1
|
Vijayan K, Schroder HJ, Hameed A, Hitos K, Lo W, Laurence JM, Yoon PD, Nahm C, Lim WH, Lee T, Yuen L, Wong G, Pleass H. Kidney Transplantation Outcomes From Uncontrolled Donation After Circulatory Death: A Systematic Review and Meta-analysis. Transplantation 2024; 108:1422-1429. [PMID: 38361237 DOI: 10.1097/tp.0000000000004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD). METHODS MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD. RESULTS Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I 2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I 2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts. CONCLUSIONS Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.
Collapse
Affiliation(s)
- Keshini Vijayan
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Hugh J Schroder
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Ahmer Hameed
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Kerry Hitos
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Warren Lo
- Institute of Urology and Nephrology, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Jerome M Laurence
- Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Peter D Yoon
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher Nahm
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Taina Lee
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Lawrence Yuen
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Germaine Wong
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Henry Pleass
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| |
Collapse
|
2
|
Hasjim BJ, Sanders JM, Alexander M, Redfield RR, Ichii H. Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2024; 13:642. [PMID: 38929081 PMCID: PMC11200710 DOI: 10.3390/antiox13060642] [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: 03/27/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
The limited supply and rising demand for kidney transplantation has led to the use of allografts more susceptible to ischemic reperfusion injury (IRI) and oxidative stress to expand the donor pool. Organ preservation and procurement techniques, such as machine perfusion (MP) and normothermic regional perfusion (NRP), have been developed to preserve allograft function, though their long-term outcomes have been more challenging to investigate. We performed a systematic review and meta-analysis to examine the benefits of MP and NRP compared to traditional preservation techniques. PubMed (MEDLINE), Embase, Cochrane, and Scopus databases were queried, and of 13,794 articles identified, 54 manuscripts were included (n = 41 MP; n = 13 NRP). MP decreased the rates of 12-month graft failure (OR 0.67; 95%CI 0.55, 0.80) and other perioperative outcomes such as delayed graft function (OR 0.65; 95%CI 0.54, 0.79), primary nonfunction (OR 0.63; 95%CI 0.44, 0.90), and hospital length of stay (15.5 days vs. 18.4 days) compared to static cold storage. NRP reduced the rates of acute rejection (OR 0.48; 95%CI 0.35, 0.67) compared to in situ perfusion. Overall, MP and NRP are effective techniques to mitigate IRI and play an important role in safely expanding the donor pool to satisfy the increasing demands of kidney transplantation.
Collapse
Affiliation(s)
- Bima J. Hasjim
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Jes M. Sanders
- Department of Surgery, Division of Transplantation, Northwestern Memorial Hospital, Chicago, IL 60611, USA;
| | - Michael Alexander
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Robert R. Redfield
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Hirohito Ichii
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| |
Collapse
|
3
|
Watson CJ, Gaurav R, Butler AJ. Current Techniques and Indications for Machine Perfusion and Regional Perfusion in Deceased Donor Liver Transplantation. J Clin Exp Hepatol 2024; 14:101309. [PMID: 38274508 PMCID: PMC10806097 DOI: 10.1016/j.jceh.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024] Open
Abstract
Since the advent of University of Wisconsin preservation solution in the 1980s, clinicians have learned to work within its confines. While affording improved outcomes, considerable limitations still exist and contribute to the large number of livers that go unused each year, often for fear they may never work. The last 10 years have seen the widespread availability of new perfusion modalities which provide an opportunity for assessing organ viability and prolonged organ storage. This review will discuss the role of in situ normothermic regional perfusion for livers donated after circulatory death. It will also describe the different modalities of ex situ perfusion, both normothermic and hypothermic, and discuss how they are thought to work and the opportunities afforded by them.
Collapse
Affiliation(s)
- Christopher J.E. Watson
- University of Cambridge Department of Surgery, Box 210, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | - Rohit Gaurav
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| | - Andrew J. Butler
- University of Cambridge Department of Surgery, Box 210, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
- The Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
| |
Collapse
|
4
|
Farinelli P, Juri J, Varela D, Salome M, Bisigniano L, Raimondi C, Magnate AD, Barone ME, Fernandez MF, Cambariere R, Villavicencio S, Pregno E, Klein F, Villamil A, Schelotto PB, Gondolesi GE. Donation after Cardiocirculatory Death: a program that we must implement. Experts Argentinean meeting report. TRANSPLANTATION REPORTS 2023. [DOI: 10.1016/j.tpr.2023.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
5
|
Oniscu GC, Mehew J, Butler AJ, Sutherland A, Gaurav R, Hogg R, Currie I, Jones M, Watson CJE. Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death. Transplantation 2023; 107:438-448. [PMID: 35993664 DOI: 10.1097/tp.0000000000004280] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND . We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD). METHODS . This is a retrospective analysis of UK adult cDCD donors' where at least 1 abdominal organ was accepted for transplantation between January 1, 2011, and December 31, 2019. RESULTS . A mean of 3.3 organs was transplanted when NRP was used compared with 2.6 organs per donor when NRP was not used. When adjusting for organ-specific donor risk profiles, the use of NRP increased the odds of all abdominal organs being transplanted by 3-fold for liver ( P < 0.0001; 95% confidence interval [CI], 2.20-4.29), 1.5-fold for kidney ( P = 0.12; 95% CI, 0.87-2.58), and 1.6-fold for pancreas ( P = 0.0611; 95% CI, 0.98-2.64). Twelve-mo liver transplant survival was superior for recipients of a cDCD NRP graft with a 51% lower risk-adjusted hazard of transplant failure (HR = 0.494). In risk-adjusted analyses, NRP kidneys had a 35% lower chance of developing delayed graft function than non-NRP kidneys (odds ratio, 0.65; 95% CI, 0.465-0.901)' and the expected 12-mo estimated glomerular filtration rate was 6.3 mL/min/1.73 m 2 better if abdominal NRP was used ( P < 0.0001). CONCLUSIONS . The use of NRP during DCD organ recovery leads to increased organ utilization and improved transplant outcomes compared with conventional organ recovery.
Collapse
Affiliation(s)
- Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Mehew
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Andrew J Butler
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), London, United Kingdom
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
| | - Andrew Sutherland
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Rohit Gaurav
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
| | - Rachel Hogg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Ian Currie
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Jones
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Christopher J E Watson
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), London, United Kingdom
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Bristol, United Kingdom
| |
Collapse
|
6
|
Lung transplantation following donation after circulatory death. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
7
|
Polanco Pujol L, Velasco JC, González García J, Herranz Amo F, Lledó García E, Chomón GB, Castro JMD, Chamizo JA, Chacón GA, Gárate MM, Ríos DS, Diez Cordero J, Durán Merino R, Hernández Fernández C. Deceased donor kidney procurement: Systematic review of the surgical technique. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2022; 47:140-148. [PMID: 36462604 DOI: 10.1016/j.acuroe.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. OBJECTIVES Review of the available literature on kidney procurement procedure. MATERIAL AND METHODS Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. RESULTS Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. CONCLUSIONS Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.
Collapse
|
8
|
Salvage of Declined Extended Criteria DCD Livers Using in-situ Normothermic Regional Perfusion. Ann Surg 2022; 276:e223-e230. [PMID: 35861530 DOI: 10.1097/sla.0000000000005611] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigates whether liver grafts donated after circulatory death (DCD) that are declined by the entire Euro-transplant region can be salvaged with abdominal normothermic regional perfusion (aNRP). SUMMARY BACKGROUND DATA aNRP is increasingly used for DCD liver grafts because it prevents typical complications. However, it is unclear whether aNRP is capable to rescue pre-transplant declined liver grafts, by providing the opportunity to test function during donation. METHODS Donor livers from DCD donors, declined by all centers in the Euro-transplant region, were included for this study. The comparator cohort included standard DCD livers and livers donated after brain death, transplanted in the same time period. RESULTS After withdrawal of life-sustaining treatment, 28 from the 43 donors had a circulatory death within 2 hours, in which case aNRP was initiated. Out of these 28 cases, in 3 cases perfusion problems occurred, 5 grafts were declined based on liver assessment, and 20 liver grafts were transplanted. The main differences during aNRP between the transplanted grafts and the assessed non-transplanted grafts were ALT levels of 53 (34-68) versus 367 (318-488; P=0.001) U/l and bile production in 100% versus 50% of the grafts (P=0.024). The 12-month graft and patient survival were both 95%, similar to the comparator cohort. The incidence of ischemic cholangiopathy was 11%, which was lower than in the standard DCD cohort (18%). CONCLUSIONS aNRP can safely select and thus is able to rescue DCD liver grafts that were deemed unsuitable for transplantation, while preventing primary non-function and minimizing ischemic cholangiopathy.
Collapse
|
9
|
Polanco Pujol L, Velasco JC, González García J, Herranz Amo F, Lledó García E, Chomón GB, Castro JMD, Chamizo JA, Chacón GA, Gárate MM, Ríos DS, Diez Cordero J, Durán Merino R, Hernández Fernández C. Extracción renal en donante cadáver: revisión sistemática de la técnica quirúrgica. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Barreda Monteoliva P, Redondo-Pachón D, Miñambres García E, Rodrigo Calabia E. Kidney transplant outcome of expanded criteria donors after circulatory death. Nefrologia 2022; 42:135-144. [PMID: 36153910 DOI: 10.1016/j.nefroe.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/31/2021] [Indexed: 06/16/2023] Open
Abstract
The increase in the number of patients on the kidney transplant waiting list has led to an attempt to increase the number of potential donors by incorporating candidates that previously would not have been considered optimal, including donors after cardiac death (DCD) and those with "expanded" criteria (ECD). Recipients of controlled DCD (cDCD) grafts suffer more delayed graft function (DGF), but have a long-term evolution comparable to those of brain-dead donors, which has allowed an increase in the number of cDCD transplants in different countries in recent years. In parallel, the use of cDCD with expanded criteria (cDCD/ECD) has increased in recent years in different countries, allowing the waiting list for kidney transplantation to be shortened. The use of these grafts, although associated with a higher frequency of DGF, offers similar or only slightly lower long-term graft survival than those of brain death donors with expanded criteria. Different studies have observed that cDCD/ECD graft recipients have worse kidney function than cDCD/standard and DBD/ECD. Mortality associated with cDCD/ECD graft transplantation mostly relates to the recipient age. Patients who receive a cDCD/≥60 graft have better survival than those who continue on the waiting list, although this fact has not been demonstrated in recipients of cDCD/>65 years. The use of this type of organ should be accompanied by the optimization of surgical times and the shortest possible cold ischemia.
Collapse
Affiliation(s)
- Paloma Barreda Monteoliva
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Eduardo Miñambres García
- Coordinación de trasplantes, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Emilio Rodrigo Calabia
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, Spain.
| |
Collapse
|
11
|
Hosgood SA, Brown RJ, Nicholson ML. Advances in Kidney Preservation Techniques and Their Application in Clinical Practice. Transplantation 2021; 105:e202-e214. [PMID: 33982904 PMCID: PMC8549459 DOI: 10.1097/tp.0000000000003679] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.
Collapse
Affiliation(s)
- Sarah A. Hosgood
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Rachel J. Brown
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Michael L. Nicholson
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| |
Collapse
|
12
|
De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, Kimenai HJAN, Knight SR, Neyrinck AP, Paredes D, Watson CJE, Rega F, Jochmans I. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int 2021; 34:2046-2060. [PMID: 34570380 DOI: 10.1111/tri.14121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
Collapse
Affiliation(s)
- Julie De Beule
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Liset H M Pengel
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Pearson R, Geddes C, Mark P, Clancy M, Asher J. Transplantation of kidneys after normothermic perfusion: A single center experience. Clin Transplant 2021; 35:e14431. [PMID: 34288129 DOI: 10.1111/ctr.14431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND In order to expand the pool of usable donors from circulatory death (DCD) there is increasing interest in normothermic regional perfusion (NRP) to assess and improve liver viability.1,2 NRP may also improve outcomes in kidney transplantation.We present our single center experience of outcomes in imported kidneys following NRP. METHODS Data was obtained from a prospectively maintained database between December 2012 and September 2018. Primary endpoints were incidence of delayed graft function (DGF) and estimated glomerular filtration rate (eGFR). RESULTS Six-hundred and thirty-two decease donor kidneys were transplanted, 229 from DCD donors, 29 of which had NRP. The DGF rate was lower for NRP versus DCD (six of 29, 20.7% vs. 70 of 200, 35.0%) with reduced duration of DGF. Multivariate analysis demonstrated transplant type to be a statistically significant independent predictor of eGFR at 7 and 14 days. Early transplant function in NRP kidneys was comparable to DBD. There were no graft losses within 30 days in the NRP group. One-year graft loss rate was 3.4% for NRP and 6.0% for standard DCD. CONCLUSION This data suggests NRP is safe, and reduces rates of DGF and improves early renal transplant function.
Collapse
Affiliation(s)
- Robert Pearson
- Department of Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Geddes
- Department of Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Patrick Mark
- Institute of Cardiovascular and Molecular Sciences, University of Glasgow, Glasgow, UK
| | - Marc Clancy
- Department of Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - John Asher
- Department of Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
15
|
Barreda Monteoliva P, Redondo-Pachón D, Miñambres García E, Rodrigo Calabria E. Kidney transplant outcome of expanded criteria donors after circulatory death. Nefrologia 2021; 42:S0211-6995(21)00104-1. [PMID: 34154848 DOI: 10.1016/j.nefro.2021.01.014] [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: 11/18/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 10/21/2022] Open
Abstract
The increase in the number of patients on the kidney transplant waiting list has led to an attempt to increase the number of potential donors by incorporating candidates that previously would not have been considered optimal, including donors after cardiac death (DCD) and those with "expanded" criteria (ECD). Recipients of controlled DCD (cDCD) grafts suffer more delayed graft function (DGF), but have a long-term evolution comparable to those of brain-dead donors, which has allowed an increase in the number of cDCD transplants in different countries in recent years. In parallel, the use of cDCD with expanded criteria (cDCD/ECD) has increased in recent years in different countries, allowing the waiting list for kidney transplantation to be shortened. The use of these grafts, although associated with a higher frequency of DGF, offers similar or only slightly lower long-term graft survival than those of brain death donors with expanded criteria. Different studies have observed that cDCD/ECD graft recipients have worse kidney function than cDCD/standard and brain death/ECD. Mortality associated with cDCD/ECD graft transplantation mostly relates to the recipient age. Patients who receive a cDCD/≥60 graft have better survival than those who continue on the waiting list, although this fact has not been demonstrated in recipients of cDCD/>65 years. The use of this type of organ should be accompanied by the optimization of surgical times and the shortest possible cold ischemia.
Collapse
Affiliation(s)
- Paloma Barreda Monteoliva
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España
| | | | - Eduardo Miñambres García
- Coordinación de trasplantes, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España
| | - Emilio Rodrigo Calabria
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla/IDIVAL, Universidad de Cantabria, Santander, España.
| |
Collapse
|
16
|
Danion J, Thuillier R, Allain G, Bruneval P, Tomasi J, Pinsard M, Hauet T, Kerforne T. Evaluation of Liver Quality after Circulatory Death Versus Brain Death: A Comparative Preclinical Pig Model Study. Int J Mol Sci 2020; 21:ijms21239040. [PMID: 33261172 PMCID: PMC7730280 DOI: 10.3390/ijms21239040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/14/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023] Open
Abstract
The current organ shortage in hepatic transplantation leads to increased use of marginal livers. New organ sources are needed, and deceased after circulatory death (DCD) donors present an interesting possibility. However, many unknown remains on these donors and their pathophysiology regarding ischemia reperfusion injury (IRI). Our hypothesis was that DCD combined with abdominal normothermic regional recirculation (ANOR) is not inferior to deceased after brain death (DBD) donors. We performed a mechanistic comparison between livers from DBD and DCD donors in a highly reproducible pig model, closely mimicking donor conditions encountered in the clinic. DCD donors were conditioned by ANOR. We determined that from the start of storage, pro-lesion pathways such as oxidative stress and cell death were induced in both donor types, but to a higher extent in DBD organs. Furthermore, pro-survival pathways, such as resistance to hypoxia and regeneration showed activation levels closer to healthy livers in DCD-ANOR rather than in DBD organs. These data highlight critical differences between DBD and DCD-ANOR livers, with an apparent superiority of DCD in terms of quality. This confirms our hypothesis and further confirms previously demonstrated benefits of ANOR. This encourages the expended use of DCD organs, particularly with ANOR preconditioning.
Collapse
Affiliation(s)
- Jérôme Danion
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU de Poitiers, Service de Chirurgie Générale et Endocrinienne, F-86021 Poitiers, France
| | - Raphael Thuillier
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
| | - Géraldine Allain
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Patrick Bruneval
- Hôpital Européen Georges Pompidou, Service D’anatomie Pathologique, F-75015 Paris, France;
- Faculté de Médecine, Université Paris-Descartes, F-75006 Paris, France
| | - Jacques Tomasi
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Michel Pinsard
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
| | - Thierry Hauet
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
- Fédération Hospitalo-Universitaire SUPORT, F-86000 Poitiers, France
- IBiSA Plateforme ‘Plate-Forme MOdélisation Préclinique—Innovation Chirurgicale et Technologique (MOPICT)’, Domaine Expérimental du Magneraud, F-17700 Surgères, France
- Pr. Thierry HAUET, INSERM U1082, CHU de Poitiers, 2 rue de la Miletrie, CEDEX BP 577, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-5-49-44-48-29; Fax: +33-5-49-44-38-34
| | - Thomas Kerforne
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
| |
Collapse
|
17
|
Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death: A Systematic Review and Critical Appraisal. Transplantation 2020; 104:1776-1791. [PMID: 32541563 DOI: 10.1097/tp.0000000000003345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominal normothermic regional perfusion (aNRP) for donation after circulatory death is an emerging organ preservation technique that might lead to increased organ utilization per donor by facilitating viability testing, improving transplant outcome by early reversal of ischemia, and decreasing the risk of unintentional surgical damage. The aim of the current review is to evaluate the recent literature on the added value of aNRP when compared to local standard perfusion technique. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for systematic reviews was used, and relevant literature databases were searched. Primary outcomes were organ utilization rate and patient and graft survival after 1 year. Secondary outcomes included delayed graft function, primary nonfunction, serum creatinine, and biliary complications. RESULTS A total of 24 articles were included in this review. The technique is unanimously reported to be feasible and safe, but the available studies are characterized by considerable heterogeneity and bias. CONCLUSIONS Uniform reported outcome measures are needed to draw more definitive conclusions on transplant outcomes and organ utilization. A randomized controlled trial comparing aNRP with standard procurement technique in donation after circulatory death donors would be needed to show the added value of the procedure and determine its place among modern preservation techniques.
Collapse
|
18
|
Kidney Transplant From Uncontrolled Donation After Circulatory Death: Contribution of Normothermic Regional Perfusion. Transplantation 2020; 104:130-136. [PMID: 30985577 DOI: 10.1097/tp.0000000000002753] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33-36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome. METHODS We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model. RESULTS This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD-specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function. CONCLUSIONS Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
Collapse
|
19
|
Zanierato M, Dondossola D, Palleschi A, Zanella A. Donation after circulatory death: possible strategies for in-situ organ preservation. Minerva Anestesiol 2020; 86:984-991. [DOI: 10.23736/s0375-9393.20.14262-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
20
|
Novel Organ Perfusion and Preservation Strategies in Transplantation – Where Are We Going in the United Kingdom? Transplantation 2020; 104:1813-1824. [DOI: 10.1097/tp.0000000000003106] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
21
|
Gelpi R, Paredes D, Rodríguez-Villar C, Roque R, Ruiz A, Adalia R, Peri-Cusí L, Sole M, Oppenheimer F, Diekmann F. The development of a predictive model of graft function in uncontrolled donors after circulatory death: validity of a pulsatile renal preservation machine cut-off value for kidney acceptance. Nephrol Dial Transplant 2019; 34:531-538. [PMID: 30085267 DOI: 10.1093/ndt/gfy241] [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] [Received: 10/10/2017] [Accepted: 06/14/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The criteria for kidney suitability in uncontrolled donors after circulatory death (uDCD) procured after regional normothermic perfusion are based on macroscopic appearance and renal haemodynamic values with final renal resistance (FRR). However, these criteria have not been analysed to predict the future graft function. This study presents a model to predict the outcome in uDCD kidneys and define the predictive FRR value. METHODS All uDCD kidney transplants performed in our hospital from 2004 to 2016 were included. Donors and recipients and pre-transplantation data are described. The endpoint was glomerular filtration rate (GFR) ≥30 mL/min at 6 months after transplantation. RESULTS A total of 194 recipients were included. FRR in donors ≥60 years old was (mean ± SD) 0.27 ± 0.11 versus 0.22 ± 0.09 mmHg/mL/min in donors <60 years (P = 0.042). Kidney survival was 88.2% versus 84% at 12 months and 60.7% versus 30.8% at 120 months (P = 0.067). For the group of recipients from donors ≥60 years, the FRR was 0.37 ± 0.08 mmHg/mL/min in the GFR <30 mL/min group versus 0.18 ± 0.06 mmHg/mL/min in the GFR ≥30 mL/min group (P < 0.001). The value FRR ≥0.3 mmHg/mL/min predicts 59-79% of GFR <30 mL/min [odds ratio = 2.16, 95% confidence interval (CI) 1.80-6.40; P < 0.001]. The predictive accuracy of FRR for GFR by ROC curve was 0.968 (95% CI). The best cut-off for FRR was 0.3 mmHg/mL/min to predict GFR at 6 months with a sensitivity of 67%, specificity of 100%, positive predictive value of 83% and negative predictive value of 92%. CONCLUSIONS Our results suggest that in uDCD donors the combination of donor age ≥60 years together with FRR ≥0.3 mmHg/mL/min could predict poor outcome at 6 months after transplantation in low immunological risk recipients.
Collapse
Affiliation(s)
- Rosana Gelpi
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - David Paredes
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Camino Rodríguez-Villar
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Rebeca Roque
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Angel Ruiz
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Ramon Adalia
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Luis Peri-Cusí
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Manel Sole
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplant Department, Donation and Transplant Coordination Department, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| |
Collapse
|
22
|
Georgiades F, Hosgood SA, Butler AJ, Nicholson ML. Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney. Am J Transplant 2019; 19:3415-3419. [PMID: 31355509 DOI: 10.1111/ajt.15547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/07/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) have both been used in the procurement and conditioning of abdominal organs from donation after circulatory death donors with reported improved outcomes for the recipients. Here, we describe an unusual case of a kidney that underwent NMP after NRP. After 2 hours of abdominal NRP, the intra-abdominal organs were cold flushed in situ. The liver and right kidney were well flushed, but the left kidney was poorly flushed. Further attempts to clear the left kidney by flushing on the backtable were unsuccessful, and the kidney was thought to be unsuitable for transplant. The left kidney then underwent a 1-hour period of NMP using a red cell-based perfusate. During NMP, the kidney met previously described quality assurance criteria for transplant with good global perfusion and adequate renal blood flow and urine production. The kidney was transplanted into a suitable recipient who had slow early graft function but did not require dialysis posttransplant. The recipient was discharged 6 days posttransplant, and the serum creatinine level was 160 μmol/L (1.8 mg/dL) at 2 months posttransplant.
Collapse
Affiliation(s)
- Fanourios Georgiades
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sarah A Hosgood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Andrew J Butler
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Michael L Nicholson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
Thuillier R, Delpy E, Matillon X, Kaminski J, Kasil A, Soussi D, Danion J, Sauvageon Y, Rod X, Donatini G, Barrou B, Badet L, Zal F, Hauet T. Preventing acute kidney injury during transplantation: the application of novel oxygen carriers. Expert Opin Investig Drugs 2019; 28:643-657. [PMID: 31165652 DOI: 10.1080/13543784.2019.1628217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Delayed graft function (DGF) has a significant impact on kidney transplantation outcome. One of the underlying pivotal mechanisms is organ preservation and associated hypothermia and biochemical alteration. AREAS COVERED This paper focuses on organ preservation and its clinical consequences and describes 1. A comprehensive presentation of the pathophysiological mechanism involved in delayed graft function development; 2. The impact on endothelial cells and microvasculature integrity and the consequences on transplanted organ outcome; 3. The reassessment of dynamic organ preservation motivated by the growing use of extended criteria donors and the interest in the potential of normothermia; 4. The role of oxygenation during dynamic preservation; and 5. Novel oxygen carriers and their proof of concept in transplantation, among which M101 (HEMO2life®) is currently the most extensively investigated. EXPERT OPINION Metabolic disturbances and imbalance of oxygen supply during preservation highlight the importance of providing oxygen. Normothermia, permitted by recent advances in machine perfusion technology, appears to be the leading edge of preservation technology. Several oxygen transporters are compatible with normothermia; however, only M101 also demonstrates compatibility with standard hypothermic preservation.
Collapse
Affiliation(s)
- Raphael Thuillier
- a Inserm U1082 , Inserm, Poitiers , France.,b Fédération Hospitalo-Universitaire SUPORT , CHU Poitiers, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France.,d Service de Biochimie , CHU Poitiers , Poitiers , France
| | - Eric Delpy
- e HEMARINA S.A., Aéropole centre, Biotechnopôle , Morlaix , France
| | - Xavier Matillon
- a Inserm U1082 , Inserm, Poitiers , France.,f Modélisations Précliniques Innovation Chirurgicale et Technologique , Infrastructures en Biologie et Santé Animale, Génétique, Expérimentations et Systèmes Innovants, Département Génétique Animale , INRA Le Magneraud,Surgères , France.,g Service d'urologie et de chirurgie de la transplantation , Hospices Civiles de Lyon , Lyon , France.,h Faculté de Médecine Lyon Est , Université Claude Bernard Lyon 1 , Villeurbanne , France
| | - Jacques Kaminski
- a Inserm U1082 , Inserm, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France
| | - Abdelsalam Kasil
- a Inserm U1082 , Inserm, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France
| | - David Soussi
- a Inserm U1082 , Inserm, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France.,d Service de Biochimie , CHU Poitiers , Poitiers , France
| | - Jerome Danion
- a Inserm U1082 , Inserm, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France.,i Service de Chirurgie viscérale et endocrinienne , CHU Poitiers , Poitiers , France
| | - Yse Sauvageon
- a Inserm U1082 , Inserm, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France.,d Service de Biochimie , CHU Poitiers , Poitiers , France
| | - Xavier Rod
- a Inserm U1082 , Inserm, Poitiers , France
| | - Gianluca Donatini
- a Inserm U1082 , Inserm, Poitiers , France.,i Service de Chirurgie viscérale et endocrinienne , CHU Poitiers , Poitiers , France
| | - Benoit Barrou
- a Inserm U1082 , Inserm, Poitiers , France.,j Service de Transplantation Rénale, Département d'Urologie et de Transplantation , Groupe Hospitalier Pitié Salpétrière , Paris , France
| | - Lionel Badet
- a Inserm U1082 , Inserm, Poitiers , France.,f Modélisations Précliniques Innovation Chirurgicale et Technologique , Infrastructures en Biologie et Santé Animale, Génétique, Expérimentations et Systèmes Innovants, Département Génétique Animale , INRA Le Magneraud,Surgères , France.,g Service d'urologie et de chirurgie de la transplantation , Hospices Civiles de Lyon , Lyon , France.,h Faculté de Médecine Lyon Est , Université Claude Bernard Lyon 1 , Villeurbanne , France
| | - Franck Zal
- e HEMARINA S.A., Aéropole centre, Biotechnopôle , Morlaix , France
| | - Thierry Hauet
- a Inserm U1082 , Inserm, Poitiers , France.,b Fédération Hospitalo-Universitaire SUPORT , CHU Poitiers, Poitiers , France.,c Faculté de Médecine et de Pharmacie , Université de Poitiers , Poitiers , France.,d Service de Biochimie , CHU Poitiers , Poitiers , France.,f Modélisations Précliniques Innovation Chirurgicale et Technologique , Infrastructures en Biologie et Santé Animale, Génétique, Expérimentations et Systèmes Innovants, Département Génétique Animale , INRA Le Magneraud,Surgères , France.,k Consortium for Organ Preservation in Europe, Nuffield Department of Surgical Sciences , Oxford Transplant Centre, Churchill Hospital , Oxford , United Kingdom
| |
Collapse
|
24
|
Watson CJE, Hunt F, Messer S, Currie I, Large S, Sutherland A, Crick K, Wigmore SJ, Fear C, Cornateanu S, Randle LV, Terrace JD, Upponi S, Taylor R, Allen E, Butler AJ, Oniscu GC. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant 2019; 19:1745-1758. [PMID: 30589499 DOI: 10.1111/ajt.15241] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/09/2018] [Accepted: 12/16/2018] [Indexed: 01/25/2023]
Abstract
Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of nonfunction, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from whom 43 livers were transplanted. These were compared with 187 non-NRP DCD donor livers transplanted at the same two UK centers in the same period. The use of NRP was associated with a reduction in early allograft dysfunction (12% for NRP vs. 32% for non-NRP livers, P = .0076), 30-day graft loss (2% NRP livers vs. 12% non-NRP livers, P = .0559), freedom from ischemic cholangiopathy (0% vs. 27% for non-NRP livers, P < .0001), and fewer anastomotic strictures (7% vs. 27% non-NRP, P = .0041). After adjusting for other factors in a multivariable analysis, NRP remained significantly associated with freedom from ischemic cholangiopathy (P < .0001). These data suggest that NRP during organ recovery from DCD donors leads to superior liver outcomes compared to conventional organ recovery.
Collapse
Affiliation(s)
- Christopher J E Watson
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, UK.,Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Fiona Hunt
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Simon Messer
- Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Ian Currie
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Stephen Large
- Royal Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Andrew Sutherland
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Keziah Crick
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen J Wigmore
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Corrina Fear
- Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Sorina Cornateanu
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - John D Terrace
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Sara Upponi
- Department of Radiology, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Rhiannon Taylor
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Elisa Allen
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Andrew J Butler
- University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.,National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, UK.,Cambridge Transplant Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Gabriel C Oniscu
- The Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
25
|
Introducing of the First DCD Kidney Transplantation Program in Poland. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6302153. [PMID: 31016193 PMCID: PMC6425340 DOI: 10.1155/2019/6302153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022]
Abstract
In many countries, including Poland, the main problem with transplantation is the insufficiency of organ donors in relation to the demand for organs. Hence, the common aim globally is to increase the pool of donors. The prolonged survival of patients after transplantation, with respect to the survival time of patients on dialysis, makes the search much more intense. After the recourse of expanded criteria donors (ECD), the next step was obtaining kidneys from donors after irreversible cardiac death (DCD). Therefore, based on Dutch, British, and Spanish experience, it can be hypothesized that the introduction of DCD procedures in countries that have not launched these programs and the improvement of DCD procedures may shorten the waiting time for organ transplantation globally. The legal basis for the procurement of organs after irreversible cardiac arrest came into existence in Poland in 2010. Previously, such organ procurements were not in practice. Since 1984, when Poland published irreversible cardiac arrest as a criterion of brain death, it became the only way to determine death prior to the procurement of organs. The aim of this report was to evaluate the results of the first 19 transplantation cases involving harvested kidneys from donors after cardiac arrest, which was irreversible and clinically confirmed, without any doubt as per the ethical protocol of DCD. Understanding, support, and public perception are essential for this program's initiation and maintenance.
Collapse
|
26
|
Kerforne T, Allain G, Giraud S, Bon D, Ameteau V, Couturier P, Hebrard W, Danion J, Goujon JM, Thuillier R, Hauet T, Barrou B, Jayle C. Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study. Am J Transplant 2019; 19:737-751. [PMID: 30091857 DOI: 10.1111/ajt.15063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as normothermic regional perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30 minutes of cardiac arrest) for 2, 4, or 6 hours compared to a control group (No-NRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to an increased expression of HIF1α-dependent survival pathway. At 2 hours, blood levels of ischemic injury biomarkers increased: creatinine, lactate/pyruvate ratio, LDH, AST, NGAL, KIM-1, CD40 ligand, and soluble-tissue-factor. All these markers then decreased with time; however, AST, NGAL, and KIM-1 increased again at 6 hours. Hemoglobin and platelets decreased at 6 hours, after which the procedure became difficult to maintain. Regarding inflammation, active tissue-factor, cleaved PAR-2 and MCP-1 increased by 4-6 hours, but not TNF-α and iNOS. Compared to No-NRP, NRP kidneys showed lower resistance during hypothermic machine perfusion (HMP), likely associated with pe-NRP eNOS activation. Kidneys transplanted after 4 and 6 hours of NRP showed better function and outcome, compared to No-NRP. In conclusion, our results confirm the mechanistic benefits of NRP and highlight 4 hours as its optimal duration, after which injury markers appear.
Collapse
Affiliation(s)
- Thomas Kerforne
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Anesthesia and Intensive Care Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Geraldine Allain
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Sebastien Giraud
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Delphine Bon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Virginie Ameteau
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Pierre Couturier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
| | - William Hebrard
- Unité expérimentale Génétique, Expérimentations et systèmes innovants (GENESI), INRA, Domaine Expérimental du Magneraud, Surgères, France
| | - Jerome Danion
- INSERM U1082, (IRTOMIT), Poitiers, France.,Visceral Surgery Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Jean-Michel Goujon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Pathology Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Raphael Thuillier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Thierry Hauet
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France.,FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', Poitiers, France
| | - Benoit Barrou
- INSERM U1082, (IRTOMIT), Poitiers, France.,Service d'Urologie et de transplantation rénale, AP-HP, GH Pitié-Salpêtrière, Paris, France.,Pierre and Marie Curie Paris VI University, Paris, France
| | - Christophe Jayle
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW Donation after circulatory death (DCD) is still performed in a limited number of countries. This article summarizes the development of DCD in Spain and presents recent Spanish contributions to gain knowledge on the potential benefits and the practical use of normothermic regional perfusion (nRP). RECENT FINDINGS DCD now contributes to 24% of deceased donors in Spain. The development of DCD has been based on an assessment of practices in the treatment of cardiac arrest and end-of-life care to accommodate the option of DCD; the creation of an adequate regulatory framework; and institutional support, professional training and public education. Appropriate posttransplant outcomes have been obtained with organs from both uncontrolled and controlled DCD donors. nRP is increasingly used, with preliminary data supporting improved results compared with other in-situ preservation/recovery approaches. Mobile teams with portable extracorporeal membrane oxygenation devices are making nRP possible in hospitals without these resources. To avoid the possibility of reestablishing brain circulation after the determination of death, a specific methodology has been validated. SUMMARY DCD has been successfully developed in Spain following a streamlined process. nRP may become a standard in DCD, although further evidence on the benefits of this technology is eagerly awaited.
Collapse
|
28
|
Molina M, Guerrero-Ramos F, Fernández-Ruiz M, González E, Cabrera J, Morales E, Gutierrez E, Hernández E, Polanco N, Hernández A, Praga M, Rodriguez-Antolín A, Pamplona M, de la Rosa F, Cavero T, Chico M, Villar A, Justo I, Andrés A. Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long-term outcomes comparable to standard criteria donation after brain death. Am J Transplant 2019; 19:434-447. [PMID: 29947163 DOI: 10.1111/ajt.14991] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplant (KT) with short-term outcomes similar to those obtained from donation after brain death (DBD) donors. However, heterogeneous results in the long term have been reported. We compared 10-year outcomes between 237 KT recipients from uDCD donors maintained by normothermic extracorporeal membrane oxygenation (nECMO) and 237 patients undergoing KT from standard criteria DBD donors during the same period at our institution. We further analyzed risk factors for death-censored graft survival in the uDCD group. Delayed graft function (DGF) was more common in the uDCD group (73.4% vs 46.4%; P < .01), although glomerular filtration rates at the end of follow-up were similar in the 2 groups. uDCD and DBD groups had similar rates for 10-year death-censored graft (82.1% vs 80.4%; P = .623) and recipient survival (86.2% vs 87.6%; P = .454). Donor age >50 years was associated with graft loss in the uDCD group (hazard ratio: 1.91; P = .058), whereas the occurrence of DGF showed no significant effect. uDCD KT under nECMO support resulted in similar graft function and long-term outcomes compared with KT from standard criteria DBD donors. Increased donor age could negatively affect graft survival after uDCD donation.
Collapse
Affiliation(s)
- María Molina
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Félix Guerrero-Ramos
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Jimena Cabrera
- Programa de Prevención y Tratamiento de las Glomerulopatías, Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Nephrology, Hospital Evangelico, Montevideo, Uruguay
| | - Enrique Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Eduardo Gutierrez
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Eduardo Hernández
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Ana Hernández
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alfredo Rodriguez-Antolín
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Manuel Pamplona
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Federico de la Rosa
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Teresa Cavero
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Mario Chico
- Department of Intensive Care Medicine, Hospital Universitario "12 de Octubre", Madrid, Spain
| | | | - Iago Justo
- Department of Abdominal Organ Transplantation and General and Digestive Surgery, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
29
|
Shapey IM, Summers A, Augustine T, van Dellen D. Systematic review to assess the possibility of return of cerebral and cardiac activity after normothermic regional perfusion for donors after circulatory death. Br J Surg 2019; 106:174-180. [PMID: 30667536 PMCID: PMC6749564 DOI: 10.1002/bjs.11046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/13/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Normothermic regional perfusion (NRP) is a novel technique that aids organ recovery from donors after circulatory death (DCDs). However, ethical concerns exist regarding the potential return of spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to determine the likelihood of ROSCCA in NRP-DCDs of abdominal organs. METHODS Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OOHCA) was identified as a comparator for NRP-DCDs and as a validation cohort. A systematic search identified all articles relating to NRP-DCDs and ECPR-OOHCA. Rates of ROSCCA and survival outcomes (ECPR-OOHCA only) were recorded and analysed according to the duration of no perfusion. RESULTS In NRP-DCDs, 12 of 410 articles identified by database searching were eligible for inclusion. There were no instances of ROSCCA recorded among 493 donors. In ECPR-OOHCA, eight of 947 screened articles were eligible for inclusion (254 patients). Where the absence of perfusion exceeded 5 min in ECPR-OOHCA, there were no survivors with a favourable neurological outcome. CONCLUSION ROSCCA is unlikely following commencement of NRP and has not occurred to date. Strict observance of the 5-min interval following asystole provides satisfactory assurance that ROSCCA will not occur following NRP.
Collapse
Affiliation(s)
- I M Shapey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Summers
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - T Augustine
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - D van Dellen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Renal and Pancreatic Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
30
|
Del Río F, Andrés A, Padilla M, Sánchez-Fructuoso AI, Molina M, Ruiz Á, Pérez-Villares JM, Peiró LZ, Aldabó T, Sebastián R, Miñambres E, Pita L, Casares M, Galán J, Vidal C, Terrón C, Castro P, Sanroma M, Coll E, Domínguez-Gil B. Kidney transplantation from donors after uncontrolled circulatory death: the Spanish experience. Kidney Int 2018; 95:420-428. [PMID: 30579725 DOI: 10.1016/j.kint.2018.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
Abstract
Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have died following cardiac arrest and unsuccessful attempt at resuscitation. We report the Spanish experience of uDCD kidney transplantation, and identify factors related to short-term post-transplant outcomes. The Spanish CORE system compiles data on all donation and transplant procedures in the country. Between 2012-2015, 517 kidney transplants from 288 uDCD donors were performed. The incidence of primary non-function was 10%, and the incidence of delayed graft function was 76%. One-year death-censored graft survival was 87%. In a Cox-Model, donor age ≥ 60 years (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.2-6.1), in situ cooling of kidneys versus normothermic regional perfusion (OR 5.6; 95% CI 2.7-11.5) or hypothermic regional perfusion based on the use of extracorporeal membrane oxygenation devices (OR 4.3; 95% CI 2.1-8.6), and a recipient history of prior kidney transplant (OR 3.5; 95% CI 1.5-8.3) all significantly increased the risk of graft loss during the first year after transplantation. Kidney transplantation from uDCD donors provides acceptable 1-year outcomes, although there is room for improvement. Hypothermic and normothermic regional perfusion strategies are preferable to in situ cooling of kidneys from uDCD donors.
Collapse
Affiliation(s)
| | - Amado Andrés
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - María Molina
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Teresa Aldabó
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Lidia Pita
- Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | | | - Juan Galán
- Hospital Universitario y Politécnico de la Fe, Valencia, Spain
| | | | | | - Pablo Castro
- Regional Coordination of the Autonomous Community of Andalucía, Sevilla, Spain
| | - Marga Sanroma
- Regional Coordination of the Autonomous Community of Cataluña, Barcelona, Spain
| | | | | | | |
Collapse
|
31
|
Barriers and Advances in Kidney Preservation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9206257. [PMID: 30643824 PMCID: PMC6311271 DOI: 10.1155/2018/9206257] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022]
Abstract
Despite the fact that a significant fraction of kidney graft dysfunctions observed after transplantation is due to ischemia-reperfusion injuries, there is still no clear consensus regarding optimal kidney preservation strategy. This stems directly from the fact that as of yet, the mechanisms underlying ischemia-reperfusion injury are poorly defined, and the role of each preservation parameter is not clearly outlined. In the meantime, as donor demography changes, organ quality is decreasing which directly increases the rate of poor outcome. This situation has an impact on clinical guidelines and impedes their possible harmonization in the transplant community, which has to move towards changing organ preservation paradigms: new concepts must emerge and the definition of a new range of adapted preservation method is of paramount importance. This review presents existing barriers in transplantation (e.g., temperature adjustment and adequate protocol, interest for oxygen addition during preservation, and clear procedure for organ perfusion during machine preservation), discusses the development of novel strategies to overcome them, and exposes the importance of identifying reliable biomarkers to monitor graft quality and predict short and long-term outcomes. Finally, perspectives in therapeutic strategies will also be presented, such as those based on stem cells and their derivatives and innovative models on which they would need to be properly tested.
Collapse
|
32
|
Roncon-Albuquerque R, Gaião S, Figueiredo P, Príncipe N, Basílio C, Mergulhão P, Silva S, Honrado T, Cruz F, Pestana M, Oliveira G, Meira L, França A, Almeida-Sousa JP, Araújo F, Paiva JA. An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest. Resuscitation 2018; 133:88-94. [PMID: 30321624 DOI: 10.1016/j.resuscitation.2018.10.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
AIM To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA). METHODS Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min. Otherwise they were considered for uDCDD after a ten minute no touch period using normothermic regional perfusion. RESULTS 58 patients were included, of which 41 (71%) were OHCA and 18 (31%) had ECPR initiated. Median age was 52 (IQR 45-56) years. Cannulation was successful in 49/58 (84%) cases. Compared to ECPR, patients referred for uDCDD were more frequently OHCA (90 vs. 28%), had bystander CPR (28 vs. 83%) and prolonged low-flow period (40 (35-50) vs. 60 (49-78) min). Survival to hospital discharge with full neurological recovery (cerebral performance category 1) occurred in 6/18 (33%) ECPR patients. uDCDD resulted in transplantation of 44 kidneys. CONCLUSIONS An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.
Collapse
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Figueiredo
- Department of Infectious Diseases, São João Hospital Centre, Porto, Portugal
| | - Nuno Príncipe
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Paulo Mergulhão
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Teresa Honrado
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Francisco Cruz
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Urology, São João Hospital Centre, Porto, Portugal; i3S: Instituto de Investigação e Inovação em Saúde, Portugal
| | - Manuel Pestana
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Department of Nephrology, São João Hospital Centre, Porto, Portugal; Nephrology and Infectious Diseases R&D Group, Instituto de Investigação e Inovação em Saúde (INEB-i3S), Universidade do Porto, Portugal
| | - Gerardo Oliveira
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Organ Donation and Transplant Coordination Office, São João Hospital Centre, Porto, Portugal
| | - Luis Meira
- National Institute of Medical Emergency, Portugal
| | - Ana França
- Portuguese Institute for Blood and Transplantation, Portugal
| | | | | | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
33
|
Opatrný V, Moláček J, Třeška V, Matějka R, Hes O. Perfusion of a Kidney Graft From a Donor After Cardiac Death Based on Immediately Started Pulsatile Machine Perfusion—An Experimental Study on a Small Animal. Transplant Proc 2018; 50:1544-1548. [DOI: 10.1016/j.transproceed.2018.02.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/28/2018] [Accepted: 02/17/2018] [Indexed: 10/14/2022]
|
34
|
Delsuc C, Faure A, Berthiller J, Dorez D, Matillon X, Meas-Yedid V, Floccard B, Marcotte G, Labeye V, Rabeyrin M, Codas R, Chauvet C, Robinson P, Morelon E, Badet L, Hanf W, Rimmelé T. Uncontrolled donation after circulatory death: comparison of two kidney preservation protocols on graft outcomes. BMC Nephrol 2018; 19:3. [PMID: 29310591 PMCID: PMC5759186 DOI: 10.1186/s12882-017-0805-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background Kidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes. Methods The primary endpoint was the one-year measured graft filtration rate (mGFR). We collected retrospective data from 64 consecutive uDCD recipients transplanted over a seven-year period in a single centre. Results Thirty-two grafts were preserved by in situ perfusion and 32 by normothermic recirculation. The mean ± SD mGFR at 1 year post-transplantation was 43.0 ± 12.8 mL/min/1.73 m2 in the in situ perfusion group and 53.2 ± 12.8 mL/min/1.73 m2 in the normothermic recirculation group (p = 0.01). Estimated GFR levels were significantly higher in the normothermic recirculation group at 12 months (p = 0.01) and 24 months (p = 0.03) of follow-up. We did not find any difference between groups regarding patient and graft survival, delayed graft function, graft rejection, or interstitial fibrosis. Conclusions Function of grafts preserved by normothermic recirculation was better at 1 year and the results suggest that this persists at 2 years, although no difference was found in short-term outcomes. Despite the retrospective design, this study provides an additional argument in favour of normothermic recirculation. Electronic supplementary material The online version of this article (10.1186/s12882-017-0805-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Claire Delsuc
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France. .,EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-Induced Immunosuppression - PI3", Lyon, France. .,Service d'Anesthésie Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
| | - Alexandre Faure
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Julien Berthiller
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Epidémiologie Clinique, Pôle Information Médicale Evaluation Recherche (unité statistiques), Lyon, France
| | - Didier Dorez
- Centre Hospitalier Annecy Genevois, service de Coordination des Prélèvements d'Organes et de Tissus, Metz-Tessy, France
| | - Xavier Matillon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | | | - Bernard Floccard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Guillaume Marcotte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France
| | - Vanessa Labeye
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Coordination des Prélèvements d'Organes et de Tissus, Lyon, France
| | - Maud Rabeyrin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Anatomopathologie, Lyon, France
| | - Ricardo Codas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | - Cécile Chauvet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Emmanuel Morelon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France
| | - Lionel Badet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service d'Urologie, Lyon, France
| | - William Hanf
- Centre Hospitalier Alpes-Léman, service de Néphrologie, Contamine-sur-Arve, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d'Anesthésie Réanimation, Lyon, France.,EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-Induced Immunosuppression - PI3", Lyon, France
| |
Collapse
|
35
|
Abstract
OBJECTIVES Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.
Collapse
|
36
|
Abdominal regional in-situ perfusion in donation after circulatory determination of death donors. Curr Opin Organ Transplant 2016; 21:322-8. [DOI: 10.1097/mot.0000000000000315] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
37
|
Successful Porcine Renal Transplantation After 60 Minutes of Donor Warm Ischemia: Extracorporeal Perfusion and Thrombolytics. ASAIO J 2016; 61:474-9. [PMID: 25851315 DOI: 10.1097/mat.0000000000000228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Donation from uncontrolled circulatory determination of death donors (uDCD) is impractical in United States because of the time needed to organize procurement before irreversible organ damage. Salvaging organs after prolonged warm ischemic time (WIT) may address this limitation. We evaluated the combination of extracorporeal support (ECS) and thrombolytics in a porcine uDCD renal transplant model. Nonanticoagulated uDCD sustained 60 min of WIT, and two groups were studied. Rapid recovery (RR)-uDCD renal grafts procured using the standard quick topical cooling and renal flush, and ECS-assisted donation (E-uDCD), 4 hr ECS plus thrombolytics for in situ perfusion before procurement. All kidneys were flushed and cold stored, followed by transplantation into healthy nephrectomized recipients without immunosuppression. Delayed graft function (DGF) was defined as creatinine more than 5.0 mg/dl on any postoperative day. Twelve kidneys in E-uDCD and 6 in RR-uDCD group were transplanted. All 12 E-uDCD recipients had urine production and adequate function in the first 48 hr, but two grafts (16.7%) had DGF at 96 hr. All six recipients from RR-uDCD group had DGF at 48 hr and were killed. Creatinine and blood urea nitrogen (BUN) levels were significantly lower in E-uDCD compared with RR-uDCD group at 24 hr (2.9 ± 0.7 mg/dl vs. 5.2 ± 0.9 mg/dl) and 48 hr (3.2 ± 0.9 mg/dl vs. 7.2 ± 1.0 mg/dl); BUN levels at 24 and 48 hr were 28.3 ± 6.7 mg/dl vs. 39.5 ± 7.5 mg/dl and 23.9 ± 5.0 mg/dl vs. 46 ± 12.9 mg/dl, respectively. Thrombolytics plus ECS precondition organs in situ yielding functional kidneys in a porcine model of uDCD with 60 min of WIT. This procurement method addresses logistical limitations for uDCD use in the United States and could have a major impact on the organ donor pool.
Collapse
|
38
|
Domínguez-Gil B, Duranteau J, Mateos A, Núñez JR, Cheisson G, Corral E, De Jongh W, Del Río F, Valero R, Coll E, Thuong M, Akhtar MZ, Matesanz R. Uncontrolled donation after circulatory death: European practices and recommendations for the development and optimization of an effective programme. Transpl Int 2016; 29:842-59. [PMID: 26706366 DOI: 10.1111/tri.12734] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/19/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022]
Abstract
The shortage of organs remains one of the biggest challenges in transplantation. To address this, we are increasingly turning to donation after circulatory death (DCD) donors and now in some countries to uncontrolled DCD donors. We consolidate the knowledge on uncontrolled DCD in Europe and provide recommendations and guidance for the development and optimization of effective uncontrolled DCD programmes.
Collapse
Affiliation(s)
| | - Jacques Duranteau
- Department of Anesthesia and Intensive Care, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alonso Mateos
- Summa 112 and Francisco de Vitoria University, Madrid, Spain
| | - Jose R Núñez
- Transplant Coordination Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Gaelle Cheisson
- Department of Anesthesia and Intensive Care, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Wim De Jongh
- Transplant Coordination Unit, University Hospital Maastricht, Maastricht, The Netherlands
| | - Francisco Del Río
- Transplant Coordination Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Ricard Valero
- Department of Anesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | | |
Collapse
|
39
|
|
40
|
Demiselle J, Augusto JF, Videcoq M, Legeard E, Dubé L, Templier F, Renaudin K, Sayegh J, Karam G, Blancho G, Dantal J. Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion. Transpl Int 2016; 29:432-42. [PMID: 26606511 DOI: 10.1111/tri.12722] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/26/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022]
Abstract
The aim of this study was to compare the outcomes of kidney transplants from uncontrolled DCD (uDCD) with kidney transplants from extended (ECD) and standard criteria donors (SCD). In this multicenter study, we included recipients from uDCD (n = 50), and from ECD (n = 57) and SCD (n = 102) who could be eligible for a uDCD program. We compared patient and graft survival, and kidney function between groups. To address the impact of preservation procedures in uDCD, we compared in situ cold perfusion (ICP) with normothermic regional perfusion (NRP). Patient and graft survival rates were similar between the uDCD and ECD groups, but were lower than the SCD group (P < 0.01). Although delayed graft function (DGF) was more frequent in the uDCD group (66%) than in the ECD (40%) and SCD (27%) groups (P = 0.08 and P < 0.001), graft function was comparable between the uDCD and ECD groups at 3 months onwards post-transplantation. The use of NRP in the uDCD group (n = 19) was associated with a lower risk of DGF, and with a better graft function at 2 years post-transplantation, compared to ICP-uDCD (n = 31) and ECD. In conclusion, the use of uDCD kidneys was associated with post-transplantation results comparable to those of ECD kidneys. NRP preservation may improve the results of uDCD transplantation.
Collapse
Affiliation(s)
- Julien Demiselle
- Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.,LUNAM Université, Angers, France
| | - Jean-François Augusto
- Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.,LUNAM Université, Angers, France
| | - Michel Videcoq
- Coordination des prélèvements d'organe et de tissus, Hôtel Dieu, Nantes Cedex 1, France
| | | | - Laurent Dubé
- Coordination Hospitalière, CHU Angers, Angers Cedex 9, France
| | | | | | - Johnny Sayegh
- Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.,LUNAM Université, Angers, France
| | - Georges Karam
- ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France
| | - Gilles Blancho
- ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France
| | - Jacques Dantal
- ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France
| |
Collapse
|
41
|
Yu J, Murakami M, Aoki T, Jiang B, Jin Z, Koizumi T, Kusano M, Kamijo R, Miyamoto Y, Enami Y, Watanabe M, Otsuka K. Oxygenated Static Preservation of Donation after Cardiac Death Liver Grafts Improves Hepatocyte Viability and Function. Eur Surg Res 2015; 56:1-18. [PMID: 26559804 DOI: 10.1159/000441058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cell therapy, such as hepatocyte transplantation (HTx), is promising for the treatment of metabolic liver diseases or as a bridge to orthotopic liver transplantation in patients with fulminant liver failure. However, one of the limitations of this therapy is the shortage of donors. The present study aims to investigate whether the two-layer method (TLM) of cold preservation with oxygenation improves the viability and activity of hepatocytes from rat donation after cardiac death (DCD) donors compared with results obtained with the University of Wisconsin (UW) solution. Moreover, we evaluated the hepatocyte function after culture or transplantation into the spleen. MATERIALS AND METHODS We used male Sprague-Dawley rats for this study. The DCD model was induced by phrenotomy after injecting heparin. We assigned rats based on warm ischemia times of 15 and 30 min to groups S and L, respectively. Each group (n = 5) was then subdivided as follows: (1) group S: not preserved (S/N), preserved by TLM for 3 h (S/TLM3) and 12 h (S/TLM12), and in the UW solution for 3 h (S/UW3) and 12 h (S/UW12), and (2) group L: not preserved (L/N), preserved by TLM for 3 h (L/TLM3) and 12 h (L/TLM12), and in the UW solution for 3 h (L/UW3) and 12 h (L/UW12). The cell viability and function of isolated DCD hepatocytes were analyzed for culture or HTx into the spleen. RESULTS The viability and ATP levels of DCD hepatocytes significantly improved after TLM compared with the values after preservation in cold UW solution in group S/N (p < 0.059). The levels of albumin production and urea synthesis by hepatocytes after culture were significantly higher in groups S/TLM3 and S/TLM12 than in groups S/UW3 and S/UW12 (p < 0.05), respectively. Further, serum albumin levels after HTx were also markedly higher in groups S/TLM3 and S/TLM12 than in groups S/UW3 and S/UW12. The morphological features revealed that cultured and transplanted hepatocytes remained clearly viable and maintained an expression for specific hepatic function, such as the production of albumin and glycogen. CONCLUSION This novel method of oxygenated cold preservation of DCD livers can expand the hepatocyte donor pool for HTx and establish a wider application of this developing technique.
Collapse
Affiliation(s)
- Jiwei Yu
- Division of General and Gastroenterological Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
van Heurn LWE, Talbot D, Nicholson ML, Akhtar MZ, Sanchez-Fructuoso AI, Weekers L, Barrou B. Recommendations for donation after circulatory death kidney transplantation in Europe. Transpl Int 2015; 29:780-9. [PMID: 26340168 DOI: 10.1111/tri.12682] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/19/2015] [Accepted: 08/26/2015] [Indexed: 12/29/2022]
Abstract
Donation after circulatory death (DCD) donors provides an invaluable source for kidneys for transplantation. Over the last decade, we have observed a substantial increase in the number of DCD kidneys, particularly within Europe. We provide an overview of risk factors associated with DCD kidney function and survival and formulate recommendations from the sixth international conference on organ donation in Paris, for best-practice guidelines. A systematic review of the literature was performed using Ovid Medline, Embase and Cochrane databases. Topics are discussed, including donor selection, organ procurement, organ preservation, recipient selection and transplant management.
Collapse
Affiliation(s)
| | - David Talbot
- Department of Liver/Renal Transplant, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Michael L Nicholson
- Department of Surgery, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | | | - Laurent Weekers
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Benoit Barrou
- Department of Urology - Transplantation, GHzu Pitié Salpêtriere, Paris, France
| |
Collapse
|
43
|
Molecular pathways in protecting the liver from ischaemia/reperfusion injury: a 2015 update. Clin Sci (Lond) 2015; 129:345-62. [PMID: 26014222 DOI: 10.1042/cs20150223] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ischaemia/reperfusion injury is an important cause of liver damage during surgical procedures such as hepatic resection and liver transplantation, and represents the main cause of graft dysfunction post-transplantation. Molecular processes occurring during hepatic ischaemia/reperfusion are diverse, and continuously include new and complex mechanisms. The present review aims to summarize the newest concepts and hypotheses regarding the pathophysiology of liver ischaemia/reperfusion, making clear distinction between situations of cold and warm ischaemia. Moreover, the most updated therapeutic strategies including pharmacological, genetic and surgical interventions, as well as some of the scientific controversies in the field are described.
Collapse
|
44
|
Lanchon C, Long JA, Boudry G, Terrier N, Skowron O, Badet L, Descotes JL, Rambeaud JJ, Malvezzi P, Boillot B, Thuillier C, Arnoux V, Fiard G, Poncet D, Dorez D. [Renal transplantation using a Maastricht category III non-heartbeating donor: First French experience and review of the literature]. Prog Urol 2015; 25:576-82. [PMID: 26159053 DOI: 10.1016/j.purol.2015.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/31/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
In 2015, Annecy Hospital was the first French hospital to perform non-heartbeating organ donation from a Maastricht category III donor (patient awaiting cardiac arrest after withdrawal of treatment). Non-heartbeating organ donation (NHBD), performed in France since 2006, had initially excluded this category, due to ethical questions concerning end of life and treatment withdrawal, as well as technical specificities linked to this procedure. Grenoble University Hospital and Edouard-Herriot Hospital in Lyon then performed the first kidney transplants, with satisfactory outcomes in both recipients. This article presents the details and results of this new experience, challenging both on a deontological and organizational level. Functional outcomes of kidney grafts from NHBD are now well known in the literature and confirm their benefit for patients, with similar results to those from heartbeating donors (HBD). International experiences concerning specifically Maastricht category III NHBD are encouraging and promising.
Collapse
Affiliation(s)
- C Lanchon
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France.
| | - J-A Long
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - G Boudry
- Service d'urologie, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, Metz-Tessy, BP 90074, 74374 Pringy cedex, France
| | - N Terrier
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - O Skowron
- Service d'urologie, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, Metz-Tessy, BP 90074, 74374 Pringy cedex, France
| | - L Badet
- Service d'urologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon cedex 03, France
| | - J-L Descotes
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - J-J Rambeaud
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - P Malvezzi
- Service de néphrologie, de dialyse et de transplantation, CHU de Grenoble, 38043 Grenoble cedex 9, France
| | - B Boillot
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - C Thuillier
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - V Arnoux
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - G Fiard
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - D Poncet
- Service d'urologie et de transplantation rénale, CHU de Grenoble, 1, boulevard de la Chantourne, 38043 Grenoble cedex 9, France
| | - D Dorez
- Service de réanimation, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, Metz-Tessy, BP 90074, 74374 Pringy cedex, France
| |
Collapse
|
45
|
Abstract
INTRODUCTION Cold storage of organs for preservation and transplantation is reaching its limits especially with extended criteria for heart beating donors and donation after cardiac death. We will discuss recent findings and perspectives in normothermic kidney preservation. METHODS A literature review was performed from original articles and syntheses selected by the search engine PubMed. Keywords used were: cold ischemia; warm ischemia, normothermic, organ preservation, preconditioning, organ perfusion. RESULTS We identified several ways to improve kidney preservation: Ischemic normothermic preconditioning; Pharmacologic normothermic preconditioning; Ex vivo normothermic reperfusion; Remote ischemic transplantation preconditioning; Ischemic postconditioning. In clinical practice, only uses of ECMO for organ preconditioning or ex vivo normothermic organ perfusion were used. CONCLUSION Promising experimental and clinical results make challenge cold preservation. The most suitable and physiological method seems to be a normothermic perfusion and conservation with autologous oxygenated blood using Extra Corporeal Membrane Oxygenation or Regional Normothermic Circulation.
Collapse
Affiliation(s)
- X Tillou
- Urology and Transplantation department, University Hospital, Caen, France.
| | - R Thuret
- Urology and Transplantation department, University Hospital, Montpellier, France
| | - A Doerfler
- Urology and Transplantation department, University Hospital, Caen, France
| |
Collapse
|
46
|
Matsuno N, Uchida K, Furukawa H. Impact of machine perfusion preservation of liver grafts from donation after cardiac death. Transplant Proc 2015; 46:1099-103. [PMID: 24815138 DOI: 10.1016/j.transproceed.2013.11.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 12/23/2022]
Abstract
Because of the critical shortage of deceased donor grafts, using a donation after cardiac death (DCD) donor is an important resource. However, the ischemic damage of those DCD grafts jeopardizes organ viability during cold storage. Maintaining organ viability after donation until transplantation is important for optimal graft function and survival. This review describes the effective preservation in transplantation for DCD livers. Concepts and development of machine perfusion for DCD liver grafts to reduce ischemia/reperfusion injury are discussed. Despite the fact that hypothermic machine perfusion might be superior to static cold preservation, DCD livers are exposed to hypothermia-induced damage. Recently, some groups introduced the beneficial effects of normothermic or subnormothermic machine perfusion in DCD liver preservation and transplantation.
Collapse
Affiliation(s)
- N Matsuno
- Department of Innovative Surgery and Transplantation, National Research Institute, National Center for Child Health and Development, Tokyo, Japan; Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan; Department of Surgery, Asahikawa Medical University, Hokkaido, Japan.
| | - K Uchida
- Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - H Furukawa
- Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| |
Collapse
|
47
|
Oniscu GC, Randle LV, Muiesan P, Butler AJ, Currie IS, Perera MTPR, Forsythe JL, Watson CJE. In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience. Am J Transplant 2014; 14:2846-54. [PMID: 25283987 DOI: 10.1111/ajt.12927] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/17/2014] [Accepted: 07/01/2014] [Indexed: 02/06/2023]
Abstract
Organs recovered from donors after circulatory death (DCD) suffer warm ischemia before cold storage which may prejudice graft survival and result in a greater risk of complications after transplant. A period of normothermic regional perfusion (NRP) in the donor may reverse these effects and improve organ function. Twenty-one NRP retrievals from Maastricht category III DCD donors were performed at three UK centers. NRP was established postasystole via aortic and caval cannulation and maintained for 2 h. Blood gases and biochemistry were monitored to assess organ function. Sixty-three organs were recovered. Forty-nine patients were transplanted. The median time from asystole to NRP was 16 min (range 10-23 min). Thirty-two patients received a kidney transplant. The median cold ischemia time was 12 h 30 min (range 5 h 25 min-18 h 22 min). The median creatinine at 3 and 12 months was 107 µmol/L (range 72-222) and 121 µmol/L (range 63-157), respectively. Thirteen (40%) recipients had delayed graft function and four lost the grafts. Eleven patients received a liver transplant. The first week median peak ALT was 389 IU/L (range 58-3043). One patient had primary nonfunction. Two combined pancreas-kidney transplants, one islet transplant and three double lung transplants were performed with primary function. NRP in DCD donation facilitates organ recovery and may improve short-term outcomes.
Collapse
Affiliation(s)
- G C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Oniscu GC, Siddique A, Dark J. Dual temperature multi-organ recovery from a Maastricht category III donor after circulatory death. Am J Transplant 2014; 14:2181-6. [PMID: 25056864 DOI: 10.1111/ajt.12808] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/14/2014] [Accepted: 04/20/2014] [Indexed: 01/25/2023]
Abstract
Donation after circulatory death (DCD) makes a significant contribution to the transplant activity but is associated with significantly lower organ recovery rates and poorer function for the abdominal extra-renal organs compared with donation after brain death. Traditionally, DCD organ recovery involves cold thoracic and abdominal perfusion with a rapid removal of organs in order to minimize the ischemic damage. Novel approaches to organ recovery and preservation include the use of normothermic regional perfusion in the donor and ex vivo organ preservation. We report a new technique for multi-organ recovery from Maastricht category III donors with abdominal normothermic perfusion and concomitant cold lung flushing which allows a rapid removal of the lungs with preservation of the abdominal normothermic circulation throughout the thoracic procurement. This approach could lead to an increased organ recovery and better function for the abdominal organs.
Collapse
Affiliation(s)
- G C Oniscu
- Transplant Unit, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | |
Collapse
|
49
|
Normothermic regional perfusion for donation after circulatory death without prior heparinization. Transplantation 2014; 97:1272-8. [PMID: 24646774 DOI: 10.1097/tp.0000000000000082] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over 40% of deceased donors in the UK donate after circulatory death (DCD). Normothermic regional perfusion has been reported to improve outcomes in such donors in Europe and the United States. Unlike the United States, legal and professional requirements in the UK prevent cannulation and heparinization before verification of death, which must be a minimum of 5 min after circulatory arrest. We developed a novel protocol for in situ normothermic regional perfusion (NRP) which complied with these requirements. METHODS NRP was achieved by cannulating the aorta and vena cava after death. Donor blood was then warmed and oxygenated using a bespoke extracorporeal membrane oxygenator circuit before return to the donor. A shunt was incorporated into the extracorporeal circuit to permit heparin mixing before oxygenation and warming was commenced to prevent thrombosis of the oxygenator. Normothermic perfusion was continued for 2 hr before in situ cold perfusion with preservation fluid. All organs were subject to static cold storage after recovery. RESULTS Eight controlled DCD donors underwent NRP from which 3 livers, 2 pancreases, and 14 kidneys were transplanted. Four livers were not used because of biochemical evidence of hepatocellular damage and one because of cirrhosis. Two kidneys were lost from venous thrombosis before function returned and two developed delayed graft function; all transplanted livers and pancreases had primary function. CONCLUSIONS Cannulation and heparinization after circulatory arrest does not prevent successful normothermic regional perfusion. The technique permits evaluation of donor organs before implantation and may improve short-term outcomes.
Collapse
|
50
|
Hessheimer AJ, Billault C, Barrou B, Fondevila C. Hypothermic or normothermic abdominal regional perfusion in high-risk donors with extended warm ischemia times: impact on outcomes? Transpl Int 2014; 28:700-7. [PMID: 24797796 DOI: 10.1111/tri.12344] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/05/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
Abstract
Donation after circulatory determination of death (DCD) has the potential to increase the applicability of transplantation as a treatment for end-stage organ disease; its use is limited, however, by the warm ischemic damage suffered by potential grafts. Abdominal regional perfusion (ARP) has been employed in this setting to not only curtail the deleterious effects of cardiac arrest by re-establishing oxygenated flow but also test and even improve the viability of the kidneys and liver prior to transplantation. In the present review article, we discuss experimental and clinical studies that have been published to date on the use of ARP in DCD, differentiating between its application under hypothermic and normothermic conditions. In addition to describing results that have been achieved thus far, we describe the major obstacles limiting the broader implementation of ARP in this context as well as potential means for improving the effectiveness of this modality in the future.
Collapse
Affiliation(s)
- Amelia J Hessheimer
- Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Claire Billault
- Department of Urology, Nephrology and Transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Benoit Barrou
- Department of Urology, Nephrology and Transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Constantino Fondevila
- Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|