1
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Rajsic S, Treml B, Rugg C, Innerhofer N, Eckhardt C, Breitkopf R. Organ Utilization From Donors Following Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review of Graft and Recipient Outcome. Transplantation 2024:00007890-990000000-00816. [PMID: 39020459 DOI: 10.1097/tp.0000000000005133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND The global shortage of solid organs for transplantation is exacerbated by high demand, resulting in organ deficits and steadily growing waiting lists. Diverse strategies have been established to address this issue and enhance organ availability, including the use of organs from individuals who have undergone extracorporeal cardiopulmonary resuscitation (eCPR). The main aim of this work was to examine the outcomes for both graft and recipients of solid organ transplantations sourced from donors who underwent eCPR. METHODS We performed a systematic literature review using a combination of the terms related to extracorporeal life support and organ donation. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, PubMed and Scopus databases were searched up to February 2024. RESULTS From 1764 considered publications, 13 studies comprising 130 donors and 322 organ donations were finally analyzed. On average, included patients were 36 y old, and the extracorporeal life support was used for 4 d. Kidneys were the most often transplanted organs (68%; 220/322), followed by liver (22%; 72/322) and heart (5%; 15/322); with a very good short-term graft survival rate (95% for kidneys, 92% for lungs, 88% for liver, and 73% for heart). Four studies with 230 grafts reported functional outcomes at the 1-y follow-up, with graft losses reported for 4 hearts (36%), 8 livers (17%), and 7 kidneys (4%). CONCLUSIONS Following eCPR, organs can be successfully used with very high graft and recipient survival. In terms of meeting demand, the use of organs from patients after eCPR might be a suitable method for expanding the organ donation pool.
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Affiliation(s)
- Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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2
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Rajsic S, Treml B, Innerhofer N, Eckhardt C, Radovanovic Spurnic A, Breitkopf R. Organ Donation from Patients Receiving Extracorporeal Membrane Oxygenation: A Systematic Review. J Cardiothorac Vasc Anesth 2024; 38:1531-1538. [PMID: 38643059 DOI: 10.1053/j.jvca.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The mismatch between the demand for and supply of organs for transplantation is steadily growing. Various strategies have been incorporated to improve the availability of organs, including organ use from patients receiving extracorporeal membrane oxygenation (ECMO) at the time of death. However, there is no systematic evidence of the outcome of grafts from these donors. DESIGN Systematic literature review (Scopus and PubMed, up to October 11, 2023). SETTING All study designs. PARTICIPANTS Organ recipients from patients on ECMO at the time of death. INTERVENTION Outcome of organ donation from ECMO donors. MEASUREMENTS AND MAIN RESULTS The search yielded 1,692 publications, with 20 studies ultimately included, comprising 147 donors and 360 organ donations. The most frequently donated organs were kidneys (68%, 244/360), followed by liver (24%, 85/360). In total, 98% (292/299) of recipients survived with a preserved graft function (92%, 319/347) until follow-up within a variable period of up to 3 years. CONCLUSION Organ transplantation from donors supported with ECMO at the time of death shows high graft and recipient survival. ECMO could be a suitable approach for expanding the donor pool, helping to alleviate the worldwide organ shortage.
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Affiliation(s)
- Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
| | - Benedikt Treml
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Nicole Innerhofer
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Christine Eckhardt
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Robert Breitkopf
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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3
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Altshuler PJ, Pace DJ, Preston WA, Vincent SA, Shah AP, Glorioso JM, Maley WR, Frank AM, Ramirez CB, West S, Hasz R, Bodzin AS. Assessing Kidney Transplantation Using ECMO-Supported Donors Within a KDPI-Based Allocation System. Transplant Direct 2023; 9:e1521. [PMID: 37829245 PMCID: PMC10566806 DOI: 10.1097/txd.0000000000001521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 10/14/2023] Open
Abstract
Background Organ donors supported by extracorporeal membrane oxygenation (ECMO) have historically been considered high-risk and are judiciously utilized. This study examines transplant outcomes using renal allografts from donors supported on ECMO for nondonation purposes. Methods Retrospective review of the Gift of Life (Pennsylvania, New Jersey, Delaware) organ procurement organization database, cross-referenced to the Organ Procurement and Transplantation Network database, assessed kidney transplants using donors supported on venoarterial (VA) and venovenous (VV) ECMO for nondonation purposes. Transplants using VA- and VV-ECMO donors were compared with Kidney Donor Profile Index (KDPI)-stratified non-ECMO donors. Regression modeling of the entire ECMO and non-ECMO populations assessed ECMO as predictive of graft survival. Additional regression of the ECMO population alone assessed for donor features associated with graft survival. Results Seventy-eight ECMO donors yielded 128 kidney transplants (VA: 80, VV: 48). Comparing outcomes using these donors to kidney transplants using organs from KDPI-stratified non-ECMO donors, VA- and VV-ECMO donor grafts conferred similar rates of delayed graft function and posttransplant renal function to KDPI-matched non-ECMO counterparts. VA-ECMO kidneys demonstrated superior graft survival compared with the lowest-quality (KDPI 86%-100%) non-ECMO kidneys and similar graft survival to KDPI <85% non-ECMO kidneys. VV-ECMO showed inferior graft survival to all but the lowest-quality (KDPI 86%-100%) non-ECMO kidneys. VV-ECMO, but not VA-ECMO, was associated with increased risk of graft loss on multivariable regression (hazard ratios-VA: 1.02, VV: 2.18). Higher KDPI, advanced age, increased body mass index, hypertension, and diabetes were identified as high-risk features of ECMO donors. Conclusions Kidney transplantation using appropriately selected ECMO donors can safely expand the donor pool. Ongoing studies are necessary to determine best practice patterns using kidneys from these donors.
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Affiliation(s)
| | - Devon J. Pace
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Sage A. Vincent
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ashesh P. Shah
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Jaime M. Glorioso
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Warren R. Maley
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Adam M. Frank
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Carlo B. Ramirez
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, PA
| | | | - Adam S. Bodzin
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
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4
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Altshuler PJ, Preston WA, Pace DJ, Kittle H, Shah AP, Glorioso JM, Maley WR, Frank AM, Ramirez CB, West S, Hasz R, Bodzin AS. Extracorporeal membrane oxygenation for cardiopulmonary failure in organ donation: Assessing liver transplant outcomes. Liver Transpl 2023; 29:1151-1160. [PMID: 37387680 DOI: 10.1097/lvt.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
Liver transplantation continues to face significant organ shortages and efficient utilization of marginal donors is paramount. This study evaluates the practice patterns and outcomes in liver transplantation when utilizing allografts from marginal donors who required extracorporeal membrane oxygenation (ECMO) support. We performed a retrospective review of the Gift of Life (PA, NJ, DE) organ-procuring organization database for transplants performed using donors supported on ECMO for nondonation purposes. These were cross-referenced to the transplant recipients within the Organ Procurement and Transplantation Network database, and the outcomes of liver transplants using donors on ECMO support were compared with those not requiring ECMO. Organ use and nonuse patterns were then evaluated in ECMO-supported donors, identifying the factors associated with nonuse compared with the factors associated with graft failure. Thirty-nine of the 84 ECMO-supported donors contributing at least one intra-abdominal organ for transplant donated a liver. Graft survival and patient survival up to 5 years were comparable between transplants from ECMO and non-ECMO-supported donors, and no cases of primary nonfunction were seen in the ECMO group. ECMO support was not associated with 1-year graft failure on regression modeling. Additional regression analyses within the ECMO donor population identified bacteremia (HR: 19.81) and elevated total bilirubin at donation (HR: 2.44) as predictive of post-transplant graft failure. Livers from donors supported on ECMO before donation appear safe to use in select transplant settings. Better understanding of the impact of predonation ECMO on liver allograft function will help guide the optimal use of these scarcely used donors.
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Affiliation(s)
- Peter J Altshuler
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - William A Preston
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Devon J Pace
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Haley Kittle
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Ashesh P Shah
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Jaime M Glorioso
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Warren R Maley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Adam M Frank
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Carlo B Ramirez
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Richard Hasz
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Adam S Bodzin
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA Pennsylvania, USA
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5
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Reid TD, Kratzke I, Dayal D, Raff L, Serrano P, Kumar A, Boddie O, Zendel A, Gallaher J, Carlson R, Boone J, Charles AG, Desai CS. The role of extracorporeal membrane oxygenation in adult kidney transplant patients: A qualitative systematic review of literature. Artif Organs 2023; 47:24-37. [PMID: 35986612 DOI: 10.1111/aor.14376] [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: 04/20/2022] [Revised: 06/23/2022] [Accepted: 07/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND A paucity of evidence exists regarding the risks and benefits of Extracorporeal Membrane Oxygenation (ECMO) in adult kidney transplantation. METHODS This was a systematic review conducted from Jan 1, 2000 to April 24, 2020 of adult kidney transplant recipients (pre- or post- transplant) and donors who underwent veno-arterial or veno-venous ECMO cannulation. Death and graft function were the primary outcomes, with complications as secondary outcomes. RESULTS Twenty-three articles were identified that fit inclusion criteria. 461 donors were placed on ECMO, with an overall recipient 12-month mortality rate of 1.3% and a complication rate of 61.5%, the majority of which was delayed graft function. Fourteen recipients were placed on ECMO intraoperatively or postoperatively, with infection as the most common indication for ECMO. The 90-day mortality rate for recipients on ECMO was 42.9%, with multisystem organ failure and infection as the ubiquitous causes of death. 35.7% of patients experienced rejection within 6 months of decannulation, yet all were successfully treated. CONCLUSIONS ECMO use in adult kidney transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO mirrors that of recipients from standard criteria donors. The morbidity and mortality of recipients placed on ECMO are also similar to other patient populations requiring ECMO.
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Affiliation(s)
- Trista D Reid
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian Kratzke
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diana Dayal
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Raff
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pablo Serrano
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aman Kumar
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Olivia Boddie
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Zendel
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Gallaher
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joshua Boone
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony G Charles
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chirag S Desai
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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6
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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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7
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Reid TD, Kratzke IM, Dayal D, Raff L, Serrano P, Kumar A, Zendel A, Herdman V, Gallaher J, Carlson R, Charles AG, Desai CS. The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature. Artif Organs 2021; 46:578-596. [PMID: 34816462 DOI: 10.1111/aor.14120] [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: 08/26/2021] [Revised: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation. METHODS This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre- or post-transplant) and donors who underwent Veno-arterial or Veno-venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. RESULTS Forty-one articles were identified that fit criteria. A total of 183 donors were placed on ECMO, with recipient complication profiles and mortality that mirrored rates from standard criteria donors. Sixty-one recipients were placed on ECMO intraoperatively or postoperatively. Most patients experienced at least one complication with infections as the most common cause and minimal complications specifically related to ECMO use. Multisystem organ failure (MSOF) and infections were more common among liver recipients who died compared to those who survived. Overall mortality at 90 days was 45.9%. Causes of death were most commonly MSOF and infections. CONCLUSIONS ECMO use in adult liver transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO parallel that of recipients from standard criteria donors, and morbidity and mortality of recipients placed on ECMO are similar to other ECMO populations.
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Affiliation(s)
- Trista D Reid
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian M Kratzke
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diana Dayal
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Raff
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pablo Serrano
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aman Kumar
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Zendel
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victoria Herdman
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Gallaher
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony G Charles
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chirag S Desai
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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8
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Loforte A, Odaldi F, Berardi M, Boschi S, Potena L, Gliozzi G, Cavalli GG, Ravaioli M, Cescon M, Pacini D. Multiple organ retrieval in a brain dead left ventricular assist device donor. J Artif Organs 2021; 25:155-157. [PMID: 34652561 PMCID: PMC8517934 DOI: 10.1007/s10047-021-01298-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
Left ventricular assist device (LVAD) support in donors may contribute in preserving proper haemodynamics and systemic perfusion during organ retrieval thus decreasing the risk of multiple organ injury. This is an option to expand the current organ supply. We report on intra-abdominal organs procurement strategy in a selected LVAD recipient who suffered a fatal cerebrovascular accident at the time of COVID-19 pandemic outbreak. The liver and kidneys grafts have been successfully transplanted.
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Affiliation(s)
- Antonio Loforte
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Federica Odaldi
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Marianna Berardi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Silvia Boschi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Luciano Potena
- Cardiology Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Matteo Ravaioli
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Matteo Cescon
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
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9
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Opatrný V, Třeška V, Zeithaml J, Hes O, Matějka R, Moláček J. Perfusion of a Kidney Graft from a Donor After Cardiac Death Based on Immediately Started Machine Perfusion: An Experimental Study on a Big Animal. Transplant Proc 2021; 53:2082-2090. [PMID: 34274120 DOI: 10.1016/j.transproceed.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Donation after circulatory death donors are becoming a common source of organs for transplant. Despite good long-term outcomes of grafts from donation after circulatory death, this group is affected by a higher occurrence of delayed graft function and primary nonfunction. Our hypothesis is based on the assumption that washing the kidney grafts in the donor's body using a simple mechanical perfusion pump will result in faster and better perfusion of the parenchyma and more efficient cooling compared with hydrostatic perfusion alone. METHODS A total of 7 experimental animals (pigs) were used. The animals were divided into 2 groups: group A (n = 3) and group B (n = 4). After a 30-minute ischemic period for the selected kidney (clamped renal vessels), intra-arterial perfusion was performed. In group A perfusion was performed using hydrostatic pressure; in group B mechanical controlled perfusion was performed. After perfusion, declamping of the renal vessels caused restoration of flow. For graft quality evaluation, biopsy specimens were harvested, and the cooling speed was observed. Laboratory markers or renal failure were determined. RESULTS We found no significant differences between temperature drop and total diuresis between groups A and B. A significant difference was found between the groups in both flow parameters (flow maximum and mean flow) (P = .007, respectively P = .019). No laboratory parameters were found to be statistically significantly different. Histopathological analysis strongly supports the hypothesis of better flushing of kidney grafts using mechanical perfusion. CONCLUSIONS Based on our results, better kidney graft quality can be expected after immediately started mechanical perfusion in situ.
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Affiliation(s)
- Václav Opatrný
- Faculty of Medicine in Plzen, Department of Surgery, Charles University, University Hospital in Plzen, Plzen, Czech Republic; Faculty of Medicine in Plzen, Transplantcentrum, Charles University, University Hospital in Plzen, Plzen, Czech Republic
| | - Vladislav Třeška
- Faculty of Medicine in Plzen, Department of Surgery, Charles University, University Hospital in Plzen, Plzen, Czech Republic; Faculty of Medicine in Plzen, Transplantcentrum, Charles University, University Hospital in Plzen, Plzen, Czech Republic
| | - Jan Zeithaml
- Faculty of Medicine in Plzen, Department of Surgery, Charles University, University Hospital in Plzen, Plzen, Czech Republic
| | - Ondřej Hes
- Sikl's Institute of Pathological Anatomy, University Hospital in Plzen, Plzen, Czech Republic
| | - Roman Matějka
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jiří Moláček
- Faculty of Medicine in Plzen, Department of Surgery, Charles University, University Hospital in Plzen, Plzen, Czech Republic; Faculty of Medicine in Plzen, Transplantcentrum, Charles University, University Hospital in Plzen, Plzen, Czech Republic.
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10
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Groba-Marco MDV, Portela-Torrón F, Peña-Morant V, Romero-Luján JL, Caballero-Dorta E, García-Quintana A. Expandiendo los nichos de donación: trasplante cardiaco de un donante con ECMO veno-venoso. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Expanding donation niches. Heart transplant from a donor on veno-venous ECMO. ACTA ACUST UNITED AC 2021; 74:633-635. [PMID: 33745913 DOI: 10.1016/j.rec.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
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12
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De Carlis R, Buscemi V, Checchini G, Frassoni S, Bagnardi V, Pagnanelli M, Lauterio A, De Carlis L. Liver transplantation from brain-dead donors on mechanical circulatory support: a systematic review of the literature. Transpl Int 2020; 34:5-15. [PMID: 33037727 DOI: 10.1111/tri.13766] [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: 07/25/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Mechanical circulatory support (MCS) refers to a range of rescue devices to assist circulation for the treatment of heart failure, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and ventricular assist devices (VADs). This review aims at evaluating the transplant outcome of the livers procured from brain-dead donors on MCS, who are currently considered as having extended criteria. We identified 22 records (17 on VA-ECMO and 5 on VADs), most of which (68.2%) were case reports. We performed a meta-analysis only when the outcome was reported homogeneously among studies; otherwise, we illustrated the results with narrative synthesis. A total of 156 liver transplants (LTs) have been reported, where VA-ECMO was initiated in the donor with resuscitative intent or as a bridge to donation. Early graft survival approached 100% in most studies. The pooled rate of primary nonfunction was 1% (95% CI: 0-3%). Only three successful LTs from VAD donors have been reported. Particular attention should be paid to cardiological history, biochemical tests, and imaging, as well as MCS parameters, to determine graft eligibility for transplantation. Although further analysis is needed in this field, the results of this review advocate a more systematic consideration of brain-dead patients on MCS as potential liver donors.
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Affiliation(s)
- Riccardo De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Buscemi
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuliana Checchini
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Surgical Sciences, University of Pavia, Pavia, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michele Pagnanelli
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of General Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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13
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Chakaramakkil MJ, Sivathasan C. ECMO in cardiogenic shock and bridge to heart transplant. Indian J Thorac Cardiovasc Surg 2020; 37:319-326. [PMID: 33967452 DOI: 10.1007/s12055-020-00923-2] [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: 10/15/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose The aim of this review is to discuss the role of extracorporeal membrane oxygenation (ECMO) in cardiogenic shock and its use to bridge patients to heart transplantation. Methods and results Consideration of published literature reveals indications for ECMO in cardiogenic shock and tools for patient selection, adequate evidence of its efficacy, its advantages when compared with other temporary mechanical circulatory support devices and details of its use as a bridge to decision, bridge to recovery, bridge to bridge (durable ventricular assist device) and bridge to heart transplant. Conclusion ECMO is invaluable in treating patients with medically refractory profound cardiogenic shock and allows for cardiac recovery or planning for permanent heart replacement treatments.
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Affiliation(s)
- Mathew Jose Chakaramakkil
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital drive, Singapore, 169609 Singapore
| | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital drive, Singapore, 169609 Singapore
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14
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Seo HW, Lee S, Lee HY, Park SC, Chung BH, Yang CW, Ban TH. Successful kidney transplantation from an expanded criteria donor with long-term extracorporeal membrane oxygenation treatment: A case report. World J Clin Cases 2020; 8:540-545. [PMID: 32110664 PMCID: PMC7031827 DOI: 10.12998/wjcc.v8.i3.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Due to a shortage of donor kidneys, many centers have utilized graft kidneys from brain-dead donors with expanded criteria. Kidney transplantation (KT) from donors on extracorporeal membrane oxygenation (ECMO) has been identified as a successful way of expanding donor pools. However, there are currently no guidelines or recommendations that guarantee successful KT from donors undergoing ECMO treatment. Therefore, acceptance of appropriate allografts from those donors is solely based on clinician decision.
CASE SUMMARY We report a case of successful KT from a brain-dead donor supported by ECMO for the longest duration to date. A 69-year-old male received a KT from a 63-year-old brain-dead donor who had been on therapeutic ECMO treatment for the previous three weeks. The recipient experienced slow recovery of graft function after surgery but was discharged home on post-operative day 17 free from hemodialysis. Allograft function gradually improved thereafter and was comparatively acceptable up to the 12 mo follow-up, with serum creatinine level of 1.67 mg/dL.
CONCLUSION This case suggests that donation even after long-term ECMO treatment could provide successful KT to suitable candidates.
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Affiliation(s)
- Hye Won Seo
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- Transplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Sua Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- Transplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Hwa Young Lee
- Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju-do 63241, South Korea
| | - Sun Cheol Park
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- Transplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- Transplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Tae Hyun Ban
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Eunpyeong-gu, Seoul 03312, South Korea
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15
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Hypothermic Machine Perfusion as an Alternative to Biopsy Assessment in Transplantation of Kidneys Donated After Cardiocirculatory Death: A Pilot Study. Transplant Proc 2019; 51:2890-2898. [DOI: 10.1016/j.transproceed.2019.02.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
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16
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Leblanc C, Genuini M, Deho A, Lodé N, Philippe-Chomette P, Hervieux E, Amblard A, Pracros N, Léger PL, Jean S. Successful extracorporeal membrane oxygenation transport of a 4-month-old brain-dead infant for organ donation: A case report. Pediatr Transplant 2019; 23:e13515. [PMID: 31441187 DOI: 10.1111/petr.13515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
A 4-month-old infant was declared brain-dead 2 days after being initiated on venoarterial ECMO for a refractory septic shock. All brain death diagnostic criteria were fulfilled according to French law, and parental consent was given for organ donation. The hospital where ECMO was initiated had no authorization for organ procurement, and the donor was then transferred to the local referral center for child organ recovery with our mobile ECMO team to maintain organ perfusion. The kidneys were recovered and successfully transplanted to a child who is now well and alive. Although the transport elements of this case report are of limited relevance to an international audience as no other country, to our knowledge, has this particular organization, it does show excellent collaboration between teams to realize the goal of organ donation for this family. This is the first case describing a successful inter-hospital transport for organ procurement of a brain-dead infant on ECMO. Brain-dead pediatric patients undergoing ECMO can be considered as potential organ donors to expand the donor pool.
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Affiliation(s)
- Claire Leblanc
- Pediatric Intensive Care Transport Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France
| | - Mathieu Genuini
- Pediatric Intensive Care Transport Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France
| | - Anna Deho
- Pediatric Intensive Care Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France.,Organ Donation Coordination, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France
| | - Noëlla Lodé
- Pediatric Intensive Care Transport Unit, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France
| | | | - Erik Hervieux
- Department of Surgery, Hôpital Trousseau, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Alain Amblard
- Neonatal and Pediatric Intensive Care Unit, Hôpital Trousseau, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Nancy Pracros
- Organ Donation Coordination, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Paris, France
| | - Pierre-Louis Léger
- Neonatal and Pediatric Intensive Care Unit, Hôpital Trousseau, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Sandrine Jean
- Neonatal and Pediatric Intensive Care Unit, Hôpital Trousseau, AP-HP, Université Pierre et Marie Curie, Paris, France
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17
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Ding GY, Zhao Y, Wu W, Zhong M, Fu PY, Xu M, Zhou J, Fan J, Huang XW, Song K. In Situ Normothermic Regional Perfusion for Liver Donation From China Category III (Organ Donation After Brain Death Followed by Circulatory Death): A Single-Center Cohort Study. EXP CLIN TRANSPLANT 2019; 18:83-88. [PMID: 31617836 DOI: 10.6002/ect.2019.0200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Organ donation after brain death followed by circulatory death is practiced in China. This study evaluated the application of normothermic regional perfusion to protect the liver grafts from these donors from warm ischemia in a large transplant center in China. MATERIALS AND METHODS This prospective study involved 19 liver transplants from brain death followed by circulatory death donors that were conducted between December 2014 and June 2017. We evaluated the baseline characteristics of the donors and recipients and compared outcomes of both groups. Graft and recipient survival and postoperative complications were also analyzed. RESULTS Although the normothermic regional perfusion group consisted of marginal donors with prolonged warm ischemia and recipients with higher Model for End-Stage Liver Disease scores (P < .05), postoperative tests indicated no differences in liverfunction recovery in both groups. Furthermore, total bilirubin decreased significantly faster in the normothermic regional perfusion group than in the control group (P < .05). Both groups showed similar 1-year recipient survival rates. No recipients in the normothermic regional perfusion group had any biliary complications, whereas 2 recipients in the control group developed ischemic cholangiopathy and received invasive treatment during follow-up. CONCLUSIONS In situ normothermic regional perfusion demonstrated a significant benefit in grafts from brain death followed by circulatory death donors and could potentially increase both the number and quality of donated organs.
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Affiliation(s)
- Guang-Yu Ding
- From the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
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18
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Liver Transplantation Followed by Renal Transplantation on Extracorporeal Membrane Oxygenation: A Case Report. Transplant Proc 2019; 51:3107-3110. [PMID: 31324485 DOI: 10.1016/j.transproceed.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022]
Abstract
We report the case of a 68-year-old woman with end-stage liver disease and end-stage renal disease scheduled for simultaneous liver and kidney transplant. Intraoperatively, she became hemodynamically unstable during her liver transplant surgery, and her renal transplant had to be postponed. On the following day, she required extracorporeal membrane oxygenation and ABIOMED Impella support for managing her severe cardiovascular decompensation. At the same time, the renal transplant was conducted to use the donor kidney already allocated for this patient. The patient was successfully managed postoperatively in the cardiothoracic intensive care unit and was discharged after 2 months. This case is unique because there are no similar cases previously reported in which renal transplantation was performed with extracorporeal membrane oxygenation and Impella support following cardiogenic shock after a liver transplant.
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19
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Liem S, Cavarocchi NC, Hirose H. Comparing in-patient extracorporeal cardiopulmonary resuscitation to standard cardiac treatment group of extracorporeal membrane oxygenation patients: 8 years of experience at a single institution. Perfusion 2019; 35:73-81. [PMID: 31296118 DOI: 10.1177/0267659119860735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Post-cardiac arrest survivals remain low despite the effort of cardiopulmonary resuscitation. Utilization of extracorporeal membrane oxygenation during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation) can provide immediate cardiovascular support and potentially improve outcomes of patients with cardiac arrest requiring cardiopulmonary resuscitation. There is renewed interest in the use of extracorporeal cardiopulmonary resuscitation due to improved outcomes over the years. METHODS Extracorporeal membrane oxygenation data between 2010 and 2018 were reviewed. Patients with extracorporeal membrane oxygenation placed under cardiopulmonary resuscitation were identified, and demographics, extracorporeal membrane oxygenation survival, survival to discharge, and neurological recovery were retrospectively analyzed with institutional review board approval. RESULTS Among 230 cases of extracorporeal membrane oxygenation, 34 (21 males and 13 females, age of 49 ± 13 years) underwent extracorporeal cardiopulmonary resuscitation. The mean duration of extracorporeal membrane oxygenation support after extracorporeal cardiopulmonary resuscitation was 8.3 ± 7.9 days. Extracorporeal membrane oxygenation mortality among extracorporeal cardiopulmonary resuscitation patients was 32% (11/34) and hospital survival was 38% (13/34), which are similar to standard cardiac extracorporeal membrane oxygenation (extracorporeal membrane oxygenation survival 62% and hospital survival 39% in cardiac extracorporeal membrane oxygenation). Among the extracorporeal membrane oxygenation death after extracorporeal cardiopulmonary resuscitation, the majority was due to neurological injury (73%, 8/11); 8/34 extracorporeal membrane oxygenation survival rate and 30-day survival rate were 63% and 25% in early half of study (2010-2014) and have improved to 70% and 60% in late half of study (2014-2018). CONCLUSION Over years of experience with extracorporeal membrane oxygenation, the outcome of the extracorporeal cardiopulmonary resuscitation has been improving and appears to exceed those of traditional methods, despite limited sample size. Neurological complications still need to be addressed in order for survival and outcomes to improve.
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Affiliation(s)
- Spencer Liem
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Hitoshi Hirose
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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20
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Abstract
Management of the pediatric organ donor necessitates understanding the physiologic changes that occur preceding and after death determination. Recognizing these changes allows application of the therapeutic strategies designed to optimize hemodynamics and metabolic state to allow for preservation of end-organ function for maximal organ recovery and minimal damage to the donor grafts. The pediatric pharmacist serves as the medication expert and may collaborate with the organ procurement organizations for provision of pharmacologic hemodynamic support, hormone replacement therapy, antimicrobials, and nutrition for the pediatric organ donor.
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21
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Peng JC, Ding J, He ZY, Deng YX, Xing SP, Zhao XY, Li Z, Dai YL, Gao Y. The efficacy of extracorporeal membrane oxygenation in liver transplantation from non-heart-beating donors: A systemic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14722. [PMID: 30817617 PMCID: PMC6831268 DOI: 10.1097/md.0000000000014722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A systematic review and meta-analysis was made to see whether extracorporeal membrane oxygenation (ECMO) in liver transplantation could improve non-heart-beating donors (NHBDs) recipients' outcomes compared with donors after brain death (DBDs) recipients. METHODS We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for eligible studies. The study eligible criteria are cohort or case-control studies using ECMO in all NHBDs; studies involved a comparison group of DBDs; and studies evaluated 1-year graft and patient survival rate in NHBDs and DBDs groups. RESULTS Four studies with 704 patients fulfilled the inclusion criteria. The pooled odds ratio (OR) of 1-year patient survival rate in NHBDs recipients compared with DBDs recipients was 0.8 (95% confidence interval [CI], 0.41-1.55). The pooled OR of 1-year graft survival rate in NHBDs recipients compared with DBDs recipients was 0.46 (95% CI, 0.26-0.81). NHBDs recipients were at greater risks to the occurrence of primary nonfunction (PNF) (OR = 7.12, 95% CI, 1.84-27.52) and ischemic cholangiopathy (IC) (OR = 9.46, 95% CI, 2.76-32.4) than DBDs recipients. CONCLUSIONS ECMO makes 1-year patient survival acceptable in NHBDs recipients. One-year graft survival rate was lower in NHBDs recipients than in DBDs recipients. Compared with DBDs recipients, the risks to develop PNF and IC were increased among NHBDs recipients.
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22
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De Carlis R, Di Sandro S, Lauterio A, Botta F, Ferla F, Andorno E, Bagnardi V, De Carlis L. Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death. Liver Transpl 2018; 24:1523-1535. [PMID: 30022597 DOI: 10.1002/lt.25312] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.
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Affiliation(s)
- Riccardo De Carlis
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Surgical Sciences, University of Pavia, Pavia, Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca Botta
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Fabio Ferla
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enzo Andorno
- Department of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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23
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Chang W. Extracorporeal Life Support in Organ Transplant Donors. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:328-332. [PMID: 30402392 PMCID: PMC6200175 DOI: 10.5090/kjtcs.2018.51.5.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/02/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
Background Extracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation. Methods Between June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month. Results ECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications. Conclusion The benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.
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Affiliation(s)
- Wonho Chang
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital
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24
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Early Graft Loss after Kidney Transplantation: Endothelial Dysfunction of Renal Microvasculature. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4074209. [PMID: 30148166 PMCID: PMC6083599 DOI: 10.1155/2018/4074209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 11/27/2022]
Abstract
Decision process about the acceptance of the deceased donor kidney for transplantation might be challenging. Although histological evaluation of pretransplant donor kidney biopsy provides reliable information regarding cortical necrosis, vascular thrombosis, extensive global glomerulosclerosis, and interstitial fibrosis/tubular atrophy, only electron microscopy enables thorough and reliable insights into microvasculature changes of kidney graft. The aim of the present paper is to briefly present two cases of early kidney graft loss. In one case, the donor was exposed to long-term extracorporeal membrane oxygenation (ECMO); in the other case, the donor experienced Takotsubo cardiomyopathy. In both cases, light microscopy of pretransplant biopsy found no pathology or significant discrepancy in morphology of kidney graft, while electron microscopy revealed severe endothelial dysfunction of renal microvasculature. Our results suggest that severe injury of renal microvasculature with relatively preserved tubular epithelium may be associated with some conditions of deceased kidney donors leading to early kidney graft nonfunction and loss. Further studies are needed to determine prognostic significance of severe ultrastructural microvasculature lesions and to evaluate disease states and conditions that could be associated with severe endothelial dysfunction of kidney graft.
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25
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Panholzer B, Huenges K, Cremer J, Haneya A. Cardiac Graft from Donors with Extracorporeal Support-A Report of Two Cases. Thorac Cardiovasc Surg Rep 2018; 7:e33-e34. [PMID: 29977737 PMCID: PMC6023715 DOI: 10.1055/s-0038-1661410] [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: 12/20/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
The persistent global shortage of organ donors is still a major limitation for transplantation. Experiences of heart transplantation from donors with extracorporeal support are rare. Here, we report from two cases of donors who were supported by extracorporeal membrane oxygenation due to acute circulatory failure. In both cases, the direct postoperative course was uneventful and free from major complications. The patients were discharged to a rehabilitation clinic. Our experience suggests that the use of heart organ from carefully selected donors with extracorporeal support is possible and may lead to an excellent outcome.
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Affiliation(s)
- Bernd Panholzer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
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Assalino M, Majno P, Toso C, Berney T, Giraud R, Dutkowski P, Andres A, Wildhaber B, Elkrief L. In situ liver splitting under extracorporeal membrane oxygenation in brain-dead donor. Am J Transplant 2018; 18:258-261. [PMID: 28801937 DOI: 10.1111/ajt.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/21/2017] [Accepted: 08/01/2017] [Indexed: 01/25/2023]
Abstract
Hemodynamic instability is generally considered as a contraindication to liver splitting, in particular when using an in situ technique. We describe the cases of two young donors with brain death in whom refractory cardiac arrest and hemodynamic instability were supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), allowing uneventful in situ splitting. Two adult and two pediatric liver recipients were successfully transplanted with immediate graft function. Favorable outcomes were also observed for the other transplanted organs, including one heart, two lungs, and four kidneys. Refractory cardiac arrest and hemodynamic instability corrected by VA-ECMO should not be considered as a contraindication to in situ liver splitting.
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Affiliation(s)
- Michela Assalino
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Pietro Majno
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland.,HPB Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Raphaël Giraud
- Intensive Care University Hospitals, Geneva, Switzerland
| | - Philipp Dutkowski
- Division of Transplantation, University Hospital, Zurich, Switzerland
| | - Axel Andres
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Barbara Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, University Hospitals, Geneva, Switzerland
| | - Laure Elkrief
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
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Abstract
OBJECTIVES To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors. DESIGN Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database). SETTING National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013. PATIENTS Donors after brain death and their organ recipients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation. CONCLUSIONS Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.
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Matsumoto K, Yamasaki N, Tsuchiya T, Miyazaki T, Kamohara R, Hatachi G, Tanigawa K, Eishi K, Nagayasu T. Single lung retrieval from a donor supported by a left ventricular assist device. J Thorac Dis 2017; 9:E685-E688. [PMID: 28932586 DOI: 10.21037/jtd.2017.07.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The number of patients who need cardiac support with a left ventricular assist device (LVAD) has increased over the last decade. However, the number of reports of organ retrieval from donors with an LVAD is still small. Successful lung retrieval for single lung transplantation was performed from a donor on LVAD support. This required special care not to injure the heart, great vessels, and the device, particularly the outflow conduit, because of significant conglutination around the device. A right single lung transplantation was performed successfully, with no postoperative complications. This means that patients on an LVAD could be potential donors for lung transplantation.
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Affiliation(s)
- Keitaro Matsumoto
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryotaro Kamohara
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Hatachi
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuyoshi Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Mattei G, Magliaro C, Pirone A, Ahluwalia A. Decellularized Human Liver Is Too Heterogeneous for Designing a Generic Extracellular Matrix Mimic Hepatic Scaffold. Artif Organs 2017; 41:E347-E355. [PMID: 28543403 DOI: 10.1111/aor.12925] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/24/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022]
Abstract
Decellularized human livers are considered the perfect extracellular matrix (ECM) surrogate because both three-dimensional architecture and biological features of the hepatic microenvironment are thought to be preserved. However, donor human livers are in chronically short supply, both for transplantation or as decellularized scaffolds, and will become even scarcer as life expectancy increases. It is hence of interest to determine the structural and biochemical properties of human hepatic ECM to derive design criteria for engineering biomimetic scaffolds. The intention of this work was to obtain quantitative design specifications for fabricating scaffolds for hepatic tissue engineering using human livers as a template. To this end, hepatic samples from five patients scheduled for hepatic resection were decellularized using a protocol shown to reproducibly conserve matrix composition and microstructure in porcine livers. The decellularization outcome was evaluated through histological and quantitative image analyses to evaluate cell removal, protein, and glycosaminoglycan content per unit area. Applying the same decellularization protocol to human liver samples obtained from five different patients yielded five different outcomes. Only one liver out of five was completely decellularized, while the other four showed different levels of remaining cells and matrix. Moreover, protein and glycosaminoglycan content per unit area after decellularization were also found to be patient- (or donor-) dependent. This donor-to-donor variability of human livers thus precludes their use as templates for engineering a generic "one-size fits all" ECM-mimic hepatic scaffold.
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Affiliation(s)
| | | | - Andrea Pirone
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Shaheen FAM, Shalabi M, Zain A, Hasanain M, Al Sayyari A. Immediately Functioning Grafts from Brain-Dead Donors Treated with Extracorporeal Membrane Oxygenation. EXP CLIN TRANSPLANT 2017; 17:404-407. [PMID: 28229804 DOI: 10.6002/ect.2016.0369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A brain-dead donor experienced repeated cardiac arrests followed by severe hypotension requiring multiple vasoactive agents. These events were associated with severe lactic acidosis and dysregulated kidney function in the donor. A 10-hour treatment with extracorporeal membranous oxygenation was instituted, which was able to hemodynamically stabilize the donor. This treatment protocol resulted in the procurement of 2 viable kidney grafts transplanted into 2 recipients, who had immediate kidney graft function and excellent serum creatinine levels upon hospital discharge. These results are all the more significant considering that both cases involved long cold ischemia times, and one of the recipients had diabetes and was receiving his second kidney graft.
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31
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Deshpande S, Maher K, Morales D. Mechanical circulatory support in children: Challenges and opportunities. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Fan X, Chen Z, Nasralla D, Zeng X, Yang J, Ye S, Zhang Y, Peng G, Wang Y, Ye Q. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor. Clin Transplant 2016; 30:1306-1313. [PMID: 27460305 DOI: 10.1111/ctr.12823] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Xiaoli Fan
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Zhiquan Chen
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - David Nasralla
- Transplant Center; Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
| | - Xianpeng Zeng
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Jing Yang
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Shaojun Ye
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Yi Zhang
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Guizhu Peng
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Yanfeng Wang
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University; Wuhan China
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33
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Dalle Ave AL, Gardiner D, Shaw DM. The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors. Transpl Int 2016; 29:612-8. [DOI: 10.1111/tri.12772] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/20/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Anne L. Dalle Ave
- Ethics Unit; University Hospital of Lausanne; Lausanne Switzerland
- Institute for Biomedical Ethics; University Medical Center; Geneva Switzerland
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust; Nottingham UK
| | - David M. Shaw
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
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34
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Abstract
The use of extracorporeal membrane oxygenation (ECMO) is an important issue for intensivists, critical care nurses, surgeons, cardiologists, and many others. There has been a continued increase in the number of centres performing ECMO. This review examines novel applications and recent trends in the use of ECMO over the last 2 years. These include ECMO to facilitate the safe use of other treatments, changing the timing of initiation, newer equipment and better biocompatibility, and the ability of ECMO programs to essentially choose which cluster of potential complications they are prepared to accept. ECMO continues to evolve, diversify in its applications, and improve in safety.
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Affiliation(s)
- Warwick Butt
- Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, VIC, 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Clinical Sciences, Melbourne, Australia
| | - Graeme MacLaren
- Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, VIC, 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Cardiothoracic Intensive Care Unit, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore
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35
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Jang HR, Park JH, Kwon GY, Park JB, Lee JE, Kim DJ, Kim YG, Kim SJ, Oh HY, Huh W. Aging has small effects on initial ischemic acute kidney injury development despite changing intrarenal immunologic micromilieu in mice. Am J Physiol Renal Physiol 2016; 310:F272-83. [DOI: 10.1152/ajprenal.00217.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 12/08/2015] [Indexed: 12/20/2022] Open
Abstract
Inflammatory process mediated by innate and adaptive immune systems is a major pathogenic mechanism of renal ischemia-reperfusion injury (IRI). There are concerns that organ recipients may be at increased risk of developing IRI after receiving kidneys from elder donors. To reveal the effects of aging on the development of renal IRI, we compared the immunologic micromilieu of normal and postischemic kidneys from mice of three different ages (9 wk, 6 mo, and 12 mo). There was a higher number of total T cells, especially effector memory CD4/CD8 T cells, and regulatory T cells in the normal kidneys of old mice. On day 2 after IRI, the proportion of necrotic tubules and renal functional changes were comparable between groups although old mice had a higher proportion of damaged tubule compared with young mice. More T cells, but less B cells, trafficked into the postischemic kidneys of old mice. The infiltration of NK T cells was similar across the groups. Macrophages and neutrophils were comparable between groups in both normal kidneys and postischemic kidneys. The intrarenal expressions of TNF-α and VEGF were decreased in normal and postischemic kidneys of aged mice. These mixed effects of aging on lymphocytes and cytokines/chemokines were not different between the two groups of old mice. Our study demonstrates that aging alters the intrarenal micromilieu but has small effects on the development of initial renal injury after IRI. Further study investigating aging-dependent differences in the repair process of renal IRI may be required.
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Affiliation(s)
- Hye Ryoun Jang
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyeon Park
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea; and
| | - Jung Eun Lee
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Joong Kim
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Goo Kim
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea; and
| | - Ha Young Oh
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wooseong Huh
- Nephrology Division, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
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36
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Zhu XS, Wang SS, Cheng Q, Ye CW, Huo F, Li P. Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation. Liver Transpl 2016; 22:188-91. [PMID: 26334555 DOI: 10.1002/lt.24318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/12/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver.
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Affiliation(s)
- Xian-Sheng Zhu
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Sha-Sha Wang
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Qi Cheng
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Chuang-Wen Ye
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Feng Huo
- The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Peng Li
- The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
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Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests. J Thorac Cardiovasc Surg 2015; 150:1344-9. [DOI: 10.1016/j.jtcvs.2015.07.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 11/21/2022]
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38
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Balsorano P, Ciapetti M, Cianchi G, Bonizzoli M, Migliaccio ML, Ferraro MC, Franci A, Peris A. Extracorporeal life support and multiorgan donation in a severe polytrauma patient: A case report. Int J Surg Case Rep 2015; 9:109-11. [PMID: 25756801 PMCID: PMC4392376 DOI: 10.1016/j.ijscr.2015.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/16/2015] [Accepted: 02/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Organ availability represents a key factor in transplants due to an almost universal shortage of deceased donors. PRESENTATION OF CASE We present the case of a 41-year-old patients with severe polytrauma, where extracorporeal life support (ECLS) allowed brain death (BD) declaration and multiorgan retrieval and transplantation. DISCUSSION Organ procurement is of utmost importance for transplant procedures. The presented case could rise ethical doubts as ECLS could be viewed as a tool for organ preservation instead of patient support. Nonetheless, it is obvious how organ preservation represents the necessary condition for patient preservation. CONCLUSION Besides it' role in non heart beating donors, ECLS is emerging as an adjunctive tool for brain dead donors management when standard treatment fails, potentially allowing a substantial increase in organ availability.
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Affiliation(s)
- Paolo Balsorano
- Department of Health Science, Section of Anaesthesiology, Intensive Care and Pain medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Marco Ciapetti
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Giovanni Cianchi
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Manuela Bonizzoli
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Maria Luisa Migliaccio
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Maria Cristina Ferraro
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Andrea Franci
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Adriano Peris
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
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40
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Ventetuolo CE, Muratore CS. Extracorporeal life support in critically ill adults. Am J Respir Crit Care Med 2014; 190:497-508. [PMID: 25046529 PMCID: PMC4214087 DOI: 10.1164/rccm.201404-0736ci] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/13/2014] [Indexed: 12/18/2022] Open
Abstract
Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome that characterized the 2009 influenza A(H1N1) pandemic have stimulated renewed interest in the use of venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to support the respiratory system. Theoretical advantages of ECLS for respiratory failure include the ability to rest the lungs by avoiding injurious mechanical ventilator settings and the potential to facilitate early mobilization, which may be advantageous for bridging to recovery or to lung transplantation. The use of venoarterial ECMO has been expanded and applied to critically ill adults with hemodynamic compromise from a variety of etiologies, beyond postcardiotomy failure. Although technology and general care of the ECLS patient have evolved, ECLS is not without potentially serious complications and remains unproven as a treatment modality. The therapy is now being tested in clinical trials, although numerous questions remain about the application of ECLS and its impact on outcomes in critically ill adults.
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Affiliation(s)
- Corey E. Ventetuolo
- Division of Pulmonary, Critical Care, and Sleep, Rhode Island Hospital, Departments of Medicine and Health Services, Policy, and Practice, and
| | - Christopher S. Muratore
- Division of Pediatric Surgery, Hasbro Children’s Hospital, Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
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