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Donneurs à critères élargis: jusqu’où ?

Extended criteria donor: how far?

  • Enseignement Supérieur en Soins Infirmiers
  • Published:
Réanimation

Résumé

Les donneurs à critères élargis sont en augmentation, du fait du vieillissement de la population des donneurs, des modifications des causes de décès et des progrès dans le domaine de la transplantation permettant de prélever des donneurs de plus en plus âgés et/ou présentant des comorbidités en particulier vasculaires. L’utilisation de greffons provenant de tels donneurs est rationnelle et bénéfique pour les receveurs à condition d’être attentifs aux modalités de réanimation de ces donneurs, à l’expertise de la qualité des organes, à leur conservation et à leur attribution. L’usage d’un score permet d’identifier les greffons à risque significatif d’échec, pour lesquels les outils diagnostiques seront multipliés afin d’évaluer au mieux leur qualité et leur masse fonctionnelle. Cette stratégie doit aboutir à la mise en place de toutes les stratégies d’optimisation de fonction mais aussi, le cas échéant, doit permettre de reconnaître un greffon qui présente tous les risques d’être non ou peu fonctionnel et de l’écarter de la greffe.

Abstract

Extended-criteria donors are increasing due to aging of the donor population, changes in causes of death, and medical progresses in the field of transplantation, allowing to transplant grafts from older and/or with vascular co-morbidities donors. The use of grafts from such donors is evidence-based and beneficial for recipients with respect of certain conditions including maintenance of donors as well as evaluation of viability, conservation, and allocation of the organs. Scoring systems allow the detection of grafts at significant risk of failure, for which diagnostic tools will be developed in order to better assess their quality and function. This policy should lead to the implementation of all strategies to optimize graft function but also allow, when appropriate, the recognition of grafts that present the risk of poor or no functional status, to be discarded from transplantation.

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  1. Agence de la biomédecine, DGMS, direction prélèvement greffe organes-tissus, pôle stratégie greffe, 1, avenue du Stade de France, F-93212, Saint Denis la Plaine cedex, France

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Correspondence to C. Antoine.

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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Prélèvement multiorganes.

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Antoine, C. Donneurs à critères élargis: jusqu’où ?. Réanimation 22 (Suppl 2), 488–494 (2013). https://doi.org/10.1007/s13546-012-0626-y

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  • DOI: https://doi.org/10.1007/s13546-012-0626-y

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