1
|
Merani S, Urban M, Westphal SG, Dong J, Miles CD, Maskin A, Hoffman A, Langnas AN. Improved Early Post-Transplant Outcomes and Organ Use in Kidney Transplant Using Normothermic Regional Perfusion for Donation after Circulatory Death: National Experience in the US. J Am Coll Surg 2024; 238:107-118. [PMID: 37772721 DOI: 10.1097/xcs.0000000000000880] [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: 09/30/2023]
Abstract
BACKGROUND Normothermic regional perfusion (NRP) is a technique that is intended to enhance organ transplant outcomes from donation circulatory death (DCD) donors. STUDY DESIGN A retrospective analysis of data from the Scientific Registry of Transplant Recipients was performed. DCD donors were screened for inclusion based on date of donation 2020 or later, and whether the heart was also recovered for transplantation. We grouped donors as either donation after brain death or DCD. DCD donors were further divided into groups including those in which the heart was not recovered for transplant (Non-Heart DCD) and those in which it was, based on recovery technique (thoracoabdominal-NRP [TA-NRP] Heart DCD and Super Rapid Recovery Heart DCD). RESULTS A total of 219 kidney transplant recipients receiving organs from TA-NRP Heart DCD donors were compared to 436 SRR Super Rapid Recovery DCD, 10,630 Super Rapid Recovery non-heart DCD, and 27,820 donations after brain death recipients. Kidney transplant recipients of TA-NRP DCD allografts experienced shorter length of stay, lower rates of delayed graft function, and lower serum creatinine at the time of discharge when compared with recipients of other DCD allografts. CONCLUSIONS Our analysis demonstrates superior early kidney allograft function when TA-NRP is used for DCD organ recovery.
Collapse
Affiliation(s)
- Shaheed Merani
- From the Division of Transplant, Department of Surgery (Merani, Maskin, Hoffman, Langnas), University of Nebraska Medical Center, Omaha, NE
| | - Marian Urban
- Division of Cardiothoracic Surgery, Department of Surgery (Urban), University of Nebraska Medical Center, Omaha, NE
| | - Scott G Westphal
- Division of Nephrology Department of Medicine (Westphal, Dong, Miles), University of Nebraska Medical Center, Omaha, NE
| | - James Dong
- Division of Nephrology Department of Medicine (Westphal, Dong, Miles), University of Nebraska Medical Center, Omaha, NE
- Department of Biostatistics (Dong), University of Nebraska Medical Center, Omaha, NE
| | - Clifford D Miles
- Division of Nephrology Department of Medicine (Westphal, Dong, Miles), University of Nebraska Medical Center, Omaha, NE
| | - Alexander Maskin
- From the Division of Transplant, Department of Surgery (Merani, Maskin, Hoffman, Langnas), University of Nebraska Medical Center, Omaha, NE
| | - Arika Hoffman
- From the Division of Transplant, Department of Surgery (Merani, Maskin, Hoffman, Langnas), University of Nebraska Medical Center, Omaha, NE
| | - Alan N Langnas
- From the Division of Transplant, Department of Surgery (Merani, Maskin, Hoffman, Langnas), University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
2
|
O'Neill S, Asgari E, Callaghan C, Gardiner D, Hartog H, Iype S, Manara A, Nasralla D, Oniscu GC, Watson C. The British transplantation society guidelines on organ donation from deceased donors after circulatory death. Transplant Rev (Orlando) 2023; 37:100791. [PMID: 37598591 DOI: 10.1016/j.trre.2023.100791] [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: 08/08/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Recipient outcomes after transplantation with organs from donation after circulatory death (DCD) donors can compare favourably and even match recipient outcomes after transplantation with organs from donation after brain death donors. Success is dependent upon establishing common practices and accepted protocols that allow the safe sharing of DCD organs and maximise the use of the DCD donor pool. The British Transplantation Society 'Guideline on transplantation from deceased donors after circulatory death' has recently been updated. This manuscript summarises the relevant recommendations from chapters specifically related to organ donation.
Collapse
Affiliation(s)
- Stephen O'Neill
- Consultant Transplant Surgeon, Belfast City Hospital, Belfast, Northern Ireland.
| | - Ellie Asgari
- Consultant Nephrologist, Guy's Hospital, London, England
| | - Chris Callaghan
- Consultant Transplant Surgeon, Guy's Hospital, London, England
| | - Dale Gardiner
- Consultant Intensivist, Queen's Medical Centre, Nottingham, England
| | - Hermien Hartog
- Consultant Transplant Surgeon, Queen Elizabeth Hospital, Birmingham, England
| | - Satheesh Iype
- Consultant Transplant Surgeon, Royal Free Hospital, London, England
| | - Alex Manara
- Consultant Intensivist, Southmead Hospital, Bristol, England
| | - David Nasralla
- Consultant Transplant Surgeon, Royal Free Hospital, London, England
| | - Gabi C Oniscu
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, Scotland
| | - Chris Watson
- Consultant Transplant Surgeon, Addenbrooke's Hospital, Cambridge, England
| |
Collapse
|
3
|
Thomas J, Chen Q, Roach A, Wolfe S, Osho AA, Sundaram V, Wisel SA, Megna D, Emerson D, Czer L, Esmailian F, Chikwe J, Kim I, Catarino P. Donation after circulatory death heart procurement strategy impacts utilization and outcomes of concurrently procured abdominal organs. J Heart Lung Transplant 2023; 42:993-1001. [PMID: 37037750 PMCID: PMC11181754 DOI: 10.1016/j.healun.2023.02.1497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION The impact of donation after circulatory death (DCD) heart procurement techniques on the utilization and outcomes of concurrently procured DCD livers and kidneys remains unclear. METHODS Using the United Network for Organ Sharing database, we identified 246 DCD donors whose heart was procured using direct procurement and ex-situ machine perfusion and 128 DCD donors whose heart was procured using in-situ thoracoabdominal normothermic regional perfusion (12/2019-03/2022). We evaluated the transplantation rate of concurrently procured DCD livers and kidneys (defined as the number of organs transplanted/total number of organs available for procurement) and their post-transplant outcomes. RESULTS The transplantation rate of concurrently procured DCD livers was higher with in-situ perfusion compared to direct procurement (67.1% vs 56.5%, p = 0.045). After excluding pediatric, multiorgan, and repeat transplant recipients, there was no difference in 6-month liver graft failure rate (direct procurement 0.9% vs in-situ perfusion 0%, p > 0.99). Recipients of kidneys procured with in-situ perfusion had less delayed graft function (11.3% vs 41.5%, p < 0.0001) shorter length of stay, and lower serum creatinine at discharge (both p < 0.05). Six-month recipient survival in the direct procurement and in-situ perfusion group were similar after DCD liver and kidney transplantation (p = 0.24 and 0.79 respectively). CONCLUSIONS Compared to direct procurement, DCD heart procurement with in-situ thoracoabdominal normothermic regional perfusion was associated with increased utilization of DCD livers and a lower incidence of delayed graft function in concurrently procured DCD kidneys. Broader implementation of DCD heart transplantation must maximize the transplant potential of concurrently procured abdominal organs and ensure their successful outcomes.
Collapse
Affiliation(s)
- Jason Thomas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stanley Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Asishana A Osho
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Sundaram
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven A Wisel
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Los Angeles, California
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Irene Kim
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|