Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation

Article Immunology

Improved Organ Utilization and Better Transplant Outcomes With In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Death

Gabriel C. Oniscu et al.

Summary: The use of normothermic regional perfusion (NRP) during controlled donation after circulatory death (cDCD) is associated with increased organ recovery and improved transplant outcomes.

TRANSPLANTATION (2023)

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Article Surgery

The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death

Cyrus A. Feizpour et al.

Summary: The study shows that the use of MPH in DCD procurements does not cause delays in WIT and does not negatively affect organ yield of other concurrently procured organs.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss

Amelia J. Hessheimer et al.

Summary: The study shows the benefits of using A-NRP over SRR in cDCD liver transplants in Spain, with reduced risks of overall biliary complications, ischemic type biliary lesions, graft loss, and patient death. Cold ischemia time and re-transplantation indication are significant independent predictors for graft loss in cDCD livers with A-NRP. Further improvements are needed for cases with prolonged cold ischemia and technically complex recipients, suggesting a potential role for complementary ex situ perfusion preservation techniques.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Gastroenterology & Hepatology

The Current Landscape of Liver Transplantation After Ex Situ Machine Perfusion and Normothermic Regional Perfusion in the United States

Kristopher P. Croome et al.

LIVER TRANSPLANTATION (2022)

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Article Surgery

OPTN/SRTR 2020 Annual Data Report: Pancreas

R. Kandaswamy et al.

Summary: The number of pancreas transplants and new waitlist registrations decreased in 2020. Waiting times increased for certain types of transplants, but the rates of graft failure and other long-term outcomes showed consistent improvement over the past decade.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

OPTN/SRTR 2020 Annual Data Report: DOD

A. K. Israni et al.

Summary: SRTR uses data from OPTN to calculate metrics such as donation rate, organ yield, and rate of organs not transplanted. The number of deceased donors and organ transplants increased in 2020 despite the pandemic, with a notable increase in kidney, liver, and heart transplants. The data also suggests an opportunity to increase transplants by reducing the number of discarded organs.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

OPTN/SRTR 2020 Annual Data Report: Liver

A. J. Kwong et al.

Summary: The COVID-19 pandemic had a significant impact on transplant programs and outcomes, but the number of liver transplants performed in the United States reached a record high. Living donation activity decreased, but the survival rates for patients with liver transplants continued to improve. The liver transplant waitlists for both adults and children decreased in size, and a new liver distribution policy based on acuity circles was implemented. The predominant indication for liver transplants among adults in 2020 was alcohol-associated liver disease.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

OPTN/SRTR 2020 Annual Data Report: Kidney

K. L. Lentine et al.

Summary: The year 2020 presented challenges for kidney transplantation, with a slight decrease in the total number of transplants and a significant decline in living donor transplants due to the COVID-19 pandemic. Racial disparities in living donor transplant access persist. Pediatric kidney transplants were also impacted, with a decrease in the total number of transplants and a continued decrease in deceased donor transplants among pediatric candidates.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

Liver Transplantation Outcomes From Controlled Circulatory Death Donors SCS vs in situ NRP vs ex situ NMP

Rohit Gaurav et al.

Summary: NRP and NMP were associated with better early liver function compared to SCS, whereas NRP was associated with superior preservation of the biliary system.

ANNALS OF SURGERY (2022)

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Article Surgery

Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: A multi-institutional observational study

Marty T. Sellers et al.

Summary: This study retrospectively reviewed the outcomes of the first 13 liver transplants using thoraco-abdominal normothermic perfusion (TA-NRP) in donation after circulatory determination of death (DCD) donors in the US. The results showed that the majority of recipients had good liver function during the post-transplant period, indicating that TA-NRP could decrease deaths on the waiting list.

CLINICAL TRANSPLANTATION (2022)

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Article Cardiac & Cardiovascular Systems

Early experience with donation after circulatory death heart transplantation using normothermic regional perfusion in the United States

Deane E. Smith et al.

Summary: The feasibility of a donation after circulatory death (DCD) heart transplantation protocol using cardiopulmonary bypass (CPB) for normothermic regional reperfusion (NRP) was evaluated in this pilot study. The study showed excellent outcomes of DCD heart transplantation, indicating the potential for wider adoption of the DCD protocol and increased availability of donor hearts in the United States.

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY (2022)

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Article Immunology

Varying Utilization Rates but Superior Outcomes in Liver Transplantation From Hepatitis C-positive Donors in the United States: An Analysis of the OPTN/UNOS Database

Yuki Bekki et al.

Summary: The study found that using HCV-positive donors for liver transplantation, especially Ab + / NAT + donors aged 40-69, can expand the donor pool without impairing short-term outcomes after transplantation.

TRANSPLANTATION (2022)

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Article Surgery

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

Fiona Hunt et al.

Summary: This article describes a model for the implementation of Normothermic Regional Perfusion (NRP) into standard clinical practice. The model involved iterative refinement incorporating training, staffing, and operative techniques. The results showed successful implementation of NRP throughout the UK and a significant increase in organ transplantation. In addition, the model enabled the implementation of ex situ normothermic liver perfusion, contributing to a significant portion of liver transplant activity in 2021.

TRANSPLANT INTERNATIONAL (2022)

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Article Immunology

Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society

Amelia J. Hessheimer et al.

Summary: The working group of the International Liver Transplantation Society evaluated current evidence and combined experience to create guidance on DCD liver procurement, including best practices and the use of adjuncts. Events during DCD liver recovery have a significant impact on the success of subsequent transplantation.

TRANSPLANTATION (2021)

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Review Surgery

A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation

Julie De Beule et al.

Summary: The study systematically reviewed outcomes of solid organ transplantation after RP and found that RP is a safe alternative for DCD. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers.

TRANSPLANT INTERNATIONAL (2021)

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Article Surgery

Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion

Maria Padilla et al.

Summary: NRP in controlled DCDD kidney transplants shows better short-term outcomes compared to RR, with a lower risk of delayed graft function and 1-year graft loss in the NRP group.

AMERICAN JOURNAL OF TRANSPLANTATION (2021)

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Article Cardiac & Cardiovascular Systems

Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion

Jordan R. H. Hoffman et al.

Summary: This study conducted heart transplantations using DCD allografts, extending cold ischemic time with TA-NRP and cold static storage, which improved the feasibility and success rate of heart transplantation.

JOURNAL OF HEART AND LUNG TRANSPLANTATION (2021)

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Article Surgery

Graft utilization after normothermic regional perfusion in controlled donation after circulatory death-a single-center perspective from France

Xavier Muller et al.

Summary: The study found that in cDCD donors, abdominal NRP led to transplantation of at least one graft in the majority of cases. While the utilization rate for kidneys was high, nearly half of the liver grafts were discarded, requiring further improvements in utilization rates through training, novel viability markers, and ex-vivo liver graft perfusion.

TRANSPLANT INTERNATIONAL (2021)

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Article Surgery