title: The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor.
abstract: Between 2010 and 2013, we recorded 66 cases of failed organ donation after brain death (DBD) due to the excessive use of the vasoactive drugs resulting in impaired hepatic and/or renal function. To investigate the effect of extracorporeal membrane oxygenation (ECMO) in donor management, ECMO was used to provide support for DBD donors with circulatory and/or respiratory failure from 2013 to 2015. A retrospective cohort study between circulatory non-stable DBD with vasoactive drugs (DBD-drug) and circulatory non-stable DBD with ECMO (DBD-ECMO) was designed to compare the transplant outcomes. A total of 19 brain death donors were supported by ECMO. The incidence rate of post-transplant liver primary non-function (PNF) was 10% (two of 20) in DBD-drug group and zero in DBD-ECMO group. Kidney function indicators, including creatinine clearance and urine production, were significantly better in DBD-ECMO group, as well as the kidney delayed graft function (DGF) rate was found to be decreased by the use of ECMO in our study. Donation success rate increased steadily from 47.8% in 2011 to 84.6% in 2014 after the ECMO intervention. The use of ECMO in assisting circulatory and respiratory function of DBD can reduce liver and kidney injury from vasoactive drugs, thereby improving organ quality and reducing the organ discard rates.
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Fan
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Zhiquan
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Transplant Center, Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Nasralla
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Xianpeng
authors.initials: X
authors.lastname: Zeng
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Shaojun
authors.initials: S
authors.lastname: Ye
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Guizhu
authors.initials: G
authors.lastname: Peng
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Zhongnan Hospital of Wuhan University, Transplant Center of Wuhan University, Wuhan, China. yqf_china@163.com.
authors.forename: Qifa
authors.initials: Q
authors.lastname: Ye
mesh_terms: D000328:Adult; D001926:Brain Death; D002317:Cardiovascular Agents / Q000009:adverse effects; D051799:Delayed Graft Function / Q000139:chemically induced / Q000517:prevention & control*; D004298:Dopamine / Q000009:adverse effects; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000009:adverse effects; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*
chemical_list: D002317:Cardiovascular Agents; D004298:Dopamine; D009638:Norepinephrine
keywords: donation after brain death; donor management; extracorporeal membrane oxygenation; organ preservation; transplant outcome