Impact of Machine Perfusion of the Heart on Abdominal Organ Procurement from Donation After Cardiac Death Donors
Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
Meeting: 2021 American Transplant Congress
Abstract number: 455
Keywords: Donors, non-heart-beating, Machine preservation, Outcome, Preservation
Topic: Clinical Science » Organ Inclusive » Non-Organ Specific:Organ Preservation/Ischemia Reperfusion Injury
Session Information
Session Time: 7:30pm-8:30pm
Presentation Time: 7:30pm-7:40pm
Location: Virtual
*Purpose: Superior preservation with normothermic machine perfusion devices has been demonstrated in thoracic and abdominal allografts, especially DCD donation, where clinical utilization of DCD hearts has become feasible with the use of machine perfusion. The addition of heart donation has increased the complexity of DCD donor procurement. In this study, the impact of heart procurement on organ retrieval activities and abdominal organ yield was examined.
*Methods: All potential DCD donors between 2015 and 2020 were identified using the UNOS STARfile. Two donor cohorts were generated based on the presence of Machine Perfusion for the Heart (MPH) group (n=99) or its absence, (Control) group (n=3502). Time from withdrawal to circulatory arrest and circulatory arrest to cross-clamp was calculated and compared between groups. Organ utilization was determined and reasons for discard were examined. Further analysis after propensity score matching for donor age, BMI and cause of death was also done.
*Results: MPH procurements had shorter total warm ischemia time (27.0 ± 10.0 vs 29.9 ± 14.0, p=0.04) as well as shorter time from cardiac arrest to aortic cross-clamp (10.6 ± 3.6 vs 12.9 ± 6.5, p=0.001). Liver (53% vs 29%), kidney (87% vs 81%), and pancreas allograft (7% vs 1.1%) utilization were greater in the MPH group. Most discarded livers (79%) in the MPH group were due to anatomic abnormalities, poor flush or biopsy findings. 3 livers discarded for excessive warm ischemia time all had shorter than average arrest to cross-clamp times. After propensity score matching similar shorter procurement times (cardiac arrest to aortic cross-clamp 10.6 ± 3.6 min. vs 13.1 ± 6.3 min, p=0.0007) and enhanced organ utilization (51% vs 34%) were found in the MPH group compared to control.
*Conclusions: MPH during DCD procurements does not lead to delays in time from cardiac arrest to aortic cross-clamp. Complex multi-organ procurements, incorporating MPH devices, can be done successfully in DCD donors with increased donor organs.
To cite this abstract in AMA style:
Feizpour C, Hwang C, Shubin A, Shah J, DeGregoria L, Hanish S, Vagefi P, MacConmara M. Impact of Machine Perfusion of the Heart on Abdominal Organ Procurement from Donation After Cardiac Death Donors [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-machine-perfusion-of-the-heart-on-abdominal-organ-procurement-from-donation-after-cardiac-death-donors/. Accessed May 16, 2025.« Back to 2021 American Transplant Congress