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O.Reznik, A. Skvortsov, A.Reznik, Y.Moysyuk, S.Bagnenko, and S.Gautier

New Perspective for Expanding Donor’s Pool -Resuscitation Kidney In Uncontrolled Donors by Normothermic Perfusion “In Situ” with Oxygenation and Leucocyte Depletion Saint-Petersburg, Russia State Research Institute for Emergency, ISODP-2011 Buenos-Aires, Argentina.

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O.Reznik, A. Skvortsov, A.Reznik, Y.Moysyuk, S.Bagnenko, and S.Gautier

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  1. New Perspective for Expanding Donor’s Pool -Resuscitation Kidney In Uncontrolled Donors by Normothermic Perfusion “In Situ” with Oxygenation and Leucocyte Depletion Saint-Petersburg, RussiaState Research Institute for Emergency, ISODP-2011Buenos-Aires, Argentina O.Reznik, A. Skvortsov, A.Reznik,Y.Moysyuk, S.Bagnenko, and S.Gautier

  2. The design of this study, protocols of perfusion, and procurement and transplantation procedures were approved by the Scientific Board and Ethics Committee of the Saint Petersburg State Research Institute for Emergency (Decision 7/0615/09) and authorized for clinical application by the Federal Advisory Service of the Health Ministry of the Russian Federation (Resolution N2010/299) The authors don’t have the conflict of interests

  3. Introduction In the US, the number of potential uncontrolled donors after cardiac death was estimated at 22,000 per year in 2006 IOM: Organ Donation: Opportunities for Action. Washington, DC: National Academies Press; 2006 Hanto DW, Veatch RM. Uncontrolled Donation after Circulatory Determination of Death (UDCDD) and the Definition of Death. Am J Transplant 2011; 11(7): 1351-1352. Hoogland ERP, et al. Kidney Transplantation from Donors after Cardiac Death: Uncontrolled versus Controlled Donation. AJT 2011; 11(7): 1427-1434. Wall SP, et al. Derivation of the Uncontrolled Donation after Circulatory Determination of Death Protocol for New York City. Am J Transplant 2011; 11(7): 1417-1426

  4. background • The number of patients died form irreversible sudden asystole was 173 in 2009 in Saint Petersburg •Most of potential grafts from uDCD are lost due to irreversible ischemic damage during warm ischemic time • The main task our work was the development procurement protocol which would lead to the organ resuscitation after ischemical damage and due to this expanding the donor pool

  5. “Compilation approach” • Sanchez-Fructuoso A.I.,et al.Non-heart beating donors: experience from the Hospital Clinico of Madrid, J. Nephrol;2003;16(3);387-92. • Steen S., Ingemansson R. et. al.First Human Transplantation of Nonacceptable donor lung after reconditioning ex vivo Ann of Thor Surgery,2007,83(6),2191-95 • Talbot D. et al. How to improve the quality of kidneys from non-heart-beating donors: a randomized controlled trial of thrombolysis in non-heart-beating donors,Transplantation,2003,76(12),1714-19 • Jamieson R. W., Friend P. J. Normothermic organ preservation, Tr Rev,2006,Vol. 20,P.172-8 • Nicholson M. L., Simon J. F., Harper L.W. et. al. The Effect of Warm Ischemic Time on Renal Function and Injury in the Isolated Hemoperfused Kidney,Transplantation,2008,86(3), 445-51 • Fondevila C., et al., Am J Tr 2007;7;1849 Liver transplant using donors after unexpectedcardiac death: novel preservation protocol andacceptance criteria

  6. «Soviet Experiments in the Revival of Whole Organisms and Isolated Dog Head» 1927 Sergei S. Brukhonenko, 1890-1960 Konstantinov I.E., Alexi-Meskishvili V.V. Sergei s. Brukhonenko: the Development of the First Heart-Lung Machine for Total Body Perfusion Ann. Thorac. Surg. – 2000. - Vol. 69. - P. 962 – 966. Probert W.R., Melrouse D.G. An Early Russian Heart-Lung Machine BMJ, 1960 April. -12. - Р.104

  7. material & methods • New logistic procurement model • Extracorporal perfusion circuit • Perfusat (modificated donor’s blood) • 17 uncontrolled donors, 2009-2010 • 34 recipients of kidney from uDCD

  8. Material and Methods: New Uncontrolled Donation Logistics Chain Warm Ischemic Time 45-91 minutes

  9. surgical femoral vessels access and three-lumen double balloon catheterization of abdominal region

  10. Scheme of isolated abdominal perfusion procedure

  11. Composition of perfusat • Modificated donor blood (27°-32°C) • 25000 U heparin • 1,5 mln U streptokinase • 400 ml perfluorocarbonic emulsion • for primary filling of perfusion circuit is used the HTK-solution

  12. Donors characteristics

  13. Donors’ Perfusion procedure data *рО2: partial pressureof oxygen **рСО2: partial pressureof carbon dioxide ***NECP and LD: normothermic extracorporeal perfusion andleukocyte depletion

  14. Recipients characteristics

  15. Conclusion • The results of the 1-year follow-up of our initial clinical experience with this procedure provide evidence that transplantation of organs that are “resuscitated” using this method are satisfactory and meet the generally accepted criteria for graft survival and functioning. • The implementation of NECP with oxygenation and leukocyte depletion allows expanding the donor pool due to inclusion of the resource of donors with unexpected cardiac death

  16. Sergei Brukhonenko1890-1960 THANK YOU FOR YOUR ATTENTION

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