Development of a portable abdominal normothermic regional perfusion (A-NRP) program in the United States.

In situ abdominal normothermic regional perfusion (A-NRP) has been used for liver transplantation (LT) with donation after circulatory death (DCD) liver grafts in Europe with excellent results; however, adoption of A-NRP in the United States has been lacking. The current report describes the implementation and results of a portable, self-reliant A-NRP program in the United States. Isolated abdominal in situ perfusion with an extracorporeal circuit was achieved through cannulation in the abdomen or femoral vessels and inflation of a supraceliac aortic balloon and cross-clamp. The Quantum Transport System by Spectrum was used. The decision to use livers for LT was made through an assessment of perfusate lactate (q15min). From May to November 2022, 14 A-NRP donation after circulatory death procurements were performed by our abdominal transplant team (N = 11 LT, N = 20 kidney transplants, and 1 kidney-pancreas transplant). The median A-NRP run time was 68 minutes. None of the LT recipients had post-reperfusion syndrome, nor were there any cases of primary nonfunction. All livers were functioning well at the time of maximal follow-up with zero cases of ischemic cholangiopathy. The current report describes the feasibility of a portable A-NRP program that can be used in the United States. Excellent short-term post-transplant results were achieved with both livers and kidneys procured from A-NRP.

Defining the rest interval associated with the main sleep period in actigraph scoring.

Actigraphy is increasingly used for sleep monitoring. However, there is a lack of standardized methodology for data processing and analysis, which often makes between study comparisons difficult, if not impossible, and thus open to flawed interpretation. This study evaluated a manual method for detection of the rest interval in actigraph data collected with Actiwatch 2. The rest interval (time in bed), defined as the bedtime and rise time and set by proprietary software, is an essential requirement for the estimation of sleep indices. This study manually and systematically detected the rest interval of 187 nights of recording from seven healthy males and three females, aged 13.5±0.7 (mean ± standard deviation) years. Data were analyzed for agreement between software default algorithm and manual scoring. Inter-rater reliability in manual scoring was also tested between two scorers. Data showed consistency between default settings and manual scorers for bedtime and rise time, but only moderate agreement for the rest interval duration and poor agreement for activity level at bedtime and rise time. Manual detection of rest intervals between scorers showed a high degree of agreement for all parameters (intraclass correlations range 0.864 to 0.995). The findings demonstrate that the default algorithm on occasions was unable to detect rest intervals or set the exact interval. Participant issues and inter-scorer issues also made difficult the detection of rest intervals. These findings have led to a manual detection protocol to define bedtime and rise time, supplemented with an event diary.