Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Rojas-Pena, Alvaro; Reoma, Junewai L.; Krause, Eric; Boothman, Erika; Padiyar, Niru; Cook, Keith E.; Bartlett, R. H.; Punch, Jeffrey D.

doi:10.1111/j.1600-6143.2010.03063.x

Cited by 38 publications

(28 citation statements)

References 34 publications

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“…Cardiac arrest was induced by apnea via ventilator withdrawal and paralytics were given as previously described. [5,7] No heparin was given prior to cardiac arrest and no external heat source was used, to mimic a clinical uDCD setting. Circulatory death was defined as a systolic carotid arterial pressure <20mmHg and a pulse pressure <10mmHg.…”

Section: Methodsmentioning

confidence: 99%

“…[5-8] Our results had shown that room temperature extracorporeal support (ECS) is as effective as 37°C, and that ECS can be used during DCD donation in animals anticoagulated with heparin before or soon after cardiac arrest. This results in conditioning of kidneys, livers and lungs to transplantable status after 30 minutes of WIT.…”

Section: Introductionmentioning

confidence: 99%

“…In these experiments we found that microvascular thrombosis during WIT uniformly caused kidney failure. [5] Intravascular thrombosis after death appears to limit tolerable WIT longer than 30 minutes, even with ECS and heparinization. This study was undertaken to evaluate the use of ECS with streptokinase (STK) as a thrombolytic, on kidney resuscitation and transplantation after 60 minutes of untreated WIT after cardiac death.…”

Section: Introductionmentioning

confidence: 99%

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Successful Porcine Renal Transplantation After 60 Minutes of Donor Warm Ischemia

et al. 2015

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Donation from uncontrolled circulatory determination of death donors (uDCD) is impractical in America because of the time needed to organize procurement before irreversible organ damage. Salvaging organs after prolonged warm ischemic time (WIT) may address this limitation. We evaluated the combination of extracorporeal support (ECS) and thrombolytics in a porcine uDCD renal transplant model. Non anti-coagulated uDCD sustained 60min of WIT, and two groups were studied. Rapid recovery (RR-uDCD), kidneys procured using rapid topical cooling; and ECS assisted donation (E-uDCD), 4hr ECS plus thrombolytics for in-situ perfusion prior to procurement. All kidneys were flushed and cold stored, followed by transplantation into healthy nephrectomized recipients without immunosuppression. Delayed graft function (DGF) was defined as creatinine>5.0mg/dL on any postoperative day. Twelve kidneys in E-uDCD and 6 in RR-uDCD group were transplanted. All 12 E-uDCD recipients had urine production and adequate function in the first 48hr, but two grafts (16.7%) had DGF at 96hr. All 6 recipients from RR-uDCD group had DGF at 48hr and were euthanized. Creatinine and BUN levels were significantly lower in E-uDCD compared to RR-uDCD group at 24hr (2.9±0.7mg/dL vs. 5.2±0.9mg/dL), and 48hr (3.2±0.9mg/dL vs. 7.2±1.0mg/dl); BUN levels at 24hr, (28.3±6.7mg/dL vs. 39.5±7.5mg/dL), and 48hr (23.9±5.0mg/dL vs. 46±12.9mg/dL) respectively. ECS plus thrombolytics precondition organs in-situ yielding functional kidneys in a porcine model of uDCD with 60 minutes of WIT. This procurement method addresses logistical limitations for uDCD use in the US, and could have a major impact on the organ donor pool.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful Porcine Renal Transplantation After 60 Minutes of Donor Warm Ischemia

et al. 2015

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“…A series of methods have been offered with this aim: organs cooling by way of the perfusion of cooled preserving liquid through premortum cannulated femoral vessels, applying reperfusion technique for normothermic extracorporeal oxygenation, etc. (9). Legislation is the other opportunity.…”

Section: Discussionmentioning

confidence: 99%

The Use of Deceased Donors for Kidneys Transplantations

Mal’tsev¹,

Jushinskis²,

Rozentāls³

2011

Acta Chirurgica Latviensis

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111Summary Introduction. The lack of donor organs aimed at transplanting is a great problem all over the world. To solve the problem the criteria of selecting donors progressively expand including donors after cardiac death. Analysis performed in this report refers to the use of donors after the controlled cardiac death to transplant kidneys at the Latvian transplantation center. Aim of the study. To clarify the renal transplant outcomes after transplantation from deceased donors of two types -donors after cardiac death and donors after brain death. Materials and methods. Study included 351 consecutive primary renal transplantations from deceased donors procured in a single transplant center during the period since 2000 till 2005. Kidneys were recovered from 244 deceased donors at the age of 41.2 + 13.2 (8 -68): from 68 -after cardiac death (DCD) and from 176 -after stating the brain death (DBD), (control group). Results of transplantations were compared regarding the type of deceased donors been used. Results.The percentage of non functioning graft recovered from donors after cardiac death made up 1.8 % (at the rate of 1.6 % in a control group). Delayed graft function of transplants made up respectively 14.0% and 12.3%. Within a period of 5 years mortality in DCD group made up 15 % and in BDB group 12.3 %. Graft survival was respectively 76.7 % and 84.8% (p = 0,046). Conclusion.Results of study show the efficiency of transplanting kidneys received from donors after cardiac death and brain death. Long term results in DCD donation should be improved by introduction of new technologies.

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“…These results are exciting, but no other groups have reported similar results. The same group recently published data on a similar model with 30 min of induced warm ischemia followed by ECMO support [66] . Organs were recovered to a transplantable level.…”

Section: In-vivo (In-situ) Perfusionmentioning

confidence: 99%

Current status and recent advances of liver transplantation from donation after cardiac death

Perera

Bramhall

2011

WJGS

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The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

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Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Cited by 38 publications

References 34 publications

Successful Porcine Renal Transplantation After 60 Minutes of Donor Warm Ischemia

Successful Porcine Renal Transplantation After 60 Minutes of Donor Warm Ischemia

The Use of Deceased Donors for Kidneys Transplantations

Current status and recent advances of liver transplantation from donation after cardiac death

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