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Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy?

Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy?. Spurlock D; Koch KL; Sall LE; Ranney D; El-Sabbagh A; Ceballos C; Mira JC; Cook KE; Bartlett RH; Pelletier SG; Punch JD; Rojas A University of Michigan Health System

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Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy?

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  1. Improving ECS-DCD Assisted Donation: Are Thrombolytics a Beneficial Strategy? Spurlock D; Koch KL; Sall LE; Ranney D; El-Sabbagh A; Ceballos C; Mira JC; Cook KE; Bartlett RH; Pelletier SG; Punch JD; Rojas A University of Michigan Health System Department of Surgery, Section of Transplantation and the Extracorporeal Life Support Program

  2. DCD Limitation in the US Most potential DCD are unable to donate due to unexpected death Long time periods: death to organ procurement =  WIT & clot formation ECS (cDCD) / Can be used in the uDCD? .

  3. Hypothesis Unexpected (uDCD) donation could be improved with the use of thrombolyticsduring extracorporeal support (ECS) assisted donation

  4. DCD Animal model - Swine DCD sustained 30 or 60 minutes of WI followed by 3hr of ECS at 30˚C Four Study Groups

  5. Transplant ModelRojas A, et al. American Journal of Transplantation, 2010; 10: 1365-74 Renal artery flow >50mL/min Organs procured, flushed and cold storage with HTK for 4-5hrs. Transplanted in healthy nephrectomized swine and perfused for 4hrs. • Data collection for DCD and recipients: • Hemodynamics (systemic, renal, ECS) and renal function

  6. UM Lab – ECS circuit

  7. Donor Results ECS was able to be implemented in both the STK and NO-STK groups, but: 60min NO-STK group  poor abdominal organ perfusion indicators at procurement Low ECS flow (42.1+/-1.0mL/kg/min) Low renal artery flow (40.8+/-4.3mL/min) High renal vascular resistance (1.54+/-0.14mmHg/mL/min)

  8. Donor Results

  9. Recovered and TransplantedGrafts All grafts from the STK groups regardless of WI time met criteria for transplantation. 60min NO-STK group only 33.5% (3 of 8)

  10. Graft Survival & End of Study RRI Only grafts from No-STK were lost Adequate UO, abnormal CrCl RRI decreased over time no significant differences

  11. Take Home Message • Successful ECS assisted donation can be achieved with the use of STK in this model (WI up to 60min) • The addition of STK to ECS run during uDCD donation results in renal grafts suitable for transplantation after 60min of WI in this model. • However, proper renal function is still limited, and long term outcomes need to be studied. • Based on this study, we propose:

  12. Criteria for Organ Procurement & Transplantation in an ECS-uDCD model: • Renal artery flow >50mL/min or renal vascular resistance <1.2mmHg/mL/min • ECS flows (ECS-f): > 45mL/min/Kg • ECS perfusion pressure:>60mmHg • Blood pH: 7.30 – 7.5 • Macroscopic signs of poor perfusion, or NONE severe graft ischemia

  13. Acknowledgments Mentors: • Dr. Jeff Punch • Dr. Robert H. Bartlett UM- ECS Lab Staff • Techs / Research – Surgical Fellows UM- Medical & Undergraduate Students UM – Transplant team • Larry Slate II Chief Transplant perfusionist

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