In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience

Am J Transplant. 2014 Dec;14(12):2846-54. doi: 10.1111/ajt.12927. Epub 2014 Oct 3.

Abstract

Organs recovered from donors after circulatory death (DCD) suffer warm ischemia before cold storage which may prejudice graft survival and result in a greater risk of complications after transplant. A period of normothermic regional perfusion (NRP) in the donor may reverse these effects and improve organ function. Twenty-one NRP retrievals from Maastricht category III DCD donors were performed at three UK centers. NRP was established postasystole via aortic and caval cannulation and maintained for 2 h. Blood gases and biochemistry were monitored to assess organ function. Sixty-three organs were recovered. Forty-nine patients were transplanted. The median time from asystole to NRP was 16 min (range 10-23 min). Thirty-two patients received a kidney transplant. The median cold ischemia time was 12 h 30 min (range 5 h 25 min-18 h 22 min). The median creatinine at 3 and 12 months was 107 µmol/L (range 72-222) and 121 µmol/L (range 63-157), respectively. Thirteen (40%) recipients had delayed graft function and four lost the grafts. Eleven patients received a liver transplant. The first week median peak ALT was 389 IU/L (range 58-3043). One patient had primary nonfunction. Two combined pancreas-kidney transplants, one islet transplant and three double lung transplants were performed with primary function. NRP in DCD donation facilitates organ recovery and may improve short-term outcomes.

Keywords: Clinical research/practice; donors and donation; donors and donation: donation after circulatory death (DCD); extra-corporeal membrane oxygenation (ECMO); kidney transplantation/nephrology; liver transplantation/hepatology; organ perfusion and preservation; organ procurement; organ transplantation in general.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catheterization
  • Cause of Death
  • Cold Ischemia
  • Delayed Graft Function
  • Donor Selection
  • Extracorporeal Membrane Oxygenation
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Kidney Transplantation*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Organ Preservation / adverse effects*
  • Pancreas Transplantation*
  • Perfusion
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Harvesting*
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control*
  • Young Adult