Strategies like donation after cardiac death (DCD) have become more widely accepted to increase potential organ supply and decrease waiting list time. Warm ischemia time (WIT) is a key prognostic factor for organ function. Any process that can decrease WIT could decrease the number of discarded organs as well as improve graft and patient survival. A novel endovascular aortic crossclamping technique in DCD donors is described. Six kidneys and two livers were recovered from three donors. Mean WIT from extubation to aortic crossclamp was 25 ± 8 minutes. Time from initial glidewire placement to crossclamp was less than 2 minutes. All the organs were adequately flushed; back table examination confirmed clean venous effluent and no signs of thrombosis. Four kidneys were transplanted. Two kidneys were discarded after DCD was prolonged and WIT was 60 minutes. The two livers were not allocated. The WIT can be manipulated after cardiac activity has stopped. The endovascular crossclamp is a novel and feasible technique that can decrease WIT after cardiac death by reducing the surgical time to aortic crossclamp.
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References
1.
The Organ Procurement and Transplantation Network National Data. [Internet]. Available at www.ustransplant.org. Accessed Nov. 1, 2007.
2.
DoshiM.D., HunsickerL.G.Short- and long-term outcomes with the use of kidneys and livers donated after cardiac death.Am J Transplant2007; 7: 122–9.
3.
SalvalaggioP.R., DaviesD.B., FernandezL.A., KaufmanD.B.Outcomes of pancreas transplantation in the United States using cardiac-death donors.Am J Transplant2006; 6: 1059–65.
4.
ColliniA., De BartolomeisC., RuggieriG.Long-term outcome of renal transplantation from marginal donors.Transplant Proc2006; 38: 3398–9.
5.
TectorA.J., MangusR.S., ChestovichP.Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival.Ann Surg2006; 244: 439–50.
6.
PottsJ.T.Institute of Medicine: Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement.Washington, DC: National Academy Press, 1997.
7.
NishikidoM., NoguchiM., KogaS.Kidney transplantation from non-heart-beating donors: Analysis of organ procurement and outcome.Transplant Proc2004; 36: 1888–90.
8.
TojimbaraT., FuchinoueS., IwadohK.Improved outcomes of renal transplantation from cardiac death donors: A 30-year single center experience.Am J Transplant2007; 7: 609–17.
9.
NicholsonM.L., MetcalfeM.S., WhiteS.A.A comparison of the results of renal transplantation from non-heart-beating, conventional cadaveric, and living donors.Kidney Int2000; 58: 2585–91.
10.
DroupyS., BlanchetP., EschwegeP.Long-term results of renal transplantation using kidneys harvested from non-heartbeating donors: A 15-year experience.J Urol2003; 169: 28–31.
11.
AndreoniK.A., BraymanK.L., GuidingerM.K.Kidney and pancreas transplantation in the United States, 1996–2005.Am J Transplant2007; 7: 1359–75.
12.
LockeJ.E., SegevD.L., WarrenD.S.Outcomes of kidneys from donors after cardiac death: Implications for allocation and preservation.Am J Transplant2007; 7: 1797–807.
13.
LeeK.W., SimpkinsC.E., MontgomeryR.A.Factors affecting graft survival after liver transplantation from donation after cardiac death donors.Transplantation2006; 82: 1683–8.
14.
Garcia-RinaldiR., LefrakE.A., DeforeW.W.In situ preservation of cadaver kidneys for transplantation: Laboratory observations and clinical application.Ann Surg1975; 182: 576–84.
15.
GokM.A., BhattiA.A., AsherJ.The effect of inadequate in situ perfusion in the non heart-beating donor.Transpl Int2005; 18: 1142–6.
16.
MaglioccaJ.F., MageeJ.C., RoweS.A.Extracorporeal support for organ donation after cardiac death effectively expands the donor pool.J Trauma2005; 58: 1095–101; discussion 1101–2.
17.
GravelM.T., ArenasJ.D., ChenaultR.IIKidney transplantation from organ donors following cardiopulmonary death using extracorporeal membrane oxygenation support.Ann Transplant2004; 9: 57–8.
18.
BernatJ.L., D'AlessandroA.M., PortF.K.Report of a national conference on donation after cardiac death.Am J Transplant2006; 6: 281–91.
