organ transplantation; Non heart beating donation; donation after cardiac death; end of life; heart transplantation
Résumé :
[en] BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol. METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circu- lation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room.
RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotro- pic support. Post-operative evaluation of cardiac function was excellent and the patients were subse- quently discharged home.
CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention.
TCHANA-SATO, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
LEDOUX, Didier ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service des soins intensifs généraux
DETRY, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
HANS, Grégory ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
ANCION, Arnaud ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Insuffisance cardiaque - Transplantation
D'ORIO, Virginie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Insuffisance cardiaque - Transplantation
MASSION, Paul ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service des soins intensifs généraux
AMABILI, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
BRULS, Samuel ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
LAVIGNE, Jean-Paul ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
MONARD, Josée ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
DELBOUILLE, Marie-Hélène ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
SAKALIHASAN, Natzi ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
DEFRAIGNE, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service de chirurgie cardio-vasculaire et thoracique
Summers, DM, Watson, CJ, Pettigrew, GJ, et al. Kidney donation after circulatory death (DCD): state of the art. Kidney Int 88 (2015), 241–249.
Erasmus, ME, van Raemdonck, D, Akhtar, MZ, et al. DCD lung donation: donor criteria, procedural criteria, pulmonary graft function validation, and preservation. Transpl Int 29 (2016), 790–797.
Morissey, PE, Monaco, AP, Donation after circulatory death: current practices, ongoing challenges, and potential improvements. Transplantation 97 (2014), 258–264.
The report was published by Statistics and Clinical Studies, NHS Blood and Transplant (UK). Available at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12300/transplant-activity-report-2017-2018.pdf/.
Detry, O, van Deynse, D, van Vlierberghe, H, Pirenne, J, Organ procurement and transplantation in Belgium. Transplantation 101 (2017), 1953–1955.
Singhal, AK, Abrams, JD, Mohara, J, et al. Potential suitability for transplantation of hearts from human non-heart beating donors: data review from the Gift of Life Donor Program. J Heart Lung Transplant 24 (2005), 1654–1664.
Noterdaeme, T, Detry, O, Hans, M-F, et al. What is the potential increase in the heart graft pool by cardiac donation after circulatory death?. Transpl Int 26 (2013), 61–66.
Messer, S, Lannon, J, Wong, E, et al. The potential of transplanting hearts from donation after circulatory determined death (DCD) donors within the United Kingdom. J Heart Lung Transplant, 34(suppl), 2015, S275.
Dhital, KK, Lyer, A, Connellan, M, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet 385 (2015), 2585–2591.
Garcia Saez, D, Bowles, CT, Mohite, PN, et al. Heart transplantation after circulatory death in patients bridged to transplant with implantable left ventricular assist devices. J Heart Lung Transplant 35 (2016), 1255–1260.
Messer, SJ, Axell, RG, Colah, S, et al. Functional assessment and transplantation of the donor heart after circulatory death. J Heart Lung Transplant 35 (2016), 1443–1452.
Messer, S, Page, A, Axell, R, et al. Outcome after heart transplantation from donation after circulatory-determined death donors. J Heart Lung Transplant 36 (2017), 1311–1318.
Boucek, MM, Mashburn, C, Dunn, SM, et al. Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med 359 (2008), 709–714.
Messer, S, Page, A, Colah, S, et al. Human heart transplantation from donation after circulatory-determined death donors using normothermic regional perfusion and cold storage. J Heart Transplant 37 (2018), 865–869.
Joris, J, Kaba, A, Lauwick, S, et al. End of life care in the operating room for non-heart beating donors: organization at the University Hospital of Liege. Transplant Proc 43 (2011), 3441–3444.
Ledoux, D, Delbouille, MH, Deroover, A, et al. Does comfort therapy during controlled donation after circulatory death shorten the life of potential donors?. Clin Transplant 28 (2014), 47–51.
Ohsumi, A, Marseu, K, Slinger, P, et al. Sevoflurane attenuates ischemia-reperfusion injury in a rat lung transplantation model. Ann Thorac Surg 103 (2017), 1578–1586.
Lee, J, Yoo, YJ, Lee, JM, Park, YJ, Ryu, HG, Sevoflurane versus desflurane on the incidence of postreperfusion syndrome during living donor liver transplantation: a randomized controlled trial. Transplantation 100 (2016), 600–606.
Detry, O, Donckier, V, Lucidi, V, et al. Liver transplantation from donation after cardiac death donors: initial Belgian experience 2003-2007. Transpl Int 23 (2010), 611–618.
Detry, O, DeRoover, A, Meurisse, N, et al. Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme. Br J Surg 101 (2014), 784–792.
Le Dinh, H, DeRoover, A, Kaba, A, et al. Donation after cardio-circulatory death liver transplantation. World J Gastroenterol 18 (2012), 4491–4506.
Tsui, SSL, Oniscu, GC, Extending normothermic regional perfusion to the thorax in donors after circulatory death. Curr Opin Organ Transplant 22 (2017), 245–250.
Weiss, ES, Allen, JG, Arnaoutakis, GJ, et al. Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT). Ann Thorac Surg 92 (2011), 914–921.
Shemie, SD, Baker, AJ, Knoll, G, et al. National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada. CMAJ 175:suppl (2006), S1–S24.
Graftieaux, JP, Bollaert, PE, Haddad, L, et al. Contribution of the ethics committee of the French Society of Intensive Care Medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France. Réanimation 33 (2014), 128–134.
Bos, M., Ethical and legal issues in non-heart beating organ donation. Transplant Proc 37 (2005), 574–576.
Reich, J, Mulligan, D, Abt, P, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant 9 (2009), 2004–2011.
