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
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.
Transplantation,
Journal Year:
2024,
Volume and Issue:
unknown
Published: July 18, 2024
To
overcome
organ
shortages,
donation
after
circulatory
death
(DCD)
kidneys
are
being
increasingly
used
for
transplantation.
Prior
research
suggests
that
DCD
have
inferior
outcomes
compared
with
donated
brain
death.
Normothermic
machine
perfusion
(NMP)
and
normothermic
regional
(NRP)
may
enhance
the
preservation
of
improve
transplant
outcomes.
This
study
aimed
to
review
evidence
surrounding
NMP
NRP
in
kidney
Journal of Nephrology,
Journal Year:
2024,
Volume and Issue:
37(6), P. 1449 - 1461
Published: March 6, 2024
Based
on
the
current
projection
of
general
population
and
combined
increase
in
end-stage
kidney
disease
with
age,
number
elderly
donors
recipients
is
increasing,
raising
crucial
questions
about
how
to
minimize
discard
rate
organs
from
improve
graft
patient
outcomes.
In
2002,
extended
criteria
were
focus
a
meeting
Crystal
City
(VA,
USA),
goal
maximizing
use
deceased
donors.
Since
then,
have
progressively
contributed
large
transplanted
grafts
worldwide,
posing
specific
issues
for
allocation
systems,
recipient
management,
therapeutic
approaches.
This
review
analyzes
what
we
learned
last
20
years
donor
utilization,
promising
innovations
immunosuppressive
molecular
pathways
involved
aging
process,
which
constitute
potential
targets
novel
therapies.
Transplantation,
Journal Year:
2024,
Volume and Issue:
unknown
Published: July 25, 2024
Controlled
donation
after
the
circulatory
determination
of
death
(cDCDD)
has
emerged
as
a
strategy
to
increase
availability
organs
for
clinical
use.
Traditionally,
from
cDCDD
donors
have
been
subject
standard
rapid
recovery
(SRR)
with
poor
posttransplant
outcomes
abdominal
organs,
particularly
liver,
and
limited
organ
utilization.
Normothermic
regional
perfusion
(NRP),
based
on
use
extracorporeal
membrane
oxygenation
devices,
consists
in
situ
that
will
be
transplantation
oxygenated
blood
under
normothermic
conditions
declaration
before
recovery.
NRP
is
potential
solution
address
limitations
traditional
methods.
It
become
normal
practice
several
European
countries
recently
introduced
United
States.
The
increased
occurred
result
growing
body
evidence
its
association
improved
utilization
compared
SRR.
However,
expansion
precluded
by
obstacles
an
organizational,
legal,
ethical
nature.
This
article
details
technique
both
thoracoabdominal
NRP.
Based
available
evidence,
it
describes
benefits
terms
thoracic
addresses
cost-effectiveness
aspects
NRP,
well
logistical
limit
implementation
this
innovative
preservation
strategy.
American Journal of Transplantation,
Journal Year:
2022,
Volume and Issue:
22(7), P. 1852 - 1860
Published: April 7, 2022
Despite
the
benefits
of
abdominal
normothermic
regional
perfusion
(A-NRP)
for
grafts
in
controlled
donation
after
circulatory
death
(cDCD),
there
is
limited
information
on
effect
A-NRP
quality
cDCD
lungs.
We
aimed
to
study
lungs
obtained
from
and
its
impact
recipients´
outcomes.
This
a
comparing
outcomes
lung
transplants
(LT)
donors
(September
2014
December
2021)
using
as
preservation
method.
As
controls,
all
recipients
transplanted
brain
(DBD)
were
considered.
The
primary
recipient
3-month,
1-year,
5-year
survival.
A
total
269
LT
performed
(60
209
DBD).
There
was
no
difference
survival
at
3
months
(98.3%
vs.
93.7%
DBD),
1
year
(90.9%
87.2%),
5
years
(68.7%
69%).
group
had
higher
rate
graft
dysfunction
grade
72
h
(10%
3.4%;
p
<
.001).
largest
experience
ever
reported
with
use
combined
retrieval
donors.
method
safe
presenting
short-term
equivalent
those
through
DBD.
Liver Transplantation,
Journal Year:
2024,
Volume and Issue:
30(11), P. 1132 - 1144
Published: July 22, 2024
Liver
transplantation
(LTX)
using
donors
after
controlled
circulatory
death
(cDCD)
is
associated
with
poorer
graft
survival
and
increased
incidence
of
nonanastomotic
biliary
strictures
(NASs)
compared
to
livers
procured
from
brain-dead
(DBD).
The
use
normothermic
regional
perfusion
(NRP)
during
cDCD
procurement
may
improve
posttransplant
outcomes
reduce
the
NAS.
In
Sweden,
LTX
was
introduced
through
a
national
pilot
protocol
mandatory
NRP.
This
study
aims
evaluate
outcome
period.
Donor
recipient
data
were
collected
on
all
liver
transplants
period
between
January
2020
December
2022.
Outcome
NAS,
patient
survival,
early
allograft
dysfunction,
acute
kidney
injury,
comprehensive
complication
index
matched
cohort
28
patients
transplanted
DBD
2018
Eighteen
donor
mean
functional
warm
ischemia
time
29
±
6
minutes.
lactate
reduction
NRP
8.7
2.4
mmol/L,
end
perfusate
alanine
aminotransferase
1.4
1
µkat/L.
When
comparing
recipients
transplant
DBD,
no
significant
differences
observed
in
index,
or
injury.
Study
magnetic
resonance
cholangiopancreatography
showed
signs
subclinical
strictures.
Evaluation
Swedish
shows
comparable
94.4%
1-year
NAS
within
first
year.
