Affiliation:
1. Botkin Hospital;
Russian Medical Academy of Continuous Professional Education
2. Botkin Hospital;
Shumakov National Medical Research Center of Transplantology and Artificial Organs
3. Shumakov National Medical Research Center of Transplantology and Artificial Organs
4. Botkin Hospital
Abstract
Objective: to present the successful experience with a donor with out-of-hospital cardiac arrest (OHCA) in whom a set of modern perfusion techniques was used to obtain kidneys suitable for transplantation.Materials and methods. Automatic chest compression was resumed in an OHCA donor (after biological death has been confirmed in the hospital) to maintain minimal perfusion under mechanical ventilation with 100% FiO2. With femoral vein cannulation, an extracorporeal circuit with a centrifuge pump and oxygenator was connected and abdominal normothermic regional perfusion was initiated. After 215 minutes, kidney was explanted under normothermic machine perfusion. Next, the left kidney was placed in the LifePort Kidney Transporter for hypothermic machine perfusion of donor kidneys. Perfusion time was 285 minutes. The right kidney was transplanted without additional ex-vivo perfusion.Results. Due to the complex use of perfusion techniques both in the donor body and ex-vivo, donor kidneys, after OHCA, with a total warm ischemia time of 110 minutes, were transplanted to recipients with good results. In the postoperative period, there was delayed function of the left and right renal grafts. The patients were discharged in a satisfactory condition under outpatient follow-up.Conclusion. The possibility and efficiency of organ donation after OHCA, facilitated by modern perfusion techniques and devices, open up a new perspective in addressing the organ shortage crisis.
Publisher
V.I. Shimakov Federal Research Center of Transplantology and Artificial Organs
Subject
Transplantation,Immunology and Allergy
Reference30 articles.
1. Renaudier M, Binois Y, Dumas F, Lamhaut L, Beganton F, Jost D et al. Paris Sudden Death Expertise Center group. Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center. Ann Intensive Care. 2022; 6; 12 (1): 48.
2. Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ. New classification of donation after circulatory death donors’ definitions and terminology. Transpl Int. 2016; 29 (7): 749–759.
3. Shabunin AV, Minina MG, Drozdov PA, Sevostianov VM, Nesterenko IV, Makeev DA, Zhuravel OS. Asystole kidney donation using automated chest compression system and hypothermic oxygenated machine perfusion (first experience in the Russian Federation). Russian Journal of Transplantology and Artificial Organs. 2022; 24 (2): 102–107.
4. Reznik ON, Skvortsov AE, Reznik AO, Ananyev AN, Tutin AP, Kuzmin DO, Bagnenko SF. Uncontrolled Donors with Controlled Reperfusion after Sixty Minutes of Asystole: A Novel Reliable Resource for Kidney Transplantation, Published: 2013; 30 (5).
5. Zhong Z, Hu Q, Fu Z. Increased Expression of Aldehyde Dehydrogenase 2 Reduces Renal Cell Apoptosis During Ischaemia/Reperfusion Injury After Hypothermic Machine Perfusion. Artif Organs. 2016; 40: 596–603.