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"Tissue and Organ Harvesting"
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The undead : organ harvesting, the ice-water test, beating-heart cadavers-- how medicine is blurring the line between life and death
Science writer Dick Teresi examines how death is determined by the medical community and explores organ trafficking, brain death, and near-death experiences.
Book
A randomized trial of normothermic preservation in liver transplantation
Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.
Normothermic machine perfusion of the liver improved early graft function, demonstrated by reduced peak serum aspartate transaminase levels and early allograft dysfunction rates, and improved organ utilization and preservation times, although no differences were seen in graft or patient survival.
Journal Article
Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass
In this trial, 1150 patients undergoing coronary-artery bypass grafting were assigned to open or endoscopic vein-graft harvesting. At a median of 2.78 years, there was no significant difference between the groups in the rate of the composite of death from any cause, nonfatal myocardial infarction, or repeat revascularization.
Journal Article
A Comparative Study on the Application of Robotic Hair Restoration Technology Versus Traditional Follicular Unit Excision in Male Androgenetic Alopecia
Background The robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation. Objective To compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation. Methods Thirteen Chinese male patients with Norwood–Hamilton II–IV AGA aged 25–35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow‐up results were investigated and evaluated. Results The total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries. Conclusion The current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery.
Journal Article
No-touch versus conventional vein in coronary artery bypass grafting: three year follow-up of multicentre randomised PATENCY trial
AbstractObjectiveTo assess the three year outcomes of the no-touch vein harvesting technique in coronary artery bypass grafting surgery compared with the conventional approach.DesignThree year extended follow-up of the randomised PATENCY (graft patency between the no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery) trial.SettingSeven cardiac surgery centres in China; enrolment between April 2017 and June 2019.Participants2655 participants aged 18 and older undergoing isolated coronary artery bypass grafting surgery.InterventionsPatients were randomly assigned 1:1 to the no-touch vein harvesting technique group or the conventional approach group during surgery and followed up.Main outcome measuresVein graft occlusion (based on computed tomography angiography) at three years.ResultsMean age of participants was 61 years (standard deviation ±8 years) and 22% were women. 99.4% (2621) attended the three year follow-up visit, while 86.5% (2281) received computed tomography angiography. At three years, the no-touch group showed a significantly lower vein graft occlusion rate (5.7% v 9.0%, P<0.001) than the conventional group (odds ratio 0.62, 95% confidence interval 0.48 to 0.80), with absolute risk difference of −3.2% (95% confidence interval −5.0% to −1.4%). The intention-to-treat analysis, including all 2655 randomised patients with multiple imputations for missing data, showed consistent findings, with occlusion rates of 6.1% in the no-touch group versus 9.3% in the conventional group (odds ratio 0.63, 95% confidence interval 0.51 to 0.81; absolute risk difference−3.1%, 95% confidence interval −4.9% to −1.4%; P<0.001). These results confirm the robustness of the no-touch technique in reducing vein graft occlusion.ConclusionsThe no-touch technique consistently and robustly reduced the risk of vein graft occlusion and several cardiac events by one third to one half within three years after coronary artery bypass grafting surgery.Trial registrationClinicalTrials.gov NCT03126409.
Journal Article
Rationale and design of a multicenter randomized trial to compare the graft patency between no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery
Vein graft failure is a crucial challenge in coronary artery bypass graft (CABG) surgery. Previous studies have suggested a patency benefit of the No-Touch vein harvesting technique, but only with small sample sizes.
This study is a prospective, multicenter randomized clinical trial with a large sample size, aiming to investigate the efficacy of the No-Touch technique compared with the conventional approach. All patients requiring isolated CABG with left internal mammary artery plus at least one saphenous vein graft will be considered for entry into the study. Two thousand cases (1000 in each arm) will be enrolled over 1 to 2 years in 7 hospitals in China. Participants will be randomized in equal proportions between two surgical strategies: the No-Touch or conventional technique. The primary endpoint is graft vessel occlusion at 3 months after CABG surgery by CT coronary angiography. Secondary outcomes are major adverse cardiac or cerebrovascular events at 3 and 12 months post-operation and graft vessel occlusion at 1 year.
This study will define the role of the No-Touch vein harvesting technique in CABG surgery and provide strong evidence to answer whether this technique could reduce vein graft occlusion.
Journal Article
Clinical and Patient‐Reported Outcome Measures of Palatal Donor Site Healing Using Polyvinylpyrrolidone–Sodium Hyaluronate Gel as a Dressing Material Following Free Gingival Graft Harvesting: A Randomized Controlled Clinical Trial
Objectives This study evaluates the efficacy of polyvinylpyrrolidone–sodium hyaluronate (PVP‐SH) gel as a dressing material in enhancing both clinical and patient‐reported outcomes post‐free gingival graft (FGG) harvesting from the hard palate. Material and Methods This randomized clinical trial included 18 patients and spanned from June 2022 to August 2023. Patients received an FGG procedure to manage a lack of attached gingiva. Following graft harvesting, patients were divided into two groups: the control group, which received Coe‐Pak, and the test group, which was treated with PVP‐SH gel. The primary outcome measured was complete epithelialization. Secondary outcomes included the Landry healing scale, post‐operative pain level, and patient willingness to receive the same treatment again. Results The test group reported significantly lower analgesic use (p < 0.001) and reduced pain severity (p < 0.001) compared to the control group. Furthermore, test group patients indicated a higher level of satisfaction regarding the prospect of retreatment. In contrast, the control group showed significantly slower progress in wound healing and epithelization (p < 0.05) compared to the test group. Conclusions The findings of this study suggest that PVP‐SH gel is a superior dressing material post‐FGG harvesting, yielding improved clinical and patient‐reported outcomes relative to Coe‐Pak.
Journal Article
Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions
Purpose
To compare the incidence, extent of sensory loss, its clinical effect and natural course caused by three different skin incisions used for autogenous hamstring graft harvest during anterior cruciate ligament (ACL) reconstruction.
Methods
One hundred and twenty patients who underwent hamstring graft harvest during ACL reconstruction, participated in the study. All patients were randomized into 3 groups as per the 3 incisions used—vertical, transverse and oblique. The area of sensory loss was documented as per anatomical distribution of the infrapatellar branch of saphenous nerve (IPSBN) and sartorial branch of sensory nerve (SBSN) at 6 weeks, 3 months and 6 months follow-ups. The length of incision, area of sensory loss and subjective pain score (out of 10) were also noted.
Results
The incidence, area of hypesthesia and persistence at 6 months were significantly higher with vertical incision at all times, whereas it was the least with oblique incision. Injury to IPSBN was maximum with vertical incision (
p
= 0.000), and it was similar in the transverse and oblique incision groups. The SBSN injury incidence was not significantly different between the three groups (n.s.). Subjective cutaneous hypesthesia incidence was quite low in all the three groups. The oblique incision group had highest subjective satisfaction closely followed by the horizontal incision group.
Conclusions
Vertical incision has highest incidence of IPBSN injury, persistent hypesthesia, largest area of sensory loss and poorest subjective outcome. Oblique and transverse incision groups had statistically comparable results, though better outcome was noted in the oblique incision group. The SBSN injury was equally common in all the three incisions used. However, the sensory loss does not impair normal daily activities in the patients. We recommend use of oblique incision for hamstring graft harvest.
Level of evidence
Therapeutic randomized controlled prospective study, Level I.
Journal Article
Fat Necrosis After Autologous Fat Transfer (AFT) to Breast: Comparison of Low-Speed Centrifugation with Sedimentation
BackgroundDespite the advantages of autologous fat transfer to the breast, there are many complications after the surgery, such as oil cysts, calcification and palpable breast nodules. The fat purification process is a key step to reduce those complications, but there is currently no standard processing method. This study was designed to compare the incidence of fat necrosis after autologous fat grafting to the breast with low-speed centrifugation and sedimentation.MethodsThis study analyzed 100 patients (167 breasts) who underwent autologous fat grafts to the breasts from January, 2015 to March, 2017. Patients were divided into two groups randomly, low-speed centrifugation (800 r/min) and sedimentation (15 min). Postoperative fat necrosis such as oil cysts and palpable breast nodules was measured using physical examination and breast ultrasound 3 months after the surgery. The number and the diameter of the fat necroses were detected.ResultsA total of 100 patients (167 breasts) were included this research. There were 21 breasts with clinically palpable nodules (12.57%); fifteen (19.48%) were in the low-speed centrifugation group and six (6.67%) were in the sedimentation group (p < 0.05). According to postoperative breast ultrasounds, there were 83 breasts with hypoechoic cyst formations (49.7%); forty-five (58.44%) in the low-speed centrifugation group and 38 (42.22%) in the sedimentation group (p < 0.05). A positive correlation between the number of operative sessions and fat necrosis was found out.ConclusionAlthough low-speed centrifugation could achieve higher fat purification efficacy when compared with sedimentation, it causes more fat necrosis than sedimentation, such as clinically palpable nodules and subclinical nodules, especially in patients who had a history of breast surgery and those who needed more than one fat grafting session.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Journal Article
SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)
Background
Single centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG).
Methods
Adults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results.
Results
Two hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%),
p
= 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%),
p
= 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%,
p
< 0.01). Including this study’s results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29–0.82,
p
= 0.007 in 3 randomized and 1 observational study at 1 year postoperatively.
Conclusions
The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting.
Trial registration
NCT01047449
.
Journal Article