Lung Transplantation in Controlled Donation after Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion

Transplant International, Journal Year: 2024, Volume and Issue: 37

Published: May 1, 2024

The main limitation to increased rates of lung transplantation (LT) continues be the availability suitable donors. At present, largest source allografts is still donation after neurologic determination death (brain-death donors, DBD). However, only 20% these donors provide acceptable for transplantation. One proposed strategies increase donor pool use circulatory-determination-of-death (DCD), which has potential significantly alleviate shortage transplantable lungs. According Maastricht classification, there are five types DCD first two categories uncontrolled (uDCD); other three controlled (cDCD). Clinical experience with scarce and remains limited small case series. Controlled donation, meanwhile, most accepted type Although increased, it underutilized worldwide. To achieve a high retrieval rate, adequate management at intensive care unit (ICU), expertise in combined organ procurement critical. This review presents concise update includes step-by-step protocol using abdominal normothermic regional perfusion.

Language: Английский

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American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Ethical, Legal, and Operational Conformance

Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: July 16, 2024

Background. The American Society of Transplant Surgeons convened a multidisciplinary working group to address operational, ethical, and legal considerations surrounding normothermic regional perfusion (NRP) procurement. Methods. group, comprising members from AST across various disciplines including transplant surgery, hepatology, critical care, bioethics, collaborated formulate recommendations guidance for NRP Results. following topics were identified by the as essential standards that need be addressed legal, operational conformance: terminology; conceptualization death in context NRP; communication, logistics, training competency. Conclusions. Fourteen support ethical acceptability United States set expectations conduct procedures are provided.

Language: Английский

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Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion

Transplantation, Journal Year: 2024, Volume and Issue: unknown

Published: July 16, 2024

Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines TA-NRP implementation are lacking, prompting the need consensus recommendations to ensure safe and effective utilization of this technique.

Language: Английский

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Consensus on Clinical Application of Normothermic Regional Perfusion in Organ Donation After Circulatory Determination of Death

Organ medicine., Journal Year: 2025, Volume and Issue: unknown

Published: March 31, 2025

ABSTRACT Organ transplantation is the most effective treatment for end‐stage organ disease. One of major challenges in shortage. For this reason, more and extended criteria donor organs, including those from donation after circulatory determination death (DCDD), are used clinical practice. However, DCDD organs suffer additional warm ischemic damage, which seriously affects transplant outcomes utilization. Recent studies at home abroad have shown that application normothermic regional perfusion (NRP) able to improve quality outcomes. At present, an expert consensus on NRP lacking China, limits standardization high‐quality development our country. We summarized results conducted in‐depth discussions based principles evidence‐based medicine form DCDD. This focuses executive specification corresponding research evidence applying technology DCDD, aiming provide reference opinions guidance promote rapid China.

Language: Английский

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Normothermic Regional Perfusion Performed by a US Organ Procurement Organization for Non-thoracic Organ Donors

American Journal of Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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EXPANDING THE CRITERIA FOR SELECTION OF DONOR HEARTS USING NORMOTHERMIC REGIONAL PERFUSION IN BRAIN-DEAD DONORS

Eastern Ukrainian Medical Journal, Journal Year: 2025, Volume and Issue: 13(1), P. 81 - 92

Published: Jan. 1, 2025

Background. Heart transplantation is a life-saving procedure for patients with end-stage heart failure. The critical shortage of donor organs, martial law in Ukraine causes to expand the criteria selecting hearts using so-called "marginal donors." Due use marginal can increase organ pool by 40%. Methods. We made retrospective analysis 12 cases performed team State Institution "Heart Institute Ministry Health Ukraine" 2012-2023, during which normothermic regional perfusion was used preconditioning. Results. 106 transplants from donors confirmed brain death. In (11.3%) cases, total duration 124.5±10.1 minutes. All had metabolic acidosis, hyperkalemia, and hyperlactatemia before NRP initiation. characterized normalization acid-base state, significant pH (p<0.001), elimination base deficiency (BE) (p<0.001) an HCO3- (p<0.001). There also pO2 decrease pCO2 Moreover, significantly reduced baseline levels lactate 10.4±2.91 mmol/L 1.57±0.33 potassium (p=0.003). Conclusion. Our study showed that brain-dead water-electrolyte disorders, need norepinephrine maintain mean arterial pressure above 50 mm Hg, one-year survival rate 75.0%.

Language: Английский

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Thoracoabdominal normothermic regional perfusion in donors with neurological determination of death extends organ donors pool

Perfusion, Journal Year: 2025, Volume and Issue: 40(1_suppl)

Published: April 1, 2025

Background Heart transplantation team of the Institute Ministry Health Ukraine performs thoracoabdominal normothermic regional perfusion (TA-NRP) procedure for organ preconditioning in marginal donors. Martial law worsens preexisting shortage donor organs since February 2022. The use TA-NRP has been shown to be effective rescucitating donors with circulatory determination death (CDD), and we hypothesize that can used perform situ neurological (NDD) as well, thereby improve quality. Methods A single centre, retrospective analysis outcomes after heart using from NDD who underwent 2022 2024 year at Ukraine. indications were hemodynamic instability NDD, characterized by need norepinephrine >1.0 μg/kg/h maintain mean blood pressure >50 mm Hg. Results was performed 12 cases (11.3%) 106 transplantations between 2019 2023. average duration 124.5 ± 10.1 minutes. Prior initiation, all exhibited metabolic acidosis, hyperkalemia, hyperlactatemia. implementation normalized acid-base balance, demonstrated a significant increase pH ( p < .001), correction base excess (BE) an bicarbonate levels (HCO3-) .001). also significantly reduced baseline lactate 10.4 2.91 mmol/L 1.57 0.33 .001) decreased potassium = .003). Additionally, it led reduction rate arterial .012), accompanied 6.6-fold requirements Conclusion improved quality which resulted 30 days survival 83% 1-year 75% recipients.

Language: Английский

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Donación en asistolia controlada con el uso de perfusión regional normotérmica en membrana de circulación extracorpórea: experiencia en Colombia

Acta Colombiana de Cuidado Intensivo, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

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Liver transplant program utilization of donation after circulatory death liver grafts by procurement technique and storage modality: a survey of US liver transplant surgical directors

Baylor University Medical Center Proceedings, Journal Year: 2025, Volume and Issue: 38(3), P. 253 - 258

Published: Feb. 5, 2025

Introduction Donation after circulatory death (DCD) increased in the US over past decade. However, 30% of DCD liver grafts procured for transplantation are not utilized. Barriers to utilization include quality concerns, particularly risk ischemic cholangiopathy and retransplantation, costs associated with organ acquisition. This study investigated attitudes community toward identified barriers utilization.

Language: Английский

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Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time

Clinical Transplantation, Journal Year: 2025, Volume and Issue: 39(3)

Published: March 1, 2025

ABSTRACT Introduction Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited 30 min. Normothermic machine perfusion (NMP) can mitigate these and facilitate LT DCD grafts with extended tDWIT. We aimed compare outcomes tDWIT preserved on NMP versus static cold storage (SCS). Methods This single‐center study included adult ≥ 2019 2023. Outcomes SCS were compared including EAD, IC, graft survival, patient survival. Results Among 68 30, 64.7% ( n = 44) 35.3% 24) SCS. No differences or recipient demographics observed. The median was 33 min for 30.5 p < 0.01). Despite longer tDWIT, group had lower rates EAD (4.5% vs. 66.7%, 0.01) IC (2.3% 29.2%, One‐year survival higher 0.01), 1‐year comparable between groups 0.18). Conclusion challenges traditional constraints increase pool viable transplantation.

Language: Английский

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