A metabolic approach during normothermic regional perfusion in uncontrolled donors after circulatory death—A pilot study

Abstract

The use of donation after circulatory death (DCD) has increased significantly to face the persistent mismatch between supply and demand of organs for transplantation. While controlled (c) DCDs have warm ischemic time (WIT) that can be estimated, the WIT is often inexact and extended in uncontrolled DCD (uDCD), making assessment of injury difficult. We aimed at investigating the effects of cold ischemia on potential donor organ damage in the course of nRP by assessing the dynamic variations of transaminases and creatinine values in 17 uDCD donors. In our series, lactate values did not show significant changes during the study period (P = 0.147). Creatinine values did not significantly changed while transaminases progressive increased throughout the study period, even if it was significant only for AST (P = 0.035). According to our data, nRP duration affects splanchnic organs, being the liver sensitive to hypoperfusion, and serial biochemical measurements could help in detecting organ functional status.

Machine Perfusions in Liver Transplantation: The Evidence‐Based Position Paper of the Italian Society of Organ and Tissue Transplantation

“…In several reports, NRP contributed to an increased acceptance rate in both controlled and uncontrolled DCD. (59,67,73) recOMMenDatiOn In type 2 DCD, we recommend the use of NRP to overcome the unpredictable effects of prolonged warm ischemia time and to reduce the incidence of PNF, EAD, ITBLs, and ultimately graft and patient survival. (Ungraded Statement)…”

“…A total of 16 out of 25 studies reported selection criteria for DCD liver grafts during NRP. (55)(56)(57)(58)(59)(61)(62)(63)65,(67)(68)(69)(70)(72)(73)(74) Graft survival ranged from 42.9% to 100%, and follow-up ranged from 3 to 32 months.…”

Hemolytic uremic syndrome and kidney transplantation in uncontrolled donation after circulatory death (DCD): A two-case report

“…However, use of eculizumab has not been shown to decrease the risk of DGF. In our donor service area, we adopted a DCD protocol of in situ preservation of abdominal organs with compartmentalized normothermic regional perfusion with extracorporeal membrane oxygenation (nECMO) and ex situ preservation of kidneys with hypothermic machine perfusion [ 18 , 19 ]; normothermic regional perfusion (nRP) has been associated with a reduced risk for DGF if compared to in situ cooling [ 14 ]. The adopted immunosuppressive regimen provides a reduced tacrolimus concentration in order to avoid vascular renal injury.…”

Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?

“…In the development and validation processes related to novel drugs and medical devices, it is standard practice to pass through in vitro/ex vivo assessments and in vivo animal models before moving on to clinical trials, to demonstrate the overall safety and expected benefits of the products. Concerning organ transplantation, the process may be different due to the urgency of the life-saving treatment and the persistent mismatch between supply and organ demand [ 1 ]. Indeed, these needs have been pushing to obtain new kinds of donors directly in clinics.…”