UNASSIGNED:本研究旨在评估体外循环胸腹常温局部灌注对心脏死亡器官捐献者移植前捐献代谢环境的影响。
UNASSIGNED:对心脏死亡后的当地捐赠供者的适用性和参与意愿进行评估。在手术室中进行维持生命疗法的撤回。在宣布循环性死亡和5分钟观察期后,心脏团队进行了正中胸骨切开术,主动脉弓血管结扎,并在37°C下通过中心体外循环开始胸腹常温局部灌注。注入三个含有50mEq碳酸氢钠和0.5g碳酸钙的氯化钠零平衡超滤袋。在输注每个零平衡超滤袋后,每15分钟获得动脉血气测量值,并根据需要输血以维持血红蛋白大于8mg/dL。体外循环断奶,同时对供体心脏进行血流动力学和经食道超声心动图评估。剩余的采购,包括腹部器官,以类似于脑死亡后标准捐赠的受控方式进行捐赠。
UNASSIGNED:在2020年1月至2022年5月之间,在我们机构使用胸腹常温区域灌注方案进行了18例心脏死亡移植后捐赠。供体年龄中位数为42.5岁(范围,20-51年),男性占88.9%(16/18)。平均总供体体外循环时间为88.8±51.8分钟。在体外循环开始时,供体乳酸平均为9.4±1.5mmol/L,最终乳酸平均为5.3±2.7mmol/L(P<0.0001)。平均起始钾为6.5±1.8mmol/L,平均终止钾为4.2±0.4mmol/L(P<.0001)。平均起始血红蛋白为6.8±0.7g/dL,平均终末血红蛋白为8.2±1.3g/dL(P<.001)。平均而言,心脏死亡后的献血者接受了2.3±1.5单位包装红细胞的输血.在18位接受了常温区域灌注的捐献者中,所有的心脏都被认为适合恢复并成功移植,100%的收益率。其他成功回收和移植的器官包括肾脏(产率为80.6%),肝脏(66.7%的收益率),和双侧肺(27.8%的产率)。
UNASSIGNED:使用体外循环进行胸腹常温区域灌注是提高心脏死亡捐献者捐献器官质量的新兴选择。对心脏死亡供者的术中精心管理,特别注重改善其代谢环境,可能会改善移植受者的移植物功能。
UNASSIGNED: This study aimed to evaluate the impact of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion on the metabolic milieu of donation after cardiac death organ donors before transplantation.
UNASSIGNED: Local donation after cardiac death donor offers are assessed for suitability and willingness to participate. Withdrawal of life-sustaining therapy is performed in the operating room. After declaration of circulatory death and a 5-minute observation period, the cardiac team performs a median sternotomy, ligation of the aortic arch vessels, and initiation of thoraco-abdominal normothermic regional perfusion via central cardiopulmonary bypass at 37 °C. Three sodium chloride zero balance ultrafiltration bags containing 50 mEq sodium bicarbonate and 0.5 g calcium carbonate are infused. Arterial blood gas measurements are obtained every 15 minutes after every zero balance ultrafiltration bag is infused, and blood is transfused as needed to maintain hemoglobin greater than 8 mg/dL. Cardiopulmonary bypass is weaned with concurrent hemodynamic and transesophageal echocardiogram evaluation of the donor heart. The remainder of the procurement, including the abdominal organs, proceeds in a similar controlled fashion as is performed for a standard donation after brain death donor.
UNASSIGNED: Between January 2020 and May 2022, 18 donation after cardiac death transplants using the thoraco-abdominal normothermic regional perfusion protocol were performed at our institution. The median donor age was 42.5 years (range, 20-51 years), and 88.9% (16/18) were male. The mean total donor cardiopulmonary bypass time was 88.8 ± 51.8 minutes. At the beginning of cardiopulmonary bypass, the average donor lactate was 9.4 ± 1.5 mmol/L compared with an average final lactate of 5.3 ± 2.7 mmol/L (P<.0001). The average beginning potassium was 6.5 ± 1.8 mmol/L compared with an average end potassium of 4.2 ± 0.4 mmol/L (P<.0001) . The average beginning hemoglobin was 6.8 ± 0.7 g/dL, and the average end hemoglobin was 8.2 ± 1.3 g/dL (P<.001) . On average, donation after cardiac death donors received transfusions of 2.3 ± 1.5 units of packed red blood cells. Of the 18 donors who underwent normothermic regional perfusion, all hearts were deemed suitable for recovery and successfully transplanted, a yield of 100%. Other organs successfully recovered and transplanted include kidneys (80.6% yield), livers (66.7% yield), and bilateral lungs (27.8% yield).
UNASSIGNED: The use of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion is a burgeoning option for improving the quality of organs from donation after cardiac death donors. Meticulous intraoperative management of donation after cardiac death donors with a specific focus on improving their metabolic milieu may lead to improved graft function in transplant recipients.