Tuscany Normothermic Regional Perfusion Mobile Teams for Controlled Donation After Circulatory Death

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-08 DOI:10.1111/ctr.15429

Chiara Lazzeri, Bonizzoli Manuela, Sara Bagatti, Stefano Antonelli, Paolo Lo Pane, Davide Ghinolfi, Adriano Peris

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引用次数: 0

Abstract

Introduction

To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local extracorporeal membrane oxygenation (ECMO) team, some countries have launched a local cDCD network with an ECMO mobile team for normothermic regional perfusion (NRP). In the Tuscany region, in 2021, the Regional Transplant Authority launched a cDCD program to make the cDCD pathway feasible even in peripheral hospitals with NRP mobile teams, which were “converted” existing ECMO mobile teams, composed of highly skilled and experienced personnel.

Methods

We describe the Tuscany cDCD program, (2021–2023), for cDCD from peripheral hospitals with NRP mobile teams.

Results

Twenty-six cDCDs (26/40, 65%) came from peripheral hospitals. Following the launch of the cDCD program, cDCDs from peripheral hospitals increased, from 33% (2021) to 75% (2022 and 2023) of the overall cDCDs. The mean age was 63 years, with older donors (>75 years) in half the cases. The median warm ischemia time was 45 min (20 min are required by the Italian law for death certification), ranging from 35 to 59 min. Among the 20 livers retrieved and 18 kidneys retrieved, 16 livers, and 11 kidneys (single kidney transplantation) were transplanted, after ex vivo reperfusion, respectively.

Conclusions

The use of NRP mobile teams proved to be feasible and safe in the management of cDCD in peripheral hospitals. No complications were reported with NRP despite the advanced age of most cDCDs.

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托斯卡纳常温区域灌注流动小组，用于循环死亡后的控制性捐献。

导言：为了促进循环死亡后控制性捐献（cDCD）计划的实施，即使在当地没有配备体外膜肺氧合（ECMO）团队的医院，一些国家已经启动了当地的cDCD网络，并配备了常温区域灌注（NRP）的ECMO流动团队。2021 年，托斯卡纳地区器官移植管理局启动了一项 cDCD 计划，目的是让拥有 NRP 流动团队的外围医院也能采用 cDCD 途径，NRP 流动团队由现有的 ECMO 流动团队 "改造 "而成，由技术娴熟、经验丰富的人员组成：我们介绍了托斯卡纳 cDCD 计划（2021-2023 年），该计划针对拥有 NRP 流动小组的外围医院的 cDCD：结果：26 个 cDCD（26/40，65%）来自外围医院。在 cDCD 计划启动后，来自外围医院的 cDCD 人数有所增加，在整个 cDCD 人数中所占比例从 33%（2021 年）增至 75%（2022 年和 2023 年）。平均年龄为 63 岁，半数病例的供体年龄较大（大于 75 岁）。温暖缺血时间的中位数为 45 分钟（意大利法律规定死亡证明时间为 20 分钟），从 35 分钟到 59 分钟不等。在取回的 20 个肝脏和 18 个肾脏中，分别有 16 个肝脏和 11 个肾脏（单肾移植）在体外再灌注后进行了移植：结论：事实证明，在外围医院管理 cDCD 时，使用 NRP 流动小组是可行且安全的。结论：事实证明，在外围医院使用 NRP 流动小组治疗 cDCD 是可行和安全的，尽管大多数 cDCD 患者年龄偏高，但 NRP 未出现任何并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.