Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: With the ever enlarging list of potential recipients on the transplant list, the need for deceased donor organs has become critical. Avoiding injury to the procured organs then becomes paramount. All OPO’s across the US were asked to participate in a data collection study coordinated by the Association of Organ Procurement Organizations (AOPO) with the intent to determine causes of allograft procurement injury. A data collection form was developed and using this, 27 (of 58) OPO’s have contributed data. Data collection interval has, to date, been 11 months.
*Methods: To date, data has been collected on 3415 donors. 2685 of these donors were BD (brain dead) donors and 730 were DCD (donor after cardiac death) donors. The procurement of 6018 kidneys, 2638 livers, 479 pancreata and 1129 hearts were reviewed with data specifically collected on donors in which allograft injury was apparent either to the procuring or transplanting team. Injuries were classified as level 1 (minimal injury; no repair required), 2 (repair required for transplantation) or 3 (non-transplantable due to procurement injury). For the purposes of this abstract, our focus will be on injury levels 2 and 3.
*Results: Level 2 and 3 injuries respectfully for each organ were as follows (# of BD – vs DCD – are in parentheses): Kidney: 53 (38), 25 (17); Liver: 13 (11), 6 (2); Lung: 3 (2), 3 (2); Pancreas 1 (1), 8 (8); Heart – 1 (1) level 3 (no level 2 injuries). Level 2 and 3 injuries in the kidney cohort were more likely to be to the right kidney (49) vs. the left (28). In organs with reasonable numbers to evaluate (excluding pancreas and heart), injuries tended to be more common in DCD donors than in BD donors (as compared to relative total numbers and thus expected injury rate). Mean warm ischemia times in DCD donors in kidney donors were as follows: level 2: 26.5 minutes (range 7-52); level 3: 61.8 minutes (range 30-99 minutes). In addition, level of training of procurement surgeon for level 2 and 3 injuries were also queried with the following results: Attending 72 / 49; Trainee 27 / 17; non-MD 3 / 0.
*Conclusions: Procurement injury, while rare, remains an issue with variable impact among the different types of allografts. Right kidneys were more likely to be affected than left kidneys likely due to anatomic realities. Organs procured from DCD donors in most cases tended to have a higher incidence of organ injury vs expected. With the added pressure of potential injury due to warm ischemia time, this is not unexpected. In addition, mean warm ischemia times tended to be greater in type 3 injuries than type 2 (p value 0.0004). Causes for this increased potential for damage with prolonged warm ischemia times could include the presumed necessity for procurement speed in order to optimize viability of the allograft. Specific types of procurement injuries, evaluation of origin OPO size, potential cofounding donor history (previous abdominal surgery) and inclusion of type 1 injuries will be more fully discussed at time of presentation.
To cite this abstract in AMA style:Taber-Hight E, Cauwels R, Eidbo E, Paramesh AS, Squires R, Taber T. Determinants of Allograft Injury during Procurement in Deceased Donors [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/determinants-of-allograft-injury-during-procurement-in-deceased-donors/. Accessed May 8, 2021.
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