Kidney from uncontrolled donors after cardiac death with one hour warm ischemic time: resuscitation by extracorporal normothermic abdominal perfusion “<i>in situ</i>” by leukocytes‐free oxygenated blood

Резник, О. Н.; Скворцов, А. Е.; Логинов, И. В.; Ananyev, A. N.; Багненко, С. Ф.; Moysyuk, Ya. G.

doi:10.1111/j.1399-0012.2010.01333.x

Cited by 35 publications

(25 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…33,[65][66][67][68] Other biotechnology approaches, for example, specific miRNA or cell therapy, could also improve NRP. 33,[65][66][67][68] Other biotechnology approaches, for example, specific miRNA or cell therapy, could also improve NRP.…”

Section: Discussionmentioning

confidence: 99%

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

Kerforne

Allain

Giraud

et al. 2019

American Journal of Transplantation

View full text Add to dashboard Cite

Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as normothermic regional perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30 minutes of cardiac arrest) for 2, 4, or 6 hours compared to a control group (No-NRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to an increased expression of HIF1α-dependent survival pathway. At 2 hours, blood levels of ischemic injury biomarkers increased: creatinine, lactate/pyruvate ratio, LDH, AST, NGAL, KIM-1, CD40 ligand, and soluble-tissue-factor. All these markers then decreased with time; however, AST, NGAL, and KIM-1 increased again at 6 hours. Hemoglobin and platelets decreased at 6 hours, after which the procedure became difficult to maintain. Regarding inflammation, active tissue-factor, cleaved PAR-2 and MCP-1 increased by 4-6 hours, but not TNF-α and iNOS. Compared to No-NRP, NRP kidneys showed lower resistance during hypothermic machine perfusion (HMP), likely associated with pe-NRP eNOS activation. Kidneys transplanted after 4 and 6 hours of NRP showed better function and outcome, compared to No-NRP. In conclusion, our results confirm the mechanistic benefits of NRP and highlight 4 hours as its optimal duration, after which injury markers appear.

show abstract

Section: Discussionmentioning

confidence: 99%

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

Kerforne

Allain

Giraud

et al. 2019

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…If the duration of warm ischemia is not quantifiable, the depth of injury cannot be assessed properly, and therefore, such organs should not be used. Consequently, death by cardiac arrest of type 1 according to the Maastricht classification excludes the possibility of LT, although some interesting results have been reported in kidney transplantation . When the duration of warm ischemia is known, DCD donors can be evaluated as a potential source of grafts.…”

mentioning

confidence: 99%

First experience of liver transplantation with type 2 donation after cardiac death in France

et al. 2015

View full text Add to dashboard Cite

Organ donation after unexpected cardiac death [type 2 donation after cardiac death (DCD)] is currently authorized in France and has been since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation (LT) with type 2 DCD donors. After the declaration of death, abdominal normothermic oxygenated recirculation was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 LTs were performed in 3 French centers. Six patients had a rapid and uneventful postoperative recovery. However, primary nonfunction occurred in 3 patients, with each requiring urgent retransplantation, and 4 early allograft dysfunctions were observed. One patient developed a nonanastomotic biliary stricture after 3 months, whereas 8 patients showed no sign of ischemic cholangiopathy at their 1-year follow-up. In comparison with a control group of patients receiving grafts from braindead donors (n 5 41), donor age and cold ischemia time were significantly lower in the type 2 DCD group. Time spent on Additional Supporting Information may be found in the online version of this article.

show abstract

“…The development of better preservation methods immediately after cardiac arrest in future has the potential to encourage DCD organ donation in a big way, and the recent advances in normothermic organ perfusion as well as hypothermic machine perfusion of organs has been reported to reduce or reverse preservation-related injury which if implemented routinely can greatly increase this source of organs. [12181920]…”

Section: Discussionmentioning

confidence: 99%

A single-center experience of kidney transplantation from donation after circulatory death: Challenges and scope in India

et al. 2017

View full text Add to dashboard Cite

Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. The present report describes the initial experience of transplantation of organs from DCD donors in a tertiary care center in India. Between 2011 and 2015, five donors had kidneys retrieved after cardiac arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following cardiopulmonary resuscitation (CPR), which was restarted in three patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 9/10 kidneys were utilized. Mean donor age was 29.6 ± 16.3 years, M:F 4:1 and mean age of recipients was 38.7 ± 10.8 years, M:F 7:2. Seven patients required dialysis in postoperative period. Mean postoperative day 0 urine output was 1.9 ± 2.6 L. Baseline creatinine achieved was 1.38 ± 0.35 mg/dl after a mean duration of 26.12 ± 15.4 days. Kidneys from donors where CPR was continued after the declaration of death (n = 3) had better recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days, baseline creatinine 1.36 ± 0.25 vs. 1.52 ± 0.45 mg%). In donors without CPR, one kidney never functioned and others had patchy cortical necrosis on protocol biopsy, which was not seen in the kidneys from donors with CPR. Kidneys from DCD donors can serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death seems to help in improving outcomes.

show abstract

Kidney from uncontrolled donors after cardiac death with one hour warm ischemic time: resuscitation by extracorporal normothermic abdominal perfusion “in situ” by leukocytes‐free oxygenated blood

Cited by 35 publications

References 36 publications

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study

First experience of liver transplantation with type 2 donation after cardiac death in France

A single-center experience of kidney transplantation from donation after circulatory death: Challenges and scope in India

Contact Info

Product

Resources

About