The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death.
clinical research/practice
donors and donation
donors and donation: donation after circulatory death (DCD)
health services and outcomes research
organ procurement
organ procurement and allocation
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
10
12
2021
received:
26
09
2021
accepted:
03
01
2022
pubmed:
11
1
2022
medline:
11
5
2022
entrez:
10
1
2022
Statut:
ppublish
Résumé
Successful normothermic machine perfusion of heart allografts (MPH) has led to rapid growth in transplantation of donation after circulatory death (DCD) heart allografts but has introduced complexity in the procurement process. This study examines the impact of MPH use in DCD procurements on warm ischemia time (WIT) and organ yield. DCD procurements from 2019 to 2020 were identified using the OPTN database. Procurements with and without the use of MPH were compared using propensity score matching. Observed to expected (O:E) yield ratios were calculated, where the expected values were obtained using the models developed by the Scientific Registry of Transplant Recipients. In total, 1237 DCD procurements met inclusion criteria (MPH: 109 and control: 1128). After PSM, no difference was found between groups in median total WIT (24.0 min vs. 24.0 min, p = .89), but the MPH group demonstrated shorter median operative WIT (circulatory arrest to cross-clamp; 8.7 min vs. 10.9 min, p = .003). The overall organ yield of DCD heart donors was observed to be 33% higher than expected (O:E 1.33; 95% CI: 1.22-1.45). Observed yield of non-heart organs was not significantly different from expected for liver, kidney, lung, and pancreas grafts. MPH use in DCD procurements does not lead to delays in WIT and does not negatively affect organ yield of other concurrently procured organs.
Identifiants
pubmed: 35007385
doi: 10.1111/ajt.16952
pii: S1600-6135(22)08215-6
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1451-1458Subventions
Organisme : Healthcare Systems Bureau, Division of Transplantation
ID : HHSH250201900001C
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Chew HC, Iyer A, Connellan M, et al. Outcomes of donation after circulatory death heart transplantation in Australia. J Am Coll Cardiol. 2019;73(12):1447-1459. doi:10.1016/j.jacc.2018.12.067
Markmann JF, Abouljoud MS, Ghobrial RM, et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS Liver PROTECT randomized clinical trial. JAMA Surg. 2022; 5: e216781. doi: 10.1001/jamasurg.2021.6781
Nasralla D, Coussios CC & Mergental H et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018 ; 557(7703):50-56. doi: 10.1038/s41586-018-0047-9
MacConmara M, Hanish SI, Hwang CS, et al. Making every liver count. Ann Surg. 2020;272(3):397-401. doi:10.1097/sla.0000000000004198
Dhital KK, Iyer A, Connellan M, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet. 2015;385(9987):2585-2591. doi:10.1016/S0140-6736(15)60038-1
DeOliveira ML, Jassem W, Valente R, et al. Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center. Ann Surg. 2011;254(5):716-722. doi:10.1097/SLA.0b013e318235c572
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(8):838-846. doi:10.1111/j.1432-2277.2012.01508.x
Croome KP, Daneshmand MA. Successfully sharing the sandbox: a perspective on combined DCD liver and heart donor procurement. Am J Transplant. 2021;21(2):484-487. doi:10.1111/ajt.16309
Wisel SA, Thiessen C, Day R, et al. Setting rules for the sandbox: a response to “Successfully sharing the sandbox: a perspective on combined DCD liver and heart donor procurement”. Am J Transplant. 2021;21(5):1981-1982. doi:10.1111/ajt.16426
Thuong M, Ruiz A, Evrard P, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016;29(7):749-759. doi:10.1111/tri.12776
Choubey AP, Siskind EJ, Ortiz AC, et al. Disparities in DCD organ procurement policy from a national OPO survey: a call for standardization. Clin Transplant. 2020;34(4):1-8. doi:10.1111/ctr.13826
Vece GR, Robinson A, Rosendale J, et al. Maximizing donors’ gifts: a comparison of actual and expected solid organ yield among VCA donors. Am J Transplant off J Am Soc Transplant Am Soc Transpl Surg. 2021;21(3):1263-1268. doi:10.1111/ajt.16319
Scientific Registry of Transplant Recipients. SRTR Risk Adjusted Yield Model documentation. Accessed January 21, 2021. https://www.srtr.org/reports-tools/risk-adjustment-models-opos/
Scientific Registry of Transplant Recipients. Technical methods for the program-specific reports. Accessed July 1, 2021. https://www.srtr.org/about-the-data/technical-methods-for-the-program-specific-reports/.
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783-790. doi:10.1111/j.1600-6143.2006.01242.x
Copeland H, Hayanga JWA, Neyrinck A, et al. Donor heart and lung procurement: a consensus statement. J Hear Lung Transplant. 2020;39(6):501-517. doi:10.1016/j.healun.2020.03.020
Chew HC, Scheuer S, Dhital K, Macdonald P. Banked blood for normothermic machine perfusion of the donor heart: a clinical perspective. J Hear Lung Transplant. 2019;38(12):1322. doi:10.1016/j.healun.2019.09.001
Schroder JN, D'Alessandro D, Esmailian F, et al. Successful utilization of Extended Criteria Donor (ECD) hearts for transplantation - results of the OCSTM heart EXPAND trial to evaluate the effectiveness and safety of the OCS heart system to preserve and assess ECD hearts for transplantation. J Hear Lung Transplant. 2019;38(4):S42. doi:10.1016/j.healun.2019.01.088
Messer S, Page A, Axell R, et al. Outcome after heart transplantation from donation after circulatory-determined death donors. J Hear Lung Transplant. 2017;36(12):1311-1318. doi:10.1016/j.healun.2017.10.021