title: Improving the Outcomes of Organs Obtained From Controlled Donation After Circulatory Death Donors Using Abdominal Normothermic Regional Perfusion.
abstract: The use of donation after circulatory death (DCD) has increased significantly during the past decade. However, warm ischemia results in a greater risk for transplantation. Indeed, controlled DCD (cDCD) was associated with inferior outcomes compared with donation after brain death. The use of abdominal normothermic regional perfusion (nRP) to restore blood flow before organ recovery in cDCD has been proposed as better than rapid recovery to reverse the effect of ischemia and improve recipients' outcome. Here, the first Spanish series using abdominal nRP as an in situ conditioning method is reported. A specific methodology to avoid restoring circulation to the brain after death determination is described. Twenty-seven cDCD donors underwent abdominal nRP during at least 60 min. Thirty-seven kidneys, 11 livers, six bilateral lungs, and one pancreas were transplanted. The 1-year death-censored kidney survival was 91%, and delayed graft function rate was 27%. The 1-year liver survival rate was 90.1% with no cases of ischemic cholangiopathy. Transplanted lungs and pancreas exhibited primary function. The use of nRP may represent an advance to increase the number and quality of grafts in cDCD. Poor results in cDCD livers could be reversed with nRP. Concerns about restoring brain circulation after death are easily solved.
authors.affiliation: Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Miñambres
authors.affiliation: Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Suberviola
authors.affiliation: Organización Nacional de Trasplantes (ONT), Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Dominguez-Gil
authors.affiliation: Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Rodrigo
authors.affiliation: Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: J C
authors.identifier: http://orcid.org/0000-0002-7904-8730
authors.initials: JC
authors.lastname: Ruiz-San Millan
authors.affiliation: Service of General Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Rodríguez-San Juan
authors.affiliation: Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Ballesteros
mesh_terms: D000368:Aged; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D016377:Organ Transplantation; D010477:Perfusion; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000592:standards*
keywords: clinical research/practice; donors and donation: donation after circulatory death (DCD); extracorporeal membrane oxygenation (ECMO); organ procurement and allocation; organ transplantation in general; patient survival