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Doppenberg JB, Van Rooden RM, Van Dijk MC, De Goeij FH, Van der Heijden FJ, Alwayn IP, De Koning EJ, De Jonge J, Engelse MA, Huurman VA. Abdominal Normothermic Regional Perfusion after Donation after Circulatory Death Improves Pancreatic Islet Isolation Yield. Am J Transplant 2024:S1600-6135(24)00603-8. [PMID: 39366509 DOI: 10.1016/j.ajt.2024.09.034] [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: 07/04/2024] [Revised: 09/18/2024] [Accepted: 09/30/2024] [Indexed: 10/06/2024]
Abstract
Abdominal Normothermic Regional Perfusion (aNRP) is an in-situ normothermic oxygenated donor perfusion technique before procurement during controlled donation after circulatory death (cDCD) procedures and allows for organ quality evaluation. There are few data on the effect of aNRP on pancreatic islet isolation and subsequent transplantation outcomes. We aim to evaluate the impact of aNRP on cDCD pancreatic islet isolation and transplantation. A retrospective analysis was performed on pancreatic islet isolation outcomes from aNRP, cDCD, and Donation after Brain death (DBD) pancreases. Isolations were compared to previous donor age (60-75) matched isolations. Islet function was asses by a dynamic Glucose Stimulated Insulin Secretion (dGSIS). Donor baseline characteristics did not differ among groups. Isolations from aNRP pancreases (471,739 IEQ [655,435 - 244,851]) yielded more islets compared to cDCD (218,750 IEQ [375,951 - 112,364, p<0.01) and to DBD (206,522 IEQ [385,544 - 142,446, p=0.03) pancreases. dGSIS tests in seven aNRP islet preparations showed a mean stimulation index of 4.91, indicating good functionality. Bilirubin and alanine aminotransferase during aNRP correlated with islet yield (r2=0.685, p=0.002; r2=0.491, p=0.016 respectively). Islet isolation after aNRP in cDCD donors results in a high islet yield with viable functional islets. aNRP could increase the utilization of pancreases for islet transplantation.
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Affiliation(s)
- Jason B Doppenberg
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger M Van Rooden
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Madeleine C Van Dijk
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke Hc De Goeij
- Transplant Institute, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fenna J Van der Heijden
- Transplant Institute, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ian Pj Alwayn
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Eelco Jp De Koning
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Transplant Center, Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen De Jonge
- Transplant Institute, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marten A Engelse
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Transplant Center, Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Volkert Al Huurman
- Transplant Center, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Spencer BL, Wilhelm SK, Urrea KA, Chakrabortty V, Sewera S, Mazur DE, Niman JB, Bartlett RH, Rojas-Peña A, Drake DH. Twenty-four-hour Normothermic Ex Vivo Heart Perfusion With Low Flow Functional Assessment in an Adult Porcine Model. Transplantation 2024; 108:1350-1356. [PMID: 38411562 DOI: 10.1097/tp.0000000000004956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Cold static storage and normothermic ex vivo heart perfusion are routinely limited to 6 h. This report describes intermittent left atrial (LA) perfusion that allows cardiac functional assessment in a working heart mode. METHODS Using our adult porcine model, general anesthesia was induced and a complete cardiectomy was performed following cardioplegic arrest. Back-table instrumentation was completed and normothermic ex vivo heart perfusion (NEHP) was initiated in a nonworking heart mode (Langendorff). After 1 h of resuscitation and recovery, LA perfusion was initiated and the heart was transitioned to a coronary flow-only working heart mode for 30 min. Baseline working heart parameters were documented and the heart was returned to nonworking mode. Working heart assessments were performed for 30 min every 6 h for 24 h. RESULTS Twenty-four-hour NEHP on 9 consecutive hearts (280 ± 42.1 g) was successful and no significant differences were found between working heart parameters at baseline and after 24 h of perfusion. There was no difference between initial and final measurements of LA mean pressures (5.0 ± 3.1 versus 9.0 ± 6.5 mm Hg, P = 0.22), left ventricular systolic pressures (44.3 ± 7.2 versus 39.1 ± 9.0 mm Hg, P = 0.13), mean aortic pressures (30.9 ± 5.8 versus 28.1 ± 8.1 mm Hg, P = 0.37), and coronary resistance (0.174 ± 0.046 versus 0.173 ± 0.066 mL/min/g, P = 0.90). There were also no significant differences between lactate (2.4 ± 0.5 versus 2.6 ± 0.4 mmol/L, P = 0.17) and glucose (173 ± 75 versus 156 ± 70 mg/dL, P = 0.37). CONCLUSIONS A novel model using intermittent LA perfusion to create a coronary flow-only working heart mode for assessment of ex vivo cardiac function has been successfully developed.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Spencer K Wilhelm
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Kristopher A Urrea
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Vikramjit Chakrabortty
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Sebastian Sewera
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | | | - Joseph B Niman
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Robert H Bartlett
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Alvaro Rojas-Peña
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI
| | - Daniel H Drake
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
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Spencer BL, Wilhelm SK, Urrea KA, Chakrabortty V, Sewera SJ, Mazur DE, Bartlett RH, Rojas-Peña A, Drake DH. Twenty-Four Hour Normothermic Ex Vivo Heart Perfusion With Hemofiltration In an Adult Porcine Model. Transplant Proc 2023; 55:2241-2246. [PMID: 37783593 DOI: 10.1016/j.transproceed.2023.08.014] [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: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Historically, cardiac transplantation relied on cold static storage at 5 °C for ex vivo myocardial preservation. Currently, machine perfusion is the standard of care at many transplant centers. These storage methods are limited to 12 hours. We sought to evaluate the efficacy of hemofiltration and filtrate replacement in adult porcine hearts using normothermic heart perfusion (NEVHP) for 24 hours. METHODS We performed 24-hour NEVHP on 5 consecutive hearts. After anesthetic induction, sternotomy, cardioplegia administration, explantation, and back-table instrumentation, NEVHP was initiated in beating, unloaded mode. After 1 hour, plasma exchange was performed, and hemofiltration was initiated. Heart function parameters and arterial blood gasses were obtained hourly. RESULTS All hearts (n = 5) were viable at the 24-hour mark. The average left ventricular systolic pressure at the beginning of the prep was 36.6 ± 7.9 mm Hg compared with 27 ± 5.5 mm Hg at the end. Coronary resistance at the beginning of prep was 0.79 ± 0.10 mm Hg/L/min and 0.93 ± 0.28 mm Hg/L/min at the end. Glucose levels averaged 223 ± 13.9 mg/dL, and the lactate average at the termination of prep was 2.6 ± 0.3 mmol/L. CONCLUSIONS We successfully perfused adult porcine hearts at normothermic temperatures for 24 hours with results comparable to our pediatric porcine heart model. The next step in our research is NEVHP evaluation in a working mode using left atrial perfusion.
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Affiliation(s)
- Brianna L Spencer
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Spencer K Wilhelm
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Kristopher A Urrea
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Vikramjit Chakrabortty
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Sebastian J Sewera
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | | | - Robert H Bartlett
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Alvaro Rojas-Peña
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI; Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI
| | - Daniel H Drake
- Department of Surgery and ECLS Laboratory, University of Michigan Medical School, Ann Arbor, MI; Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI.
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