Factors That Complicated the Implementation of a Program of Donation After Unexpected Circulatory Death of Lungs and Kidneys. Lessons Learned From a Regional Trial in the Netherlands

Venema, Leonie H; Brat, Aukje; Nijkamp, Danielle M.; Krikke, Christina; Leuvenink, Henri G. D.; Jongh, W. C. De; Tromp, Tjarda N.; Vliet, J. Adam van der; Bens, Bas W J; Erasmus, Michiel E.

doi:10.1097/tp.0000000000002814

Cited by 7 publications

(13 citation statements)

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“…20,21 In addition, there is emerging evidence that oxygenation is an important advantage during hypothermic machine perfusion. 27,28 Oxygen supplementation during organ preservation may drive ATP production through oxidative phosphorylation. Thus, cells can use ATP to sustain metabolic processes that protect from ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy

et al. 2020

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Background. The lack of organs for kidney transplantation is a growing concern. Expansion in organ supply has been proposed through the use of organs after circulatory death (donation after circulatory death [DCD]). However, many DCD grafts are discarded because of long warm ischemia times, and the absence of reliable measure of kidney viability. 31P magnetic resonance imaging (pMRI) spectroscopy is a noninvasive method to detect high-energy phosphate metabolites, such as ATP. Thus, pMRI could predict kidney energy state, and its viability before transplantation. Methods. To mimic DCD, pig kidneys underwent 0, 30, or 60 min of warm ischemia, before hypothermic machine perfusion. During the ex vivo perfusion, we assessed energy metabolites using pMRI. In addition, we performed Gadolinium perfusion sequences. Each sample underwent histopathological analyzing and scoring. Energy status and kidney perfusion were correlated with kidney injury. Results. Using pMRI, we found that in pig kidney, ATP was rapidly generated in presence of oxygen (100 kPa), which remained stable up to 22 h. Warm ischemia (30 and 60 min) induced significant histological damages, delayed cortical and medullary Gadolinium elimination (perfusion), and reduced ATP levels, but not its precursors (AMP). Finally, ATP levels and kidney perfusion both inversely correlated with the severity of kidney histological injury. Conclusions. ATP levels, and kidney perfusion measurements using pMRI, are biomarkers of kidney injury after warm ischemia. Future work will define the role of pMRI in predicting kidney graft and patient’s survival.

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Section: Discussionmentioning

confidence: 99%

Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy

et al. 2020

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“…In addition, all available information from the previous uDCD pilot study was used, which contained data from the ED until donor recognition and eventually transplantation. 3 Figure 1 illustrates the distribution of the participating regions in the Netherlands. Data from 3 successful foreign uDCD programs were used for comparison.…”

Section: Methodsmentioning

confidence: 99%

“…In the period October 2014–April 2016, a uDCD protocol was implemented at the EDs of the University Medical Center Groningen (safety region Groningen), Radboud University Medical Center in Nijmegen (safety region Gelderland-Zuid), and Maastricht University Medical Center (safety region Zuid-Limburg). 3 …”

Section: Methodsmentioning

confidence: 99%

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Potential of Donation After Unexpected Circulatory Death Programs Defined by Their Demographic Characteristics

Brat

Venema

Bens

et al. 2021

Transplantation Direct

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Background. Donation after unexpected circulatory death (uDCD) donors are often suggested to increase the number of donor organs. In 2014, a uDCD protocol was implemented in three transplant centers in the Netherlands which unfortunately did not result in additional transplantations. This study was initiated to identify demographic factors influencing the potential success of uDCD programs. Methods. Dutch resuscitation databases covering various demographic regions were analyzed for potential donors. The databases were compared with the uDCD implementation project and successful uDCD programs in Spain, France, and Russia. Results. The resuscitation databases showed that 61% of all resuscitated patients were transferred to an emergency department. Age selection reduced this uDCD potential to 46% with only patients aged 18–65 years deemed eligible. Of these patients, 27% died in the emergency department. The urban region of Amsterdam showed the largest potential in absolute numbers (52 patients/y). Comparison with the uDCD implementation project showed large similarities in the percentage of potential donors; however, in absolute numbers, it showed a much smaller potential. Calculation of the potential per million persons and the extrapolation of the potential based on the international experience revealed the largest potential in urban regions. Conclusions. Implementation of a uDCD program should not only be based on the number of potential donors calculated from resuscitation databases. They show promising potential uDCD percentages for large rural regions and small urban regions; however, actual numbers per hospital are low, leading to insufficient exposure rates. It is, therefore, recommendable to limit uDCD programs to large urban regions.

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“…In this scenario, the uncontrolled (u-) setting is the most promising for its potential. Nevertheless, the challenges to overcome organizational problems and those related to graft preservation and evaluation are undeniable 2,3,4 . In 2014 our Lung-DCD project started, including in-situ preservation with normothermic open-lung approach and ex-situ assessment with ex-vivo lung perfusion (EVLP) 5 .…”

Section: Introductionmentioning

confidence: 99%

Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor

et al. 2021

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Factors That Complicated the Implementation of a Program of Donation After Unexpected Circulatory Death of Lungs and Kidneys. Lessons Learned From a Regional Trial in the Netherlands

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Cited by 7 publications

References 47 publications

Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy

Ex Vivo Analysis of Kidney Graft Viability Using 31P Magnetic Resonance Imaging Spectroscopy

Potential of Donation After Unexpected Circulatory Death Programs Defined by Their Demographic Characteristics

Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor

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