Seminars in Cardiothoracic and Vascular Anesthesia,
Journal Year:
2024,
Volume and Issue:
28(2), P. 100 - 105
Published: April 17, 2024
Noteworthy
in
Cardiothoracic
Surgery
2023
summarizes
a
few
of
the
most
high-impact
trials
and
provocative
trends
cardiothoracic
surgery
transplantation
this
past
year.
Transplantation
using
organs
procured
from
donation
after
circulatory
death
(DCD)
continues
to
increase,
American
Society
Transplant
Surgeons
released
recommendations
on
best
practices
2023.
We
review
summary
data
impact
DCD
heart
lung
transplantation.
There
has
been
increased
interest
extracorporeal
life
support
(ECLS),
particularly
COVID-19
pandemic,
we
results
highly
discussed
ECLS-SHOCK
trial,
which
randomized
patients
cardiogenic
shock
with
planned
revascularization
ECLS
vs
usual
care.
With
improving
survival
outcomes
complex
aortic
surgery,
there
is
need
for
higher-quality
evidence
guide
cooling
cerebral
perfusion
strategies
may
optimize
cognitive
these
patients.
short-term
GOT
ICE
trial
(Cognitive
Effects
Body
Temperature
During
Hypothermic
Circulatory
Arrest),
multicenter,
controlled
three
different
nadir
temperatures,
evaluating
cognition
associated
changes
functional
magnetic
resonance
imaging.
Finally,
both
Thoracic
(STS)
College
Cardiology,
Heart
Association,
Chest
Physicians
Rhythm
(ACC/AHA/ACCP/HRS)
updated
atrial
fibrillation
guidelines
2023,
surgically
relevant
updates
behind
them.
Liver Transplantation,
Journal Year:
2023,
Volume and Issue:
unknown
Published: April 12, 2023
In
situ
abdominal
normothermic
regional
perfusion
(A-NRP)
has
been
used
for
liver
transplantation
(LT)
with
donation
after
circulatory
death
(DCD)
grafts
in
Europe
excellent
results;
however,
adoption
of
A-NRP
the
United
States
lacking.
The
current
report
describes
implementation
and
results
a
portable,
self-reliant
program
States.
Isolated
an
extracorporeal
circuit
was
achieved
through
cannulation
abdomen
or
femoral
vessels
inflation
supraceliac
aortic
balloon
cross-clamp.
Quantum
Transport
System
by
Spectrum
used.
decision
to
use
livers
LT
made
assessment
perfusate
lactate
(q15min).
From
May
November
2022,
14
procurements
were
performed
our
transplant
team
(N
=
11
LT,
N
20
kidney
transplants,
1
kidney-pancreas
transplant).
median
run
time
68
minutes.
None
recipients
had
post-reperfusion
syndrome,
nor
there
any
cases
primary
nonfunction.
All
functioning
well
at
maximal
follow-up
zero
ischemic
cholangiopathy.
feasibility
portable
that
can
be
Excellent
short-term
post-transplant
both
kidneys
procured
from
A-NRP.
JAMA Surgery,
Journal Year:
2024,
Volume and Issue:
159(6), P. 677 - 677
Published: April 3, 2024
Normothermic
regional
perfusion
(NRP)
is
an
emerging
recovery
modality
for
transplantable
allografts
from
controlled
donation
after
circulatory
death
(cDCD)
donors.
In
the
US,
only
11.4%
of
liver
recipients
who
are
transplanted
a
deceased
donor
receive
cDCD
liver.
NRP
has
potential
to
safely
expand
US
pool
with
improved
transplant
outcomes
as
compared
standard
super
rapid
(SRR).
Journal of Clinical Medicine,
Journal Year:
2023,
Volume and Issue:
12(3), P. 909 - 909
Published: Jan. 23, 2023
While
adoption
of
machine
perfusion
technologies
into
clinical
practice
in
the
United
States
has
been
much
slower
than
Europe,
recent
changes
transplant
landscape
as
well
device
availability
following
FDA
approval
have
paved
way
for
rapid
growth.
Machine
may
provide
one
mechanism
to
maximize
utilization
potential
donor
liver
grafts.
Indeed,
multiple
studies
shown
increased
organ
with
implementation
such
ex-situ
normothermic
(NMP),
hypothermic
(HMP)
and
in-situ
regional
(NRP).
The
current
review
describes
history
development
Unites
along
future
directions.
It
also
differences
between
Europe
how
this
shaped
application
these
technologies.
Transplantation,
Journal Year:
2024,
Volume and Issue:
unknown
Published: July 16, 2024
Normothermic
regional
perfusion
(NRP)
has
emerged
as
a
vital
technique
in
organ
procurement,
particularly
donation
after
circulatory
death
(DCD)
cases,
offering
the
potential
to
optimize
utilization
and
improve
posttransplant
outcomes.
Recognizing
its
significance,
American
Society
of
Transplant
Surgeons
(ASTS)
convened
work
group
develop
standardized
recommendations
for
abdominal
NRP
United
States.
Transplantation,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Dec. 24, 2024
The
availability
of
in
situ
normothermic
regional
perfusion
(NRP)
or
ex
machine
(NMP)
has
revolutionized
donation
after
circulatory
death
(DCD)
liver
transplant
(LT).
While
some
have
suggested
that
NRP
and
NMP
may
represent
competing
technologies
for
DCD
LT,
there
are
many
scenarios
where
these
can
function
a
complementary
manner.
The Hastings Center Report,
Journal Year:
2024,
Volume and Issue:
54(4), P. 14 - 23
Published: May 20, 2024
Abstract
In
transplant
medicine,
the
use
of
normothermic
regional
perfusion
(NRP)
in
donation
after
circulatory
determination
death
raises
ethical
difficulties.
NRP
is
objectionable
because
it
restores
donor's
circulation,
thus
invalidating
a
declaration
based
on
permanent
cessation
circulation.
NRP's
defenders
respond
with
arguments
that
are
tortuous
and
factually
inaccurate
depend
introducing
extraneous
concepts
into
law.
However,
results
comparable
to
NRP's—more
higher‐quality
organs
more
efficient
allocation—can
be
achieved
by
removing
from
deceased
donors
using
machine
(NMP)
support
outside
body,
without
jeopardizing
confidence
transplantation's
legal
foundations.
Given
controversy
generates
convoluted
justifications
made
for
it,
we
recommend
prudential
approach
call
“ethical
parsimony,”
which
holds
that,
choice
between
competing
means
achieving
result,
ethically
simpler
one
preferred.
This
makes
clear
policy‐makers
should
favor
NMP
over
.
Transplantation,
Journal Year:
2024,
Volume and Issue:
109(1), P. 10 - 21
Published: Oct. 22, 2024
On
November
9
and
10,
2023,
the
Organización
Nacional
de
Trasplantes
(ONT),
under
Spanish
Presidency
of
Council
European
Union,
convened
in
Santander
a
Global
Summit
entitled
"Towards
Convergence
Transplantation:
Sufficiency,
Transparency
Oversight."
This
article
summarizes
two
distinct
but
related
challenges
elaborated
at
by
Working
Group
2
that
must
be
overcome
if
we
are
to
develop
expand
deceased
donation
worldwide
achieve
goal
self-sufficiency
organ
transplantation.
Challenge
1:
need
for
unified
concept
death
based
on
permanent
cessation
brain
function.
group
proposed
challenge
1
requires
global
community
work
toward
uniform,
definition
human
death,
conceptually
unifying
circulatory
neurological
criteria
around
function
accepting
is
valid
criterion
determine
death.
2:
reducing
disparities
increasing
utilization
through
after
determination
(DCDD).
DCDD,
expanding
DCDD
situ
normothermic
regional
perfusion,
ex
machine
perfusion
technology.
Recommendations
implementation
described.
