Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death

Transplantation, Journal Year: 2022, Volume and Issue: 107(2), P. 438 - 448

Published: Aug. 22, 2022

Background . We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD). Methods This is a retrospective analysis UK adult cDCD donors‚ where at least 1 abdominal accepted for transplantation between January 1, 2011, December 31, 2019. Results A mean 3.3 organs transplanted when NRP used compared 2.6 per donor not used. When adjusting organ-specific risk profiles, odds all being by 3-fold liver ( P < 0.0001; 95% confidence interval [CI], 2.20-4.29), 1.5-fold kidney = 0.12; CI, 0.87-2.58), 1.6-fold pancreas 0.0611; 0.98-2.64). Twelve-mo survival superior recipients graft 51% lower risk-adjusted hazard failure (HR 0.494). In analyses, kidneys had 35% chance developing delayed function than non-NRP (odds ratio, 0.65; 0.465-0.901)‚ expected 12-mo estimated glomerular filtration rate 6.3 mL/min/1.73 m 2 better if 0.0001). Conclusions The during DCD leads to utilization conventional recovery.

Language: Английский

---

Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(6), P. 1511 - 1519

Published: May 25, 2023

Kidney transplantation is the optimal treatment for end-stage renal disease, but it still severely limited by a lack of suitable organ donors. Kidneys from donation after circulatory death (DCD) donors have been used to increase transplant rates, these organs are susceptible cold ischemic injury in storage period before transplantation, clinical consequence which high rates delayed graft function (DGF). Normothermic machine perfusion (NMP) an emerging technique that circulates warmed, oxygenated red-cell-based perfusate through kidney maintain near-physiological conditions. We conducted randomized controlled trial compare outcome DCD transplants conventional static (SCS) alone or SCS plus 1-h NMP. A total 338 kidneys were randomly allocated (n = 168) NMP 170), and 277 included final intention-to-treat analysis. The primary endpoint was DGF, defined as requirement dialysis first 7 d transplant. rate DGF 82 135 (60.7%) versus 83 142 (58.5%) (adjusted odds ratio (95% confidence interval) 1.13 (0.69-1.84); P 0.624). not associated with any thrombosis, infectious complications other adverse events. at end did reduce kidneys. demonstrated be feasible, safe application. Trial registration number: ISRCTN15821205 .

Language: Английский

---

Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

Transplantation Direct, Journal Year: 2023, Volume and Issue: 9(3), P. e1450 - e1450

Published: Feb. 17, 2023

Normothermic regional perfusion (NRP) has gained widespread adoption in multiple European countries. The aim of this study was to examine the influence thoracoabdominal-NRP (TA-NRP) on utilization and outcomes liver, kidney, pancreas transplantation United States.Using US national registry data between 2020 2021, donation after circulatory death (DCD) donors were separated into 2 groups: DCD with TA-NRP without TA-NRP. There 5234 donors; among them 34 After 1:4 propensity score matching, rates compared TA-NRP.Although kidney comparable (P = 0.71 P 0.06, 94.1% versus 95.6% 8.8% 2.2%, respectively), that liver significantly higher < 0.001; 70.6% 39.0%). Among 24 transplantations, 62 3 transplantations from TA-NRP, there grafts 1 graft failed within y transplantation.TA-NRP States increased rate abdominal organs transplantation. Increasing use NRP may expand donor pool compromising transplant outcomes.

Language: Английский

---

The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study

EClinicalMedicine, Journal Year: 2023, Volume and Issue: 58, P. 101887 - 101887

Published: March 2, 2023

BackgroundHeart transplantation is an effective treatment offering the best recovery in both quality and quantity of life those affected by refractory, severe heart failure. However, limited donor organ availability. The reintroduction donation after circulatory determination death (DCD) 2014 offered uplift transplant activity 30%. Thoraco-abdominal normothermic regional perfusion (taNRP) enables in-situ reperfusion DCD heart. objective this paper to assess clinical outcomes hearts recovered transplanted from donors undergoing taNRP.MethodThis was a multicentre retrospective observational study. Outcomes included functional warm ischaemic time, use mechanical support immediately following transplantation, perioperative long-term actuarial survival incidence acute rejection requiring treatment. 157 taNRP transplants, performed between February 2, 2015, July 29, 2022, have been 15 major centres worldwide including UK, Spain, USA Belgium. 673 donations neurological (DBD) transplantations same were used as comparison group for survival.FindingstaNRP resulted 23% increase activity. Survival similar when compared DBD. 30-day 96.8% ([92.5%–98.6%] 95% CI, n = 156), 1-year 93.2% ([87.7%–96.3%] 72) 5-year 84.3% ([69.6%–92.2%] 13).InterpretationOur study suggests that provides significant boost rates are comparable obtained DBD may part be related short time or through possible selection bias younger donors, being uncontrolled Therefore, our offers method preservation procurement. This early success technique warrants further investigation use.FundingNone authors financial relationship with commercial entity has interest subject.

Language: Английский

---

Maintaining the permanence principle of death during normothermic regional perfusion in controlled donation after the circulatory determination of death: Results of a prospective clinical study

American Journal of Transplantation, Journal Year: 2023, Volume and Issue: 24(2), P. 213 - 221

Published: Sept. 21, 2023

Language: Английский

---

A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation

Transplant International, Journal Year: 2021, Volume and Issue: 34(11), P. 2046 - 2060

Published: Sept. 27, 2021

Language: Английский

---

Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation’s Transplant Learning Journey

Transplant International, Journal Year: 2021, Volume and Issue: 34(11), P. 2019 - 2030

Published: June 19, 2021

Language: Английский

---

Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(12), P. 3871 - 3871

Published: June 6, 2023

The high demand for organs in kidney transplantation and the expansion of donor pool have led to widespread implementation machine perfusion technologies. In this study, we aim provide an up-to-date systematic review developments expanding field over past 10 years, with answering question: “which technique is most promising transplantation?” A literature related was performed. primary outcome measure delayed graft function (DGF), secondary outcomes included rates rejection, survival, patient survival after 1 year. Based on available data, a meta-analysis results were compared data from static cold storage, which still standard care many centers worldwide. total 56 studies conducted humans included, 43 reported hypothermic (HMP), DGF rate 26.4%. 16 showed significantly lower HMP group those storage (SCS). Five + O2, overall 29.7%. Two explored normothermic (NMP). These pilot studies, designed assess feasibility approach clinical setting. Six regional (NRP). incidence 71.5%, as it primarily used uncontrolled DCD (Maastricht category I-II). Three comparing NRP situ NRP. evidence that dynamic preservation strategies can improve following transplantation. More recent approaches such O2 do show but need further This study shows could play important role safely pool.

Language: Английский

---

Should advanced perfusion be the standard of care for donation after circulatory death liver transplant?

American Journal of Transplantation, Journal Year: 2024, Volume and Issue: 24(7), P. 1127 - 1131

Published: March 19, 2024

Language: Английский

---

The economic impact of machine perfusion technology in liver transplantation

Artificial Organs, Journal Year: 2021, Volume and Issue: 46(2), P. 191 - 200

Published: Dec. 8, 2021

Abstract Introduction Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine costs related associated outcomes. Methods Expert opinion several groups representing different modalities. Critical analysis published literature reporting most used techniques transplantation (normothermic hypothermic ex situ normothermic regional perfusion). Results Machine include disposable components device, perfusate components, personnel facility fees, depreciation device or lease fee. The limited current suggests that this upfront cost varies between modalities, use is highly likely be cost‐effective. Optimization donor utilization rate, local conditions transplant programs (long waiting list times higher MELD scores), a decreased rate complications, changes logistics, length hospital stay potential savings points must highlight expected benefits intervention. An additional unaccounted factor optimizing organ allows patients transplanted earlier, avoiding deterioration while on with admissions other required procedures. Conclusion So far, guided implementation transplantation. Albeit there data suggesting benefit technique, further investigation healthcare systems society needed.

Language: Английский

---