42nd Congress of the Italian Transplantation SocietyOrgan procurement and allocationKidney Transplantation From Circulatory Death Donors: Monocentric Experience
Section snippets
Materials and Methods
We describe DCD KTX activity the University Hospital of Modena from the implementation of the program in November 2017 to June 2018.
According to our protocol, every graft underwent in situ normothermic regional perfusion (ECMO), followed by ex situ hypothermic oxygenated perfusion (HOPE) by Kidney Assist, to ensure optimal graft preservation and evaluation. A kidney biopsy was performed for allocation strategy based on the Karpinski score (Single KTX up to 4-4, discarded over 6-6, double for
Results
We performed a total of 6 KTX (3 single and 3 double) from Maastricht category III DCD donors (Table 1). Time from asystole to ECMO start was 20 minutes. ECMO was established postasystole via aortic and caval cannulation and maintained for an average of 3 h 27 minutes (range, 2 h 51 min-4 h 44 min). The mean duration of HOPE was 4 h 47 min (range, 2 h 52 min-7 h 47 min), perfusion was maintained at an inferior systolic pressure of 120 mm Hg, average flow was 130 mL/min, and mean resistance
Discussion
The preliminary results of DCD KTX program of our unit confirm satisfactory outcomes in terms of kidney function, DGF, and PNF. A null discard rate in the perfused organs suggests effective donor selection criteria and an optimal procurement organization. This was also confirmed by low ischemia times regardless of donation site.
Perfusion fluid biochemical and dynamic values did not differ substantially from case to case, placing within or close to the normal range, thus not influencing clinical
Conclusions
The DCD program is a promising resource for increasing organ donations. ECMO and HOPE, combined with clinical and histological data, allowed adequate organ evaluation and recovery. In our experience, DCD KTX outcomes are satisfactory and encourage further development of the program.
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