Regional perfusion by extracorporeal membrane oxygenation of abdominal organs from donors after circulatory death: A systematic review

Authors

  • Iestyn M. Shapey,

    Corresponding author
    1. Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
    • Address reprint requests to Iestyn M. Shapey, M.D., BMedSc MBChB MSc MRCS(Ed) LRSM Department of Transplantation Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester, Greater Manchester M13 9WL. E-mail: i.m.shapey@doctors.org.uk

    Search for more papers by this author
  • Paolo Muiesan

    1. Department of Hepatobiliary and Transplantation Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
    Search for more papers by this author

  • This study was presented in part at the 15th Congress of the European Society of Organ Transplantation (Glasgow, Scotland, September 2011).

  • This article was submitted to the University of Edinburgh and the Royal College of Surgeons of Edinburgh as part of a thesis for the degree of Master of Surgical Sciences (Edinburgh Surgical Sciences Qualification).

  • The authors have no conflicts of interest or funding to declare.

Abstract

Organs from donors after circulatory death (DCDs) are particularly susceptible to the effects of warm ischemia injury. Regional perfusion (RP) by extracorporeal membrane oxygenation (ECMO) is increasingly being advocated as a useful remedy to the effects of ischemia/reperfusion injury, and it has been reported to enable the transplantation of organs from donors previously deemed unsuitable. The MEDLINE, Embase, and Cochrane databases were searched, and articles published between 1997 and 2013 were obtained. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two hundred ten articles were identified, and 11 were eligible for inclusion. Four hundred eighty-two kidneys and 79 livers were transplanted from regional perfusion–supported donor after circulatory death (RP-DCD) sources. One-year graft survival was lower with uncontrolled RP-DCD liver transplantation, whereas 1-year patient survival was similar. Primary nonfunction and ischemic cholangiopathy were significantly more frequent with RP-DCDs versus donors after brain death (DBDs), but there was no difference in postoperative mortality between the 2 groups. The 1-year patient and graft survival rates for RP-DCD kidney transplantation were better than the rates with standard DCDs and were comparable to, if not better than, the rates with DBDs. At experienced centers, delayed graft function (DGF) for kidney transplantation from RP-DCDs was much less frequent in comparison with all other donor types. In conclusion, RP aids the recovery of DCD organs from ischemic injury and enables transplantation with acceptable survival. RP may help to increase the donor pool, but its benefits must still be balanced with the recognition of significantly higher rates of complications in liver transplantation. In kidney transplantation, significant reductions in DGF can be obtained with RP, and there are potentially important implications for long-term outcomes. Significant ethicolegal issues exist, and they are preventing a worldwide consensus on optimum RP protocols and an accurate appreciation of outcomes. Liver Transpl 19:1292-1303, 2013. © 2013 AASLD.

Ancillary