Association of procurement technique with organ yield and cost following donation after circulatory death.

Autor:	Bakhtiyar SS; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA. Electronic address: syed.shahyanbakhtiyar@gmail.com., Maksimuk TE; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Gutowski J; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA., Park SY; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Cain MT; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA., Rove JY; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA., Reece TB; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA., Cleveland JC Jr; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA., Pomposelli JJ; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Bababekov YJ; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Nydam TL; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Schold JD; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA., Pomfret EA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA; Division of Transplant Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA., Hoffman JRH; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA; University of Colorado Hospital Transplant Center, Aurora, Colorado, USA.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2024 Oct; Vol. 24 (10), pp. 1803-1815. Date of Electronic Publication: 2024 Mar 21.
DOI:	10.1016/j.ajt.2024.03.027
Abstrakt:	Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution's experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative. Competing Interests: Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. John Gutowski and Jordan Hoffman are individual shareholders in TransMedics. Jordan Hoffman is a member of the Donor Alliance Advisory Board and recipient of the ISHLT/O.H. “Bud” Frazier Grant in MCS Translational Research sponsored by Medtronic (ended 2022). Joseph Cleveland received payment from Abbott Medical for serving as the chair of the CEC for the ARiES HM3 trial. Elizabeth Pomfret is the President of the American Society of Transplant Surgeons. Syed Shahyan Bakhtiyar, Tiffany Maksimuk, Sarah Park, Michael Cain, Jessica Rove, T. Brett Reece, James Pomposelli, Yanik Bababekov, Trevor Nydam, and Jesse Schold have no financial disclosures or conflicts of interest to report. (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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