Early United States experience with lung donation after circulatory death using thoracoabdominal normothermic regional perfusion

Zhou, Alice L.; Ruck, Jessica M.; Casillan, Alfred J.; Larson, Emily L.; Shou, Benjamin L.; Karius, Alexander; Ha, Jinny S.; Shah, Pali D.; Merlo, Christian A.; Bush, Errol L.

doi:10.1016/j.healun.2023.03.001

Cited by 20 publications

(22 citation statements)

References 10 publications

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“…However, we show that recipients of TA-NRP kidneys have similar 180-d mortality and graft survival compared with recipients of direct recovery grafts, even after controlling for baseline characteristics and propensity matching on donor KDPI. Our study builds upon previously published studies of excellent outcomes with cardiac, 4,5 lung, [16][17][18] and liver 19,20 transplants after TA-NRP, and it underscores the short-term safety and efficacy of this novel perfusion technique specifically for kidney allografts.…”

Section: Discussionsupporting

confidence: 53%

“…Although this is currently just a small fraction of total DCD donors, we expect to see these numbers increase further as more cardiothoracic transplant centers adopt this practice, particularly in light of recently published data demonstrating excellent early outcomes of this technique for cardiac transplantation. 4,5 Additionally, TA-NRP has the potential to decrease the need for ex situ machine perfusion of individual organs, as shown in our study by the decreased utilization of machine perfusion for kidney allografts procured using TA-NRP, 18 potentially making it a cost-effective multiorgan procurement technique. 21 With the recent interest in TA-NRP, we are already beginning to see recommendations regarding this technique being incorporated into abdominal transplant guidelines.…”

Section: Discussionmentioning

confidence: 81%

“…Recipients receiving grafts recovered using TA-NRP were younger (44 versus 57 [47-65] y, P < 0.001), were less likely to have diabetes (24.2% versus 41.8%, P < 0.001), spent more years on dialysis (4.5 [2.5-6.8] versus 3.9 [2.0-5.9] y, P = 0.003), and were more likely to be blood group O (60.8% versus 45.9%, P < 0.001) compared with recipients of direct recovery grafts. TA-NRP donors had similar time between withdrawal of life support and asystole (19 [15-27] versus 19 [14][15][16][17][18][19][20][21][22][23][24][25][26] min, P = 0.05) and, by definition, longer time between declaration of death and aortic cross-clamp (71 [59-103] versus 7 [4-9] min, P < 0.001). Donors for which TA-NRP was used were more likely to be shared nationally (27.5% versus 24.6%, P = 0.02).…”

Section: Donor Recipient and Transplant Characteristicsmentioning

confidence: 99%

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Kidney Donation After Circulatory Death Using Thoracoabdominal Normothermic Regional Perfusion: The Largest Report of the United States Experience

Zhou,

Leng,

Ruck

et al. 2023

Transplantation

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Background. Thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used for donation after circulatory death (DCD) procurements in the United States. We present the largest report of outcomes of kidney transplants performed using DCD donor grafts perfused with TA-NRP. Methods. Adult DCD kidney transplants between 2020 and 2022 in the United Network for Organ Sharing database were included. Donors with ≥50 min between asystole and aortic cross-clamp time in which the heart was also transplanted were considered TA-NRP donors. All other donors were considered direct recovery donors. Multivariable regressions were used to assess delayed graft function, as well as posttransplant survival and all-cause graft failure at 30, 90, and 180 d. A propensity-matched analysis of cohorts matched on donor Kidney Donor Profile Index was performed. Results. Of the 16 140 total DCD kidney transplants performed during the study period, 306 (1.9%) used TA-NRP. TA-NRP donors were younger (P < 0.001) and had lower Kidney Donor Profile Index (P < 0.001) compared with direct recovery donors. Recipients receiving grafts recovered using TA-NRP were younger (P < 0.001) and more likely to be blood group O (P < 0.001). Transplants using TA-NRP had lower likelihood of delayed graft function (adjusted odds ratio 0.22 [95% confidence interval, 0.15-0.31], P < 0.001) but similar 180-d survival (P = 0.8) and all-cause graft failure (P = 0.3) as transplants using direct recovery grafts. These inferences were unchanged on propensity-matched analysis. Conclusions. Our results demonstrate that kidney transplants using TA-NRP DCD allografts have positive short-term mortality and graft survival outcomes, with significantly decreased rates of delayed graft function compared with direct recovery DCD grafts.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 81%

Section: Donor Recipient and Transplant Characteristicsmentioning

confidence: 99%

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Kidney Donation After Circulatory Death Using Thoracoabdominal Normothermic Regional Perfusion: The Largest Report of the United States Experience

Zhou,

Leng,

Ruck

et al. 2023

Transplantation

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“…Zhou et al recently published their early experience with the use of TA-NRP and lung utilization-with lower rates of being on the ventilator for >48 h and shorter hospital stays. 12 Malas et al also published results of their use of TA-NRP in organ procurement after DCD lung donation, which led to lower rates of extracorporeal membrane oxygenation. 13 Although these 2 series were mainly adult recipients, TA-NRP proved to safely increase the pediatric donor pool for other organs.…”

Section: Increasing the Donor Pool And Other Options For Lung Transpl...mentioning

confidence: 99%

From 6-wk Lungs to 6 y: Increasing the Donor Pool for Pediatric Lung Transplantation

Purmessur,

Spencer,

Onwuka

et al. 2023

Transplantation

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Background. Lung transplantation in the pediatric population is a challenge. With the donor pool being so small and lungs from young donors rare and precious, every organ available needs to be utilized to its best potential. Case. Here, we describe the case of a 6-wk-old donor of double lungs to a 5-mo-old baby girl diagnosed with alveolar capillary dysplasia with misalignment of the pulmonary veins. The recipient is doing very well, 6 y after the transplant, now following normal growth. Discussion. The challenges facing pediatric cardiothoracic transplantation in terms of organ supply and demand are enormous. Conclusions. In this article, we discuss some of the issues around the shortage of organs and alternatives to increase the organ donor pool.

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“…3,4 DCD lung transplantation utilizing NRP is beginning to be reported on with good results. 5 In 2019 the first DCD HLTx was performed in the U.K. utilizing off-label modifications to an ex situ portable lung device (OCS Lung, TransMedics, North Andover, MA). 6 A multi-institutional clinical trial was recently published confirming the safety and effectiveness of DCD heart transplant using TransMedics OCS Heart.…”

mentioning

confidence: 99%

Heart-Lung Transplantation From Donation After Circulatory Death Using Mobile Normothermic Regional Perfusion

Spencer,

Saddoughi,

Choi

et al. 2023

ASAIO Journal

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Combined heart-lung transplant (HTLx) is the most durable treatment available for end-stage heart and lung failure. Many patients are unable to receive combined organs due to organ availability and allocation policies prioritizing separate heart or lung transplantation. While an average of 45 HTLxs have been performed per year in the United States half the listed patients do not receive organs. Recently, donation after circulatory death (DCD) utilizing normothermic regional perfusion (NRP) has been utilized for heart allografts with excellent results, and here, we present a case utilizing mobile NRP to procure a heart and lung block from a circulatory death donor and successful implantation for a recipient in a separate center.

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Early United States experience with lung donation after circulatory death using thoracoabdominal normothermic regional perfusion

Cited by 20 publications

References 10 publications

Kidney Donation After Circulatory Death Using Thoracoabdominal Normothermic Regional Perfusion: The Largest Report of the United States Experience

Kidney Donation After Circulatory Death Using Thoracoabdominal Normothermic Regional Perfusion: The Largest Report of the United States Experience

From 6-wk Lungs to 6 y: Increasing the Donor Pool for Pediatric Lung Transplantation

Heart-Lung Transplantation From Donation After Circulatory Death Using Mobile Normothermic Regional Perfusion

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