Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Cuesta, Víctor Manuel Mora; Ballesteros, M.Á.; Naranjo, Sara; Sánchez, Laura; Suberviola, Borja; Iturbe, David; Cimadevilla, Bonifacio; Tello, Sandra; Álvaréz, Carlos; Miñambres, Eduardo

doi:10.1111/ajt.17057

Cited by 19 publications

(25 citation statements)

References 42 publications

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“…However, NRP is increasingly used in DCD heart and abdominal organ procurements in the United States and has shown favorable utilization and graft outcomes for both kidney and liver transplantations compared with static cold storage 13,41,42 . NRP was also found to be safe for DCD lung retrieval in a large institutional series 43 . While no studies have demonstrated the superiority of NRP over EVP for DCD heart transplantation, this procurement strategy for DCD hearts is associated with improved utilization and posttransplant outcomes for concomitantly procured abdominal organs 44 .…”

Section: Discussionmentioning

confidence: 94%

“…13,41,42 NRP was also found to be safe for DCD lung retrieval in a large institutional series. 43 While no studies have demonstrated the superiority of NRP over EVP for DCD heart transplantation, this procurement strategy for DCD hearts is associated with improved utilization and posttransplant outcomes for concomitantly procured abdominal organs. 44 Despite this, the current analysis reports that NRP is currently used in a minority of DCD transplants, and our findings do not account for any potential benefit of NRP on posttransplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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Objectives: To summarize waitlist and transplant outcomes in kidney, liver, lung, and heart transplantation using organ donation after circulatory death (DCD). Background: DCD has expanded the donor pool for solid organ transplantation, most recently for heart transplantation. Methods: The United Network for Organ Sharing registry was used to identify adult transplant candidates and recipients in the most recent allocation policy eras for kidney, liver, lung, and heart transplantation. Transplant candidates and recipients were grouped by acceptance criteria for DCD versus brain-dead donors [donation after brain death (DBD)] only and DCD versus DBD transplant, respectively. Propensity matching and competingrisks regression was used to model waitlist outcomes. Survival was modeled using propensity matching and Kaplan-Meier and Cox regression analysis. Results: DCD transplant volumes have increased significantly across all organs. Liver candidates listed for DCD organs were more likely to undergo transplantation compared with propensity-matched candidates listed for DBD only, and heart and liver transplant candidates listed for DCD were less likely to experience death or clinical deterioration requiring waitlist inactivation. Propensity-matched DCD recipients demonstrated an increased mortality risk up to 5 years after liver and kidney transplantation and up to 3 years after lung transplantation compared with DBD. There was no difference in 1-year mortality between DCD and DBD heart transplantation. Conclusions: DCD continues to expand access to transplantation and improves waitlist outcomes for liver and heart transplant candidates. Despite an increased risk for mortality with DCD kidney, liver, and lung transplantation, survival with DCD transplant remains acceptable.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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“…Furthermore, a theoretical risk of compromise to organs exists because of the temperature differential between thoracic and abdominal cavities. A retrospective study of lungs transplanted from controlled DCD donors utilizing A-NRP compared with standard DBD donors demonstrated higher rates of PGD in the A-NRP DCD group (though similar PGD rate to lungs recovered from a non-NRP standard DCD donor); short-term and long-term survival was equivalent between A-NRP DCD and DBD groups [52 ▪ ]. Thoracoabdominal-NRP differs from A-NRP in that cerebral vessels are ligated to prevent blood flow to the brain while perfusion to thoracic organs is maintained.…”

Section: Normothermic Regional Perfusionmentioning

confidence: 99%

Lung preservation: from perfusion to temperature

Bromberger¹,

Brzeziński²,

Kukreja

2023

Current Opinion in Organ Transplantation

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Purpose of reviewThis article will review the evidence behind elements of the lung preservation process that have remained relatively stable over the past decade as well as summarize recent developments in ex-vivo lung perfusion and new research challenging the standard temperature for static cold storage.Recent findingsEx-vivo lung perfusion is becoming an increasingly well established means to facilitate greater travel distance and allow for continued reassessment of marginal donor lungs. Preliminary reports of the use of normothermic regional perfusion to allow utilization of lungs after DCD recovery exist, but further research is needed to determine its ability to improve upon the current method of DCD lung recovery. Also, research from the University of Toronto is re-assessing the optimal temperature for static cold storage; pilot studies suggest it is a feasible means to allow for storage of lungs overnight to allow for daytime transplantation, but ongoing research is awaited to determine if outcomes are superior to traditional static cold storage.SummaryIt is crucial to understand the fundamental principles of organ preservation to ensure optimal lung function posttransplant. Recent advances in the past several years have the potential to challenge standards of the past decade and reshape how lung transplantation is performed.

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“…There was no difference in survival at 3 months, 1, and 5 years. Lung allografts from A-NRP donors did have a higher rate of PGD at 72 h, 10 vs. 3.4% [25] They point out what they consider to be flaws in view of the ACP; that reperfusion with NRP is not therapeutic, and that there is no intent to resuscitate a dead individual whom does not wish to be resuscitated [33 && ]. Instead, perfusion of only their organs occurs to honor their wishes to donate.…”

Section: Key Pointsmentioning

confidence: 99%

Normothermic regional perfusion for donation after circulatory death donors

Pasrija

Tipograf

Shah

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewThis review is intended to provide an update on the logistics, technique, and outcomes associated with normothermic regional perfusion (NRP), as well as provide a discussion of the associated ethical issues.Recent findingsThere has been renewed interest in utilizing NRP to increase quality and availability of organs from donation after circulatory death (DCD) donors. Our institution has increasing experience with thoraco-abdominal NRP (TA-NRP) in controlled DCD donors (cDCD), whereas abdominal NRP (A-NRP) has been used with success in both cDCD and uncontrolled DCD (uDCD). There is increasing evidence that NRP can be conducted in a practical and cost-efficient manner, and that the organ yield may be of better quality than standard direct procurement and perfusion (DPP).SummaryNRP is increasingly successful and will likely prove to be a superior method for cDCD recovery. However, before TA-NRP can be widely accepted the ethical debate surrounding this technique must be settled.Video abstracthttp://links.lww.com/COOT/A11

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Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Cited by 19 publications

References 42 publications

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

Lung preservation: from perfusion to temperature

Normothermic regional perfusion for donation after circulatory death donors

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