Combined lung and liver procurement in controlled donation after circulatory death using normothermic abdominal perfusion. Initial experience in two Spanish centers

Miñambres, Eduardo; Ruíz, P.; Ballesteros, María Ángeles; Álvaréz, Carlos; Cifrián, José Manuel; Atutxa, Lánder; Ventoso, A.; Castillo, Federico; Gastaca, Mikel

doi:10.1111/ajt.15520

Cited by 46 publications

(52 citation statements)

References 52 publications

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“…Transaminases more than three times the upper normal value at baseline and/or more than four times the upper normal limit at the end of A-NRP are considered a relative contraindication for liver transplantation [77][78][79][80]. A decrease of the initial lactate levels (following 30 and 60 min of A-NRP) may also be a good biomarker of an adequate perfusion of organs [78,81]. A-NRP is run for 90-120 min to allow the adequate reconditioning of abdominal organs.…”

Section: Abdominal Nrp With Ante Mortem Vessel Cannulationmentioning

confidence: 99%

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

et al. 2021

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A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.

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Section: Abdominal Nrp With Ante Mortem Vessel Cannulationmentioning

confidence: 99%

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

et al. 2021

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“…In case 2, lungs were not considered for transplantation to facilitate this new procedure. However, we do think the combined recovery of heart and lungs is feasible with this protocol as it has been shown by the Papworth group 28 and was initially done with the combined lung and liver procurement in cDCDD using abdominal NRP 12,29 …”

Section: Discussionmentioning

confidence: 98%

“…Only one SKP recipient developed DGF, which is quite a low incidence comparing to the international studies, 20 and all had a creatinine value ≤2 mg/dL at 1 month after the transplant. During the recirculatory phase, a real‐time monitoring of transaminases and lactate levels is performed, which helps in the assessment of viability of the abdominal grafts 10,12,21,22 …”

Section: Discussionmentioning

confidence: 99%

“…The initial arterial lactate level decreased and the transaminases barely increased, and remained stable during the recirculatory phase in all donors, because of an adequate perfusion provided by the heart. The three centers involved have large experience with abdominal NRP, 10,12,23 and this background was easily transferred to the TA‐NRP facilitating the embracement of this technique.…”

Section: Discussionmentioning

confidence: 99%

“…During the last 5 years, the development of cDCDD in Spain is to be highlighted, pioneering the use of NRP with extracorporeal membrane oxygenation (ECMO) devices as an in situ blood reperfusion strategy in both cDCDD 10‐13 and uncontrolled DCDD 14‐16 …”

Section: Introductionmentioning

confidence: 99%

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Spanish experience with heart transplants from controlled donation after the circulatory determination of death using thoraco-abdominal normothermic regional perfusion and cold storage

Miñambres

Royo‐Villanova

Redondo

et al. 2021

American Journal of Transplantation

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Heart transplantation from controlled donation after the circulatory determination of death (cDCDD) may help to increase the availability of hearts for transplantation. During 2020, four heart transplants were performed at three different Spanish hospitals based on the use of thoraco‐abdominal normothermic regional perfusion (TA‐NRP) followed by cold storage (CS). All donors were young adults <45 years. The functional warms ischemic time ranged from 8 to 16 minutes. In all cases, the heart recovered sinus rhythm within 1 minute of TA‐NRP. TA‐NRP was weaned off or decreased <1L within 25 minutes. No recipient required mechanical support after transplantation and all were immediately extubated and discharged home (median hospital stay: 21 days) with an excellent outcome. Four livers, eight kidneys, and two pancreata were also recovered and transplanted. All abdominal grafts recipients experienced an excellent outcome. The use of TA‐NRP makes heart transplantation feasible and allows assessing heart function before organ procurement without any negative impact on the preservation of abdominal organs. The use of TA‐NRP in cDCDD heart donors in conjunction with cold storage following retrieval can eliminate the need to use ex situ machine perfusion devices, making cDCDD heart transplantation economically possible in other countries.

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Similar Results in Liver Transplantation From Controlled Donation After Circulatory Death Donors With Normothermic Regional Perfusion and Donation After Brain Death Donors: A Case‐Matched Single‐Center Study

et al. 2021

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Although good results have been reported with the use of normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation (LT), there is a lack of evidence to demonstrate similar results to donation after brain death (DBD). We present a single‐center retrospective case‐matched (1:2) study including 100 NRP cDCD LTs and 200 DBD LTs and a median follow‐up of 36 months. Matching was done according to donor age, recipient Model for End‐Stage Liver Disease score, and cold ischemia time. The following perioperative results were similar in both groups: alanine transaminase peaks of 909 U/L in the DBD group and 836 U/L in the cDCD group and early allograft disfunction percentages of 21% and 19.2%, respectively. The 1‐year and 3‐year overall graft survival for cDCD was 99% and 93%, respectively, versus 92% and 87%, respectively, for DBD (P = 0.04). Of note, no cases of primary nonfunction or ischemic‐type biliary lesion were observed among the cDCD grafts. Our results confirm that NRP cDCD LT meets the same outcomes as those obtained with DBD LT and provides evidence to support the idea that cDCD donors per se should no longer be considered as “marginal donors” when recovered with NRP.

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Combined lung and liver procurement in controlled donation after circulatory death using normothermic abdominal perfusion. Initial experience in two Spanish centers

Cited by 46 publications

References 52 publications

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

Spanish experience with heart transplants from controlled donation after the circulatory determination of death using thoraco-abdominal normothermic regional perfusion and cold storage

Similar Results in Liver Transplantation From Controlled Donation After Circulatory Death Donors With Normothermic Regional Perfusion and Donation After Brain Death Donors: A Case‐Matched Single‐Center Study

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