Improving the Outcomes of Organs Obtained From Controlled Donation After Circulatory Death Donors Using Abdominal Normothermic Regional Perfusion
| Autor: | M.A. Ballesteros, Beatriz Domínguez-Gil, Emilio Rodrigo, Borja Suberviola, J. C. Rodríguez-San Juan, J. C. Ruiz-San Millan, Eduardo Miñambres |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Tissue and Organ Procurement Ischemia 030230 surgery 03 medical and health sciences 0302 clinical medicine medicine Immunology and Allergy Humans Pharmacology (medical) Survival rate Aged Retrospective Studies Transplantation Kidney business.industry Graft Survival Blood flow Organ Preservation Organ Transplantation Middle Aged medicine.disease Prognosis Circulatory death Tissue Donors Surgery Death Perfusion medicine.anatomical_structure Anesthesia Donation 030211 gastroenterology & hepatology Female Pancreas business Follow-Up Studies |
| Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 17(8) |
| ISSN: | 1600-6143 |
| Popis: | The use of donation after circulatory death (DCD) has increased significantly during the past decade. However, warm ischemia results in a greater risk for transplantation. Indeed, controlled DCD (cDCD) was associated with inferior outcomes compared with donation after brain death. The use of abdominal normothermic regional perfusion (nRP) to restore blood flow before organ recovery in cDCD has been proposed as better than rapid recovery to reverse the effect of ischemia and improve recipients' outcome. Here, the first Spanish series using abdominal nRP as an in situ conditioning method is reported. A specific methodology to avoid restoring circulation to the brain after death determination is described. Twenty-seven cDCD donors underwent abdominal nRP during at least 60 min. Thirty-seven kidneys, 11 livers, six bilateral lungs, and one pancreas were transplanted. The 1-year death-censored kidney survival was 91%, and delayed graft function rate was 27%. The 1-year liver survival rate was 90.1% with no cases of ischemic cholangiopathy. Transplanted lungs and pancreas exhibited primary function. The use of nRP may represent an advance to increase the number and quality of grafts in cDCD. Poor results in cDCD livers could be reversed with nRP. Concerns about restoring brain circulation after death are easily solved. |
| Databáze: | OpenAIRE |
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