The effect of inadequate in situ perfusion in the non heart-beating donor
- 1 October 2005
- journal article
- case report
- Published by Frontiers Media SA in Transplant International
- Vol. 18 (10), 1142-1146
- https://doi.org/10.1111/j.1432-2277.2005.00164.x
Abstract
In situ aortic perfusion in the nonheart-beating donors (NHBD) is an important procedure to reduce primary warm ischaemic injury prior to formal donor organ retrieval. It allows an interim period to obtain donor family consent and theatre preparation. This study describes our experience of inadequate aortic perfusions resulting from difficult aortic cannulations and associated adverse outcome despite reasonable viability tests. Since 1998, all NHBD in our institution are perfused in situ using a double balloon triple lumen (DBTL) catheter inserted through a femoral artery cut-down procedure. The DBTL catheter is positioned with distal occlusive balloon at the aortic bifurcation using the "pull-back" technique, the proximal occlusive balloon lies above the renal arteries. This provides selective aortic perfusion in particular the kidneys. Venous decompression using a femoral vein catheter enables a "two-way infusion system". Pre-transplant viability status of retrieved kidneys is determined by measuring pressure/resistance characteristics to the flow and biochemical markers for ischaemic injury. There were 90 NHBD renal transplants performed from 72 donors. Three renal transplants were carried out from three donors of ineffective in situ perfusion secondary to cannulation difficulties. Femoral cannulation was difficult as a result of extensive atherosclerosis of donor vessels. The comparison of allograft outcome from effective and ineffective in situ perfusion of donors showed high rate of primary nonfunction (PNF) from ineffective perfusion (chi-squared, P < 0.0001). The cases demonstrated poor outcome from ineffective perfusion related to the cannulation difficulties. Therefore a strict policy should be taken in cases where aortic cannulation and perfusion is inadequate, despite pretransplant assessment. In these circumstances, the primary warm ischaemia time should be extended to include this period of ineffective perfusion.Keywords
This publication has 12 references indexed in Scilit:
- Experiences Learned in the Successful Establishment of a Nonheart Beating Donor Program for Renal TransplantationJournal of Urology, 2003
- Use of thrombolytic streptokinase as a preflush in the NHBD procurementTransplantation Proceedings, 2003
- Pump upgrade for machine perfusion at the Freeman Hospital in NewcastleTransplant International, 2001
- Machine perfusion and viability assessment of non–heart-beating donor kidneys—a single-centre resultTransplantation Proceedings, 2001
- Assessment of Non-Heart-Beating Donor (NHBD) Kidneys for Viability on Machine Perfusioncclm, 2000
- THE TROUBLE WITH KIDNEYS DERIVED FROM THE NON HEART-BEATING DONOR: A SINGLE CENTER 10-YEAR EXPERIENCE1Transplantation, 2000
- Kidney retrieval from asystolic donors using an intra-aortic balloon catheterBritish Journal of Surgery, 1996
- IN SITU CADAVER KIDNEY PERFUSIONTransplantation, 1981
- FACTORS AFFECTING THE OUTCOME OF CADAVER RENAL TRANSPLANTATION IN NEWCASTLE UPON TYNEThe Lancet, 1977
- In Situ Preservation of Cadaver Kidneys for TransplantationAnnals of Surgery, 1975