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Antonini MV, Martin-Suàrez S, Botta L, Circelli A, Cordella E, Zani G, Terzitta M, Agnoletti V, Pacini D. Thoracoabdominal Normothermic Regional Perfusion Using Mobile Closed Extracorporeal Circuit in Circulatory Death Determination Heart Donors. ASAIO J 2024:00002480-990000000-00543. [PMID: 39145661 DOI: 10.1097/mat.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
Thoracoabdominal normothermic regional perfusion (TA-NRP) is increasingly implemented in donation after circulatory determination of death (DCD). Thoracoabdominal normothermic regional perfusion allows thoracic and abdominal organs to be perfused with warm, oxygenated blood after declaration of death, interrupting ischemia. Evidence is accumulating supporting the use of TA-NRP to improve the outcome of grafts from DCD donors. Thoracoabdominal normothermic regional perfusion may restore and maintain a near-physiological environment during procurement. Moreover, during TA-NRP it is feasible to evaluate the heart in situ. Thoracoabdominal normothermic regional perfusion could be performed through different cannulation techniques, central or peripheral, and, with different extracorporeal circuits. The use of conventional cardiopulmonary bypass and extracorporeal life support (ECLS) devices equipped with open circuits has been described. We report the use of a fully mobile, closed ECLS circuit to implement TA-NRP. The procedure was successfully performed in a peripheral center without a cardiac surgery program through a percutaneous cannulation approach. This strategy resulted in combined heart, liver, and kidney recovery despite a significantly prolonged functional warm ischemia time. The feasibility of TA-NRP using modified but still closed fully mobile ECLS circuits could furtherly support the expansion of DCD programs, increasing the availability of heart for transplantation, and the quality of the grafts, improving recipients' outcome.
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Affiliation(s)
- Marta Velia Antonini
- From the Anesthesia and Intensive Care Department, Bufalini Hospital-Azienda Unità Sanitaria Locale (AUSL) della Romagna, Cesena, Italy
- PhD program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy
| | - Sofia Martin-Suàrez
- Cardiac Surgery Unit, IRCCS Az. Osp. Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Luca Botta
- Cardiac Surgery Unit, IRCCS Az. Osp. Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Alessandro Circelli
- From the Anesthesia and Intensive Care Department, Bufalini Hospital-Azienda Unità Sanitaria Locale (AUSL) della Romagna, Cesena, Italy
| | - Erika Cordella
- Emilia-Romagna Transplant Reference Centre, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluca Zani
- Anesthesia and Intensive Care Unit, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Marina Terzitta
- Anesthesia and Intensive Care Unit, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Vanni Agnoletti
- From the Anesthesia and Intensive Care Department, Bufalini Hospital-Azienda Unità Sanitaria Locale (AUSL) della Romagna, Cesena, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, IRCCS Az. Osp. Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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Royo-Villanova M, Miñambres E, Coll E, Domínguez-Gil B. Normothermic Regional Perfusion in Controlled Donation After the Circulatory Determination of Death: Understanding Where the Benefit Lies. Transplantation 2024:00007890-990000000-00833. [PMID: 39049104 DOI: 10.1097/tp.0000000000005143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Controlled donation after the circulatory determination of death (cDCDD) has emerged as a strategy to increase the availability of organs for clinical use. Traditionally, organs from cDCDD donors have been subject to standard rapid recovery (SRR) with poor posttransplant outcomes of abdominal organs, particularly the liver, and limited organ utilization. Normothermic regional perfusion (NRP), based on the use of extracorporeal membrane oxygenation devices, consists of the in situ perfusion of organs that will be subject to transplantation with oxygenated blood under normothermic conditions after the declaration of death and before organ recovery. NRP is a potential solution to address the limitations of traditional recovery methods. It has become normal practice in several European countries and has been recently introduced in the United States. The increased use of NRP in cDCDD has occurred as a result of a growing body of evidence on its association with improved posttransplant outcomes and organ utilization compared with SRR. However, the expansion of NRP is precluded by obstacles of an organizational, legal, and ethical nature. This article details the technique of both abdominal and thoracoabdominal NRP. Based on the available evidence, it describes its benefits in terms of posttransplant outcomes of abdominal and thoracic organs and organ utilization. It addresses cost-effectiveness aspects of NRP, as well as logistical and ethical obstacles that limit the implementation of this innovative preservation strategy.
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Affiliation(s)
- Mario Royo-Villanova
- Transplant Coordination Unit and Service of Intensive Care, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Miñambres
- Transplant Coordination Unit and Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, Universidad de Cantabria, Santander, Spain
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Normothermic Regional Perfusion Provides a Great Opportunity to Maximize Organ Procurement in Donation After the Circulatory Determination of Death. Crit Care Med 2022; 50:1649-1653. [PMID: 36227033 DOI: 10.1097/ccm.0000000000005645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Le Dorze M, Gaillard Le Roux B, Audibert G, Quéré R, Muller L, Lavoué S, Venhard JC, Perrigault PF, Lesieur O. Transferring an ICU Patient at the End of His Life for the Purpose of Organ Donation: Could It Be Considered? Transpl Int 2022; 35:10549. [PMID: 35812161 PMCID: PMC9257584 DOI: 10.3389/ti.2022.10549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/23/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Matthieu Le Dorze
- Ethics Committee of the French Society of Anesthesia and Critical Care Medicine (SFAR), Paris, France
- Department of Anesthesia and Critical Care Medicine, Hôpital Lariboisière AP-HP, Paris, France
- Université Paris-Saclay, UVSQ, INSERM, CESP, U1018, Villejuif, France
| | - Bénédicte Gaillard Le Roux
- Ethics Commission of the French Intensive Care Society (SRLF), Paris, France
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Gérard Audibert
- Ethics Committee of the French Society of Anesthesia and Critical Care Medicine (SFAR), Paris, France
- Department of Anesthesia and Critical Care Medicine, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Régis Quéré
- Ethics Commission of the French Intensive Care Society (SRLF), Paris, France
- Organ Procurement Organization, Necker University Hospital, Paris, France
| | - Laurent Muller
- Ethics Committee of the French Society of Anesthesia and Critical Care Medicine (SFAR), Paris, France
- Department of Anesthesia and Critical Care Medicine, University Hospital, Nîmes, France
| | - Sylvain Lavoué
- Ethics Commission of the French Intensive Care Society (SRLF), Paris, France
- Intensive Care Unit, University Hospital, Rennes, France
| | - Jean-Christophe Venhard
- Department of Anesthesia and Critical Care Medicine, French Society of Organ Procurement Medicine, University Hospital, Tours, France
| | - Pierre-François Perrigault
- Ethics Committee of the French Society of Anesthesia and Critical Care Medicine (SFAR), Paris, France
- Department of Anesthesia and Critical Care Medicine, University Hospital, Montpellier, France
| | - Olivier Lesieur
- Ethics Commission of the French Intensive Care Society (SRLF), Paris, France
- Intensive Care Unit, General Hospital, La Rochelle, France
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Drezza JPDO, Boteon APCDS, Calil IL, Anna RSS, Viveiros MDM, Rezende MBD, Pecora RAA, Boteon YL. Disposal of donor livers in Brazil: how to optimize their utilization rate in transplants? EINSTEIN-SAO PAULO 2021; 19:eAO6770. [PMID: 34878072 PMCID: PMC8670423 DOI: 10.31744/einstein_journal/2021ao6770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To understand the professionals´ perception of the use of deceased donor liver for transplantation, the reasons to decline them, and propose strategies to increase their use safely. Methods: This is a cross-sectional, descriptive qualitative-quantitative study. Professionals working with liver transplantation answered a self-administered, structured, and electronic questionnaire comprising 17 questions distributed into four sessions (demographic factors, perception of use of organs, reasons for disposal, and measures to favor their usage). Results: A total of 42 professionals participated in the study. The rate of use of organs was considered low by 71.43% (n=30) of respondents or very low by 19.05% (n=8). Everyone agreed that it was possible to increase it. Thirty-one (73.81%) participants believed the expansion of the population of extended criteria donors affected this index negatively. Donor-related conditions were the most frequent category of reasons for refusing a liver for transplantation, being the findings during organ retrieval the most frequent reason in clinical practice. Enhanced training of intensive care teams in the treatment of donors was the primary measure selected to favor the use of the organs, followed by investment in new technologies to optimize its preservation/evaluate its function before transplantation. Conclusion: Implementation of strategies to increase the rate of acceptance of livers is expected. Improvements in donor intensive care and implementation of new preservation technologies should favor the use of the organs.
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Affiliation(s)
| | | | | | | | | | | | | | - Yuri Longatto Boteon
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Padilla M, Coll E, Fernández-Pérez C, Pont T, Ruiz Á, Pérez-Redondo M, Oliver E, Atutxa L, Manciño JM, Daga D, Miñambres E, Moya J, Vidal B, Dueñas-Jurado JM, Mosteiro F, Rodríguez-Salgado A, Fernández-García E, Lara R, Hernández-Marrero D, Estébanez B, Rodríguez-Ferrero ML, Barber M, García-López F, Andrés A, Santiago C, Zapatero A, Badenes R, Carrizosa F, Blanco JJ, Bernal JL, Elola FJ, Vidal C, Terrón C, Castro P, Comas J, Domínguez-Gil B. Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion. Am J Transplant 2021; 21:3618-3628. [PMID: 33891793 DOI: 10.1111/ajt.16622] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 01/25/2023]
Abstract
Normothermic regional perfusion (NRP) allows the in situ perfusion of organs with oxygenated blood in donation after the circulatory determination of death (DCDD). We aimed at evaluating the impact of NRP on the short-term outcomes of kidney transplants in controlled DCDD (cDCDD). This is a multicenter, nationwide, retrospective study comparing cDCDD kidneys obtained with NRP versus the standard rapid recovery (RR) technique. During 2012-2018, 2302 cDCDD adult kidney transplants were performed in Spain using NRP (n = 865) or RR (n = 1437). The study groups differed in donor and recipient age, warm, and cold ischemic time and use of ex situ machine perfusion. Transplants in the NRP group were more frequently performed in high-volume centers (≥90 transplants/year). Through matching by propensity score, two cohorts with a total of 770 patients were obtained. After the matching, no statistically significant differences were observed between the groups in terms of primary nonfunction (p = .261) and mortality at 1 year (p = .111). However, the RR of kidneys was associated with a significantly increased odds of delayed graft function (OR 1.97 [95% CI 1.43-2.72]; p < .001) and 1-year graft loss (OR 1.77 [95% CI 1.01-3.17]; p = .034). In conclusion, compared with RR, NRP appears to improve the short-term outcomes of cDCDD kidney transplants.
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Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Preventive Medicine and Public Health Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Teresa Pont
- Donation and Transplantation Coordination Unit, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.,Vall d'Hebron Barcelona Hospital Campus, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ángel Ruiz
- Donation and Transplantation Coordination Unit, Hospital Clinic, Barcelona, Spain
| | - Marina Pérez-Redondo
- Donation and Transplantation Coordination Unit, Hospital Universitario Puerta de Hierro- Majadahona, Madrid, Spain
| | - Eva Oliver
- Donation and Transplantation Coordination Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Lander Atutxa
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario de Donostia, San Sebastián, Spain
| | - José M Manciño
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Domingo Daga
- Intensive Care Department, Regional Donor Transplant Coordination, Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Eduardo Miñambres
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
| | - José Moya
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Bárbara Vidal
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Fernando Mosteiro
- Donation and Transplantion Coordination Unit, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | - Alberto Rodríguez-Salgado
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Ramón Lara
- Intensive Care Department, Hospital Universitario Virgen de las Nieves, Regional Donor Transplant Coordination in Granada, Granada, Spain
| | - Domingo Hernández-Marrero
- Nephrology Department, Instituto de Investigación Biomédica de Málaga (IBIMA) REDINREN RD16/0009/0006, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Belén Estébanez
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - María Barber
- Intensive Care Department, Donation and Transplantation Coordination Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando García-López
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Albacete, Albacete, Spain
| | - Amado Andrés
- Nephrology Department, Donation and Transplantation Coordination Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Santiago
- Nephrology Department, Donation and Transplantation Coordination Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Ana Zapatero
- Donation and Transplantation Coordination Unit, Hospital del Mar, Barcelona, Spain
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Surgery, University of Valencia, Valencia, Spain.,INCLIVA, Research Health Institute, Valencia, Spain
| | - Francisco Carrizosa
- Intensive Care Department, Donation and Transplantation Coordination Unit, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - José J Blanco
- Intensive Care Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | | | - Pablo Castro
- Coordinación Autonómica de Trasplantes de Andalucía, Sevilla, Spain
| | - Jordi Comas
- Organització Catalana de Trasplantaments, Barcelona, Spain
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Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes. Transplant Direct 2021; 7:e725. [PMID: 34291147 PMCID: PMC8288885 DOI: 10.1097/txd.0000000000001174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. Warm ischemia time and ischemia-reperfusion damage result in higher rates of delayed graft function and primary nonfunction in kidney transplants (KTs) from controlled donation after circulatory death (cDCD). This study aimed to assess early and late kidney function and patient and graft survival of KT from cDCD preserved with normothermic regional perfusion (NRP) and to compare with KT from brain death donors (DBDs) and cDCD preserved with rapid recovery (RR). Methods. Patients who received a KT at our institution from 2012 to 2018 were included, with a minimum follow-up period of 1 y. They were categorized by donor type and conditioning methods: DBD, cDCD with NRP, and cDCD with RR. Early and late graft function, along with patient and graft survival were analyzed in all groups. Results. A total of 182 KT recipients were included in the study (98 DBD and 84 cDCD). Out of the cDCDs, 24 kidneys were recovered with the use of NRP and 62 with RR; 22 of the 24 kidneys were ultimately transplanted. The cDCD using NRP group showed lower rates of delayed graft function compared with the cDCD with RR group (36.3% versus 46.7%, P = 0.01). Also, primary nonfunction rates were lower in the cDCD using NRP group (4.5% versus 6.4% cDCD-RR and 10.2% DBD). Patient survival rates were >90% in all groups. No differences were found in graft survival rates at 1 y. Conclusions. The use of abdominal NRP improves early function recovery of KT from cDCD, making their outcomes comparable with those of DBD.
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Miñambres E, Royo-Villanova M, Pérez-Redondo M, Coll E, Villar-García S, Canovas SJ, Francisco Nistal J, Garrido IP, Gómez-Bueno M, Cobo M, Dominguez-Gil B. Spanish experience with heart transplants from controlled donation after the circulatory determination of death using thoraco-abdominal normothermic regional perfusion and cold storage. Am J Transplant 2021; 21:1597-1602. [PMID: 33319435 DOI: 10.1111/ajt.16446] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
Heart transplantation from controlled donation after the circulatory determination of death (cDCDD) may help to increase the availability of hearts for transplantation. During 2020, four heart transplants were performed at three different Spanish hospitals based on the use of thoraco-abdominal normothermic regional perfusion (TA-NRP) followed by cold storage (CS). All donors were young adults <45 years. The functional warms ischemic time ranged from 8 to 16 minutes. In all cases, the heart recovered sinus rhythm within 1 minute of TA-NRP. TA-NRP was weaned off or decreased <1L within 25 minutes. No recipient required mechanical support after transplantation and all were immediately extubated and discharged home (median hospital stay: 21 days) with an excellent outcome. Four livers, eight kidneys, and two pancreata were also recovered and transplanted. All abdominal grafts recipients experienced an excellent outcome. The use of TA-NRP makes heart transplantation feasible and allows assessing heart function before organ procurement without any negative impact on the preservation of abdominal organs. The use of TA-NRP in cDCDD heart donors in conjunction with cold storage following retrieval can eliminate the need to use ex situ machine perfusion devices, making cDCDD heart transplantation economically possible in other countries.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Mario Royo-Villanova
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Virgen de la Arrixaca. IMIB-Arrixaca Research Institute, Murcia, Spain
| | - Marina Pérez-Redondo
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Puerta de Hierro, Madrid, Spain
| | | | - Susana Villar-García
- Cardiovascular Surgery Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Sergio J Canovas
- Cardiovascular Surgery Department, University Hospital Virgen de la Arrixaca, Medical School, University of Murcia, Murcia, Spain
| | - Juan Francisco Nistal
- Service of Cardiovascular Surgery, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, School of Medicine, CIBERCV, Instituto de Salud Carlos III, Santander, Spain
| | - Iris P Garrido
- Heart Failure and Heart Transplant Unit, Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Manuel Gómez-Bueno
- Service of Cardiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Manuel Cobo
- Service of Cardiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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Pérez Redondo M, Alcántara Carmona S, Villar García S, Forteza Gil A, Villanueva Fernández H, Hernández-Pérez FJ, Campo-Cañaveral de la Cruz JL, Velasco Calvo R, Segovia-Cubero J, Alonso Menárguez B, Del Río Gallegos F, Coll E, Domínguez-Gil González B, Rubio Muñoz JJ. Transplantation of a heart donated after circulatory death via thoraco-abdominal normothermic regional perfusion and results from the first Spanish case. J Cardiothorac Surg 2020; 15:333. [PMID: 33239086 PMCID: PMC7687983 DOI: 10.1186/s13019-020-01372-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. CASE PRESENTATION We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. CONCLUSIONS This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.
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Affiliation(s)
- Marina Pérez Redondo
- Department of Intensive Care Medicine Department of Donor and Transplant Coordination, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de investigación sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain.
| | - Sara Alcántara Carmona
- Department of Intensive Care Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Villar García
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alberto Forteza Gil
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Francisco José Hernández-Pérez
- Department of Cardiology. Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Rocío Velasco Calvo
- Department of Neurology, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
| | - Javier Segovia-Cubero
- Department of Cardiology. Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- CIBER cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Alonso Menárguez
- Division of Transplant and Cardiac Anesthesia, Department of Anesthesiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Juan José Rubio Muñoz
- Department of Intensive Care Medicine Department of Donor and Transplant Coordination, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de investigación sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain
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