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UK NRP experience

UK NRP experience. 16 DCD donors 47 organs (29 kidneys, 8 livers, 4 pancreata and 3 lung pairs) 37 recipients 24 kidneys 8 livers 2 SPK 3 lung transplants 3 organs/donor Kidney DGF rate 20% Organ recovery rate: kidney (93% vs 82%) liver (50% vs 30%) lungs (18% vs 4%).

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UK NRP experience

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  1. UK NRP experience • 16 DCD donors • 47 organs (29 kidneys, 8 livers, 4 pancreata and 3 lung pairs) • 37 recipients 24 kidneys 8 livers 2 SPK 3 lung transplants • 3 organs/donor • Kidney DGF rate 20% • Organ recovery rate: kidney (93% vs 82%) liver (50% vs 30%) lungs (18% vs 4%).

  2. Kidney Transplantation • 24 recipients • CIT = 12h22’ (5h25’-18h22’). • DGF rate 20% (50% UK) • (2 donors on CVVH)

  3. Kidney function µmol/L 110 109 98 1 month 3 months 6 months

  4. Liver assessment - Biochemistry & Appearance • Aspect • Bile duct blood flow • PV / HA flows • Gallbladder mucosa aspect • Small bowel appearance Oniscu et al, ESOT 2013, Vienna

  5. ALT changes on the pump

  6. Liver Transplantation • 8 recipients • CIT = 4h10’ (2h49’-6h21’) • Peak ALT during 1st week : 257 (58-3043). • One PNF • No IC ( 2 recip 6/12)

  7. Pancreas transplantation • 4 pancreata retrieved • 2 SPK – primary function • 1 islet isolation – poor yield • 1 graft research (no islet lab after graft declined by two centres)

  8. Lung transplantation • 3 double lungs • Lungs retrieved with cold perfusion • Abdominal warm perfusion

  9. Renal Transplantation After Ex Vivo Normothermic Perfusion: The First Clinical StudyS Hosgood, Leicester American Journal of Transplantation 2013; 13:1246-52 • ECD kidneys • Pre-implantation EVNP • DGF 5.6% vs 36.2% • No survival difference

  10. Ex situ normothermic perfusion • 10 patients • 6.5-16.5 h preservation • DBD • No biliary complications • 1 pt 6 months Oxford & King’s College unpublished data

  11. Ex situ normothermic perfusion • Discarded donor livers • Pulsatile Arterial and continuous PV • 4 hours perfusion • Lactate normalised • Bile production • No hepatocellular ischaemia, biliary injury and sinusoidal damage Op den Dries S et al, 2013; 13(5):1327-35.

  12. Superior Preservation of DCD Livers With Continuous Normothermic Perfusion Constantino Fondevila, MD, PhD,∗ Amelia J. Hessheimer, MD,∗ Mark-Hugo J. Maathuis, MD, PhD,†Javier Mu˜noz, BS,∗ Pilar Taur´a, MD,‡ David Calatayud, MD,∗ Henri Leuvenink, PhD,† Antoni Rimola, MD, PhD,§ Rutger J. Ploeg, MD, PhD,† and Juan C. Garc´ıa-Valdecasas, MD, PhD∗ injury, inflammation, and synthetic function Annals of Surgery Volume 254, Number 6

  13. 20 lungs • 4 hours on the EVLP • Primary graft dysfunction at 72h: 15% vs 30% • No difference in • mortality • bronchial complications • duration of ventilation • hospital stay

  14. Twelve-hour Reanimation of a Human Heart Following Donation After Circulatory Death. Rosenfeldt F, Ou R, Woodard J, Esmore D, Marasco S.SourceDepartment of Cardiothoracic Surgery, Cardiac Surgical Research Unit, Alfred Hospital and the Department of Surgery, Monash University, Melbourne, Australia. • Case report • Ex situ, warm perfusion of a DCD heart for 12 hours

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