Does the Pulsatile Preservation Machine Have Any Impact in the Discard Rate of Kidneys From Older Donors After Brain Death?

BACKGROUND: Donors after brain death (DBD) older than 60 years have become 46.8% of our current activity, with higher risk of renal discard rate (RDR). Assessment of kidney suitability requires complementary strategies: macroscopic evaluation, kidney biopsy score (KBS), and renal hemodynamic evaluation with the Pulsatile Perfusion Machine (PPM). METHODS: Descriptive, cross-sectional, comparative study of kidneys procured and RDR, comparing 3 time periods: 2000 to June 2004, when only KBS were used; July 2004 to 2008 (introduction of PPM and learning period); and 2009 to 2013 (experienced use of PPM). Transplantation criteria were KBS <3 and PPM renal resistance <0.4 mm Hg/mL/min and arterial renal flow >70 mL/min. RESULTS: Between 2000 and 2013, a 59.2% reduction in DBD kidneys was observed. However, older kidneys had an increase from 33.5% to 46.8%. The RDR had increased, comparing the first to the third period from 25.4% to 38.3%. However, the RDR was lower when kidneys were evaluated with PPM than those evaluated only with KBS and preserved in cold storage (CS) (21.4% versus 43.7%). There was a significant difference in cold ischemia time, because CS kidney was grafted before PPM. During the third period, more kidneys with KBS ≥4 were assigned to PPM. CONCLUSIONS: Notwithstanding the decrease in DBD-procured kidneys and the increase in older kidneys during last period, the use of PPM allowed low DR compared with CS. A bias in the results of PPM could be generated when kidneys with higher KBS were excluded from PPM. The use of KBS only to decide acceptance could preclude the use of an additional tool to evaluate suitability.

Utilización de un compresor torácico mecánico (LUCAS®) en un programa de donación en asistolia: efecto sobrela perfusión de los órganos y la tasa de trasplante / Use of the Lucas mechanical chest compression device in an asystolic organ donation program: effect on kidney perfusion and organ procurement and transplantation rate

Objetivo: Analizar el efecto del uso del compresor torácico LUCAS® durante el transporte hasta el hospital de potenciales donantes en asistolia sobre la obtención, perfusión y trasplante renal. Método: Estudio ambispectivo entre enero de 2006 y enero de 2010, en dos fases: antes y después de la introducción del LUCAS®, en febrero de 2008, en un programa de donación en asistolia (DA). Se compararon los resultados obtenidos entre potenciales donantes en asistolia tipo II de Maastricht, transportados con resucitación cardiopulmonar (RCP) manual o utilizando el compresor torácico LUCAS®. Se evaluó edad, sexo, índice de masa corporal (IMC), tiempos de RCP, causas de no donación y órganos obtenidos, trasplantados y rechazados por mala perfusión. Los datos se obtuvieron del registro de la Unidad de Coordinación de Trasplantes del Hospital Clínic de Barcelona. Resultados: De 203 potenciales DA, 112 fueron trasladados con RCP manual y 91 con LUCAS®. La edad media de los potenciales donantes fue 46,6 (SD = 13,1) años y el84,2% hombres. No se observó diferencias respecto a edad (p = 0,86) y sexo (p = 0,36)entre grupos. Fueron donantes reales el 33% (n = 37) del grupo de RCP manual y el37,4% (n = 34) del grupo LUCAS®(p = 0,52). Se extrajo el 97,3% (n = 72) de los riñones de los pacientes trasladados con RCP manual por el 100% (n = 68) en el grupo LUCAS®(p = 0,34). El uso del LUCAS® se asoció a un aumento de 0,3 (IC 95% de -0,1 a 0,7; p =0,1666) riñones trasplantados por donante (p = 0,166) y a una disminución del 32,9%(IC 95% de 3,8 a 56,6%; p = 0,026) en los riñones descartados por mala perfusión. Conclusiones: El uso del compresor torácico LUCAS® permite mantener la tasa de órganos trasplantados, incluso con tendencia a aumentarla respecto a la RCP manual. En la población de nuestro estudio se observó una disminución significativa de riñones descartados por mala perfusión, asociada al uso del LUCAS® (AU)

Objective: To analyze whether using the Lucas mechanical chest compression device while transporting potential non-heart-beating donors to the hospital has an effect on kidney perfusion and the number of kidneys procured and transplanted. Methods: Retrospective and prospective study of cases between January 2006 and January 2010. Data reflected 2phases: before introduction of the Lucas device in February 2008 and afterwards. We analyzed the effect on our a systolic organ donor program by comparing the results in non-heart-beating donor candidates (type 2 according to the Maastricht classification) transported under manual cardiopulmonary resuscitation (CPR) or mechanical compressions. Variables recorded were age, sex, body mass index, CPR or mechanical compression times, reasons for not procuring donated organs, and organs procured and transplanted or rejected because of poor perfusion. Data were extracted from the records of the transplant coordination unit of Hospital Clínic de Barcelona. Results: Of 203 cardiac-death donor candidates, 112 were transported with manual CPR and 91 with compressions delivered by the Lucas device. The mean (SD) age of candidates was 46.6 (13.1) years and 84.2% were men. The age and sex distribution in the 2 time periods did not differ significantly (P=.86). In the manual CPR period 33% of the candidates (n=37) became donors, whereas 37.4% (n=34) became donors in the mechanical compression period(P=.52). Surgeons extracted 97.3% (n=72) of the kidneys in the first period and 100% (n=68) in the second period(P=.34). Use of the Lucas device was associated with an increase of 0.3 transplanted kidneys per donor (95% CI, -0.1 to(..) (AU)