Kidney Transplantation from a Donor Following Cardiac Death Supported with Extracorporeal Membrane Oxygenation

Lee, Jong Hoon; Hong, Seri; Oh, Chang‐Keun; Hong, You Sun; Yim, Hyunee

doi:10.3346/jkms.2012.27.2.115

Cited by 28 publications

(25 citation statements)

References 21 publications

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“…Advantages of ECMO include recirculation of oxygenated blood until organ procurement, maintaining or restoring adenosine-levels, and it may offer the opportunity of viability testing of normothermic perfused kidneys [34,35]. This technique has the potential to improve organ quality of ischemically damaged uncontrolled DCD kidneys with better graft function and graft survival [36,37]. In addition, preservation with ECMO after cardiac death may provide the opportunity to procure more organs, including the liver, so that they can be used for transplantation [34].…”

Section: Discussionmentioning

confidence: 99%

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

et al. 2013

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SummaryKidneys from uncontrolled donors after cardiac death (DCD) expand the donor pool, but are associated with more primary nonfunction (PNF) and delayed graft function (DGF) compared with more conventional donor kidneys. It remains unclear, which factors influence outcome of uncontrolled donation. Therefore, we studied which donor, graft, and recipient characteristics are associated with PNF in a large cohort study. The association between different characteristics and short-term graft function was analyzed for kidneys procured in the Maastricht region from 1 January 1981 to 1 July 2009. Patients were followed until 7 January 2010. A total of 135 uncontrolled donor kidneys were included in this study. The incidence of PNF and DGF was 22% and 61%, respectively. Increasing donor age is an independent risk factor for graft failure in a univariate analysis (OR 1.035, 95% CI 1.004-1.068, P = 0.028). Donor age remains strongly associated with PNF in a multivariate analysis (OR 1.064, 95% CI 1.013-1.118, P = 0.014). However, the predictive value of donor age alone is poor (AURC 0.640, 95% CI 0.553-0.721). Increasing donor age of uncontrolled DCD donors is a major risk factor for PNF. Other clinically relevant variables were not associated with PNF. Donor age is strongly associated with PNF and remains an important parameter in donor selection.

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Section: Discussionmentioning

confidence: 99%

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

et al. 2013

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“…This applies primarily to organ donation of the kidneys, to a less extent liver and lungs. Up to now, DCD programs have been successfully implemented in many countries (Spain, Italy, The Netherlands, France, Switzerland, USA) (38)(39)(40)(41). The next step in these countries was the use of ECMO perfusion-as a normothermic regional organ perfusion-nECMO, to improve the function of the transplanted organ.…”

Section: Epidemiological Needsmentioning

confidence: 99%

BEST Life—“Bringing ECMO Simulation To Life”—How Medical Simulation Improved a Regional ECMO Program

et al. 2018

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The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.

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“…Viscous solutions like University of Wisconsin (UW) solution have traditionally been too costly for this purpose, and Marshall’s hypertonic citrate (HOC) [6] or Bretschneider’s histidine-tryptophan-ketoglutarate (HTK) [4,5] have been preferred, whilst sanguineous perfusion techniques using extracorporeal membrane oxygenation requires dedicated specialist teams and remains largely experimental [7,8]. …”

Section: Introductionmentioning

confidence: 99%

The influence of perfusion solution on renal graft viability assessment

et al. 2012

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BackgroundKidneys from donors after cardiac or circulatory death are exposed to extended periods of both warm ischemia and intra-arterial cooling before organ recovery. Marshall’s hypertonic citrate (HOC) and Bretschneider’s histidine-tryptophan-ketoglutarate (HTK) preservation solutions are cheap, low viscosity preservation solutions used clinically for organ flushing. The aim of the present study was to evaluate the effects of these two solutions both on parameters used in clinical practice to assess organ viability prior to transplantation and histological evidence of ischemic injury after reperfusion.MethodsRodent kidneys were exposed to post-mortem warm ischemia, extended intra-arterial cooling (IAC) (up to 2 h) with preservation solution and reperfusion with either Krebs-Hensleit or whole blood in a transplant model. Control kidneys were either reperfused directly after retrieval or stored in 0.9% saline. Biochemical, immunological and histological parameters were assessed using glutathione-S-transferase (GST) enzymatic assays, polymerase chain reaction and mitochondrial electron microscopy respectively. Vascular function was assessed by supplementing the Krebs-Hensleit perfusion solution with phenylephrine to stimulate smooth muscle contraction followed by acetylcholine to trigger endothelial dependent relaxation.ResultsWhen compared with kidneys reperfused directly post mortem, 2 h of IAC significantly reduced smooth muscle contractile function, endothelial function and upregulated vascular cellular adhesion molecule type 1 (VCAM-1) independent of the preservation solution. However, GST release, vascular resistance, weight gain and histological mitochondrial injury were dependent on the preservation solution used.ConclusionsWe conclude that initial machine perfusion viability tests, including ischemic vascular resistance and GST, are dependent on the perfusion solution used during in situ cooling. HTK-perfused kidneys will be heavier, have higher GST readings and yet reduced mitochondrial ischemic injury when compared with HOC-perfused kidneys. Clinicians should be aware of this when deciding which kidneys to transplant or discard.

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Kidney Transplantation from a Donor Following Cardiac Death Supported with Extracorporeal Membrane Oxygenation

Cited by 28 publications

References 21 publications

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

BEST Life—“Bringing ECMO Simulation To Life”—How Medical Simulation Improved a Regional ECMO Program

The influence of perfusion solution on renal graft viability assessment

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