diego, La Jolla, California.
Taken together with prior work (Rosines et al., 2007; Steer et al., 2002),
these results support the plausibility of a developmental strategy for constructing
and propagating vascularized 3D kidney-like tissues from recombinations of
cultured renal progenitor cells and/or primordial tissue.
Examination of engineered kidney tissue 37 days
after implantation under the renal capsule of a kidney
in a nude mouse. (a, b). Hematoxylin and eosin
stained section through the host kidney and implanted
kidney tissue. (c–i) Confocal fluorescent
3D structure important for renal function.
E13 rat embryonic kidney could undergo 3D growth
and branching morphogenesis when suspended within an ECM gel.
Type I collagen, type IV collagen,
and Matrigel all supported 3D kidney growth and development
"national registry and
mechanism for allocating organs to ensure equity of access."
Waiting for their own miracles

In 2008, 4,380 Canadians were waiting for a transplant of some kind.

Of those, 215 died before donor organs could be procured.
In May 2007, the Canadian Medical Association Journal called for a "national registry and
mechanism for allocating organs to ensure equity of access." It cited a study that showed that
people under the age of 40 who lived in Ontario waited a median of eight years for a new kidney,
while for those in Alberta, the median wait was three years.

Canada's rate of organ donation seriously lagged that of several countries.
In 2005, the donation rate for deceased donors was 12.8 per million. That's just over a third the
rate in Spain (35.1 per million) and around half that of Estonia (26.5 per million), Belgium (22.8
per million), the United States (21.5 per million), and Italy (20.9 per million).








Pediatr Transplant. 2011 Jun;15(4):376-83. doi: 10.1111/j.1399-3046.2011.01495.x. Epub 2011 Apr 5.
Wait list status of pediatric dialysis patients in North America.
Nguyen S, Martz K, Stablein D, Neu A.
Source
University of California, Davis, Sacramento, CA 95817, USA. [email protected]
Abstract
Kidney transplantation is the treatment of choice for the majority of pediatric patients with end-stage kidney
disease. Previous studies demonstrating racial or gender disparities in access to the deceased donor transplant
list could not evaluate the impact of medical concerns or patient preference on waitlist status. We undertook a
retrospective cohort study using the NAPRTCS registry to begin to determine barriers to wait list registration for
kidney transplantation among pediatric dialysis patients. Clinical and demographic factors were compared in listed
vs. non-listed patients. Reasons cited for not listing patients were examined by clinical and demographic factors.
At dialysis initiation, 88.7% of pediatric dialysis patients were not on the renal transplant wait list. Twelve
months after dialysis initiation, 67.1% of pediatric dialysis patients were not on the wait list. The groups
least likely to be on the wait list were infants (adjusted OR 0.23, 95% CI 0.16, 0.32) and girls (adjusted OR 0.78,
95% CI 0.67, 0.90) after adjusting for multiple confounders. The reason most often cited for not listing was medical
reason for young infants and that the transplant workup was pending for girls. Further study is needed to identify
barriers to wait list registration
More patients/less organs
The right organ for the right recipient

need to utilize organs from as many donors as possible.

selection criteria have become less stringent to accommodate increasing demand, transplant outcomes
are more strongly influenced by recipient and donor factors;

finding the right organ for the right recipient is more important than ever.

Representative dilemmas in the matching of donor organs with recipients were discussed. These included
the following:

matching by donor and recipient risk characteristics;

use of organs with risk for disease transmission;

biologic incompatibility;

use of organs from donors after cardiac death;

the justification for combined organ transplants like liver-kidney and kidney-pancreas; and the

role of allocation in facilitating the matching of donors and recipients.
Clin Transplant. 2011 Sep 9. doi: 10.1111/j.1399-0012.2011.01513.x. [Epub ahead of print]
The right organ for the right recipient: the Ninth Annual American Society of Transplant
Surgeons' State-of-the-Art Winter Symposium.
Sung RS, Abt PL, Desai DM, Garvey CA, Segev DL, Kaufman DB.
Department of Surgery, University of Michigan, Ann Arbor, MI Department of Surgery, University of
Pennsylvania, Philadelphia, PA Department of Surgery, University of Texas Southwestern, Dallas, TX The
Transplant Center, University of Minnesota Medical Center-Fairview, Minneapolis, MN Department of
Surgery, Johns Hopkins University, Baltimore, MD Department of Surgery, University of Wisconsin,
Madison, WI, USA.
DCD- donation after cardiac death

In February 2005, a national forum was convened to discuss and develop
recommendations on the principles, procedures and practice related to DCDdonation after cardiac death, including ethical and legal considerations.

There was a consensus that Canada should resume harvesting organs under
DCD-donation after cardiac death in addition to NDD- neurological determination
of death.

It was estimated that procuring organs this way would increase the number of
available organs by 20 per cent.

published in the Canadian Medical Association Journal
DCD- donation after cardiac death

A year-and-a-half later, a paper published in the Canadian Medical Association
Journal outlined

national recommendations for donation after cardiocirculatory death.

considering DCD donation, the patient should be judged to have:



A non-recoverable injury or illness.
Dependence on life-sustaining therapy.
Anticipation of imminent death after withdrawal of life-sustaining therapy.
HEALTH
Transplants
Organ donation: the gift of life
Last Updated: Thursday, June 25, 2009 | 11:51 AM ET
CBC News
The drama that unfolded in a Toronto hospital as the lives of two infants hung in the balance in the
second week of April 2009 gripped the nation.
Kaylee's parents, Jason Wallace and Crystal Vitelli,
understood that without a machine to help her
breathe, Kaylee's heart would eventually stop
and she would die.
They decided that Kaylee's heart should live on
and give Lily a chance to live a healthy life.
Lily O'Connor, born March 9, 2009,
with a congenital heart defect lay
seriously ill at Toronto's Hospital for
Sick Children.
Her only option for survival is a
heart transplant.
"Thirty to 40 per cent of people with living
willing donors don't match their living donor.
We've been basically not utilizing these kidneys,"
Kidney Chains
"When you see those people who have come out of these swaps and they've got the
transplant, it's a miracle,"

On Feb. 12, 2009, Canada Blood Services announced the Living Donor Paired
Exchange Registry, which is designed to facilitate kidney donations among live
donors

Become a Kidney Donor
National Kidney Registry
Donate Life America

Participating Kidney Chain Centers
New York-Presbyterian/Weill-Cornell
New York Presbyterian Transplant
Pinnacle Health Systems
UCSF Medical Center
UCLA Medical Center
Stanford University Medical Center
"good Samaritan" donor
It all started with Max Zapata, from Clovis, Calif., who kicked off this chain as the
"good Samaritan" donor. He gave a kidney and expected nothing in return.

"I just really felt that it was something that I needed to do in my heart," Zapata said.
"I didn't know where it would go, but that I knew that it would be something that
would help someone out."

Zapata gave his kidney to 25-year-old Laura Amador
"domino surgery"



The first "domino surgery" occurred in late 2008 at the Ottawa Hospital, when
Ottawa resident Gene Borys intended to donate a kidney to his wife, Kelly
Shannon. She was not a compatible match, but an anonymous live kidney donor
set off a chain reaction that saved several lives.
The blood agency forecasts that the paired exchange registry for living
donors will increase donations by 20 per cent or more.
Pilot transplant programs through the registry are being conducted in Ontario,
Alberta and British Columbia, with other provinces to be added shortly.
Guidelines needed to stem 'transplant tourism': WHO
March 30, 2007

The UN agency is concerned about increasing cases of commercial
exploitation of human materials such as organs for transplant.

We believe five to 10 per cent of all kidneys transplanted were in 2005
transplanted in this setting," said Luc Noel, the head of WHO's unit, told a
news conference at the agency's headquarters in Geneva.

In Pakistan, from 40 per cent to half of residents in some villages have
only one kidney each because their other was sold to a wealthy person,
likely from another country, said Dr. Farhat Moazam of the Sindh Institute
of Urology and Transplantation in Karachi, Pakistan, and one of the
participants at the meeting.

Donors may be offered $2,500 US for a kidney but may receive only half
because of the broker's cut.
Guidelines : WHO
March 30, 2007

The principles put forward by WHO underscore that the person – whether recipient
of an organ or a donor - must be the main concern both as patient and as human
being;

that commercial exploitation of organs denies equitable access and can be harmful
to both donors and recipients;

That organ donation from live donors poses numerous health risks which can be
avoided by promoting donation from deceased donors;

and that quality, safety, efficacy and transparency are essential if society is to reap
the benefits transplantation can offer as a therapy.

The Canadian Council for Donation and Transplantation was set
up in 2001 to improve Canada's organ donation system.

In August 2008, federal, provincial and territorial ministries of
health announced funding of $35 million over five years to merge
the council's activities with Canada Blood Services in a bid to improve
organ donation and transplantation across the country.
organ donations-deceased donors
"The most important step is to have a discussion with your immediate family,"
"The most important step is to have a discussion with your immediate family," Marcello told CBC
News. "They're the ones that are going to be approached, and it will probably be during a tragic
time, and they have to be as prepared as possible to say yes [to donating your organs] … and if
they're not prepared, they're probably going to say no.“
registries are helpful but you still need to have that discussion with your immediate
family.

23 European countries use an "opt-out system" for organ donation. They
assume you want to donate your organs unless you've expressly said you don't.

90 per cent of Canadians want to donate their organs, but the system is too complicated.

some people believe that age or illness may prevent them from becoming an
organ donor.

"Everybody is an eligible donor. There was a case of a 102-year-old great grandmother who
donated three of her organs.








Enferm Infecc Microbiol Clin. 2007 Jan;25(1):54-62.
[Epidemiology of transplantation in Spain].
[Article in Spanish]
Garrido-Cantarero G, Matesanz-Acedos R.
Source
Organización Nacional de Trasplantes, Madrid, Spain. [email protected]
Abstract
During 2005, 1546 true solid organ donors were registered in Spain, yielding a rate of 35.1 per
million population (pmp), which places our country at the head of word-wide donation rates. A total
of 2200 kidney transplantations were performed in Spain during 2005, 72 of them in infants and
children. The cadaveric kidney transplantation rate was 47.9 pmp, the highest in the world for this
type of transplant. The 2005 Spanish Renal Transplant Registry showed that patient mortality
associated with these transplants is 1.6%. Graft survival is 90% to 84% at the first year and 76% to
66% at 5 years. Furthermore, in 2005, 1070 liver transplantations (24.1 pmp) were carried out.
Patient survival in this group is 81.3% the first year, 73.3% at 3 years, 56.7% at 10 years and
26.8% at 20 years. A total of 287 heart transplantations were undertaken (6.5 pmp). Patient survival
is 86% to 81% the first year, and around 70% at 5 years. There were 167 lung transplantations, 112
double and 55 single lung transplants. Patient survival in this population is 79.3% the first year and
45.2% at 5 years. Lastly, pancreas transplant activity has increased considerably in recent years,
with 96 transplants during 2005
Número de donantes y tasa de donación.
Tasa de donación por millón de población en diferentes
países del mundo.
During 2005, 1546 true solid organ donors were
registered in Spain, yielding a rate of 35.1 per million
population (pmp), which places our country at the
head of word-wide donation rates
Grupos de edad de los donantes.
Trasplante renal. Actividad en España.

Trasplante renal

Durante el año 2005 se han realizado en nuestro
país 2.200 trasplantes renales de los que 72 eran
trasplantes infantiles.
La tasa de trasplante renal de cadáver pmp se sitúa
en 47,9 lo que nos coloca a la cabeza mundial de
este tipo de trasplantes.

Trasplante hepático. Actividad en España
Trasplante cardíaco. Actividad en España
Patient survival is 86% to 81% the first year, and around 70% at 5 years