In Situ Normothermic Regional Perfusion for Controlled Donation After Circulatory Death-The United Kingdom Experience
In Situ Normothermic Regional Perfusion for Controlled Donation After Circulatory Death-The United Kingdom Experience
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DOI：
10.1111/ajt.12927
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发表时间：
2014-12-01
影响因子：
8.8
通讯作者：
Watson, C. J. E.
中科院分区：
文献类型：
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作者：
Oniscu, G. C.;Randle, L. V.;Watson, C. J. E.
供体循环死亡后的器官在冷藏前会出现热缺血，这可能会影响移植物的存活，并导致移植后并发症的风险增加。供体一段时间的常温区域灌注（NRP）可以逆转这些影响并改善器官功能。21例来自马斯特里赫特第三类DCD供体的NRP检索在三个英国中心进行。心脏收缩期后通过主动脉和腔静脉插管建立NRP并维持2h。监测血气和生物化学以评估器官功能。发现了63个器官。49例患者接受了移植。从心跳停止到NRP的中位时间为16min（范围10-23min）。32名患者接受了肾脏移植。中位冷缺血时间为12h 30min（范围5h 25min-18h 22min）。3个月和12个月时的中位肌酐分别为107 μ mol/L（范围72-222）和121 μ mol/L（范围63-157）。13例（40%）受者移植物功能延迟，4例移植物丢失。11名患者接受了肝移植。第一周ALT中位峰值为389IU/L（范围58-3043）。1例患者原发无功能。胰肾联合移植2例，胰岛移植1例，双肺移植3例。DCD捐献中的NRP有助于器官恢复，并可能改善短期预后。本研究表明，在循环性死亡后，使用常温区域灌注进行受控捐献的器官恢复，可提高器官恢复率，并可能改善短期移植结果。
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 2h. 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 16min (range 10-23min). Thirty-two patients received a kidney transplant. The median cold ischemia time was 12h 30min (range 5h 25min-18h 22min). The median creatinine at 3 and 12 months was 107 mu mol/L (range 72-222) and 121 mu mol/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 389IU/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.