organ transplantation; Non heart beating donation; donation after cardiac death; end of life; heart transplantation
Abstract :
[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.
Disciplines :
Surgery Cardiovascular & respiratory systems Anesthesia & intensive care
Author, co-author :
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
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