In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience.
Am J Transplant
; 14(12): 2846-54, 2014 Dec.
Article
in En
| MEDLINE
| ID: mdl-25283987
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.
Key words
Clinical research/practice; donors and donation; donors and donation: donation after circulatory death (DCD); extra-corporeal membrane oxygenation (ECMO); kidney transplantation/nephrology; liver transplantation/hepatology; organ perfusion and preservation; organ procurement; organ transplantation in general
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Organ Preservation
/
Tissue Donors
/
Kidney Transplantation
/
Liver Transplantation
/
Pancreas Transplantation
/
Venous Thrombosis
/
Tissue and Organ Harvesting
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Am J Transplant
Journal subject:
TRANSPLANTE
Year:
2014
Document type:
Article
Affiliation country:
Reino Unido