Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss

American Journal of Transplantation, Journal Year: 2021, Volume and Issue: 22(4), P. 1169 - 1181

Published: Dec. 2, 2021

Language: Английский

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Utilization of livers donated after circulatory death for transplantation – An international comparison

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 78(5), P. 1007 - 1016

Published: Feb. 4, 2023

Liver graft utilization rates are a hot topic due to the worldwide organ shortage and increasing number of transplant candidates on waiting lists. perfusion techniques have been introduced in several countries, may help increase supply, as they potentially enable assessment livers before use.Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht type III) arising during past decade eight including Belgium, France, Italy, Netherlands, Spain, Switzerland, UK, US. Initial type-III DCD liver correlated with accepted, recovered implanted livers.A total 34,269 offered, resulting 9,780 transplants (28.5%). The discard highest UK US, ranging between 70 80%. In contrast, much lower rates, e.g. 30-40%, found Spain Switzerland. addition, we observed large differences use various machine techniques, well donor risk factors. For example, median age functional warm ischemia time >40 min, followed by Netherlands. Importantly, such varying profiles accepted countries did not translate into 5-year survival which ranged 60-82% this analysis.Overall, across high, although primarily reflects situation Countries where situ ex strategies used routinely had better without compromised outcomes.A significant Maastricht III discarded Europe North America today. overall rate among Western is 28.5% but varies significantly 18.9% 74.2%. DCD-III five 65%, contrast 24% Despite this, despite different rules for acceptance preservation, 1- remain fairly similar all participating countries. A highly experience modern technology was observed. concepts, application tools transplantation, be key explanation utilization.

Language: Английский

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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

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Response to American College of Physician’s statement on the ethics of transplant after normothermic regional perfusion

American Journal of Transplantation, Journal Year: 2022, Volume and Issue: 22(5), P. 1307 - 1310

Published: Jan. 24, 2022

This paper responds to the position statement released by American College of Physicians (ACP) entitled "Ethics, Determination Death, and Organ Transplantation in Normothermic Regional Perfusion (NRP) with Controlled Donation after Circulatory Death (cDCD): Statement Concern." The ACP's engages critical ethical issues surrounding cDCD NRP, but several their conclusions are flawed. Contrary statement, practice respects dead donor rule legal definition death while honoring wishes deceased loved ones help save lives those need organ transplants. NRP is well established many countries, it can enhance trust medical donation, will increase availability optimal organs for life-saving

Language: Английский

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Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts

The American Journal of Bioethics, Journal Year: 2024, Volume and Issue: 24(6), P. 16 - 26

Published: June 2, 2024

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although experiencing a resurgence due to recently completed trials using ex vivo perfusion systems, interest thoracoabdominal normothermic regional (TA-NRP), wherein organs are reanimated situ prior procurement, raised many ethical questions. We outline practical, ethical, and equity considerations ensure transplant programs make well-informed decisions about TA-NRP. present multidisciplinary analysis relevant issues arising from DCDD-NRP including application Dead Donor Rule Uniform Definition Death Act, provide recommendations facilitate input all interested parties. also recommend informed consent, as distinct typical "authorization," for cadaveric organ donation

Language: Английский

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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

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Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 11(17), P. 5218 - 5218

Published: Sept. 3, 2022

Based on the renaissance of dynamic preservation techniques, extended criteria donor (ECD) livers reclaimed a valuable eligibility in transplantable organ pool. Being more vulnerable to ischemia, ECD carry an increased risk early allograft dysfunction, primary non-function and biliary complications and, hence, unveiled limitations static cold storage (SCS). There is growing evidence that techniques—dissimilar SCS—mitigate reperfusion injury by reconditioning organs prior transplantation therefore represent useful platform assess viability. Yet, debate ongoing about advantages disadvantages different perfusion strategies their best possible applications for specific categories marginal livers, including from donors after circulatory death (DCD) brain (DBD) with criteria, split steatotic grafts. This review critically discusses current clinical spectrum together various challenges posttransplant outcomes context standard preservation. this, potential role machine techniques highlighted next. Finally, future perspectives focusing how achieve higher utilization rates available pool are highlighted.

Language: Английский

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Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis

International Journal of Surgery, Journal Year: 2023, Volume and Issue: unknown

Published: Aug. 14, 2023

Background: Increasing use of extended-criteria donors (ECD) set higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes but its effects on different donor types remains unclear. Our aim was to assess the hypothermic machine (HMP), normothermic (NMP), or regional (NRP) versus static cold storage (SCS) types. Materials and Methods: A literature search comparing efficacy MP SCS in PubMed, Cochrane EMBASE database conducted. Meta-analysis performed obtain pooled extended criteria (ECD), donation after circulatory death (DCD), brainstem death. Results: 39 studies were included (9 RCTs 30 cohort studies). Compared with SCS, HMP significantly reduced risk non-anastomotic biliary stricture (NAS) (OR 0.43, 95%CI 0.26-0.72), major complications 0.55, 0.39-0.78), early allograft dysfunction (EAD) 0.46, 0.32-0.65) improve one-year 2.36, 1.55-3.62) ECD-OLT. also primary nonfunction (PNF) 0.40, 0.18-0.92) acute rejection 0.62, 0.40-0.97). NMP only ECD-OLT 0.56, 0.34-0.94), without favorable other survival. NRP lower overall NAS 0.27, 0.11-0.68), PNF 0.22-0.85), EAD 0.58, 0.42-0.80) meanwhile improved survival 2.40, 1.65-3.49) control DCD-OLT. Conclusions: might currently be considered marginal livers as it comprehensively outcomes. assists some more evidence regarding NMP-ECD is warrant. DCD-OLT recommended where longer non-touch periods exist.

Language: Английский

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Donation after circulatory death: Novel strategies to improve the liver transplant outcome

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 78(6), P. 1169 - 1180

Published: May 17, 2023

Language: Английский

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Effects of ketone body 3-hydroxybutyrate on cardiac and mitochondrial function during donation after circulatory death heart transplantation

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 8, 2024

Abstract Normothermic regional perfusion (NRP) allows assessment of therapeutic interventions prior to donation after circulatory death transplantation. Sodium-3-hydroxybutyrate (3-OHB) increases cardiac output in heart failure patients and diminishes ischemia–reperfusion injury, presumably by improving mitochondrial metabolism. We investigated effects 3-OHB on function transplanted hearts organoids. Donor pigs (n = 14) underwent followed NRP. Following static cold storage, were into recipient pigs. or Ringer’s acetate infusions initiated during NRP evaluated hemodynamics function. mediated contractility, relaxation, calcium, conduction tested organoids from human pluripotent stem cells. NRP, increased (P < 0.0001) increasing stroke volume 0.006), dP/dt 0.02) reducing arterial elastance 0.02). transplantation, infusion maintained respiration 0.009) but caused inotropy-resistant vasoplegia that prevented weaning. In organoids, contraction amplitude 0.002) shortened duration 0.013) without affecting calcium handling velocity. had beneficial may have a potential secure Further studies are needed optimize administration practice donors recipients validate the effect

Language: Английский

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