Antemortem Heparin in Organ Donation After Circulatory Death Determination: A Systematic Review of the Literature.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
27
4
2021
medline:
30
3
2022
entrez:
26
4
2021
Statut:
ppublish
Résumé
Donation after circulatory death determination frequently involves antemortem heparin administration to mitigate peri-arrest microvascular thrombosis. We systematically reviewed the literature to: (1) describe heparin administration practices and (2) explore the effects on transplant outcomes. We searched MEDLINE and EMBASE for studies reporting donation after circulatory death determination heparin practices including use, dosage, and timing (objective 1). To explore associations between antemortem heparin and transplant outcomes (objective 2), we (1) summarized within-study comparisons and (2) used meta-regression analyses to examine associations between proportions of donors that received heparin and transplant outcomes. We assessed risk of bias using the Newcastle Ottawa Scale and applied the GRADE methodology to determine certainty in the evidence. For objective 1, among 55 eligible studies, 48 reported heparin administration to at least some donors (range: 15.8%-100%) at variable doses (up to 1000 units/kg) and times relative to withdrawal of life-sustaining therapy. For objective 2, 7 studies that directly compared liver transplants with and without antemortem heparin reported lower rates of primary nonfunction, hepatic artery thrombosis, graft failure at 5 y, or recipient mortality (low certainty of evidence). In contrast, meta-regression analysis of 32 liver transplant studies detected no associations between the proportion of donors that received heparin and rates of early allograft dysfunction, primary nonfunction, hepatic artery thrombosis, biliary ischemia, graft failure, retransplantation, or patient survival (very low certainty of evidence). In conclusion, antemortem heparin practices vary substantially with an uncertain effect on transplant outcomes. Given the controversies surrounding antemortem heparin, clinical trials may be warranted.
Identifiants
pubmed: 33901108
doi: 10.1097/TP.0000000000003793
pii: 00007890-202112000-00018
doi:
Substances chimiques
Heparin
9005-49-6
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e337-e346Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
E.B.-C. reports grants from Bayer and Roche, outside the submitted work. I.M.B. received a stipend for administrative work, Trillium Gift of Life ODO 2014-2019, Motivational Speaker for Gaia Insight. M.O.M. receives salary from the Trillium Gift of Life Network of Ontario for her work as a hospital donation physician. The other authors declare no conflicts of interest.
Références
Data on Donation and Transplantation. Organ Procurement and Transplantation Network (OPTN) Data: DSA Dashboard – Comprehensive Data Through. 2016. Available at https://www.aopo.org/related-links-data-on-donation-and-transplantation/ . Accessed September 18, 2017.
CIHI Snapshot. Annual Statistics on Organ Replacement in Canada: Dialysis, Transplantation and Donation, 2009 to 2018. 2019. Canadian Institute for Health Information. Accessed December 5, 2019.
Organ Donation and Transplantation. Donation after circulatory death. 2010. Available at https://www.odt.nhs.uk/deceased-donation/best-practice-guidance/donation-after-circulatory-death/ . Accessed August 8, 2018.
Algahim MF, Love RB. Donation after circulatory death: the current state and technical approaches to organ procurement. Curr Opin Organ Transplant. 2015;20:127–132.
Sanchez PG, Bittle GJ, Williams K, et al. Ex vivo lung evaluation of prearrest heparinization in donation after cardiac death. Ann Surg. 2013;257:534–541.
Nakamura T, Vollmar B, Winning J, et al. Heparin and the nonanticoagulant N-acetyl heparin attenuate capillary no-reflow after normothermic ischemia of the lung. Ann Thorac Surg. 2001;72:1183–1188.
Young E. The anti-inflammatory effects of heparin and related compounds. Thromb Res. 2008;122:743–752.
Motta ED. The ethics of heparin administration to the potential non-heart-beating organ donor. J Prof Nurs. 2005;21:97–102.
Bastami S, Krones T, Biller-Andorno N. Whose consent matters? Controlled donation after cardiac death and premortem organ-preserving measures. Transplantation. 2012;93:965–969.
D’Aragon F, Lamontagne F, Cook D, et al.; Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program. Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study. Can J Anaesth. 2020;67:992–1004.
Gries CJ, White DB, Truog RD, et al.; American Thoracic Society Health Policy Committee. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med. 2013;188:103–109.
Human Tissue Authority. Human Tissue Act 2004. Available at www.hta.gov.uk/legislationpoliciesandcodesofpractice/legislation/humantissueact.cfm . Accessed August 28, 2019.
Shemie SD, Baker AJ, Knoll G, et al. National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada. CMAJ. 2006;175:S1.
StataCorp. Stata Statistical Software: Release 15 . StataCorp LLC. 2017. Available at https://www.stata.com/support/faqs/resources/citing-software-documentation-faqs/ . Accessed September 18, 2020.
Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed May 8, 2020.
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–406.
Guyatt G, Oxman AD, Sultan S, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013;66:151–157.
Mustafa RA, Santesso N, Brozek J, et al. The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses. J Clin Epidemiol. 2013;66:736–742.
Maheshwari A, Maley W, Li Z, et al. Biliary complications and outcomes of liver transplantation from donors after cardiac death. Liver Transpl. 2007;13:1645–1653.
de Vera ME, Lopez-Solis R, Dvorchik I, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant. 2009;9:773–781.
Skaro AI, Jay CL, Baker TB, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery. 2009;146:543–552.
Yamamoto S, Wilczek HE, Duraj FF, et al. Liver transplantation with grafts from controlled donors after cardiac death: a 20-year follow-up at a single center. Am J Transplant. 2010;10:602–611.
Hong JC, Yersiz H, Kositamongkol P, et al. Liver transplantation using organ donation after cardiac death: a clinical predictive index for graft failure-free survival. Arch Surg. 2011;146:1017–1023.
Karp SJ, Johnson S, Evenson A, et al. Minimising cold ischaemic time is essential in cardiac death donor-associated liver transplantation. HPB (Oxford). 2011;13:411–416.
Bellingham JM, Santhanakrishnan C, Neidlinger N, et al. Donation after cardiac death: a 29-year experience. Surgery. 2011;150:692–702.
Taner CB, Bulatao IG, Perry DK, et al. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int. 2012;25:838–846.
Vanatta JM, Dean AG, Hathaway DK, et al. Liver transplant using donors after cardiac death: a single-center approach providing outcomes comparable to donation after brain death. Exp Clin Transplant. 2013;11:154–163.
Oniscu GC, Randle LV, Muiesan P, et al. In situ normothermic regional perfusion for controlled donation after circulatory death–the United Kingdom experience. Am J Transplant. 2014;14:2846–2854.
Han M, Guo ZY, Zhao Q, et al. Liver transplantation using organs from deceased organ donors: a single organ transplant center experience. Hepatobiliary Pancreat Dis Int. 2014;13:409–415.
Abt PL, Praestgaard J, West S, et al. Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation. Liver Transpl. 2014;20:165–172.
Detry O, Deroover A, Meurisse N, et al. Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme. Br J Surg. 2014;101:784–792.
Firl DJ, Hashimoto K, O’Rourke C, et al. Impact of donor age in liver transplantation from donation after circulatory death donors: a decade of experience at Cleveland Clinic. Liver Transpl. 2015;21:1494–1503.
Halldorson JB, Bakthavatsalam R, Montenovo M, et al. Differential rates of ischemic cholangiopathy and graft survival associated with induction therapy in DCD liver transplantation. Am J Transplant. 2015;15:251–258.
Xia W, Ke Q, Wang Y, et al. Donation after cardiac death liver transplantation: graft quality evaluation based on pretransplant liver biopsy. Liver Transpl. 2015;21:838–846.
Chirichella TJ, Dunham CM, Zimmerman MA, et al. Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy. World J Gastroenterol. 2016;22:3392–3403.
Perez-Villares JM, Rubio JJ, Del Río F, et al. Validation of a new proposal to avoid donor resuscitation in controlled donation after circulatory death with normothermic regional perfusion. Resuscitation. 2017;117:46–49.
Bohorquez H, Seal JB, Cohen AJ, et al. Safety and outcomes in 100 consecutive donation after circulatory death liver transplants using a protocol that includes thrombolytic therapy. Am J Transplant. 2017;17:2155–2164.
LaMattina J, Alvarez-Casas J, Sultan S, et al. 108 sequential donation after cardiac death liver transplants without recipient thrombolytic therapy. Am J Transplant. 2018;18(Suppl 2):40.
Torabi J, Graham J, Bellmare S, et al. High dose tissue plasminogen activator flush during donation-after-cardiac-death (DCD) liver procurements offers optimal outcomes. Am J Transplant. 2018;18(Suppl 4):908.
Kollmann D, Sapisochin G, Goldaracena N, et al. Expanding the donor pool: donation after circulatory death and living liver donation do not compromise the results of liver transplantation. Liver Transpl. 2018;24:779–789.
de Almeida E, Silva M, Atutxa L, et al. Controlled donation after circulatory death (cDCD) in Donostia University Hospital, 2015-2018. Intensive Care Med Exp. 2018;6(Suppl 2):2.
Farid SG, Attia MS, Vijayanand D, et al. Impact of donor hepatectomy time during organ procurement in donation after circulatory death liver transplantation: the United Kingdom experience. Transplantation. 2019;103:e79–e88.
Mihaylov P, Mangus R, Ekser B, et al. Expanding the donor pool with the use of extended criteria donation after circulatory death livers. Liver Transpl. 2019;25:1198–1208.
Ruiz P, Gastaca M, Bustamante FJ, et al. Favorable outcomes after liver transplantation with normothermic regional perfusion from donors after circulatory death: a single-center experience. Transplantation. 2019;103:938–943.
Tun-Abraham, Wanis K, Garcia-Ochoa, et al. Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience. Can J Surg. 2019;62:44–51.
Crannell WC, Maynard E, Sally M, et al. Controlled donation after cardiac death donors are prothrombotic and have diminished fibrinolysis: implications in liver transplantation. Am J Transplant. 2020;20(Suppl 2):21–22.
Otero A, Vázquez MA, Suárez F, et al. Results in liver transplantation using grafts from donors after controlled circulatory death: a single-center experience comparing donor grafts harvested after controlled circulatory death to those harvested after brain death. Clin Transplant. 2020;34:e13763.
Kramer AH, Holliday K, Keenan S, et al. Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices. Can J Anaesth. 2020;67:521–531.
van Leeuwen OB, van Reeven M, van der Helm D, et al. Donor hepatectomy time influences ischemia-reperfusion injury of the biliary tree in donation after circulatory death liver transplantation. Surgery. 2020;168:160–166.
Fujita T, Matsui M, Yanaoka M, et al. Clinical application of in situ renal cooling: experience with 61 cardiac-arrest donors. Transplant Proc. 1989;21(1 Pt 2):1215–1217.
Casavilla A, Ramirez C, Shapiro R, et al. Liver and kidney transplantation from non-heart beating donors: the Pittsburgh experience. Transplant Proc. 1995;27:710–712.
Teraoka S, Nomoto K, Mito M, et al. Multivariate analyses of factors contributing to early graft function in 759 kidney transplants from non-heart-beating donors. Transplant Proc. 2001;33:1125–1126.
Gok MA, Pelzers M, Glatz JF, et al. Do tissue damage biomarkers used to assess machine-perfused NHBD kidneys predict long-term renal function post-transplant? Clin Chim Acta. 2003;338:33–43.
Ledinh H, Weekers L, Bonvoisin C, et al. Results of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience. Transpl Int. 2012;25:201–209.
Farney AC, Hines MH, al-Geizawi S, et al. Lessons learned from a single center’s experience with 134 donation after cardiac death donor kidney transplants. J Am Coll Surg. 2011;212:440–551.
Hernadez-Alejandro R, Wall W, Jevnikar A, et al. Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience. Can J Anaesth. 2011;58:599–605.
Kute VB, Vanikar AV, Shah PR, et al. Outcome of renal transplantation from deceased donors after cardiac death: a single-center experience from a developing country. Transplant Proc. 2013;45:2147–2151.
Kamal L, Lindower J, Kayler LK. Outcomes of kidney transplant recipients from donation after circulatory death donors without preagonal heparin administration. Transplantation. 2015;99:e167–e168.
Woodside KJ, Goldfarb DA, Rabets JC, et al. Enhancing kidney function with thrombolytic therapy following donation after cardiac death: a multicenter quasi-blinded prospective randomized trial. Clin Transplant. 2015;29:1173–1180.
Allen MB, Billig E, Reese PP, et al. Donor hemodynamics as a predictor of outcomes after kidney transplantation from donors after cardiac death. Am J Transplant. 2016;16:181–193.
Sidiropoulos S, Treasure E, Silvester W, et al. Organ donation after circulatory death in a university teaching hospital. Anaesth Intensive Care. 2016;44:477–483.
Foss S, Nordheim E, Hagness M, et al. Similar 1-year organ function from controlled donation after circulatory death using normo-thermic regional perfusion and donation after brain death. Transplantation. 2019;103(11 Suppl 1):S51–S52.
Van De Wauwer C, Verschuuren EA, Van Der Bij W, et al. The use of non-heart-beating lung donors category III can increase the donor pool. Interact Cardiovasc Thorac Surg. 2010;11(Suppl 2):S103.
Levvey BJ, Harkess M, Hopkins P, et al. Excellent clinical outcomes from a national donation-after-determination-of-cardiac-death lung transplant collaborative. Am J Transplant. 2012;12:2406–2413.
Machuca TN, Mercier O, Collaud S, et al. Lung transplantation with donation after circulatory determination of death donors and the impact of ex vivo lung perfusion. Am J Transplant. 2015;15:993–1002.
Costa J, Shah L, Robbins H, et al. Use of lung allografts from donation after cardiac death donors: a single-center experience. Ann Thorac Surg. 2018;105:271–278.
Inci I, Hillinger S, Schneiter D, et al. Lung transplantation with controlled donation after circulatory death donors. Ann Thorac Cardiovasc Surg. 2018;24:296–302.
Miñambres E, Ruiz P, Ballesteros MA, et al. Combined lung and liver procurement in controlled donation after circulatory death using normothermic abdominal perfusion. Initial experience in two Spanish centers. Am J Transplant. 2020;20:231–240.
Muthusamy AS, Mumford L, Hudson A, et al. Pancreas transplantation from donors after circulatory death from the United Kingdom. Am J Transplant. 2012;12:2150–2156.
Fernandez LA, Di Carlo A, Odorico JS, et al. Simultaneous pancreas-kidney transplantation from donation after cardiac death: successful long-term outcomes. Ann Surg. 2005;242:716–723.
Romano A, Alsabeah K, Wilczek H, et al. Simultaneous pancreas-kidney transplant from donors after brain death vs donors after circulatory death: a single-center follow-up study over 3 decades. Transplant Proc. 2019;51:845–851.
Kopp WH, Lam HD, Schaapherder AFM, et al. Pancreas transplantation with grafts from donors deceased after circulatory death: 5 years single-center experience. Transplantation. 2018;102:333–339.
Wadei HM, Bulatao IG, Gonwa TA, et al. Inferior long-term outcomes of liver-kidney transplantation using donation after cardiac death donors: single-center and organ procurement and transplantation network analyses. Liver Transpl. 2014;20:728–735.
Narvaez JRF, Nie J, Noyes K, et al. Transplant outcomes of donation after circulatory death livers recovered with versus without premortem heparin administration. Liver Transpl. 2020;26:247–255.
Chan EY, Olson LC, Kisthard JA, et al. Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl. 2008;14:604–610.
Detry O, Donckier V, Lucidi V, et al. Liver transplantation from donation after cardiac death donors: initial Belgian experience 2003-2007. Transpl Int. 2010;23:611–618.
Olson L, Kisthard J, Cravero L, et al. Livers transplanted from donors after cardiac death occurring in the ICU or the operating room have excellent outcomes. Transplant Proc. 2005;37:1188–1193.
Stine JG, Pelletier S, Schmitt T, et al. Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients. Hepatology. 2015;62(Suppl 1):831A.
De Roover A, Le Dinh H, Cicarelli O, et al. Liver transplantation from donation after cardiocirculatory death (DCD) donors: Belgian experience 2003-2009. Transpl Int. 2011;24(Suppl 2):84.
Riddiough GE, Fink MA, Starkey G, et al. Predictors of early graft loss in donation after circulatory death liver transplantation. Transplantation. 2013;96(Suppl 10S):S263.
Narvaez JRF, Noyes K, Nie J, et al. Outcomes of DCD kidneys recovered for transplantation with versus without pre-mortem heparin administration. Clin Transplant. 2019;33:e13624.
Choubey A, Barragan N, Nayebpour M, et al. Variations in DCD procurement procedures across OPOs and their effects on kidney transplant outcomes. Am J Transplant. 2020;20(Suppl 3):40–41.
Narvaez JR, Kayler L. Transplant outcomes of donation after circulatory death kidneys recovered with versus without pre-recovery heparin administration. Am J Transplant. 2019;19(Suppl 1):42.
Boteon APCS, Schlegel A, Kalisvaart M, et al. Retrieval practice or overall donor and recipient risk: what impacts on outcomes after donation after circulatory death liver transplantation in the United Kingdom? Liver Transpl. 2019;25:545–558.
Kubal C, Mangus R, Fridell J, et al. Optimization of perioperative conditions to prevent ischemic cholangiopathy in donation after circulatory death donor liver transplantation. Transplantation. 2016;100:1699–1704.
Coffey JC, Wanis KN, Monbaliu D, et al. The influence of functional warm ischemia time on DCD liver transplant recipients’ outcomes. Clin Transplant. 2017;31:e13068.
Abt P, Crawford M, Desai N, et al. Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation. 2003;75:1659–1663.
Foley DP, Fernandez LA, Leverson G, et al. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center. Ann Surg. 2011;253:817–825.
Mawardi M, Aba Alkhail F, Katada K, et al. The clinical consequences of utilizing donation after cardiac death liver grafts into hepatitis C recipients. Hepatol Int. 2011;5:830–833.
Foley DP, Fernandez LA, Leverson G, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242:724–731.
Hashimoto K, Eghtesad B, Gunasekaran G, et al. Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors. Am J Transplant. 2010;10:2665–2672.
Kishi E, Dixon M, Lubezky N, et al. No ischemic cholangiopathy following liver transplantation from DCD donors: implementation of selective organ recovery criteria and TPA administration before cold perfusion. Am J Transplant. 2014;14(Suppl 2):94.
van Leeuwen OB, de Vries Y, Fujiyoshi M, et al. Transplantation of high-risk donor livers after ex situ resuscitation and assessment using combined hypo- and normothermic machine perfusion: a prospective clinical trial. Ann Surg. 2019;270:906–914.
Doyle MB, Collins K, Vachharajani N, et al. Outcomes using grafts from donors after cardiac death. J Am Coll Surg. 2015;221:142–152.
Taylor R, Allen E, Richards JA, et al.; Liver Advisory Group to NHS Blood and Transplant. Survival advantage for patients accepting the offer of a circulatory death liver transplant. J Hepatol. 2019;70:855–865.
Cao Y, Shahrestani S, Chew HC, et al. Donation after circulatory death for liver transplantation: a meta-analysis on the location of life support withdrawal affecting outcomes. Transplantation. 2016;100:1513–1524.
Shahrestani S, Webster AC, Lam VW, et al. Outcomes from pancreatic transplantation in donation after cardiac death: a systematic review and meta-analysis. Transplantation. 2017;101:122–130.
Zhou J, Chen B, Liao H, et al. The comparable efficacy of lung donation after circulatory death and brain death: a systematic review and meta-analysis. Transplantation. 2019;103:2624–2633.
Kramer AH, Doig CJ. Premortem heparin administration and location of withdrawal of life-sustaining interventions in DCD: lack of high-quality evidence precludes definitive conclusions. Transplantation. 2016;100:e102–e103.
Boglione MM, Morandini MA, Barrenechea ME, et al. Pre-arrest heparinization and ventilation during warm ischemia preserves lung function in non-heart-beating donors. J Pediatr Surg. 1999;34:1805–1809.
Hodyc D, Hnilickova O, Hampl V, et al. Pre-arrest administration of the cell-permeable free radical scavenger tempol reduces warm ischemic damage of lung function in non-heart-beating donors. J Heart Lung Transplant. 2008;27:890–897.
Richter S, Yamauchi J, Minor T, et al. Heparin and phentolamine combined, rather than heparin alone, improves hepatic microvascular procurement in a non-heart-beating donor rat-model. Transpl Int. 2000;13:225–229.
Wallinder A, Steen S, Liden H, et al. Heparin does not improve graft function in uncontrolled non-heart-beating lung donation: an experimental study in pigs. Eur J Cardiothorac Surg. 2013;43:413–419.
Hessheimer AJ, Vendrell M, Muñoz J, et al. Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model. Liver Transpl. 2018;24:665–676.
Hirota M, Ishino K, Tedoriya T, et al. Post-mortem tissue-type plasminogen activator preserves graft function of hearts harvested from non-pre-treated non-heart-beating donors. J Heart Lung Transplant. 2010;29:888–893.