In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival

Watson, Christopher J.; Hunt, Fiona; Messer, Simon; Currie, Ian; Large, Stephen; Sutherland, Andrew; Crick, Keziah; Wigmore, Stephen J.; Fear, Corrina; Cornateanu, Sorina; Randle, Lucy V.; Terrace, John D.; Upponi, Sara; Taylor, Rhiannon; Allen, Elisa; Butler, Andrew; Oniscu, Gabriel C.

doi:10.1111/ajt.15241

Cited by 218 publications

(277 citation statements)

References 35 publications

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“…The authors concluded that NRP facilitated organ recovery . The same group built upon this initial encouraging experience and recently published the outcomes from 43 livers transplanted after NRP in controlled DCD donation . Compared to a contemporaneous control group, livers subjected to NRP demonstrated a significant reduction in ischaemic cholangiopathy (with no cases in the 43 NRP livers) and a strong trend towards increased graft survival.…”

Section: Perfusion and Re‐conditioning Methods For Abdominal Organsmentioning

confidence: 82%

The future of organ perfusion and re‐conditioning

et al. 2019

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Summary Organ preservation and re‐conditioning using machine perfusion technologies continue to generate promising results in terms of viability assessment, organ utilization and improved initial graft function. Here, we summarize the latest findings and study the results of ex‐vivo/ex‐situ hypothermic (HMP) and normothermic machine perfusion (NMP) in the area of abdominal organ transplantation (kidney, liver, pancreas and intestine). We also consider the potential role of normothermic regional perfusion (NRP) to re‐condition donors after circulatory death organs before retrieval. The findings from clinical studies reported to date suggest that machine perfusion will offer real benefits when compared with conventional cold preservation. Several randomized trials are expected to report their findings within the next 2 years which may shed light on the relative merits of different perfusion methods and could indicate which perfusion parameters may be most useful to predict organ quality and viability. Further work is needed to identify composite endpoints that are relevant for transplanted organs that have undergone machine preservation. Multi‐centre trials to compare and analyse the combinations of NRP followed by HMP and/or NMP, either directly after organ retrieval using transportable devices or when back‐to‐base, are needed. The potential applications of machine preservation technology beyond the field of solid organ transplantation are also considered.

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Section: Perfusion and Re‐conditioning Methods For Abdominal Organsmentioning

confidence: 82%

The future of organ perfusion and re‐conditioning

et al. 2019

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“…The use of ECMO devices to allow the perfusion of organs with oxygenated blood after the determination of death has proven to improve post‐transplant outcomes in recipients of cDCD livers. Two recent studies from Spain and the UK have shown that nRP is associated with improved graft survival and a decreased incidence of ischemic‐type biliary lesions and other biliary complications . In addition, thoraco‐abdominal nRP is being used in Belgium and the UK to validate and preserve cDCD donor hearts prior to recovery and transplantation .…”

Section: Discussionmentioning

confidence: 99%

Donation after circulatory death today: an updated overview of the European landscape

Lomero¹,

et al. 2019

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Summary Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.

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“…It has been shown to improve early liver allograft function and increase the use of livers from DCD donors . It may also reduce biliary complications . Less is known about the effects of NRP on renal transplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The terminal serum creatinine level was 66 μmol/L (0.7 mg/dL). After the withdrawal of treatment and confirmation of death, NRP was carried out as previously described by Watson and colleagues to comply with legal and professional requirements in the United Kingdom. The first warm time was 14 minutes, and NRP was performed for 138 minutes (Figure , Table ).…”

Section: Methodsmentioning

confidence: 99%

“…One initiative has been the introduction of normothermic perfusion technologies, which reduce the deleterious effects that cold storage has on DCD kidneys. This includes normothermic perfusion of organs in situ, deemed normothermic regional perfusion (NRP), and ex vivo perfusion after procurement of the organ, referred to as normothermic machine perfusion (NMP) NMP has proved useful in kidneys that would otherwise be discarded but also as a platform for assessment and reconditioning of marginal organs …”

Section: Introductionmentioning

confidence: 99%

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