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Gregorini M, Ticozzelli E, Abelli M, Grignano MA, Pattonieri EF, Giacomoni A, De Carlis L, Dell’Acqua A, Caldara R, Socci C, Bottazzi A, Libetta C, Sepe V, Malabarba S, Manzoni F, Klersy C, Piccolo G, Rampino T. Kidney Transplants From Donors on Extracorporeal Membrane Oxygenation Prior to Death Are Associated With Better Long-Term Renal Function Compared to Donors After Circulatory Death. Transpl Int 2022; 35:10179. [PMID: 35210934 PMCID: PMC8862176 DOI: 10.3389/ti.2021.10179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023]
Abstract
Donation after circulatory death (DCD) allows expansion of the donor pool. We report on 11 years of Italian experience by comparing the outcome of grafts from DCD and extracorporeal membrane oxygenation (ECMO) prior to death donation (EPD), a new donor category. We studied 58 kidney recipients from DCD or EPD and collected donor/recipient clinical characteristics. Primary non function (PNF) and delayed graft function (DGF) rates, dialysis need, hospitalization duration, and patient and graft survival rates were compared. The estimated glomerular filtration rate (eGFR) was measured throughout the follow-up. Better clinical outcomes were achieved with EPD than with DCD despite similar graft and patient survival rates The total warm ischemia time (WIT) was longer in the DCD group than in the EPD group. Pure WIT was the highest in the class II group. The DGF rate was higher in the DCD group than in the EPD group. PNF rate was similar in the groups. Dialysis need was the greatest and hospitalization the longest in the class II DCD group. eGFR was lower in the class II DCD group than in the EPD group. Our results indicate good clinical outcomes of kidney transplants from DCD despite the long “no-touch period” and show that ECMO in the procurement phase improves graft outcome, suggesting EPD as a source for pool expansion.
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Affiliation(s)
- Marilena Gregorini
- Dipartimento di Medicina Interna e Terapia Medica, Università Degli Studi di Pavia, Pavia, Italy
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
- *Correspondence: Marilena Gregorini,
| | - Elena Ticozzelli
- Unit of General Surgery 2, Department of Surgical Sciences, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Massimo Abelli
- Transplant Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maria A. Grignano
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Eleonora F. Pattonieri
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Alessandro Giacomoni
- Transplant Center, Department of General Surgery and Abdominal Transplantation, Niguarda Cà Granda Hospital, Milan, Italy
| | - Luciano De Carlis
- Transplant Center, Department of General Surgery and Abdominal Transplantation, Niguarda Cà Granda Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Antonio Dell’Acqua
- Department of Anesthesia and Critical Care, San Raffaele Scientific Institute (IRCCS), Milan, Italy
| | - Rossana Caldara
- Transplant Unit, Department of General Medicine, San Raffaele Scientific Institute, Vita‐Salute San Raffaele University, Milan, Italy
| | - Carlo Socci
- Department of Surgery, San Raffaele Scientific Institute, Vita‐Salute San Raffaele University, Milan, Italy
| | - Andrea Bottazzi
- ICU1 Department of Intensive Medicine, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelo Libetta
- Dipartimento di Medicina Interna e Terapia Medica, Università Degli Studi di Pavia, Pavia, Italy
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Vincenzo Sepe
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Stefano Malabarba
- Unit of General Surgery 2, Department of Surgical Sciences, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
| | - Federica Manzoni
- Health Promotion, Environmental Epidemiology Unit, Hygiene and Health Prevention Department, Health Protection Agency, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Teresa Rampino
- Unit of Nephrology, Dialysis and Transplant, San Matteo Hospital Foundation (IRCCS), Pavia, Italy
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102
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Villar-García S, Martín-López CE, Pérez-Redondo M, Hernández-Pérez FJ, Martínez-López D, de Villarreal-Soto JE, Ríos-Rosado EC, Vera-Puente B, Ospina-Mosquera VM, Serrano-Fiz S, Forteza-Gil A. Donación en asistolia controlada: cómo iniciar un programa. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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103
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Egan TM, Haithcock BE, Lobo J, Mody G, Love RB, Requard JJ, Espey J, Ali MH. Donation after circulatory death donors in lung transplantation. J Thorac Dis 2022; 13:6536-6549. [PMID: 34992833 PMCID: PMC8662509 DOI: 10.21037/jtd-2021-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient’s hospital emergency department. After passage of the UDDA, uDCDs were abandoned to Donation after Brain Death donors (DBDs)—perhaps prematurely. Compared to livers and kidneys, many DBDs have lungs that are unsuitable for transplant, due to aspiration pneumonia, neurogenic pulmonary edema, trauma, and the effects of brain death on lung function. Another group of donors has become available—patients with a devastating irrecoverable brain injury that do not meet criteria for brain death. If a decision is made by next-of-kin (NOK) to withdraw life support and allow death to occur by asphyxiation, with NOK consent, these individuals can have organs recovered if death occurs relatively quickly after cessation of mechanical ventilation and maintenance of their airway. These are known as controlled Donation after Circulatory Death donors (cDCDs). For a variety of reasons, in the U.S., lungs are recovered from cDCDs at a much lower rate than kidneys and livers. Ex-vivo lung perfusion (EVLP) in the last decade has had a modest impact on increasing the number of lungs for transplant from DBDs, but may have had a larger impact on lungs from cDCDs, and may be indispensable for safe transplantation of lungs from uDCDs. In the next decade, DCDs may have a substantial impact on the number of lung transplants performed in the U.S. and around the world.
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Affiliation(s)
- Thomas M Egan
- Department of Surgery, UNC at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jason Lobo
- Department of Medicine, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - Gita Mody
- Department of Surgery, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - Robert B Love
- Department of Surgery, Feinberg School of Medicine, Chicago, IL, USA
| | | | - John Espey
- Department of Surgery, UNC at Chapel Hill, Chapel Hill, NC, USA
| | - Mir Hasnain Ali
- Department of Surgery, UNC at Chapel Hill, Chapel Hill, NC, USA
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104
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de la Oliva Valentín M, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2022; 42:85-93. [PMID: 36153903 DOI: 10.1016/j.nefroe.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 06/16/2023] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, Spain
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105
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Shroff S, Seth A, Mohanka R, Navin S, Gokhale AK, Sharma A, Kumar A, Ramachandran B, Balakrishnan KR, Mirza D, Mehta D, Zirpe K, Dhital K, Sahay M, Simha S, Sundaram R, Pandit R, Mani R, Gursahani R, Gupta S, Kute V. Organ donation after circulatory determination of death in India: A joint position paper. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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106
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Hunt F, Johnston CJC, Coutts L, Sherif AE, Farwell L, Stutchfield BM, Sewpaul A, Sutherland A, Babu BI, Currie IS, Oniscu GC. From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies. Transpl Int 2022; 35:10493. [PMID: 35721469 PMCID: PMC9203686 DOI: 10.3389/ti.2022.10493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022]
Abstract
Normothermic Regional Perfusion (NRP) has shown encouraging clinical results. However, translation from an experimental to routine procedure poses several challenges. Herein we describe a model that led to the implementation of NRP into standard clinical practice in our centre following an iterative process of refinement incorporating training, staffing and operative techniques. Using this approach we achieved a four-fold increase in trained surgical staff and a 6-fold increase in competent senior organ preservation practitioners in 12 months, covering 93% of the retrieval calls. We now routinely provide NRP throughout the UK and attended 186 NRP retrievals from which 225 kidneys, 26 pancreases and 61 livers have been transplanted, including 5 that were initially declined by all UK transplant centres. The 61 DCD(NRP) liver transplants undertaken exhibited no primary non-function or ischaemic cholangiopathy with up to 8 years of follow-up. This approach also enabled successful implementation of ex situ normothermic liver perfusion which together with NRP contributed 37.5% of liver transplant activity in 2021. Perfusion technologies (in situ and ex situ) are now supported by a team of Advanced Perfusion and Organ Preservation Specialists. The introduction of novel perfusion technologies into routine clinical practice presents significant challenges but can be greatly facilitated by developing a specific role of Advanced Perfusion and Organ Preservation Specialist supported by a robust education, training and recruitment programme.
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107
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Potential of Donation After Unexpected Circulatory Death Programs Defined by Their Demographic Characteristics. Transplant Direct 2021; 8:e1263. [PMID: 34966838 PMCID: PMC8710346 DOI: 10.1097/txd.0000000000001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background. Donation after unexpected circulatory death (uDCD) donors are often suggested to increase the number of donor organs. In 2014, a uDCD protocol was implemented in three transplant centers in the Netherlands which unfortunately did not result in additional transplantations. This study was initiated to identify demographic factors influencing the potential success of uDCD programs. Methods. Dutch resuscitation databases covering various demographic regions were analyzed for potential donors. The databases were compared with the uDCD implementation project and successful uDCD programs in Spain, France, and Russia. Results. The resuscitation databases showed that 61% of all resuscitated patients were transferred to an emergency department. Age selection reduced this uDCD potential to 46% with only patients aged 18–65 years deemed eligible. Of these patients, 27% died in the emergency department. The urban region of Amsterdam showed the largest potential in absolute numbers (52 patients/y). Comparison with the uDCD implementation project showed large similarities in the percentage of potential donors; however, in absolute numbers, it showed a much smaller potential. Calculation of the potential per million persons and the extrapolation of the potential based on the international experience revealed the largest potential in urban regions. Conclusions. Implementation of a uDCD program should not only be based on the number of potential donors calculated from resuscitation databases. They show promising potential uDCD percentages for large rural regions and small urban regions; however, actual numbers per hospital are low, leading to insufficient exposure rates. It is, therefore, recommendable to limit uDCD programs to large urban regions.
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108
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Boteon YL, Hessheimer AJ, Brüggenwirth IMA, Boteon APCS, Padilla M, de Meijer VE, Domínguez-Gil B, Porte RJ, Perera MTPR, Martins PN. The economic impact of machine perfusion technology in liver transplantation. Artif Organs 2021; 46:191-200. [PMID: 34878658 DOI: 10.1111/aor.14131] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine the costs related to machine perfusion and its associated outcomes. METHODS Expert opinion of several groups representing different machine perfusion modalities. Critical analysis of the published literature reporting the economic outcomes of the most used techniques of machine perfusion in liver transplantation (normothermic and hypothermic ex situ machine perfusion and in situ normothermic regional perfusion). RESULTS Machine perfusion costs include disposable components of the perfusion device, perfusate components, personnel and facility fees, and depreciation of the perfusion device or device lease fee. The limited current literature suggests that although this upfront cost varies between perfusion modalities, its use is highly likely to be cost-effective. Optimization of the donor liver utilization rate, local conditions of transplant programs (long waiting list times and higher MELD scores), a decreased rate of complications, changes in logistics, and length of hospital stay are potential cost savings points that must highlight the expected benefits of this intervention. An additional unaccounted factor is that machine perfusion optimizing donor organ utilization allows patients to be transplanted earlier, avoiding clinical deterioration while on the waiting list and the costs associated with hospital admissions and other required procedures. CONCLUSION So far, the clinical benefits have guided machine perfusion implementation in liver transplantation. Albeit there is data suggesting the economic benefit of the technique, further investigation of its costs to healthcare systems and society and associated outcomes is needed.
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Affiliation(s)
- Yuri L Boteon
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Amelia J Hessheimer
- Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel M A Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - María Padilla
- Organización Nacional de Trasplantes, Ministerio de Sanidad, Madrid, Spain
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Robert J Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Thamara P R Perera
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paulo N Martins
- Department of Surgery, Transplant Division, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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109
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Rand A, Koch T, Ragaller M. [Organ donation-Not only a responsibility of intensive care medicine]. Anaesthesist 2021; 71:311-317. [PMID: 34873631 PMCID: PMC8647959 DOI: 10.1007/s00101-021-01066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
Im Jahr 2019 starben in Deutschland 756 Menschen, während sie auf der Warteliste für ein Spenderorgan standen. Sowohl im Eurotransplant-Verbund als auch weltweit gehört Deutschland mit 10,8 Organspendern/Mio. Einwohner im Jahr 2019 zur Schlussgruppe. Sämtliche politischen Versuche, die Spenderzahlen zu steigern, scheinen bislang ohne Effekt geblieben zu sein. Darüber hinaus hat die durch das „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) ausgelöste Pandemie zum weiteren Rückgang der Spenderzahlen geführt. Der Intensivmedizinerin kommt im Prozess der Erkennung möglicher Spender sowie als erste Ansprechpartnerin für die Angehörigen eine zentrale Rolle zu. Jedoch existieren nicht nur in den gesellschaftlichen und medialen Diskussionen um das Thema Organspende viele Unklarheiten, sondern auch bei den intensivmedizinisch tätigen Ärzten. Viele Annahmen und Hypothesen, die mit den niedrigen Spenderzahlen in einen Zusammenhang gebracht werden, lassen sich wissenschaftlich jedoch nicht belegen und sollen in diesem Beitrag diskutiert werden.
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Affiliation(s)
- A Rand
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - T Koch
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
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110
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Branchereau J, Ogbemudia AE, Bas-Bernardet SL, Prudhomme T, Rigaud J, Karam G, Blancho G, Mesnard B. Novel Organ Perfusion and Preservation Strategies in Controlled Donation After Circulatory Death in Pancreas and Kidney Transplantation. Transplant Proc 2021; 54:77-79. [PMID: 34879976 DOI: 10.1016/j.transproceed.2021.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Kidney and pancreatic transplants from controlled donation after circulatory death donors are vulnerable to ischemia-reperfusion injuries. In this context of transplant shortage, there is a need to optimize the function of these transplants and to develop novel perfusion and preservation strategies in controlled donation after circulatory death in kidney and pancreatic transplants. IN SITU PERFUSION AND PRESERVATION STRATEGIES In situ regional normothermic perfusion improves the outcome of kidney transplants from controlled donation after circulatory death and provides equivalent results for the kidney from brain-dead donors. In situ regional normothermic perfusion is under investigation for pancreatic transplants. EX SITU PERFUSION AND PRESERVATION STRATEGIES Perfusion on hypothermic machine perfusion is highly recommended for the kidney from controlled donation after cardiac death. Hypothermic oxygenated perfusion machine decreases the rate of graft rejection and graft failure in kidney transplantation. Ex situ normothermic perfusion is an easy way to assess renal function. In the future, kidney transplants could benefit from drug therapy during ex situ normothermic perfusion. In pancreas transplantation, hypothermic machine perfusion and ex situ normothermic perfusion present encouraging results in preclinical studies.
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Affiliation(s)
- J Branchereau
- Department of Urology and Transplantation Surgery, Nantes, France; Nuffield Department of Surgical Science, Oxford, United Kingdom; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France.
| | - A E Ogbemudia
- Nuffield Department of Surgical Science, Oxford, United Kingdom
| | - S Le Bas-Bernardet
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - T Prudhomme
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, Nantes, France
| | - G Karam
- Department of Urology and Transplantation Surgery, Nantes, France; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - G Blancho
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - B Mesnard
- Department of Urology and Transplantation Surgery, Nantes, France; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
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111
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Ruiz P, Valdivieso A, Palomares I, Prieto M, Ventoso A, Salvador P, Senosiain M, Fernandez JR, Testillano M, Bustamante FJ, Gastaca M. Similar Results in Liver Transplantation From Controlled Donation After Circulatory Death Donors With Normothermic Regional Perfusion and Donation After Brain Death Donors: A Case-Matched Single-Center Study. Liver Transpl 2021; 27:1747-1757. [PMID: 34455694 DOI: 10.1002/lt.26281] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/01/2021] [Accepted: 08/21/2021] [Indexed: 12/13/2022]
Abstract
Although good results have been reported with the use of normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation (LT), there is a lack of evidence to demonstrate similar results to donation after brain death (DBD). We present a single-center retrospective case-matched (1:2) study including 100 NRP cDCD LTs and 200 DBD LTs and a median follow-up of 36 months. Matching was done according to donor age, recipient Model for End-Stage Liver Disease score, and cold ischemia time. The following perioperative results were similar in both groups: alanine transaminase peaks of 909 U/L in the DBD group and 836 U/L in the cDCD group and early allograft disfunction percentages of 21% and 19.2%, respectively. The 1-year and 3-year overall graft survival for cDCD was 99% and 93%, respectively, versus 92% and 87%, respectively, for DBD (P = 0.04). Of note, no cases of primary nonfunction or ischemic-type biliary lesion were observed among the cDCD grafts. Our results confirm that NRP cDCD LT meets the same outcomes as those obtained with DBD LT and provides evidence to support the idea that cDCD donors per se should no longer be considered as "marginal donors" when recovered with NRP.
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Affiliation(s)
- Patricia Ruiz
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
| | - Andres Valdivieso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
| | - Ibone Palomares
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
| | - Alberto Ventoso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
| | - Patricia Salvador
- Hepatology and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Maria Senosiain
- Hepatology and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Jose Ramon Fernandez
- Hepatology and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Milagros Testillano
- Hepatology and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Francisco Javier Bustamante
- Hepatology and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, BioCruces Health Research Institute, University of the Bask Country, Barakaldo, Spain
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Go C, Elsisy M, Frenz B, Moses JB, Tevar AD, Demetris AJ, Chun Y, Tillman BW. A retrievable, dual-chamber stent protects against warm ischemia of donor organs in a model of donation after circulatory death. Surgery 2021; 171:1100-1107. [PMID: 34839934 DOI: 10.1016/j.surg.2021.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ischemic injury during the agonal period of donation after circulatory death donors remains a significant barrier to increasing abdominal transplants. A major obstacle has been the inability to improve visceral perfusion, while at the same time respecting the ethics of the organ donor. A retrievable dual-chamber stentgraft could potentially isolate the organ perfusion from systemic hypotension and hypoxia, without increasing cardiac work or committing the donor. METHODS Retrievable dumbbell-shaped stents were laser welded from nitinol wire and covered with polytetrafluoroethylene. Yorkshire pigs were assigned to either agonal control or dumbbell-shaped dual-chamber stentgraft. A central lumen maintained aortic flow, while an outer visceral chamber was perfused with oxygenated blood. A 1-hour agonal phase of hypoxia and hypotension was simulated. Stents were removed by simple sheath advancement. Cardiac monitoring, labs, and visceral flow were recorded followed by recovery of the animal to a goal of 48 hours. RESULTS Cardiac stress did not increase during stent deployment. Visceral pO2 and flow were dramatically improved in stented animal relative to control animals. Five of 7 control animals were killed after renal failure complications, whereas all stent animals survived. Histology confirmed increased ischemic changes among control kidneys compared to stented animals. CONCLUSION A dual-chamber stent improved outcomes after a simulated agonal phase. The stent did not increase cardiac work, thus respecting a key ethical consideration. The ability of a dual-chamber stent to prevent ischemia during organ recovery may become a powerful tool to address the critical donor organ shortage.
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Affiliation(s)
- Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA
| | - Moataz Elsisy
- Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Brian Frenz
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA
| | - J B Moses
- Department of Surgery, University of Pittsburgh Medical Center, PA
| | - Amit D Tevar
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA
| | - Anthony J Demetris
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA
| | - Youngjae Chun
- Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Bryan W Tillman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA; Department of Surgery, University of Pittsburgh Medical Center, PA; Division of Vascular Surgery, Ohio State University Wexner Medical Center, Columbus, OH.
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113
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Rubio Muñoz JJ, Dominguez-Gil González B, Miñambres García E, Del Río Gallegos F, Pérez-Villares JM. Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain. Med Intensiva 2021; 46:31-41. [PMID: 34794913 DOI: 10.1016/j.medine.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.
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Affiliation(s)
- J J Rubio Muñoz
- Servicio de Medicina Intensiva, Unidad de Coordinación de Trasplantes, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | - E Miñambres García
- Coordinación Regional de Trasplantes de la Comunidad de Cantabria, Servicio de Medicina Intensiva del Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - F Del Río Gallegos
- Coordinación Regional de Trasplantes de la Comunidad de Madrid, Servicio de Medicina Intensiva del Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J M Pérez-Villares
- Coordinador Regional de Trasplantes de la Comunidad de Andalucía, Servicio de Medicina Intensiva del Hospital Universitario Virgen de las Nieves, Granada, Spain
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114
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Barbier L, Guillem T, Savier E, Scatton O, Dondero F, Si Larbi AG, Bucur P, Sulpice L, Robin F, Goumard C, Muller X, Venhard JC, Allard MA, Pittau G, Soubrane O, Mercier E, Laffon M, Lesurtel M, Salamé E. Impact of the duration of normothermic regional perfusion on the results of liver transplant from controlled circulatory death donors: A retrospective, multicentric study. Clin Transplant 2021; 36:e14536. [PMID: 34779019 DOI: 10.1111/ctr.14536] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 12/29/2022]
Abstract
In France, the program of controlled donation after circulatory death (cDCD) was established with routine use of in situ normothermic regional perfusion (NRP). There is currently no consensus on its optimal duration. The purpose was to assess the impact of NRP duration on liver graft function and biliary outcomes. One-hundred and fifty-six liver recipients from NRP-cDCD donors from six French centers between 2015 and 2019 were included. Primary endpoint was graft function assessed by early allograft dysfunction (EAD, according to Olthoff's criteria) and MEAF (model for early allograft function) score. Overall, three (1.9%) patients had primary non-function, 30 (19.2%) patients experienced EAD, and MEAF score was 7.3 (±1.7). Mean NRP duration was 179 (±43) min. There was no impact of NRP duration on EAD (170±44 min in patients with EAD vs. 181±42 min in patients without, P = .286). There was no significant association between NRP duration and MEAF score (P = .347). NRP duration did neither impact on overall biliary complications nor on non-anastomotic biliary strictures (overall rates of 16.7% and 3.9%, respectively). In conclusion, duration of NRP in cDCD donors does not seem to impact liver graft function and biliary outcomes after liver transplantation. A 1 to 4-h perfusion represents an optimal time window.
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Affiliation(s)
- Louise Barbier
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, University of Tours, Tours, France.,FHU Support, Tours, France
| | - Thomas Guillem
- Anesthesiology and Surgical Critical Care Medicine Department, Tours University Hospital, University of Tours, Tours, France
| | - Eric Savier
- Digestive Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, St Antoine Research Center (CRSA), Sorbonne University, INSERM, Paris, France
| | - Olivier Scatton
- Digestive Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, St Antoine Research Center (CRSA), Sorbonne University, INSERM, Paris, France
| | - Federica Dondero
- Hepatobiliary Surgery and Liver Transplantation, Beaujon hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, Clichy, France
| | | | - Petru Bucur
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, University of Tours, Tours, France.,FHU Support, Tours, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
| | - Claire Goumard
- Digestive Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, St Antoine Research Center (CRSA), Sorbonne University, INSERM, Paris, France
| | - Xavier Muller
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Lyon, France
| | - Jean-Christophe Venhard
- FHU Support, Tours, France.,Anesthesiology and Surgical Critical Care Medicine Department, Tours University Hospital, University of Tours, Tours, France.,Coordination for organ and tissue donation and procurement, Tours University Hospital, University of Tours, Tours, France
| | - Marc-Antoine Allard
- AP-HP Hopital Paul Brousse, Department of HPB surgery and liver transplantation, Centre Hépato-Biliaire, Paris-Saclay University, Villejuif, France
| | - Gabriella Pittau
- AP-HP Hopital Paul Brousse, Department of HPB surgery and liver transplantation, Centre Hépato-Biliaire, Paris-Saclay University, Villejuif, France
| | - Olivier Soubrane
- Hepatobiliary Surgery and Liver Transplantation, Beaujon hospital, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University, Clichy, France
| | - Emmanuelle Mercier
- INSERM CIC 1415, Intensive Care Medicine, University Hospital of Tours, University of Tours, Tours, France
| | - Marc Laffon
- Anesthesiology and Surgical Critical Care Medicine Department, Tours University Hospital, University of Tours, Tours, France
| | - Mickael Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Lyon, France
| | - Ephrem Salamé
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, University of Tours, Tours, France.,FHU Support, Tours, France
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115
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Padilla M, Coll E, Fernández-Pérez C, Pont T, Ruiz Á, Pérez-Redondo M, Oliver E, Atutxa L, Manciño JM, Daga D, Miñambres E, Moya J, Vidal B, Dueñas-Jurado JM, Mosteiro F, Rodríguez-Salgado A, Fernández-García E, Lara R, Hernández-Marrero D, Estébanez B, Rodríguez-Ferrero ML, Barber M, García-López F, Andrés A, Santiago C, Zapatero A, Badenes R, Carrizosa F, Blanco JJ, Bernal JL, Elola FJ, Vidal C, Terrón C, Castro P, Comas J, Domínguez-Gil B. Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion. Am J Transplant 2021; 21:3618-3628. [PMID: 33891793 DOI: 10.1111/ajt.16622] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 01/25/2023]
Abstract
Normothermic regional perfusion (NRP) allows the in situ perfusion of organs with oxygenated blood in donation after the circulatory determination of death (DCDD). We aimed at evaluating the impact of NRP on the short-term outcomes of kidney transplants in controlled DCDD (cDCDD). This is a multicenter, nationwide, retrospective study comparing cDCDD kidneys obtained with NRP versus the standard rapid recovery (RR) technique. During 2012-2018, 2302 cDCDD adult kidney transplants were performed in Spain using NRP (n = 865) or RR (n = 1437). The study groups differed in donor and recipient age, warm, and cold ischemic time and use of ex situ machine perfusion. Transplants in the NRP group were more frequently performed in high-volume centers (≥90 transplants/year). Through matching by propensity score, two cohorts with a total of 770 patients were obtained. After the matching, no statistically significant differences were observed between the groups in terms of primary nonfunction (p = .261) and mortality at 1 year (p = .111). However, the RR of kidneys was associated with a significantly increased odds of delayed graft function (OR 1.97 [95% CI 1.43-2.72]; p < .001) and 1-year graft loss (OR 1.77 [95% CI 1.01-3.17]; p = .034). In conclusion, compared with RR, NRP appears to improve the short-term outcomes of cDCDD kidney transplants.
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Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Preventive Medicine and Public Health Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Teresa Pont
- Donation and Transplantation Coordination Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.,Vall d'Hebron Barcelona Hospital Campus, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ángel Ruiz
- Donation and Transplantation Coordination Unit, Hospital Clinic, Barcelona, Spain
| | - Marina Pérez-Redondo
- Donation and Transplantation Coordination Unit, Hospital Universitario Puerta de Hierro- Majadahona, Madrid, Spain
| | - Eva Oliver
- Donation and Transplantation Coordination Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Lander Atutxa
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario de Donostia, San Sebastián, Spain
| | - José M Manciño
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Domingo Daga
- Intensive Care Department, Regional Donor Transplant Coordination, Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Eduardo Miñambres
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
| | - José Moya
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Bárbara Vidal
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Fernando Mosteiro
- Donation and Transplantion Coordination Unit, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | - Alberto Rodríguez-Salgado
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Ramón Lara
- Intensive Care Department, Hospital Universitario Virgen de las Nieves, Regional Donor Transplant Coordination in Granada, Granada, Spain
| | - Domingo Hernández-Marrero
- Nephrology Department, Instituto de Investigación Biomédica de Málaga (IBIMA) REDINREN RD16/0009/0006, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Belén Estébanez
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - María Barber
- Intensive Care Department, Donation and Transplantation Coordination Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando García-López
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Albacete, Albacete, Spain
| | - Amado Andrés
- Nephrology Department, Donation and Transplantation Coordination Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Santiago
- Nephrology Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Ana Zapatero
- Donation and Transplantation Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Surgery, University of Valencia, Valencia, Spain.,INCLIVA, Research Health Institute, Valencia, Spain
| | - Francisco Carrizosa
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - José J Blanco
- Intensive Care Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | | | - Pablo Castro
- Coordinación Autonómica de Trasplantes de Andalucía, Sevilla, Spain
| | - Jordi Comas
- Organització Catalana de Trasplantaments, Barcelona, Spain
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116
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Bakhschai B, Blasczyk R. Dürfen im Ausland unter der Widerspruchsregelung gewonnene Organe nach deutschem Transplantationsrecht in Deutschland verwendet werden? TRANSFUSIONSMEDIZIN 2021. [DOI: 10.1055/a-1521-8068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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117
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Hosgood SA, Brown RJ, Nicholson ML. Advances in Kidney Preservation Techniques and Their Application in Clinical Practice. Transplantation 2021; 105:e202-e214. [PMID: 33982904 PMCID: PMC8549459 DOI: 10.1097/tp.0000000000003679] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.
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Affiliation(s)
- Sarah A. Hosgood
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Rachel J. Brown
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Michael L. Nicholson
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
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118
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Rijkse E, Bouari S, Kimenai HJAN, de Jonge J, de Bruin RWF, Slagter JS, van den Hoogen MWF, IJzermans JNM, Hoogduijn MJ, Minnee RC. Additional Normothermic Machine Perfusion Versus Hypothermic Machine Perfusion in Suboptimal Donor Kidney Transplantation: Protocol of a Randomized, Controlled, Open-Label Trial. Int J Surg Protoc 2021; 25:227-237. [PMID: 34708171 PMCID: PMC8499718 DOI: 10.29337/ijsp.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Ageing of the general population has led to an increase in the use of suboptimal kidneys from expanded criteria donation after brain death (ECD-DBD) and donation after circulatory death (DCD) donors. However, these kidneys have inferior graft outcomes and lower rates of immediate function. Normothermic machine perfusion (NMP) may improve outcomes of these suboptimal donor kidneys. Previous non-randomized studies have shown the safety of this technique and suggested its efficacy in improving the proportion of immediate functioning kidneys compared to static cold storage (SCS). However, its additional value to hypothermic machine perfusion (HMP), which has already been proved superior to SCS, has not yet been established. Methods and analysis: This single-center, open-label, randomized controlled trial aims to assess immediate kidney function after 120 minutes additional, end-ischemic NMP compared to HMP alone. Immediate kidney function is defined as no dialysis treatment in the first week after transplant. Eighty recipients on dialysis at the time of transplant who receive an ECD-DBD or DCD kidney graft are eligible for inclusion. In the NMP group, the donor kidney is taken of HMP upon arrival in the recipient hospital and thereafter put on NMP for 120 minutes at 37 degrees Celsius followed by transplantation. In the control group, donor kidneys stay on HMP until transplantation. The primary outcome is immediate kidney function. Ethics and dissemination: The protocol has been approved by the Medical Ethical Committee of Erasmus Medical Center (2020-0366). Results of this study will be submitted to peer-reviewed journals. Registration: registered in clinicaltrials.gov (NCT04882254). Highlights:
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Affiliation(s)
- Elsaline Rijkse
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sarah Bouari
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hendrikus J A N Kimenai
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jeroen de Jonge
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ron W F de Bruin
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Julia S Slagter
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Martijn W F van den Hoogen
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Martin J Hoogduijn
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert C Minnee
- Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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119
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Guerrero ER, García-Baquero R, Pérez CS, Fernández-Ávila CM, Mazuecos AB, Álvarez-Ossorio JL. Nighttime Kidney Transplant From Donor With Controlled Cardiac Death: Greater Functionality at the Cost of More Complications? Transplant Proc 2021; 53:2666-2671. [PMID: 34656367 DOI: 10.1016/j.transproceed.2021.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kidney transplantation surgery from controlled cardiac death donor (Maastricht III) is frequently performed at night, without taking into account the accumulated fatigue that the surgical team may experience. The objective of the study is to assess whether surgical complications and the functionality of the graft in the short and long term are affected by the time of day in which kidney transplantation from controlled cardiac death donors is performed. METHODS A retrospective observational study was carried out. Patient were classified according to the start of surgery, daytime hours (8:00 AM to 7:59 PM), and nighttime hours (8:00 PM to 7:59 AM). Baseline and intraoperative parameters, postoperative complications, and parameters related to graft functionality were analyzed. RESULTS A total of 77 patients were included: 37 patients had kidney transplantations performed during the daytime (48.05%), and 40 patients had kidney transplantations performed at nighttime (51.95%). No statistically significant differences were found between the baseline characteristics of both groups except for sex (55.0% men in daytime vs 78.4% men in nighttime, P = .03) and time on pretransplant dialysis (33.1 months in daytime vs 13.8 months in nighttime, P = .008). The incidence of surgical complications and the functionality of the graft was similar in both groups; however, the surgical time was shorter in night transplants (163.2 minutes in daytime vs 136.5 minutes at nighttime, P = .0006) CONCLUSION: The performance of kidney transplants at night is not associated, either in the short or long term, with an increase in surgical complications or conditions leading to the deterioration in the functionality of the graft.
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Affiliation(s)
- Estefania Ruiz Guerrero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - Rodrigo García-Baquero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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120
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Montero N, Toapanta N, Pallarès N, Crespo M, Diekmann F, Guirado L, Esteban R, Codina S, Melilli E, Buxeda A, Velis G, Torres IB, Revuelta I, Molina Andujar A, Facundo C, Bardají B, Riera L, Fiol M, Cruzado JM, Comas J, Giral M, Naesens M, Åsberg A, Moreso F, Bestard O. Deciphering transplant outcomes of expanded kidney allografts donated after controlled circulatory death in the current transplant era. A call for caution. Transpl Int 2021; 34:2494-2506. [PMID: 34626501 DOI: 10.1111/tri.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 01/20/2023]
Abstract
Outcomes of kidney transplantation (KT) after controlled circulatory death (cDCD) with highly expanded criteria donors (ECD) and recipients have not been thoroughly evaluated. We analyzed in a multicenter cohort of 1161 consecutive KT, granular baseline donor and recipient factors predicting transplant outcomes, selected by bootstrapping and Cox proportional hazards, and were validated in a contemporaneous European KT cohort (n = 1585). 74.3% were DBD and 25.7% cDCD-KT. ECD-KT showed the poorest graft survival rates, irrespective of cDCD or DBD (log-rank < 0.001). Besides standard ECD classification, dialysis vintage, older age, and previous cardiovascular recipient events together with low class-II-HLA match, long cold ischemia time and combining a diabetic donor with a cDCD predicted graft loss (C-Index 0.715, 95% CI 0.675-0.755). External validation showed good prediction accuracy (C-Index 0.697, 95%CI 0.643-0.741). Recipient older age, male gender, dialysis vintage, previous cardiovascular events, and receiving a cDCD independently predicted patient death. Benefit/risk assessment of undergoing KT was compared with concurrent waitlisted candidates, and despite the fact that undergoing KT outperformed remaining waitlisted, remarkably high mortality rates were predicted if KT was undertaken under the worst risk-prediction model. Strategies to increase the donor pool, including cDCD transplants with highly expanded donor and recipient candidates, should be performed with caution.
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Affiliation(s)
- Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Crespo
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Fritz Diekmann
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Lluis Guirado
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Rafael Esteban
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Codina
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Buxeda
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Velis
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Irina B Torres
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Ignacio Revuelta
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Alicia Molina Andujar
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bardají
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Lluís Riera
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Fiol
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Cruzado
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Comas
- Catalan Organ Transplant Organization, Barcelona, Spain
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Maarten Naesens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
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121
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Phillips BL, Ibrahim M, Greenhall GHB, Mumford L, Dorling A, Callaghan CJ. Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study. Am J Transplant 2021; 21:3346-3355. [PMID: 33756062 DOI: 10.1111/ajt.16574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF and its duration were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006 and 2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39·9%) had DGF. Of the 1847 recipients with DGF duration recorded, 926 (50·1%) had DGF < 7 days, 576 (31·2%) had DGF 7-14 days, and 345 (18·7%) had DGF >14 days. After risk adjustment, the presence of DGF was not associated with inferior long-term graft or patient survivals. However, DGF duration of >14 days was associated with an increased risk of death-censored graft failure (hazard ratio 1·7, p = ·001) and recipient death (hazard ratio 1·8, p < ·001) compared to grafts with immediate function. This study suggests that shorter periods of DGF have no adverse influence on graft or patient survival after DCD donor kidney transplantation and that DGF >14 days is a novel early biomarker for significantly worse longer-term outcomes.
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Affiliation(s)
- Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Lisa Mumford
- Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Anthony Dorling
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
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122
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De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, Kimenai HJAN, Knight SR, Neyrinck AP, Paredes D, Watson CJE, Rega F, Jochmans I. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int 2021; 34:2046-2060. [PMID: 34570380 DOI: 10.1111/tri.14121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
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Affiliation(s)
- Julie De Beule
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Liset H M Pengel
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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123
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Artiles Medina A, Burgos Revilla FJ, Álvarez Nadal M, Muriel García A, Álvarez Díaz N, Gómez Dos Santos V. Comparison of in situ preservation techniques for kidneys from donors after circulatory death: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:3286-3299. [PMID: 34532253 PMCID: PMC8421834 DOI: 10.21037/tau-21-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022] Open
Abstract
Background Several techniques have been developed to reduce the warm ischaemic injury of donation after circulatory death (DCD) organs before procurement. There are scarce data about the in situ preservation techniques for kidney graft outcomes. The aim of this systematic review was to evaluate the best in situ preservation method for kidney graft outcomes from organs obtained from controlled and uncontrolled DCD. Methods A systematic review of the PubMed (MEDLINE), Embase, LILACS and Cochrane databases was conducted. Studies that compare two or more in situ preservation techniques were identified and included. Only studies which provided enough data to calculate odds ratio were eligible for meta-analysis. PROSPERO registration: CRD42020179598. Results The search strategy yielded 7,121 studies. Ultimately, 14 retrospective studies were included. Because of heterogeneity, the included studies provided weak evidence that normothermic regional perfusion (NRP) is the best in situ preservation technique in terms of delayed graft function (DGF) rates. Regarding primary nonfunction (PNF), we carried out a meta-analysis of 10 studies with a pooled OR of 0.83 (95% CI: 0.40-1.71), for the NRP. In regard to DGF, pooled OR for NRP was 0.36 (95% CI: 0.25-0.54). Conclusions NRP in the DCD donor could improve kidney graft function and be considered the in situ preservation technique of choice for abdominal organs.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Álvarez Nadal
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alfonso Muriel García
- Department of Biostatistics, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBERESP, Universidad de Alcalá de Henares (UAH), Madrid, Spain
| | | | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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124
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Muller X, Rossignol G, Damotte S, Gregoire A, Matillon X, Morelon E, Badet L, Mohkam K, Lesurtel M, Mabrut JY. Graft utilization after normothermic regional perfusion in controlled donation after circulatory death-a single-center perspective from France. Transpl Int 2021; 34:1656-1666. [PMID: 34448267 DOI: 10.1111/tri.13987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
Normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) is a promising procurement strategy. However, a detailed analysis of graft utilization rates is lacking. This retrospective study included all cDCD donors proposed to a single center for NRP procurement of at least one abdominal organ from 2015 to 2020. Utilization rates were defined as the proportion of transplanted grafts from proposed donors in which withdrawal of life sustaining therapies (WLST) was initiated. In total, 125 cDCD donors underwent WLST with transplantation of at least one graft from 109 (87%) donors. In a total of 14 (11%) procedures NRP failure led to graft discard. Utilization rates for kidney and liver grafts were 83% and 59%, respectively. In 44% of the discarded livers, the reason was poor graft quality based on functional donor warm ischemia >45 min, macroscopic aspect, high-transaminases release, or pathological biopsy. In this study, abdominal NRP in cDCD lead to transplantation of at least one graft in the majority of cases. While the utilization rate for kidneys was high, nearly half of the liver grafts were discarded. Cannulation training, novel graft viability markers, and ex-vivo liver graft perfusion may allow to increase graft utilization.
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Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Guillaume Rossignol
- Cancer Research Center of Lyon, INSERM U1052, Lyon, France.,Department of Pediatric Surgery and Liver Transplantation, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, University of Lyon I, Bron, France
| | - Sophie Damotte
- Department of Anesthesiology and Critical Care, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Arnaud Gregoire
- Department of Anesthesiology and Critical Care, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Xavier Matillon
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Emmanuel Morelon
- Department of Urology and Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Lionel Badet
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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125
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Early Allograft Dysfunction and Complications in DCD Liver Transplantation: Expert Consensus Statements From the International Liver Transplantation Society. Transplantation 2021; 105:1643-1652. [PMID: 34291765 DOI: 10.1097/tp.0000000000003877] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Livers for transplantation from donation after circulatory death donors are relatively more prone to early and ongoing alterations in graft function that might ultimately lead to graft loss and even patient death. In consideration of this fact, this working group of the International Liver Transplantation Society has performed a critical evaluation of the medical literature to create a set of statements regarding the assessment of early allograft function/dysfunction and complications arising in the setting of donation after circulatory death liver transplantation.
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126
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Unassisted Return of Spontaneous Circulation Following Withdrawal of Life-Sustaining Therapy During Donation After Circulatory Determination of Death in a Child. Crit Care Med 2021; 50:e183-e188. [PMID: 34369429 DOI: 10.1097/ccm.0000000000005273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. DESIGN Case report based on clinical observation and medical record review. SETTING Community Children's Hospital. PATIENT Two-year old child. INTERVENTIONS Following hypoxic-ischemic brain injury, the child was taken to the operating room for withdrawal of life-sustaining treatment during controlled donation after circulatory determination of death. MEASUREMENTS AND MAIN RESULTS In addition to direct observation by experienced pediatric critical care providers, the child was monitored with electrocardiography, pulse oximetry, and invasive blood pressure via femoral arterial catheter in addition to direct observation by experienced pediatric critical care providers. Unassisted return of spontaneous circulation occurred greater than 2 minutes following circulatory arrest and was accompanied by return of respiration. CONCLUSIONS We provide the first report of unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. In our case, return of spontaneous circulation occurred in the setting of controlled donation after circulatory determination of death and was accompanied by return of respiration. Return of spontaneous circulation greater than 2 minutes following circulatory arrest in our patient indicates that 2 minutes of observation is insufficient to ensure that cessation of circulation is permanent after withdrawal of life-sustaining treatment in a child.
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127
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Hypothermic Oxygenated Machine Perfusion (HOPE) Reduces Early Allograft Injury and Improves Post-Transplant Outcomes in Extended Criteria Donation (ECD) Liver Transplantation from Donation After Brain Death (DBD): Results from a Multicenter Randomized Controlled Trial (HOPE ECD-DBD). Ann Surg 2021; 274:705-712. [PMID: 34334635 DOI: 10.1097/sla.0000000000005110] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate peak serum alanine aminotransferase (ALT) and postoperative clinical outcomes after hypothermic oxygenated machine perfusion (HOPE) versus static cold storage (SCS) in extended criteria donation (ECD) liver transplantation (LT) from donation after brain death (DBD). BACKGROUND HOPE might improve outcomes in LT, particularly in high-risk settings such as ECD organs after DBD, but this hypothesis has not yet been tested in a randomized controlled clinical trial (RCT). METHODS Between 09/2017-09/2020 46 patients undergoing ECD-DBD LT from four centers were randomly assigned to HOPE (n=23) or SCS (n=23). Peak-ALT levels within seven days following LT constituted the primary endpoint. Secondary endpoints included incidence of postoperative complications (Clavien-Dindo classification (CD), Comprehensive Complication Index (CCI)), length of intensive care- (ICU) and hospital-stay, and incidence of early allograft dysfunction (EAD). RESULTS Demographics were equally distributed between both groups (donor age: 72 [IQR:59-78] years, recipient age: 62 [IQR:55-65] years, labMELD: 15 [IQR:9-25], 38 male and 8 female recipients). HOPE resulted in a 47% decrease in serum peak ALT (418 [IQR: 221-828] vs. 796 [IQR:477-1195] IU/L, p=0.030), a significant reduction in 90-day complications (44% vs. 74% CD grade ≥3, p=0.036; 32 [IQR:12-56] vs. 52 [IQR:35-98] CCI, p=0.021), and shorter ICU- and hospital-stays (5 [IQR:4-8] vs. 8 [IQR:5-18] days, p=0.045; 20 [IQR:16-27] vs. 36 [IQR:23-62] days, p=0.002) compared to SCS. A trend towards reduced EAD was observed for HOPE (17% vs. 35%; p=0.314). CONCLUSION This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation.
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128
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Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society. Transplantation 2021; 105:945-951. [PMID: 33675315 DOI: 10.1097/tp.0000000000003729] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Donation after circulatory death (DCD) donors are an increasingly more common source of livers for transplantation in many parts of the world. Events that occur during DCD liver recovery have a significant impact on the success of subsequent transplantation. This working group of the International Liver Transplantation Society evaluated current evidence as well as combined experience and created this guidance on DCD liver procurement. Best practices for the recovery and transplantation of livers arising through DCD after euthanasia and organ procurement with super-rapid cold preservation and recovery as well as postmortem normothermic regional perfusion are described, as are the use of adjuncts during DCD liver procurement.
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129
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Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes. Transplant Direct 2021; 7:e725. [PMID: 34291147 PMCID: PMC8288885 DOI: 10.1097/txd.0000000000001174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. Warm ischemia time and ischemia-reperfusion damage result in higher rates of delayed graft function and primary nonfunction in kidney transplants (KTs) from controlled donation after circulatory death (cDCD). This study aimed to assess early and late kidney function and patient and graft survival of KT from cDCD preserved with normothermic regional perfusion (NRP) and to compare with KT from brain death donors (DBDs) and cDCD preserved with rapid recovery (RR). Methods. Patients who received a KT at our institution from 2012 to 2018 were included, with a minimum follow-up period of 1 y. They were categorized by donor type and conditioning methods: DBD, cDCD with NRP, and cDCD with RR. Early and late graft function, along with patient and graft survival were analyzed in all groups. Results. A total of 182 KT recipients were included in the study (98 DBD and 84 cDCD). Out of the cDCDs, 24 kidneys were recovered with the use of NRP and 62 with RR; 22 of the 24 kidneys were ultimately transplanted. The cDCD using NRP group showed lower rates of delayed graft function compared with the cDCD with RR group (36.3% versus 46.7%, P = 0.01). Also, primary nonfunction rates were lower in the cDCD using NRP group (4.5% versus 6.4% cDCD-RR and 10.2% DBD). Patient survival rates were >90% in all groups. No differences were found in graft survival rates at 1 y. Conclusions. The use of abdominal NRP improves early function recovery of KT from cDCD, making their outcomes comparable with those of DBD.
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130
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Valentín MDLO, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2021; 42:S0211-6995(21)00113-2. [PMID: 34294484 DOI: 10.1016/j.nefro.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 10/20/2022] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, España
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, España
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131
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Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis. Int J Surg 2021; 92:106021. [PMID: 34256169 DOI: 10.1016/j.ijsu.2021.106021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Donation after circulatory death (DCD) kidney transplantation has been introduced to address organ shortage. However, DCD kidneys are not accepted worldwide due to concerns about inferior quality. To investigate whether these concerns are justified, we performed a systematic review and meta-analysis to investigate DCD graft outcomes compared to donation after brain death (DBD). MATERIALS AND METHODS EMBASE, Medline, Cochrane, Web of Science and Google Scholar were searched from database inception until September 2020. Exclusion criteria were studies reporting on pediatric/dual kidney transplants, multi-organ transplants or studies including normothermic perfusion techniques. The primary outcome was graft survival. Secondary outcomes were primary non-function (PNF), delayed graft function (DGF), 3-months biopsy-proven acute rejection (BPAR), 1-year estimated Glomerular Filtration Rate (eGFR), patient survival, and urologic complications. A random-effects model was used for meta-analysis. Meta-regression analysis was performed in case of high between-study heterogeneity. RESULTS Fifty-one studies were included, comprising 73,454 DCD and 518,229 DBD recipients. One-year graft loss was increased in DCD recipients (death-censored: risk ratio (RR) 1.10 (95%-confidence interval (CI) 1.04-1.16), all-cause: RR 1.13 (95%-CI 1.08-1.19)). Ten-year graft loss was similar to DBD (death-censored: RR 1.02 (95%-CI 0.92-1.13), all-cause: RR 1.03 (95%-CI 0.94-1.13)). DCD recipients had an increased risk of PNF (RR 1.43 (95%-CI 1.26-1.62)), DGF (RR 2.02 (95%-CI 1.88-2.16)), and 1-year mortality (RR 1.10 (95%-CI 1.01-1.21)). No differences were observed for 3-months BPAR, ureter stenosis/leakage, 1-year eGFR and 10-year mortality. CONCLUSION Long-term DCD kidney transplant outcomes are similar to DBD despite a higher risk of PNF, DGF, and a 13% increased risk of graft loss in the first year after transplantation. These results should encourage implementation of DCD programs.
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132
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Franzin R, Stasi A, Fiorentino M, Simone S, Oberbauer R, Castellano G, Gesualdo L. Renal Delivery of Pharmacologic Agents During Machine Perfusion to Prevent Ischaemia-Reperfusion Injury: From Murine Model to Clinical Trials. Front Immunol 2021; 12:673562. [PMID: 34295329 PMCID: PMC8290413 DOI: 10.3389/fimmu.2021.673562] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
Donor organ shortage still remains a serious obstacle for the access of wait-list patients to kidney transplantation, the best treatment for End-Stage Kidney Disease (ESKD). To expand the number of transplants, the use of lower quality organs from older ECD or DCD donors has become an established routine but at the price of increased incidence of Primary Non-Function, Delay Graft Function and lower-long term graft survival. In the last years, several improvements have been made in the field of renal transplantation from surgical procedure to preservation strategies. To improve renal outcomes, research has focused on development of innovative and dynamic preservation techniques, in order to assess graft function and promote regeneration by pharmacological intervention before transplantation. This review provides an overview of the current knowledge of these new preservation strategies by machine perfusions and pharmacological interventions at different timing possibilities: in the organ donor, ex-vivo during perfusion machine reconditioning or after implementation in the recipient. We will report therapies as anti-oxidant and anti-inflammatory agents, senolytics agents, complement inhibitors, HDL, siRNA and H2S supplementation. Renal delivery of pharmacologic agents during preservation state provides a window of opportunity to treat the organ in an isolated manner and a crucial route of administration. Even if few studies have been reported of transplantation after ex-vivo drugs administration, targeting the biological pathway associated to kidney failure (i.e. oxidative stress, complement system, fibrosis) might be a promising therapeutic strategy to improve the quality of various donor organs and expand organ availability.
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Affiliation(s)
- Rossana Franzin
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Stasi
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, University Clinic for Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
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Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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134
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Park H, Jung ES, Oh JS, Lee YM, Lee JM. Organ donation after controlled circulatory death (Maastricht classification III) following the withdrawal of life-sustaining treatment in Korea: a suggested guideline. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:71-76. [PMID: 35769520 PMCID: PMC9235338 DOI: 10.4285/kjt.21.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022] Open
Abstract
The “Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life” was enacted in February 2018 in Korea. Therefore, we suggest a Korean guideline for organ donation after circulatory death (DCD) category III after the withdrawal of life-sustaining treatment (WLST). Implementation of WLST includes stopping ventilation, extubation, discontinuation of inotropics and vasoconstrictors, cessation of continuous renal replacement therapy, and cessation of extracorporeal membrane oxygenation. Medical staff involved in organ procurement or transplantation surgery cannot participate in the WLST process. Following cardiac arrest, 5 minutes of “no touch time” should pass, after which circulatory death can be declared. The procurement team can enter the room after the declaration of death. The final procurement decision is made after the surgeon visually checks the organ condition. DCD category III activation in Korea will help increase organ donation and reduce the demand-supply mismatch of organ transplantation.
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Affiliation(s)
- Hoonsung Park
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Eun-Sil Jung
- Transplantation Center, Korea University Anam Hospital, Seoul, Korea
| | | | | | - Jae-Myeong Lee
- Division of Acute Care Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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135
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van der Windt DJ, Mehta R, Jorgensen DR, Hariharan S, Randhawa PS, Sood P, Molinari M, Wijkstrom M, Ganoza A, Tevar AD. Donation after circulatory death is associated with increased fibrosis on 1-year post-transplant kidney allograft surveillance biopsy. Clin Transplant 2021; 35:e14399. [PMID: 34176169 DOI: 10.1111/ctr.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
AIM The use of kidneys donated after circulatory death (DCD) provides an invaluable expansion of the organ supply for transplantation. Here, we investigated the effect of DCD on fibrotic changes on 1 1-year post 1-transplant surveillance kidney allograft biopsy. METHODS Recipients of a deceased donor kidney transplant between 2013 and 2017 at a single institution, who survived 1 year and underwent surveillance biopsy, were included in the analysis (n = 333: 87 DCD kidneys, 246 kidneys donated after brain death [DBD]). Banff scores for interstitial fibrosis and tubular atrophy were summed as IFTA and compared between the groups. RESULTS DCD and DBD groups were comparable for baseline characteristics. Delayed graft function was 39% in DCD versus 19% in DBD, P = .0002. Patient and graft survival were comparable for DCD and DBD cohorts. IFTA scores were higher in DCD compared to DBD (2.43±..13 vs. 2.01±..08, P = .0054). On multivariate analysis, the odds of IFTA > 2 in the DCD group was 2.5× higher (95%CI: 1.354.63) than in the DBD group. Within the DCD group, kidneys with IFTA > 2 had inferior 5-year graft survival (P = .037). CONCLUSION Compared to DBD kidneys, DCD kidneys developed a greater degree of fibrotic changes on 1-year post-transplant surveillance biopsy, which affected graft longevity within the DCD cohort.
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Affiliation(s)
- Dirk J van der Windt
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajil Mehta
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dana R Jorgensen
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parmjeet S Randhawa
- Division of Transplant Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michele Molinari
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Martin Wijkstrom
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit D Tevar
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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136
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Weiss MJ, van Beinum A, Harvey D, Chandler JA. Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review. Transplant Rev (Orlando) 2021; 35:100635. [PMID: 34174656 DOI: 10.1016/j.trre.2021.100635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
AIM Pre-mortem interventions (PMIs) are performed on patients before the determination of death in order to preserve or enhance the possibility of organ donation. These interventions can be ethically controversial, and we thus undertook a scoping review of the ethical issues surrounding diverse PMIs. METHODS Using modified scoping review methods, we executed a search strategy created by an information specialist. Screening and iterative coding of each article was done by two researchers using qualitative thematic analysis, and narrative summaries of coded themes were presented. RESULTS We identified and screened 5365 references and coded 196 peer-reviewed publications. The most frequently cited issues were related to possible harms to the patient who is a potential donor, and legitimacy of consent. The most controversial issue was that PMIs may place patients at risk for physical harm, yet benefit is accrued mainly to recipients. Some authors argued that lack of direct medical benefit to the still living patient precluded valid consent from surrogate decision makers (SDMs), while many stated that some medical risk could be approved by SDMs if it aligns with non-medical benefits valued by the patient. CONCLUSION PMIs require consensus that benefit includes concepts beyond medical benefit to the patient who is a potential donor. Informed consent must be confirmed for each PMI and not assumed to be part of general consent for donation. Risk must be proportionate to the potential benefit and newly proposed interventions should be reviewed carefully for medical efficacy and potential risks.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, 4100 Rue Molson #200, Montréal, QC H1Y 3N1, Canada; Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Division of Pediatric Intensive Care, Centre Mère-Enfant Soleil du CHU de Québec, 2705 boul Laurier, Québec, Québec, Canada.
| | - Amanda van Beinum
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Sociology and Anthropology, B750 Loeb Building, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Dan Harvey
- Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG72UH, UK; University of Nottingham, University Park, Nottingham NG72RD, UK; National Health Services Blood & Transplant, Fox Den Road, Stoke Gifford, Avon, Bristol BS348RR, UK
| | - Jennifer A Chandler
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Bertram Loeb Research Chair, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada; Centre for Health Law, Policy and Ethics, Faculty of Law, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada.
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137
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Jochmans I, Hessheimer AJ, Neyrinck AP, Paredes D, Bellini MI, Dark JH, Kimenai HJAN, Pengel LHM, Watson CJE. Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European Society for Organ Transplantation's Transplant Learning Journey. Transpl Int 2021; 34:2019-2030. [PMID: 34145644 DOI: 10.1111/tri.13951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence-based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.
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Affiliation(s)
- Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Arne P Neyrinck
- Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Liset H M Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christopher J E Watson
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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138
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Jeong E, Baik S, Park H, Oh J, Lee Y, Lee JM. First Organ Donation after Circulatory Death Following Withdrawal of Life-sustaining Treatment in Korea: a Case Report. J Korean Med Sci 2021; 36:e171. [PMID: 34128599 PMCID: PMC8203855 DOI: 10.3346/jkms.2021.36.e171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist. The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of "no-touch time," circulatory death was declared. Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.
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Affiliation(s)
- Eunsil Jeong
- Transplantation Center, Korea University Anam Hospital, Seoul, Korea
| | - Seungmin Baik
- Department of Critical Care Medicine & Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hoonsung Park
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jaesook Oh
- Korea Organ and Tissue Donation Agency, Seoul, Korea
| | - Yongmin Lee
- Korea Organ and Tissue Donation Agency, Seoul, Korea
| | - Jae Myeong Lee
- Division of Acute Care Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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139
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Ehrsam JP, Benden C, Immer FF, Inci I. Current status and further potential of lung donation after circulatory death. Clin Transplant 2021; 35:e14335. [PMID: 33948997 DOI: 10.1111/ctr.14335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
Chronic organ shortage remains the most limiting factor in lung transplantation. To overcome this shortage, a minority of centers have started with efforts to reintroduce donation after circulatory death (DCD). This review aims to evaluate the experimental background, the current international clinical experience, and the further potential and challenges of the different DCD categories. Successful strategies have been implemented to reduce the problems of warm ischemic time, thrombosis after circulatory arrest, and difficulties in organ assessment, which come with DCD donation. From the currently reported results, controlled-DCD lungs are an effective and safe method with good mid-term and even long-term survival outcomes comparable to donation after brain death (DBD). Primary graft dysfunction and onset of chronic allograft dysfunction seem also comparable. Thus, controlled-DCD lungs should be ceased to be treated as marginal and instead be promoted as an equivalent alternative to DBD. A wide implementation of controlled-DCD-lung donation would significantly decrease the mortality on the waiting list. Therefore, further efforts in establishment of legislation and logistics are crucial. With regard to uncontrolled DCD, more data are needed analyzing long-term outcomes. To help with the detailed assessment and improvement of uncontrolled or otherwise questionable grafts after retrieval, ex-vivo lung perfusion is promising.
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Affiliation(s)
- Jonas P Ehrsam
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Cantonal Hospital Aarau, Zurich, Switzerland
| | | | | | - Ilhan Inci
- Department of Thoracic Surgery, Cantonal Hospital Aarau, Zurich, Switzerland.,University of Zurich Faculty of Medicine, Zurich, Switzerland
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140
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Miñambres E, Royo-Villanova M, Pérez-Redondo M, Coll E, Villar-García S, Canovas SJ, Francisco Nistal J, Garrido IP, Gómez-Bueno M, Cobo M, Dominguez-Gil B. Spanish experience with heart transplants from controlled donation after the circulatory determination of death using thoraco-abdominal normothermic regional perfusion and cold storage. Am J Transplant 2021; 21:1597-1602. [PMID: 33319435 DOI: 10.1111/ajt.16446] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
Heart transplantation from controlled donation after the circulatory determination of death (cDCDD) may help to increase the availability of hearts for transplantation. During 2020, four heart transplants were performed at three different Spanish hospitals based on the use of thoraco-abdominal normothermic regional perfusion (TA-NRP) followed by cold storage (CS). All donors were young adults <45 years. The functional warms ischemic time ranged from 8 to 16 minutes. In all cases, the heart recovered sinus rhythm within 1 minute of TA-NRP. TA-NRP was weaned off or decreased <1L within 25 minutes. No recipient required mechanical support after transplantation and all were immediately extubated and discharged home (median hospital stay: 21 days) with an excellent outcome. Four livers, eight kidneys, and two pancreata were also recovered and transplanted. All abdominal grafts recipients experienced an excellent outcome. The use of TA-NRP makes heart transplantation feasible and allows assessing heart function before organ procurement without any negative impact on the preservation of abdominal organs. The use of TA-NRP in cDCDD heart donors in conjunction with cold storage following retrieval can eliminate the need to use ex situ machine perfusion devices, making cDCDD heart transplantation economically possible in other countries.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Mario Royo-Villanova
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Virgen de la Arrixaca. IMIB-Arrixaca Research Institute, Murcia, Spain
| | - Marina Pérez-Redondo
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Puerta de Hierro, Madrid, Spain
| | | | - Susana Villar-García
- Cardiovascular Surgery Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Sergio J Canovas
- Cardiovascular Surgery Department, University Hospital Virgen de la Arrixaca, Medical School, University of Murcia, Murcia, Spain
| | - Juan Francisco Nistal
- Service of Cardiovascular Surgery, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, School of Medicine, CIBERCV, Instituto de Salud Carlos III, Santander, Spain
| | - Iris P Garrido
- Heart Failure and Heart Transplant Unit, Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Manuel Gómez-Bueno
- Service of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Manuel Cobo
- Service of Cardiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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141
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Domínguez-Gil B, Ascher N, Capron AM, Gardiner D, Manara AR, Bernat JL, Miñambres E, Singh JM, Porte RJ, Markmann JF, Dhital K, Ledoux D, Fondevila C, Hosgood S, Van Raemdonck D, Keshavjee S, Dubois J, McGee A, Henderson GV, Glazier AK, Tullius SG, Shemie SD, Delmonico FL. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med 2021; 47:265-281. [PMID: 33635355 PMCID: PMC7907666 DOI: 10.1007/s00134-020-06341-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
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Affiliation(s)
| | - Nancy Ascher
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Alexander M Capron
- Scott H. Bice Chair in Healthcare Law, Policy and Ethics, Department of Medicine and Law, University of Southern California, Los Angeles, CA, USA
| | - Dale Gardiner
- Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alexander R Manara
- Consultant in Intensive Care Medicine, The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James L Bernat
- Department of Neurology and Medicine, Active Emeritus, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Eduardo Miñambres
- Transplant Coordination Unit and Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Jeffrey M Singh
- University of Toronto, and Trillium Gift of Life Network, Toronto, Canada
| | - Robert J Porte
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - James F Markmann
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kumud Dhital
- Department of Cardiothoracic Surgery, Sant Vincent'S Hospital, Sidney, Australia
| | - Didier Ledoux
- Department of Anesthesia and Intensive Care, University of Liège, Liège, Belgium
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Sarah Hosgood
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Dirk Van Raemdonck
- University Hospitals Leuven and Catholic University Leuven, Leuven, Belgium
| | - Shaf Keshavjee
- Toronto General Hospital, University of Toronto, Toronto, Canada
| | - James Dubois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew McGee
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane City, Australia
| | - Galen V Henderson
- Director of Neurocritical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Stefan G Tullius
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam D Shemie
- Pediatric Intensive Care, Montreal Children's Hospital, McGill University, Medical Advisor, Deceased Donation, Canadian Blood Services, Montreal, Canada
| | - Francis L Delmonico
- Chief Medical Officer, New England Donor Services, 60 1st Ave, Waltham, MA, 02451, USA.
- Department of Surgery, Harvard Medical School at Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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142
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Bein T, Combes A, Meyfroidt G. Organ donation after controlled cardiocirculatory death: confidence by clarity. Intensive Care Med 2021; 47:325-327. [PMID: 33620510 PMCID: PMC7952349 DOI: 10.1007/s00134-021-06362-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 01/04/2023]
Affiliation(s)
- Thomas Bein
- Faculty of Medicine, University of Regensburg, Regensburg, Germany.
| | - Alain Combes
- Service de Médecine Intensive-Réanimation Institut de Cardiologie, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris, APHP Sorbonne Université, INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, 47 bd de l'Hôpital, 75013, Paris, France
| | - Geert Meyfroidt
- UZ Leuven, campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
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143
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Friend PJ, Dengu F. Expanding the Scope of Donation After Circulatory Death Liver Transplantation. Liver Transpl 2021; 27:325-326. [PMID: 33098747 DOI: 10.1002/lt.25924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Peter J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford Transplant Centre, Churchill Hospital, Oxford, UK
| | - Fungai Dengu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford Transplant Centre, Churchill Hospital, Oxford, UK
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144
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Abstract
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
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145
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Pérez Redondo M, Alcántara Carmona S, Villar García S, Forteza Gil A, Villanueva Fernández H, Hernández-Pérez FJ, Campo-Cañaveral de la Cruz JL, Velasco Calvo R, Segovia-Cubero J, Alonso Menárguez B, Del Río Gallegos F, Coll E, Domínguez-Gil González B, Rubio Muñoz JJ. Transplantation of a heart donated after circulatory death via thoraco-abdominal normothermic regional perfusion and results from the first Spanish case. J Cardiothorac Surg 2020; 15:333. [PMID: 33239086 PMCID: PMC7687983 DOI: 10.1186/s13019-020-01372-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. CASE PRESENTATION We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. CONCLUSIONS This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.
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Affiliation(s)
- Marina Pérez Redondo
- Department of Intensive Care Medicine Department of Donor and Transplant Coordination, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de investigación sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain.
| | - Sara Alcántara Carmona
- Department of Intensive Care Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Villar García
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alberto Forteza Gil
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Francisco José Hernández-Pérez
- Department of Cardiology. Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Rocío Velasco Calvo
- Department of Neurology, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
| | - Javier Segovia-Cubero
- Department of Cardiology. Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- CIBER cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Alonso Menárguez
- Division of Transplant and Cardiac Anesthesia, Department of Anesthesiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Juan José Rubio Muñoz
- Department of Intensive Care Medicine Department of Donor and Transplant Coordination, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de investigación sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain
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146
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147
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Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death: A Systematic Review and Critical Appraisal. Transplantation 2020; 104:1776-1791. [PMID: 32541563 DOI: 10.1097/tp.0000000000003345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominal normothermic regional perfusion (aNRP) for donation after circulatory death is an emerging organ preservation technique that might lead to increased organ utilization per donor by facilitating viability testing, improving transplant outcome by early reversal of ischemia, and decreasing the risk of unintentional surgical damage. The aim of the current review is to evaluate the recent literature on the added value of aNRP when compared to local standard perfusion technique. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for systematic reviews was used, and relevant literature databases were searched. Primary outcomes were organ utilization rate and patient and graft survival after 1 year. Secondary outcomes included delayed graft function, primary nonfunction, serum creatinine, and biliary complications. RESULTS A total of 24 articles were included in this review. The technique is unanimously reported to be feasible and safe, but the available studies are characterized by considerable heterogeneity and bias. CONCLUSIONS Uniform reported outcome measures are needed to draw more definitive conclusions on transplant outcomes and organ utilization. A randomized controlled trial comparing aNRP with standard procurement technique in donation after circulatory death donors would be needed to show the added value of the procedure and determine its place among modern preservation techniques.
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148
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Sandiumenge A, Lomero Martinez MDM, Sánchez Ibáñez J, Seoane Pillado T, Montaña-Carreras X, Molina-Gomez JD, Llauradó-Serra M, Dominguez-Gil B, Masnou N, Bodi M, Pont T. Online education about end-of-life care and the donation process after brain death and circulatory death. Can we influence perception and attitudes in critical care doctors? A prospective study. Transpl Int 2020; 33:1529-1540. [PMID: 32881149 DOI: 10.1111/tri.13728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
Impact of training on end-of-life care (EOLC) and the deceased donation process in critical care physicians' perceptions and attitudes was analysed. A survey on attitudes and perceptions of deceased donation as part of the EOLC process was delivered to 535 physicians working in critical care before and after completion of a online training programme (2015-17). After training, more participants agreed that nursing staff should be involved in the end-of-life decision process (P < 0.001) and that relatives should not be responsible for medical decisions (P < 0.001). Postcourse, more participants considered 'withdrawal/withholding' as similar actions (P < 0.001); deemed appropriate the use of pre-emptive sedation in all patients undergoing life support treatment adequacy (LSTA; P < 0.001); and were favourable to approaching family about donation upon LSTA agreement, as well as admitting them in the intensive care unit (P < 0.001) to allow the possibility of donation. Education increased the number of participants prone to initiate measures to preserve the organs for donation before the declaration of death in patients undergoing LSTA (P < 0.001). Training increased number of positive terms selected by participants to describe donation after brain and circulatory death. Training programmes may be useful to improve physicians' perception and attitude about including donation as part of the patient's EOLC.
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Affiliation(s)
- Alberto Sandiumenge
- Department of Donor and Transplant, Transplant Coordination, Clinical Research/Epidemiology In Pneumonia and Sepsis (CRIPS), Vall d´Hebrón University Hospital, Barcelona, Spain
| | | | | | - Teresa Seoane Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
| | | | | | - Mireia Llauradó-Serra
- Nursing Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | | | - Nuria Masnou
- Department of Organ Donation and Transplantation, University Hospital Girona Dr Josep Trueta, Girona, Spain
| | - Maria Bodi
- Critical Care Department, Pere Virgili Research Institute, Joan XXIII University Hospital, Rovira i Virgili University, Tarragona, Spain
| | - Teresa Pont
- Department of Donor and Transplant, Transplant Coordination, Clinical Research/Epidemiology In Pneumonia and Sepsis (CRIPS), Vall d´Hebrón University Hospital, Barcelona, Spain
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149
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Zanierato M, Dondossola D, Palleschi A, Zanella A. Donation after circulatory death: possible strategies for in-situ organ preservation. Minerva Anestesiol 2020; 86:984-991. [DOI: 10.23736/s0375-9393.20.14262-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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150
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Dhital K, Ludhani P, Scheuer S, Connellan M, Macdonald P. DCD donations and outcomes of heart transplantation: the Australian experience. Indian J Thorac Cardiovasc Surg 2020; 36:224-232. [PMID: 33061207 DOI: 10.1007/s12055-020-00998-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure. Methods This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent's Hospital, Sydney. Findings Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts. Summary DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.
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Affiliation(s)
- Kumud Dhital
- Department of Cardiothoracic Surgery & Transplantation, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia.,Transplant Laboratory, Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 Australia
| | - Prakash Ludhani
- Department of Cardiothoracic Surgery, MIOT Hospital, Chennai, India
| | - Sarah Scheuer
- Transplant Laboratory, Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 Australia.,Department of Cardiothoracic Surgery, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010 Australia
| | - Mark Connellan
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010 Australia
| | - Peter Macdonald
- Transplant Laboratory, Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 Australia.,Department of Cardiothoracic Surgery, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010 Australia
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