Extracorporeal Support May Increase Availability of Organs For Transplantation

Alvaro Rojas-Pena, MD Research Investigator, Laboratory Coordinator Robert H. Bartlett – Extracorporeal Life Support Laboratory Department of Surgery, Section of Transplantation Surgery Ann Arbor, MI 48109MedicalResearch.com Interview with: 
Alvaro Rojas-Pena, MD
Research Investigator, Laboratory Coordinator
Robert H. Bartlett – Extracorporeal Life Support Laboratory
Department of Surgery, Section of Transplantation Surgery
Ann Arbor, MI 48109

Medical Research: What are the main findings of the study?

Dr. Rojas-Pena: During the first 10 years’ experience of the University of Michigan using Extracorporeal Support (ECS) for organ donation in controlled donors after circulatory determination of death (cDCDD) we were able to increase the pool of organs suitable for transplantation by 20%.

A total of 48 renal grafts, 13 livers and 1 pancreas were successfully transplanted from 37 cDCDD. Kidneys transplanted after extracorporeal support assisted donation had a delayed graft function (DGF) rate of 31%, compared to the rate of renal grafts procured without extracorporeal support (64%).  DGF was defined as the need of hemodialysis within the first 7 days post transplantation

Finally, the 3-year survival rate of the renal transplant recipients is within the national standard for all renal recipients of cDCD at our institution.

Medical Research: Were any of the findings unexpected?

Dr. Rojas-Pena: The unexpected findings were associated to the low rates of complications during extracorporeal support implementation and most of them during the first 5 years of the study in our institution compared to other centers and literature. It’s possible that the reason for this is that our center has an experienced ECMO program. These complications include poor extracorporeal support flows (10.8%), cannulation (5.4%), bleeding and aortic balloon migration (2.7%).

Medical Research: What should clinicians and patients take away from your report?

Dr. Rojas-Pena: Extracorporeal support is an effective method to restore abdominal organ function after cardiac death. The results of kidney, liver, and pancreas transplantation after E-DCD are equal to those from brain-dead donors and better than RR-DCDD. Any medical center that is equipped to do cardiac surgery can implement the ECS technique in controlled-DCDD situations.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Rojas-Pena: If this technique were widely used, it could significantly increase the number and quality of abdominal organs for transplantation. The technique of extracorporeal support assisted DCDD developed here in controlled conditions could result in a major increase in donor organs if applied to the much larger group of potential uncontrolled DCDD.

Citation:

Donation After Circulatory Determination of Death: The University of Michigan Experience With Extracorporeal Support
Rojas-Peña A1, Sall LE, Gravel MT, Cooley EG, Pelletier SJ, Bartlett RH, Punch JD.
Transplantation. 2014 Aug 15;98(3):328-34. doi: 10.1097/TP.0000000000000070.

 

No Comments

Sorry, the comment form is closed at this time.