ABSTRACT
Introduction
The impact of donation after circulatory death (DCD) heart procurement techniques
on the utilization and outcomes of concurrently procured DCD livers and kidneys remains
unclear.
Methods
Using the United Network for Organ Sharing database, we identified 246 DCD donors
whose heart was procured using direct procurement and ex-situ machine perfusion and
128 DCD donors whose heart was procured using in-situ thoracoabdominal normothermic
regional perfusion (12/2019-03/2022). We evaluated the transplantation rate of concurrently
procured DCD livers and kidneys (defined as the number of organs transplanted/total
number of organs available for procurement) and their post-transplant outcomes.
Results
The transplantation rate of concurrently procured DCD livers was higher with in-situ
perfusion compared to direct procurement (67.1% vs. 56.5%, p=0.045). After excluding
pediatric, multiorgan, and repeat transplant recipients, there was no difference in
6-month liver graft failure rate (direct procurement 0.9% vs. in-situ perfusion 0%,
p>0.99). Recipients of kidneys procured with in-situ perfusion had less delayed graft
function (11.3% vs. 41.5%, p<0.0001) shorter length of stay, and lower serum creatinine
at discharge (both p<0.05). Six-month recipient survival in the direct procurement
and in-situ perfusion group were similar after DCD liver and kidney transplantation
(p=0.24 and 0.79 respectively).
Conclusion
Compared to direct procurement, DCD heart procurement with in-situ thoracoabdominal
normothermic regional perfusion was associated with increased utilization of DCD livers
and a lower incidence of delayed graft function in concurrently procured DCD kidneys.
Broader implementation of DCD heart transplantation must maximize the transplant potential
of concurrently procured abdominal organs and ensure their successful outcomes.
Keywords
Abbreviations:
CMV (Cytomegalovirus), DCD (Donation after Circulatory Death), ICU (Intensive Care Unit), KDPI (Kidney Donor Profile Index), POD (Postoperative Day), UNOS (United Network for Organ Sharing)To read this article in full you will need to make a payment
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