title: Hypothermic or normothermic abdominal regional perfusion in high-risk donors with extended warm ischemia times: impact on outcomes?
abstract: Donation after circulatory determination of death (DCD) has the potential to increase the applicability of transplantation as a treatment for end-stage organ disease; its use is limited, however, by the warm ischemic damage suffered by potential grafts. Abdominal regional perfusion (ARP) has been employed in this setting to not only curtail the deleterious effects of cardiac arrest by re-establishing oxygenated flow but also test and even improve the viability of the kidneys and liver prior to transplantation. In the present review article, we discuss experimental and clinical studies that have been published to date on the use of ARP in DCD, differentiating between its application under hypothermic and normothermic conditions. In addition to describing results that have been achieved thus far, we describe the major obstacles limiting the broader implementation of ARP in this context as well as potential means for improving the effectiveness of this modality in the future.
authors.affiliation: Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Hessheimer
authors.affiliation: Department of Urology, Nephrology and Transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Billault
authors.affiliation: Department of Urology, Nephrology and Transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Barrou
authors.affiliation: Department of Surgery, Institut de Malalties Digestives I Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
mesh_terms: D050377:Cold Ischemia; D003080:Cold Temperature; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion; D012306:Risk; D013696:Temperature; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D009927:Tissue and Organ Procurement; D052096:Warm Ischemia
chemical_list: D019188:Organ Preservation Solutions
keywords: abdominal regional perfusion; donation after circulatory determination of death; hypothermic; kidney transplantation; liver transplantation; normothermic