Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain

Muñoz, Juan José Rubio; González, Beatriz Domínguez-Gil; García, Eduardo Miñambres; Gallegos, Francisco; Pérez-Villares, J.M.

doi:10.1016/j.medine.2021.11.001

Cited by 2 publications

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“…The use of abdominal normothermic regional perfusion (A‐NRP) with extracorporeal membrane oxygenation (ECMO) to facilitate recovery of abdominal organs in cDCD has increased in the past 5 years. This technique can potentially improve post‐transplant outcomes by reversing ischemia‐damaged tissue, limiting the cold ischemia period and allows clinicians to validate organs prior to recovery 1,9 . A‐NRP reduces post‐transplant biliary complications in cDCD livers, 10,11 and international multicenter studies have shown that liver and kidneys obtained with A‐NRP versus the RR technique improves graft survival 10,12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…This technique can potentially improve post-transplant outcomes by reversing ischemia-damaged tissue, limiting the cold ischemia period and allows clinicians to validate organs prior to recovery. 1,9 A-NRP reduces post-transplant biliary complications in cDCD livers, 10,11 and international multicenter studies have shown that liver and kidneys obtained with A-NRP versus the RR technique improves graft survival. 10,12,13 A-NRP is now routinely used in cDCDs in France, Italy, Spain, and the UK, and is being piloted in Belgium, the Netherlands, Norway, and Switzerland.…”

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confidence: 99%

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Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Cuesta

Ballesteros

Naranjo

et al. 2022

American Journal of Transplantation

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Lung transplantation (LT) is an established therapy for endstage lung disease in selected patients. However, the shortage of organ donors has led investigators to search for new ways to increase the donor pool, such as the use of extended-criteria donors, donation after circulatory death (DCD), or ex situ lung perfusion. 1Lung transplantation using controlled DCD (cDCD) grafts has been widely accepted worldwide, and outcomes are equivalent to those obtained with donation after brain death (DBD) donors. Over the past decade, reports from several centers and multi-institutional

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Cuesta

Ballesteros

Naranjo

et al. 2022

American Journal of Transplantation

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Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model

Madrahimov

Mutsenko

Natanov

et al. 2023

ICMx

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Background Transplant candidates on the waiting list are increasingly challenged by the lack of organs. Most of the organs can only be kept viable within very limited timeframes (e.g., mere 4–6 h for heart and lungs exposed to refrigeration temperatures ex vivo). Donation after circulatory death (DCD) using extracorporeal membrane oxygenation (ECMO) can significantly enlarge the donor pool, organ yield per donor, and shelf life. Nevertheless, clinical attempts to recover organs for transplantation after uncontrolled DCD are extremely complex and hardly reproducible. Therefore, as a preliminary strategy to fulfill this task, experimental protocols using feasible animal models are highly warranted. The primary aim of the study was to develop a model of ECMO-based cadaver organ recovery in mice. Our model mimics uncontrolled organ donation after an “out-of-hospital” sudden unexpected death with subsequent “in-hospital” cadaver management post-mortem. The secondary aim was to assess blood gas parameters, cardiac activity as well as overall organ state. The study protocol included post-mortem heparin–streptokinase administration 10 min after confirmed death induced by cervical dislocation under full anesthesia. After cannulation, veno-arterial ECMO (V–A ECMO) was started 1 h after death and continued for 2 h under mild hypothermic conditions followed by organ harvest. Pressure- and flow-controlled oxygenated blood-based reperfusion of a cadaver body was accompanied by blood gas analysis (BGA), electrocardiography, and histological evaluation of ischemia–reperfusion injury. For the first time, we designed and implemented, a not yet reported, miniaturized murine hemodialysis circuit for the treatment of severe hyperkalemia and metabolic acidosis post-mortem. Results BGA parameters confirmed profound ischemia typical for cadavers and incompatible with normal physiology, including extremely low blood pH, profound negative base excess, and enormously high levels of lactate. Two hours after ECMO implantation, blood pH values of a cadaver body restored from < 6.5 to 7.3 ± 0.05, pCO2 was lowered from > 130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO3 were all elevated from below detection thresholds to 99.5 ± 0.6%, − 4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T test, p < 0.05). A substantial decrease in hyperlactatemia (from > 20 to 10.5 ± 1.7 mmol/L) and hyperkalemia (from > 9 to 6.9 ± 1.0 mmol/L) was observed when hemodialysis was implemented. On balance, the first signs of regained heart activity appeared on average 10 min after ECMO initiation without cardioplegia or any inotropic and vasopressor support. This was followed by restoration of myocardial contractility with a heart rate of up to 200 beats per minute (bpm) as detected by an electrocardiogram (ECG). Histological examinations revealed no evidence of heart injury 3 h post-mortem, whereas shock-specific morphological changes relevant to acute death and consequent cardiac/circulatory arrest were observed in the lungs, liver, and kidney of both control and ECMO-treated cadaver mice. Conclusions Thus, our model represents a promising approach to facilitate studying perspectives of cadaveric multiorgan recovery for transplantation. Moreover, it opens new possibilities for cadaver organ treatment to extend and potentiate donation and, hence, contribute to solving the organ shortage dilemma.

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Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain

Cited by 2 publications

References 49 publications

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model

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