Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation.
BACKGROUND
Cardiopulmonary resuscitation (CPR) of a person destined to become an organ donor has been associated with overall poor donor quality, especially for the intestinal donor, as splanchnic vasoconstriction that is intended to preserve coronary and cerebral blood flow may result in clinically relevant intestinal ischemia. Outcomes of recipients who receive intestine grafts that have suffered CPR are unknown. We sought to analyze our clinical experience in using intestinal grafts from donors who suffered cardiopulmonary arrest and resuscitation and to evaluate the outcome of recipients of organs coming from resuscitated donors when compared with recipients of nonresuscitated donors.


METHODS
We retrospectively analyzed the donor and recipient charts of all of our intestinal transplants with regard to the performance of donor CPR.


RESULTS
Sixty-seven intestinal transplants were performed in 65 patients from November 2003 to December 2007. Twelve donors (18%) were identified as having suffered cardiac arrest and subsequent CPR. Mean duration of CPR was 19.3+/-12.7 min. Terminal laboratory profiles of CPR donors and non-CPR donors were similar. Of the 12 resuscitated grafts, two were used for multivisceral, one for a modified multivisceral, seven for liver-intestine, and two for isolated intestinal transplant. There were no significant differences in outcome parameters such as operative time, blood use, ventilation days, length of stay, time to enteral independence, rejection, enteric bacteremia, and survival between the 12 resuscitated grafts and the 55 nonresuscitated grafts.


CONCLUSIONS
A donor history of cardiac arrest should not automatically exclude the use of the intestine graft for transplantation.
Department of Surgery, Center for Intestinal Care and Transplantation, Georgetown University Hospital, Washington DC 20007, USA. cal.matsumoto@medstar.net
Cal S
CS
Matsumoto
Stuart S
SS
Kaufman
Raffaele
R
Girlanda
Cheryl M
CM
Little
Yuliya
Y
Rekhtman
Vandad
V
Raofi
Jaqueline M
JM
Laurin
Kirti
K
Shetty
Erin M
EM
Fennelly
Lynt B
LB
Johnson
Thomas M
TM
Fishbein
D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death; D006084:Graft Rejection / Q000453:epidemiology; D006323:Heart Arrest; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D007902:Length of Stay; D016031:Liver Transplantation / Q000276:immunology; D018579:Patient Selection; D012151:Resuscitation; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D014019:Tissue Donors / Q000145:classification / Q000600:supply & distribution*; D016896:Treatment Outcome; D014781:Viscera / Q000637:transplantation