Normothermic Regional Perfusion in Pediatric Controlled Donation After Circulatory Death Can Lead to Optimal Organ Utilization and Posttransplant Outcomes

Abstract

Background. The benefits of normothermic regional perfusion (NRP) in posttransplant outcomes after controlled donation after the determination of death by circulatory criteria (cDCD) has been shown in different international adult experiences. However, there is no information on the use of NRP in pediatric cDCD donors. Methods. This is a multicenter, retrospective, observational cohort study describing the pediatric (<18 y) cDCD procedures performed in Spain, using either abdominal NRP or thoracoabdominal NRP and the outcomes of recipients of the obtained organs.Results. Thirteen pediatric cDCD donors (age range, 2-17 y) subject to abdominal NRP or thoracoabdominal NRP were included. A total of 46 grafts (24 kidneys, 11 livers, 8 lungs, 2 hearts, and 1 pancreas) were finally transplanted (3.5 grafts per donor). The mean functional warm ischemic time was 15 min (SD 6 min)‚ and the median duration of NRP was 87 min (interquartile range, 69-101 min). One-year noncensored for death kidney graft survival was 91.3%. The incidence of delayed graft function was 13%. One-year‚ noncensored-for-death liver graft survival was 90.9%. All lung and pancreas recipients had an excellent evolution. One heart recipient died due to a septic shock. Conclusions. This is the largest experience of pediatric cDCD using NRP as graft preservation method. Although our study has several limitations, such as its retrospective nature and the small sample size, its reveals that NRP may increase the utilization of cDCD pediatric organs and offer optimal recipients' outcomes.

Normothermic regional perfusion in paediatric donation after circulatory determination of death—the Oxford position statement from ELPAT

“…Benefits are related to intra-operative assessment of the graft and NRP capacity to regenerate the ischaemic tissue, diminishing post-transplant complications ( 19 ). Miñambres et al ( 1 ), achieved 85% of utilized p-DCD liver grafts obtained with P-NRP (without ex-situ perfusion) and 100% of recovered kidney grafts from p- DCD compared to 0.5% of utilized p-DCD liver grafts obtained with RR ( 20 ).…”

“…What does the success of NRP in pDCD child donors in Spain ( 1 , 2 ), the first paediatric NRP reported, mean for other countries? In children, given the variability in the DCD-donor from term infant of a few kilograms to adult-sized teenagers, and the greater cerebral blood flow relative to cardiac output in smaller children ( 24 ), it might be argued that greater technical expertise is required to reliably isolate the cerebral circulation, especially in infants.…”

“…Following the recent report of the use of both abdominal and thoracoabdominal normothermic regional perfusion in paediatric donation after circulatory death (DCD) donors in Spain ( 1 , 2 ), the area needs urgent ethical deliberation and clarification. For those involved in paediatric donation and transplantation the public acceptability of any novel approaches needs careful consideration, given the implications of negative publicity, especially in countries where healthcare innovations can be portrayed in the media in misleading ways ( 3 ).…”

American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Abdominal

“…[13][14][15] Pediatric NRP cases should be given special consideration with respect to flow rates, cannula size, and surgeon training. 20,21 Recommendation:…”

Bronchial Stenosis After Lung Transplantation From cDCD Donors Using Simultaneous Abdominal Normothermic Regional Perfusion: A Single-center Experience

“…21,22 Compared with conventional organ procurement, the use of abdominal normothermic perfusion (A-NRP) during organ procurement facilitates abdominal organ extraction and improves outcomes in liver and kidney recipients. [23][24][25][26][27][28][29] Although lung donation with A-NRP was described in 2014, 30 a limited number of cases have been reported in the literature. 31 Our group recently reported the largest series published to date and found that LT recipients from DCD donors with simultaneous A-NRP had similar outcomes to those from standard DBD donors in terms of chronic lung allograft dysfunction (CLAD) and survival.…”