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Spencer PJ, Saddoughi SA, Choi K, Dickinson TA, Richman A, Reynolds FA, Villavicencio MA. Heart-Lung Transplantation From Donation After Circulatory Death Using Mobile Normothermic Regional Perfusion. ASAIO J 2024; 70:e13-e15. [PMID: 37549658 DOI: 10.1097/mat.0000000000002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Combined heart-lung transplant (HTLx) is the most durable treatment available for end-stage heart and lung failure. Many patients are unable to receive combined organs due to organ availability and allocation policies prioritizing separate heart or lung transplantation. While an average of 45 HTLxs have been performed per year in the United States half the listed patients do not receive organs. Recently, donation after circulatory death (DCD) utilizing normothermic regional perfusion (NRP) has been utilized for heart allografts with excellent results, and here, we present a case utilizing mobile NRP to procure a heart and lung block from a circulatory death donor and successful implantation for a recipient in a separate center.
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Affiliation(s)
- Philip J Spencer
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Pergola V, Cameli M, Dandel M, Soliman-Aboumarie H. Editorial: Multimodality imaging of left ventricular assist devices: applications in advanced heart failure. Front Cardiovasc Med 2023; 10:1277563. [PMID: 37840963 PMCID: PMC10569488 DOI: 10.3389/fcvm.2023.1277563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico “Le Scotte”, Siena, Italy
| | - Michael Dandel
- Humboldt University Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Intensive Care and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield Hospitals, London, United Kingdom
- School of Cardiovascular and Metabolic Sciences and Medicine, King’s College London, London, United Kingdom
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Messer S, Rushton S, Simmonds L, Macklam D, Husain M, Jothidasan A, Large S, Tsui S, Kaul P, Baxter J, Osman M, Mehta V, Russell D, Stock U, Dunning J, Saez DG, Venkateswaran R, Curry P, Ayton L, Mukadam M, Mascaro J, Simmonds J, Macgowan G, Clark S, Jungschleger J, Reinhardt Z, Quigley R, Speed J, Parameshwar J, Jenkins D, Watson S, Marley F, Ali A, Gardiner D, Rubino A, Whitney J, Beale S, Slater C, Currie I, Armstrong L, Foley J, Ryan M, Gibson S, Quinn K, Macleod AM, Spence S, Watson CJE, Catarino P, Clarkson A, Forsythe J, Manas D, Berman M. A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom. J Heart Lung Transplant 2023; 42:1120-1130. [PMID: 37032222 DOI: 10.1016/j.healun.2023.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. METHODS This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. RESULTS From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). CONCLUSION During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.
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Affiliation(s)
- Simon Messer
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Sally Rushton
- National Health Service Blood and Transplant, Bristol, UK
| | - Lewis Simmonds
- National Health Service Blood and Transplant, Bristol, UK
| | - Debbie Macklam
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | - Stephen Large
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Steven Tsui
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Pradeep Kaul
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mohamed Osman
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | - Derval Russell
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - Uli Stock
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - John Dunning
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | | | - Philip Curry
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Lynne Ayton
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | | | | | | | - Guy Macgowan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Stephen Clark
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Zdenka Reinhardt
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Jane Speed
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - David Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Watson
- National Health Service England, Highly Specialised Services, London, UK
| | - Fiona Marley
- National Health Service England, Highly Specialised Services, London, UK
| | - Ayesha Ali
- National Health Service England, Highly Specialised Services, London, UK
| | - Dale Gardiner
- National Health Service Blood and Transplant, Bristol, UK
| | - Antonio Rubino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK
| | - Julie Whitney
- National Health Service Blood and Transplant, Bristol, UK
| | - Sarah Beale
- National Health Service Blood and Transplant, Bristol, UK
| | | | - Ian Currie
- National Health Service Blood and Transplant, Bristol, UK
| | - Liz Armstrong
- National Health Service Blood and Transplant, Bristol, UK
| | - Jeanette Foley
- National Health Service Blood and Transplant, Bristol, UK
| | - Marian Ryan
- National Health Service Blood and Transplant, Bristol, UK
| | - Sharon Gibson
- National Health Service Blood and Transplant, Bristol, UK
| | - Karen Quinn
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | | | - Pedro Catarino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - John Forsythe
- National Health Service Blood and Transplant, Bristol, UK
| | - Derek Manas
- National Health Service Blood and Transplant, Bristol, UK
| | - Marius Berman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK.
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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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Hoffman JRH, McMaster WG, Rali AS, Rahaman Z, Balsara K, Absi T, Levack M, Brinkley M, Menachem J, Punnoose L, Sacks S, Wigger M, Zalawadiya S, Stevenson L, Schlendorf K, Lindenfeld J, Shah AS. Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion. J Heart Lung Transplant 2021; 40:1408-1418. [PMID: 34334301 DOI: 10.1016/j.healun.2021.06.022] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors. METHODS Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval. RESULTS The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days. CONCLUSIONS Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.
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Affiliation(s)
- Jordan R H Hoffman
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - William G McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aniket S Rali
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zakiur Rahaman
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keki Balsara
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tarek Absi
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa Levack
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marshall Brinkley
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Menachem
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn Punnoose
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suzanne Sacks
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Wigger
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandip Zalawadiya
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynne Stevenson
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly Schlendorf
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Scheuer SE, Jansz PC, Macdonald PS. Heart transplantation following donation after circulatory death: Expanding the donor pool. J Heart Lung Transplant 2021; 40:882-889. [PMID: 33994229 DOI: 10.1016/j.healun.2021.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
Heart transplantation from donation after circulatory death (DCD) donors is a rapidly expanding practice. In this review, we describe the history and challenges of DCD heart transplantation and overview the procurement protocols and methods of limiting ischemic injury, current outcomes, and future directions. There are now at least three protocols that permit resuscitation and viability assessment of the DCD heart either in situ or ex situ. While the retrieval protocol for hearts from DCD donors will depend on local regulations, the outcomes of DCD heart transplant recipients reported to date are excellent regardless of the retrieval protocol and are comparable to the outcomes of heart transplant recipients from donation after brain death (DBD) donors. In the two centers with the largest published experience, DCD heart transplantation now accounts for one third of their heart transplant activity. With international trends indicating that there is an increasing utilisation of the DCD pathway, it is expected that DCD donors will become a major source of heart donation worldwide.
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Affiliation(s)
- Sarah E Scheuer
- Cardiac Physiology & Transplantation, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia
| | - Paul C Jansz
- Cardiac Physiology & Transplantation, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia
| | - Peter S Macdonald
- Cardiac Physiology & Transplantation, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia.
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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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