In situ normothermic regional perfusion for controlled donation after circulatory death - The United Kingdom experience

Abstract

Organs recovered from donors after circulatory death (DCD) suffer warm ischemia before cold storage which may prejudice graft survival and result in a greater risk of complications after transplant. A period of normothermic regional perfusion (NRP) in the donor may reverse these effects and improve organ function. Twenty-one NRP retrievals from Maastricht category III DCD donors were performed at three UK centers. NRP was established postasystole via aortic and caval cannulation and maintained for 2-h. Blood gases and biochemistry were monitored to assess organ function. Sixty-three organs were recovered. Forty-nine patients were transplanted. The median time from asystole to NRP was 16-min (range 10-23-min). Thirty-two patients received a kidney transplant. The median cold ischemia time was 12-h 30-min (range 5-h 25-min-18-h 22-min). The median creatinine at 3 and 12 months was 107-μmol/L (range 72-222) and 121-μmol/L (range 63-157), respectively. Thirteen (40%) recipients had delayed graft function and four lost the grafts. Eleven patients received a liver transplant. The first week median peak ALT was 389-IU/L (range 58-3043). One patient had primary nonfunction. Two combined pancreas-kidney transplants, one islet transplant and three double lung transplants were performed with primary function. NRP in DCD donation facilitates organ recovery and may improve short-term outcomes. This study shows that the use of normothermic regional perfusion for organ recovery from controlled donation after circulatory death leads to an increased organ recovery rate and may improve short-term transplant outcomes.