Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion

Abstract

Donation after the circulatory determination of death (DCDD) has emerged as a valuable strategy to increase the availability of organs for transplantation. 1 In 2018, 23% of the 39 357 deceased organ donors reported to the Global Observatory on Donation and Transplantation had been declared dead by circulatory criteria. 2,3 DCDD also provides the opportunity of posthumous donation when patients die following an unsuccessfully-resuscitated cardiac arrest (uncontrolled DCDD [uDCDD]) or the decision to withdraw of life-sustaining therapies (WLSTs) that are no longer deemed beneficial to the patient (controlled DCDD [cDCDD]). 4cDCDD programs already exist in 17 countries throughout the world. 2,3,5 In cDCDD, the effects of warm ischemia during the agonal period after the WLST and following the cessation of circulation are further exacerbated during the later phase of cold

Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss

“…Cirrhosis was the most common indication for transplantation, followed by hepatocellular carcinoma (HCC). Laboratory MELD values including and excluding HCC patients were 12 [9][10][11][12][13][14][15][16] and 13 [10][11][12][13][14][15][16][17], respectively. Median UK DCD Risk Score was 5 [3][4][5][6][7][8], with 457 classified as low risk (57%), 304 as high risk (38%), and 42 as "futile" (5%).…”

“…In the past 3 years, reports have come out of European countries describing series of cDCD livers 10–15 and kidneys 16 transplanted after recovery with postmortem in situ normothermic regional perfusion (NRP). Normothermic regional perfusion relies on placement of cannulae and occlusion balloons or clamps to isolate a region of circulation (abdomen [A‐NRP] or chest and abdomen [TA‐NRP]).…”

“…By limiting risk factors (donor age, donor warm ischemia, graft cold ischemia), adequate results have been achieved using cDCD livers recovered with SRR. [3][4][5][6][7][8][9] In the past 3 years, reports have come out of European countries describing series of cDCD livers [10][11][12][13][14][15] and kidneys 16 transplanted after recovery with postmortem in situ normothermic regional perfusion (NRP). Normothermic regional perfusion relies on placement of cannulae and occlusion balloons or clamps to isolate a region of circulation (abdomen [A-NRP] or chest and abdomen [TA-NRP]).…”

Graft utilization after normothermic regional perfusion in controlled donation after circulatory death—a single‐center perspective from France

“…For instance, Oniscu et al defined utilization rates as grafts transplanted from donors who successfully completed NRP while Watson et al [2,17] included all donors where NRP was initiated. Another large study on NRP in cDCD kidney transplantation only included transplanted grafts in the analysis [7]. Reported graft utilization rates after NRP for cDCD kidneys range from 62.7% to 92.7% and for cDCD livers range from 61.4% to 62.5%, depending on the definition [16].…”

“…France, Italy, and Norway have implemented a mandatory use of NRP for every cDCD procurement [1,5]. While studies report excellent outcomes after NRP in cDCD liver and kidney transplantation, this strategy requires additional logistics, donor cannulation training, and raises specific ethical questions [6][7][8][9][10]. In addition, a detailed analysis of utilization rates and reasons for graft discard including technical failures after NRP are currently lacking [3].…”