title: In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience.
abstract: Organs recovered from donors after circulatory death (DCD) suffer warm ischemia before cold storage which may prejudice graft survival and result in a greater risk of complications after transplant. A period of normothermic regional perfusion (NRP) in the donor may reverse these effects and improve organ function. Twenty-one NRP retrievals from Maastricht category III DCD donors were performed at three UK centers. NRP was established postasystole via aortic and caval cannulation and maintained for 2 h. Blood gases and biochemistry were monitored to assess organ function. Sixty-three organs were recovered. Forty-nine patients were transplanted. The median time from asystole to NRP was 16 min (range 10-23 min). Thirty-two patients received a kidney transplant. The median cold ischemia time was 12 h 30 min (range 5 h 25 min-18 h 22 min). The median creatinine at 3 and 12 months was 107 µmol/L (range 72-222) and 121 µmol/L (range 63-157), respectively. Thirteen (40%) recipients had delayed graft function and four lost the grafts. Eleven patients received a liver transplant. The first week median peak ALT was 389 IU/L (range 58-3043). One patient had primary nonfunction. Two combined pancreas-kidney transplants, one islet transplant and three double lung transplants were performed with primary function. NRP in DCD donation facilitates organ recovery and may improve short-term outcomes.
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: G C
authors.initials: GC
authors.lastname: Oniscu
authors.forename: L V
authors.initials: LV
authors.lastname: Randle
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
authors.forename: A J
authors.initials: AJ
authors.lastname: Butler
authors.forename: I S
authors.initials: IS
authors.lastname: Currie
authors.forename: M T P R
authors.initials: MT
authors.lastname: Perera
authors.forename: J L
authors.initials: JL
authors.lastname: Forsythe
authors.forename: C J E
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization; D002423:Cause of Death; D050377:Cold Ischemia; D051799:Delayed Graft Function; D046148:Donor Selection; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects*; D016035:Pancreas Transplantation; D010477:Perfusion; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Clinical research/practice; donors and donation; donors and donation: donation after circulatory death (DCD); extra-corporeal membrane oxygenation (ECMO); kidney transplantation/nephrology; liver transplantation/hepatology; organ perfusion and preservation; organ procurement; organ transplantation in general