Complex use of perfusion techniques in kidney transplantation from a donor with out-of-hospital cardiac arrest (clinical case)

A. Shabunin, M. Minina, P. Drozdov, I. Miloserdov, D. A. Saydulaev, V. M. Sevostyanov, E. A. Tenchurina
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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.
院外心脏骤停供体肾移植中灌注技术的复杂应用(临床病例)
目的:介绍对一名院外心脏骤停(OHCA)供体采用一套现代灌注技术获得适合移植的肾脏的成功经验。在 100% FiO2 的机械通气条件下,对一名 OHCA 供体(在医院确认生物学死亡后)恢复自动胸外按压,以维持最低限度的灌注。通过股静脉插管,连接了带有离心泵和氧合器的体外循环,并启动了腹腔常温区域灌注。215 分钟后,在常温机器灌注下取出肾脏。接着,将左肾放入 LifePort 肾脏转运器,对供体肾脏进行低温机器灌注。灌注时间为 285 分钟。右肾移植时没有进行额外的体外灌注。由于在供体体内和体外灌注技术的复杂应用,OHCA后的供肾在110分钟的热缺血时间内移植给了受体,效果良好。术后,左右肾移植物的功能出现延迟。结论:术后器官捐献的可能性和效率都很高。在现代灌注技术和设备的帮助下,心脏骤停后器官捐献的可能性和效率为解决器官短缺危机开辟了新的前景。
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