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Multicenter Study
. 2023 Aug;47(8):1371-1385.
doi: 10.1111/aor.14539. Epub 2023 Apr 19.

Evaluation of functional warm ischemia time during controlled donation after circulatory determination of death using normothermic regional perfusion (ECMO-TT): A prospective multicenter cohort study

Sara Martínez-Castro  1   2 , Rosalía Navarro  3 , María Luisa García-Pérez  1   2   3 , José Manuel Segura  4   5 , José A Carbonell  1   2   3 , Fernando Hornero  6 , Jorge Guijarro  7 , Marta Zaplana  8 , María Ángeles Bruño  9 , Ana Tur  10 , Juan Bautista Martínez-León  3   11 , Rafael Zaragoza  12 , Julio Núñez  2   13   14 , Beatriz Domínguez-Gil  15 , Rafael Badenes  1   2   3   5 ; ECMO TRANSPLANT TEAM Study Group
Collaborators, Affiliations
Multicenter Study

Evaluation of functional warm ischemia time during controlled donation after circulatory determination of death using normothermic regional perfusion (ECMO-TT): A prospective multicenter cohort study

Sara Martínez-Castro et al. Artif Organs. 2023 Aug.

Abstract

Background: Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant worldwide. As a recently developed procedure for organ retrieval, some questions remain unsolved such as the uncertainty regarding the effect of functional warm ischemia time (FWIT) on organs´ viability.

Methods: We developed a multicenter prospective cohort study collecting all data from evaluated organs during cDCD from 2017 to 2020. All the procedures related to cDCD were performed with normothermic regional perfusion. The analysis included organ retrieval as endpoint and FWIT as exposure of interest. The effect of FWIT on the likelihood for organ retrieval was evaluated with Relative distribution analysis.

Results: A total amount of 507 organs´ related information was analyzed from 95 organ donors. Median donor age was 62 years, and 63% of donors were male. Stroke was the most common diagnosis before withdrawal of life-sustaining therapy (61%), followed by anoxic encephalopathy (21%). This analysis showed that length of FWIT was inversely associated with organ retrieval rates for liver, kidneys, and pancreas. No statistically significant association was found for lungs.

Conclusions: Results showed an inverse association between functional warm ischemia time (FWIT) and retrieval rate. We also have postulated optimal FWIT's thresholds for organ retrieval. FWIT for liver retrieval remained between 6 and less than 11 min and in case of kidneys and pancreas, the optimal FWIT for retrieval was 6 to 12 min. These results could be valuable to improve organ utilization and for future analysis.

Keywords: controlled donation after circulatory determination of death; extracorporeal membrane oxygenation; normothermic regional perfusion; organ transplantation; withdrawal of life-sustaining therapy.

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References

REFERENCES

    1. Domínguez-Gil B, Ascher N, Capron AM, Gardiner D, Manara AR, Bernat JL, et al. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med. 2021;47:265-81.
    1. Peters-Sengers H, Houtzager JHE, Heemskerk MBA, Idu MM, Minnee RC, Klaasen RW, et al. DCD donor hemodynamics as predictor of outcome after kidney transplantation. Am J Transplant. 2018;18:1966-76.
    1. Hessheimer AJ, Domínguez-Gil B, Fondevila C, Matesanz R. Controlled donation after circulatory determination of death in Spain. Am J Transplant. 2016;16:2239-40.
    1. Miñambres E, Rubio JJ, Coll EDB. Donation after circulatory death and its expansion in Spain. Curr Opin Organ Transplant. 2018;23:120-9.
    1. Melandro F, Basta G, Torri F, Biancofiore G, Del Turco S, Orlando F, et al. Normothermic regional perfusion in liver transplantation from donation after cardiocirculatory death: technical, biochemical, and regulatory aspects and review of literature. Artif Organs. 2022;46:1727-40.

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