Abdominal normothermic regional perfusion in the United States: current state and future directions

Current Opinion in Organ Transplantation, Journal Year: 2024, Volume and Issue: 29(3), P. 175 - 179

Published: March 20, 2024

Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and now being applied to abdominal-only organ donors abdominal transplant programs.

Language: Английский

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Outcomes following concomitant multiorgan heart transplantation from circulatory death donors: The United States experience

The Journal of Heart and Lung Transplantation, Journal Year: 2024, Volume and Issue: 43(8), P. 1252 - 1262

Published: March 26, 2024

Language: Английский

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Thoracoabdominal Normothermic Regional Perfusion: Real-world Experience and Outcomes of DCD Liver Transplantation

Transplantation Direct, Journal Year: 2025, Volume and Issue: 11(3), P. e1767 - e1767

Published: Feb. 28, 2025

Background. Donation after circulatory death liver transplantation (DCD LT) is underused given historical outcomes fraught with ischemic cholangiopathy (IC). We aimed to assess 6-mo IC in LT from DCD via normothermic regional perfusion (NRP) compared static cold storage (SCS). Methods. A retrospective review of adult Maastricht-III donors and recipients at the University Colorado Hospital January 1, 2017, August 27, 2024, was performed. The rate between NRP SCS. Secondary included biochemical assessments accepted versus declined allografts allograft patient survival for SCS groups. Results. One hundred sixty-two LTs (SCS = 79; 97) were performed 150 74; 86) reached follow-up. Six-month lower (1.2% 9.5%, P 0.03). Donor Risk Index (2.44 [2.02–2.82] 2.17 [1.97–2.30], 0.002) UK Score (4.2 ± 2.9 3.2 2.3, 0.008) higher Liver Graft assessment Following Transplantation score less (–3.3 –3.1, < 0.05). There several differences median parameters during livers, including terminal biliary bicarbonate (22.7 [20.9–29.1] 10.8 [7.6–13.1] mEq/L, 0.004). no significant 12-mo or Conclusions. a disruptive innovation that improves utilization livers. Despite higher-risk donor-recipient pairing SCS, we demonstrate decrease NRP. These data facilitate benchmarking thoracoabdominal support further protocol development.

Language: Английский

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Ethical and legal considerations in normothermic regional perfusion for donation after circulatory death

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: March 7, 2025

Purpose of review This study aims to examine the ethical and legal discourse surrounding normothermic regional perfusion (NRP) for donation after circulatory death (DCD). Recent findings NRP is well established within Europe but faces challenges in US not utilized a variety other countries. compliance with dead donor rule (DDR) Uniform Declaration Death Act (UDDA) most significant recently addressed issue. Additionally, procedures raise concerns regarding public education, informed consent, engagement, trust. Inconsistent regulation – such as US– cause concern anticipated increase frequency support organ recovery transplantation. There no single repository technical outcome data practice refinement key aspect given variation between centers Summary NRP-based presents be by transplantation clinicians organizations conjunction representatives. Additional inquiry into determination death, family information needs authorization, coordinated needed ensure that are appropriately addressed. Public engagement essential bolster preserve

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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Organ Procurement Organization-Based Normothermic Regional Perfusion in the US: Current State and Future Direction

Current Transplantation Reports, Journal Year: 2025, Volume and Issue: 12(1)

Published: May 2, 2025

Language: Английский

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The current landscape of in situ and ex-situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US

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

Published: Sept. 1, 2024

Language: Английский

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Transforming liver transplant allocation with artificial intelligence and machine learning: a systematic review

BMC Medical Informatics and Decision Making, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 24, 2025

Abstract Background The principles of urgency, utility, and benefit are fundamental concepts guiding the ethical practical decision-making process for organ allocation; however, LT allocation still follows an urgency model. Aim To identify analyze data elements used in Machine Learning (ML) Artificial Intelligence (AI) methods, sources, their focus on or LT. Methods A comprehensive search across Ovid Medline Scopus was conducted studies published from 2002 to June 2023. Inclusion criteria targeted quantitative using ML/AI candidates, donors, recipients. Two reviewers assessed eligibility extracted data, following PRISMA guidelines. Results total 20 papers were included, synthesizing results into five major categories. Eight led by a Spanish team, focusing donor-recipient matching proposing machine learning models predict post- survival. Other international addressed supply-demand issues developed predictive optimize outcomes. highlight potential enhance Despite advancements, limitations included lack robust transplant-related improvements compared MELD. Discussion This review highlighted AI ML liver transplant Significant advancements noted, but such as need better absence model remain. Most emphasized survival Future research should address interpretability generalizability these improve post-LT predictions.

Language: Английский

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Kidney Donation After Circulatory Death Using Thoracoabdominal Normothermic Regional Perfusion: The Largest Report of the United States Experience

Transplantation, Journal Year: 2023, Volume and Issue: unknown

Published: Sept. 11, 2023

Background. Thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used for donation after circulatory death (DCD) procurements in the United States. We present largest report of outcomes kidney transplants performed using DCD donor grafts perfused with TA-NRP. Methods. Adult between 2020 and 2022 Network Organ Sharing database were included. Donors ≥50 min asystole aortic cross-clamp time which heart was also transplanted considered TA-NRP donors. All other donors direct recovery Multivariable regressions to assess delayed graft function, as well posttransplant survival all-cause failure at 30, 90, 180 d. A propensity-matched analysis cohorts matched on Kidney Donor Profile Index performed. Results. Of 16 140 total during study period, 306 (1.9%) younger ( P < 0.001) had lower compared Recipients receiving recovered more likely be blood group O 0.001). Transplants likelihood function (adjusted odds ratio 0.22 [95% confidence interval, 0.15-0.31], but similar 180-d = 0.8) 0.3) grafts. These inferences unchanged analysis. Conclusions. Our results demonstrate that allografts have positive short-term mortality outcomes, significantly decreased rates

Language: Английский

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Single center utilization and post‐transplant outcomes of thoracoabdominal normothermic regional perfusion deceased cardiac donor organs

Clinical Transplantation, Journal Year: 2024, Volume and Issue: 38(3)

Published: March 1, 2024

Abstract Introduction Thoracoabdominal normothermic regional perfusion (TA‐NRP) following cardiac death is an emerging multivisceral organ procurement technique. Recent national studies on outcomes of presumptive TA‐NRP‐procured organs are limited by potential misclassification since TA‐NRP not differentiated from donation after (DCD) in registry data. Methods We studied 22 donors whose designees consented to and performed at our institution between January 20, 2020 July 3, 2022. identified these SRTR describe utilization recipient compared them recipients traditional DCD (tDCD) brain (DBD) during the same timeframe. Results All progressed arrest underwent followed heart, lung, kidney, and/or liver procurement. Median donor age was 41 years, 55% had anoxic injury, 45% were hypertensive, 0% diabetic, median kidney profile index 40%. high across all types (88%–100%), with a higher percentage kidneys procured via tDCD (88% vs. 72%, p = .02). Recipient graft survival ranged 89% 100% comparable DBD ( ≥ .2). Delayed function lower for (27% 44%, .045). Conclusion Procurement yielded utilization, types. Further large‐scale study donors, facilitated its capture registry, will be critical fully understand impact as

Language: Английский

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