HepatoBiliary Surgery and Nutrition, Journal Year: 2024, Volume and Issue: 13(5), P. 824 - 836
Published: May 13, 2024
Michele Finotti, Anji Wall, Anthony D'Alessandro, Gary Schwartz, Chris Sonnenday, David Goldberg, Ashish Shah, Peter Friend, Jeff P. Orlowski, Greg McKenna, Steve Newton, Brad Adams, William C. Chapman, Amit Mathur, Marwan Abouljoud, Tim Pruett, Amelia Hessheimer, James F. Trotter, Sumeet K. Asrani, Giuliano Testa
Language: Английский
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).
Language: Английский
Citations
33
Transplantation, Journal Year: 2024, Volume and Issue: 108(2), P. 312 - 318
Published: Jan. 19, 2024
On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop consensus statement with supporting data on ethical tenets thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for standards practice that should govern NRP (3) implement central database collection donor recipient United States. National international leaders fields neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, families participated. The conference was designed focus controversial issues neurological flow function donation after circulatory death donors during propose technical necessary ensure this procedure is performed safely effectively. This article discusses major topics conclusions addressed at meeting.
Language: Английский
Citations
25
JAMA Surgery, Journal Year: 2025, Volume and Issue: unknown
Published: Jan. 29, 2025
Importance Normothermic machine perfusion (NMP) has been shown to reduce peritransplant complications. Despite increasing NMP use in liver transplant (LT), there is a scarcity of real-world clinical experience data. Objective To compare LT outcomes between donation after brain death (DBD) and circulatory (DCD) allografts preserved with or static cold storage (SCS). Design, Setting, Participants This single-center, retrospective observational cohort study included all consecutive adult LTs performed January 2019 December 2023 at the Mayo Clinic Arizona. Data analysis was February 2024 June 2024. Outcomes DBD-SCS, DBD-NMP, DCD-SCS, DCD-NMP transplants were compared. Exposure DBD DCD livers on SCS. Main Measures The primary early allograft dysfunction (EAD), intraoperative transfusion, post-LT hospital resource use, including length stay (LOS) readmissions. Secondary acute kidney injury (AKI) 1-year graft patient survival. Results A total 1086 following 4 groups: DBD-SCS (n = 480), DBD-NMP 63), DCD-SCS 264), 279). Among recipients, median (IQR) age 60.0 years (52.0-66.0); 399 recipients (36.7%) female. had lowest EAD rate (17.5%), followed by (50.0%), (36.8%), (27.3%) ( P < .001). transfusion requirement compared other groups. Hospital intensive care unit (ICU) LOS shortest (median [IQR] LOS, 5.0 days [4.0-7.0]; .01; ICU 1.5 [1.2-3.1]; .01). One-year cumulative readmission probability 86% lower for vs (95% CI, 0.09-0.22; .001) 53% 0.26-0.87; AKI events (31.1%) (47.4%) Compared SCS, group 78% overall reduction failure (hazard ratio [HR], 0.22; 95% 0.10-0.49; For those receiving allografts, risk even more pronounced, an 87% decrease (HR, 0.13; 0.05-0.33; significantly protective from mortality SCS 0.31; 0.12-0.80; .02). Conclusions Relevance In this high-volume study, improved reduced especially allografts. may enhance access addressing challenges historically linked use.
Language: Английский
Citations
5
The Journal of Heart and Lung Transplantation, Journal Year: 2024, Volume and Issue: 43(6), P. 954 - 962
Published: Feb. 27, 2024
Language: Английский
Citations
16
Liver Transplantation, Journal Year: 2024, Volume and Issue: 30(8), P. 775 - 784
Published: Jan. 8, 2024
Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in United States. Compared to donation brain death, DCD is less likely result transplantation. For each potential whose organs cannot be utilized for transplantation (ie, dry run), fees are associated with attempted donation, which add overall costs organ acquisition. To better characterize true liver acquisition, we performed a cost comparison acquisition versus at single transplant institute that comprises 2 centers. Cost, recipient, and transportation data all cases, including from July 1, 2019, October 31, 2021, were collected. We found total per was $15,029 more than 18% attributed runs. Overall, accounted 34.5% costs; however, 30.3% volume. Because expansion essential increasing availability grafts transplantation, strategies need implemented decrease runs, using local recovery, transferring hospitals close centers, performing prerecovery analysis. Moreover, these needed ensure financial disincentives procurement utilization do not reverse gains made by expanding machine perfusion technologies.
Language: Английский
Citations
10
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.
Language: Английский
Citations
7
Liver Transplantation, Journal Year: 2024, Volume and Issue: 30(11), P. 1169 - 1180
Published: April 16, 2024
The use of older donors after circulatory death (DCD) for liver transplantation (LT) has increased over the past decade. This study examined whether outcomes LT using DCD (≥50 y) have improved with advancements in surgical/perioperative care and normothermic machine perfusion (NMP) technology. A total 7602 cases from United Network Organ Sharing database (2003–2022) were reviewed. impact on graft survival was assessed Kaplan-Meier HR analyses. In all, 1447 (19.0%) involved donors. Although there a decrease their 2003 to 2014, resurgence noted 2015 reached 21.9% all LTs last 4 years (2019–2022). Initially, 90-day 1-year survivals DCDs worse than younger DCDs, but this difference decreased time no statistical 2015. Similarly, HRs loss recently become insignificant. LT, NMP usage recently, especially extended donor-recipient distances, while median asystole aortic cross-clamp decreased. Multivariable Cox regression analyses revealed that early phase, had highest without NMP, later phases, cold ischemic (>5.5 h) significant predictor. comparable those young donors, recent becoming strategic approach period could mitigate risks, including managing (≤5.5 h), reducing time, adopting longer distances. Optimal may alleviate donor shortage.
Language: Английский
Citations
6
Journal of the American College of Surgeons, Journal Year: 2023, Volume and Issue: 238(1), P. 107 - 118
Published: Sept. 29, 2023
Language: Английский
Citations
16
Current Surgery Reports, Journal Year: 2024, Volume and Issue: 12(3), P. 15 - 25
Published: Feb. 3, 2024
Language: Английский
Citations
5
Current Opinion in Organ Transplantation, Journal Year: 2024, Volume and Issue: 29(3), P. 180 - 185
Published: March 14, 2024
Purpose of review To provide an update regarding the state thoracoabdominal normothermic regional perfusion (taNRP) when used for thoracic organ recovery Recent findings taNRP is growing in its utilization from donation after circulatory death donors, partly because cost effectiveness. has been shown to yield cardiac allograft recipient outcomes similar those brain-dead donors. Regarding use recover donor lungs, United Network Organ Sharing (UNOS) analysis shows that recovered lungs are noninferior, and consistently excellent at high volume centers. Despite growth, ethical debate continues, though clinical data now supports notion there no meaningful brain clamping aortic arch vessels. Summary method recovering both heart donors yields satisfactory a cost-effective manner. endorsed by American Society Transplant Surgeons, continues.
Language: Английский
Citations
5