A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

Messer, Simon; Rushton, Sally; Simmonds, Lewis; Macklam, Debbie; Husain, Mubbasher; Jothidasan, A.; Large, Stephen; Tsui, Steven; Kaul, Pratibha; Baxter, Jennifer; Osman, Mohamed; Mehta, Vipin; Russell, Derval; Stock, U.; Dunning, John; Sáez, Diana García; Venkateswaran, Rajamiyer; Curry, Philip A.; Ayton, Lynne; Mukadam, Majid; Mascaro, Jorge; Simmonds, Jacob; MacGowan, Guy A.; Clark, Stephen; Jungschleger, J.; Reinhardt, Zdenka; Quigley, R.; Speed, Jane; Parameshwar, Jayan; Jenkins, David P.; Watson, Sarah; Marley, Fiona; Ali, Ayesha; Gardiner, Dale; Rubino, Antonio; Whitney, Julie; Beale, Sarah; Slater, C. Stewart; Currie, Ian; Armstrong, Liz; Foley, Jeanette; Ryan, Marian; Gibson, Sharon K.; Quinn, Karen; Macleod, Anna-Maria; Spence, Susan; Watson, Christopher J.; Catarino, Pedro; Clarkson, A. R.; Forsythe, John; Manas, Derek; Berman, Marius

doi:10.1016/j.healun.2023.03.006

Cited by 22 publications

(9 citation statements)

References 16 publications

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“…Duke University reported a reduction in days spent on posttransplant MCS (6 vs. 9 days; P ¼ 0.039), and no difference in mortality at 60-days between the two groups [17,18]. The UK study also saw no difference in ICU and hospital length-of-stay, 30-day and www.co-transplantation.com 90-day mortality between DCD and DBD recipients [19].…”

Section: Procedural Risk Factorsmentioning

confidence: 96%

“…The same centre reported outcomes from 459 consecutive patients undergoing heart transplantation between 2016 and 2021, with the incidence of severe PGD being higher in DCD than DBD recipients (19 vs. 7.4%; P ¼ 0.004) [18]. Similarly, in a UK-wide national retrospective cohort study, higher levels of severe PGD requiring VA ECMO were seen with DCD recipients compared with DBD (40 vs. 16%; P ¼ 0.0006) [19].…”

Section: Procedural Risk Factorsmentioning

confidence: 99%

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Acute complication posttransplant: primary allograft dysfunction

Brahmbhatt

Blitzer

Billia

et al. 2023

Current Opinion in Organ Transplantation

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Purpose of review Heart transplant is the gold standard treatment for patients with end-stage heart failure, improving both quality of life and survival. Despite advances in donor and recipient management, primary graft dysfunction (PGD) remains the most common cause of morbidity and mortality in the early posttransplant period. This review summarizes recent discoveries in the underlying pathophysiology, risk prediction and management of PGD. Recent findings The incidence of PGD appears to be rising and it is not clear whether this is due to better recognition or secular changes in transplant practice. The utilization of donation after circulatory death organs for transplant is a further consideration for the development of PGD. Organ transport systems and preservation techniques may help to prevent PGD. As some of the risk factors for developing PGD remain modifiable, we summarize the current evidence for prevention and management of PGD. Summary A better understanding will allow us to appropriately manage donors and recipients to reduce the complex interactions that lead to PGD. The development of an international consortium provides the opportunity for deep phenotyping and development of contemporary risk prediction models for PGD, which may reduce the incidence and consequent early mortality associated with heart transplantation.

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Section: Procedural Risk Factorsmentioning

confidence: 96%

Section: Procedural Risk Factorsmentioning

confidence: 99%

Acute complication posttransplant: primary allograft dysfunction

Brahmbhatt

Blitzer

Billia

et al. 2023

Current Opinion in Organ Transplantation

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“…12 Because TA-NRP is on pause in the United Kingdom, techniques have been developed for the direct procurement and perfusion (DPP) of thoracic organs using ex situ machine perfusion. 13,14 Although thoracic DPP is possible in combination with A-NRP, the competing needs of the abdominal and thoracic teams and the different technologies that are not complementary make widespread utilization of this complex procurement procedure challenging. Because TA-NRP can perfuse abdominal and thoracic organs simultaneously with a single machine and a unified procurement technique, it has the greatest potential for more efficient utilization of all organs for transplantation.…”

Section: Topic Statementmentioning

confidence: 99%

The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion

Wall,

Adams,

Brubaker

et al. 2024

Transplantation

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On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop a consensus statement with supporting data on the ethical tenets of thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for the standards of practice that should govern thoracoabdominal NRP and abdominal NRP; and (3) develop and implement a central database for the collection of NRP donor and recipient data in the United States. National and international leaders in the fields of neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, and donor families participated. The conference was designed to focus on the controversial issues of neurological flow and function in donation after circulatory death donors during NRP and propose technical standards necessary to ensure that this procedure is performed safely and effectively. This article discusses major topics and conclusions addressed at the meeting.

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“…Two arrests involve 2 periods of warm ischemia and 2 periods of cold ischemia, exposing the allograft to multiple bouts of ischemia reperfusion injury, potentially contributing to the 40% incidence of extracorporeal membrane oxygenation (ECMO) for primary graft dysfunction after DCD heart transplantation reported in major series. 6 We have developed a method of performing DCD heart transplantation with uninterrupted coronary perfusion after explanting the heart from the donor, and keeping the heart beating through implantation (Figure). 7 Our novel beating heart method avoids the second cardioplegic arrest and, with it, the additional warm and cold ischemic periods.…”

Section: Introductionmentioning

confidence: 99%

“…Typically, this requires 2 cardioplegic arrests, compared with DBD which involves only 1 cardioplegic arrest (Figure). Two arrests involve 2 periods of warm ischemia and 2 periods of cold ischemia, exposing the allograft to multiple bouts of ischemia reperfusion injury, potentially contributing to the 40% incidence of extracorporeal membrane oxygenation (ECMO) for primary graft dysfunction after DCD heart transplantation reported in major series …”

Section: Introductionmentioning

confidence: 99%

Beating Heart Transplant Procedures Using Organs From Donors With Circulatory Death

Krishnan,

Ruaengsri,

Guenthart

et al. 2024

JAMA Netw Open

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ImportanceThe use of ex vivo normothermic organ perfusion has enabled the use of deceased after circulatory death (DCD) donors for heart transplants. However, compared with conventional brain death donation, DCD heart transplantation performed with ex vivo organ perfusion involves an additional period of warm and cold ischemia, exposing the allograft to multiple bouts of ischemia reperfusion injury and may contribute to the high rates of extracorporeal membrane oxygenation usage after DCD heart transplantation.ObjectiveTo assess whether the beating heart method of DCD heart transplantation is safe and whether it has an acceptable rate of extracorporeal membrane oxygenation use postoperatively.Design, Setting, and ParticipantsThis case series includes 10 patients with end-stage heart failure undergoing DCD heart transplantation at a single academic medical center from October 1, 2022, to August 3, 2023. Data were analyzed from October 2022 to August 2023.InterventionsUsing a beating heart method of implantation of the donor allograft.Main Outcomes and MeasuresThe main outcome was primary graft dysfunction necessitating postoperative initiation of mechanical circulatory support. Survival and initiation of mechanical circulatory support were secondary outcomes.ResultsIn this case series, 10 consecutive patients underwent DCD heart transplantation via the beating heart method. Ten of 10 recipients were male (100%), the mean (SD) age was 51.2 (13.8) years, and 7 (70%) had idiopathic dilated cardiomyopathy. Ten patients (100%) survived, and 0 patients had initiation of extracorporeal membrane oxygenation postoperatively. No other mechanical circulatory support, including intra-aortic balloon pump, was initiated postoperatively. Graft survival was 100% (10 of 10 patients), and, at the time of publication, no patients have been listed for retransplantation.Conclusions and RelevanceIn this study of 10 patients undergoing heart transplantation, the beating heart implantation method for DCD heart transplantation was safe and may mitigate ischemia reperfusion injury, which may lead to lower rates of primary graft dysfunction necessitating extracorporeal membrane oxygenation. These results are relevant to institutions using DCD donors for heart transplantation.

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A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

Cited by 22 publications

References 16 publications

Acute complication posttransplant: primary allograft dysfunction

Acute complication posttransplant: primary allograft dysfunction

The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion

Beating Heart Transplant Procedures Using Organs From Donors With Circulatory Death

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