A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation

Abstract

In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/ 88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

“…This technique can potentially improve post‐transplant outcomes by reversing ischemia‐damaged tissue, limiting the cold ischemia period and allows clinicians to validate organs prior to recovery 1,9 . A‐NRP reduces post‐transplant biliary complications in cDCD livers, 10,11 and international multicenter studies have shown that liver and kidneys obtained with A‐NRP versus the RR technique improves graft survival 10,12,13 . A‐NRP is now routinely used in cDCDs in France, Italy, Spain, and the UK, and is being piloted in Belgium, the Netherlands, Norway, and Switzerland 10,12‐15 …”

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

“…In their recent consensus statement, 9 the European Society for Organ Transplantation (ESOT) recommends to use normothermic regional perfusion (NRP) of the abdomen cDCD procedures, rather than in-situ cooling and cold static storage, if ethical, technical and logistical requirements are met, to improve recipients outcome, potentially preventing some post-transplant complications. 9 , 10 …”

The economic impact of machine perfusion technology in liver transplantation

“…Data supporting the use of NRP in cDCD is provided by observational studies, primarily arising from Europe. A recent systematic review and meta‐analysis determined the use of postmortem NRP in cDCD liver transplantation was associated with a 71% reduction in the development of any form of biliary stricture(s) (relative risk [RR] 0.29, 95% confidence interval [CI] 0.15–0.57) and 85% reduction in ischemic‐type biliary lesions (ITBL) (RR 0.15, 95% CI 0.105–0.45) relative to SRR 37 . Decreased risk of liver graft loss (adjusted hazard ratio [HR] 0.39, 95% CI 0.20–0.78) has also been described in the context of a propensity‐adjusted multicenter study 38 .…”