Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy?
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Transcript of Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy?
Improving ECS-DCD Assisted Donation: Are Thrombolytics a
Beneficial Strategy?
Spurlock D; Koch KL; Sall LE; Ranney D; El-Sabbagh A; Ceballos C; Mira JC; Cook KE; Bartlett RH; Pelletier SG;
Punch JD; Rojas A
University of Michigan Health SystemDepartment of Surgery, Section of Transplantation and the
Extracorporeal Life Support Program
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DCD Limitation in the US
Most potential DCD are unable to donate due to unexpected death
Long time periods: death to organ procurement = WIT & clot formation
ECS
(cDCD) / Can be used in the uDCD?.
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Hypothesis
Unexpected (uDCD) donation could be improved with the use of thrombolytics during extracorporeal support (ECS) assisted donation
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DCD Animal model - Swine
DCD sustained 30 or 60 minutes of WI followed by 3hr of ECS at 30˚C
Four Study Groups
Group N = WIT STK ECS
30-No STK 6 30 min NO 3hr
60-No STK 4 60 min NO 3hr
30-STK 4 30 min YES 3hr
60-STK 5 60 min YES 3hr
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Transplant ModelRojas A, et al. American Journal of Transplantation, 2010; 10: 1365-74
Renal artery flow >50mL/min
Organs procured, flushed and cold storage with HTK for 4-5hrs.
Transplanted in healthy nephrectomized swine and perfused for 4hrs.
• Data collection for DCD and recipients:– Hemodynamics (systemic, renal, ECS) and
renal function
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UM Lab – ECS circuit
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Donor Results
ECS was able to be implemented in both the STK and NO-STK groups, but:
60min NO-STK group poor abdominal organ perfusion indicators at procurement
Low ECS flow
(42.1+/-1.0mL/kg/min)
Low renal artery flow
(40.8+/-4.3mL/min)
High renal vascular resistance
(1.54+/-0.14mmHg/mL/min)
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Donor Results
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Recovered and TransplantedGrafts
All grafts from the STK groups regardless of WI time met criteria for transplantation.
60min NO-STK group only 33.5% (3 of 8)
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Graft Survival & End of Study RRI
Only grafts from No-STK were lost
Adequate UO, abnormal CrCl
RRI decreased over time no significant differences
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Take Home Message
1. Successful ECS assisted donation can be achieved with the use of STK in this model (WI up to 60min)
2. The addition of STK to ECS run during uDCD donation results in renal grafts suitable for transplantation after 60min of WI in this model.
• However, proper renal function is still limited, and long term outcomes need to be studied.
3. Based on this study, we propose:
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Criteria for Organ Procurement & Transplantation in an ECS-uDCD model:
1. Renal artery flow >50mL/min or
renal vascular resistance <1.2mmHg/mL/min
2. ECS flows (ECS-f): > 45mL/min/Kg
3. ECS perfusion pressure: >60mmHg
4. Blood pH: 7.30 – 7.5
5. Macroscopic signs of poor perfusion, or NONE severe graft ischemia
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Acknowledgments
Mentors: • Dr. Jeff Punch• Dr. Robert H. Bartlett
UM- ECS Lab Staff• Techs / Research – Surgical Fellows
UM- Medical & Undergraduate Students
UM – Transplant team• Larry Slate II
Chief Transplant perfusionist