PMID- 24136827
OWN - NLM
STAT- MEDLINE
DCOM- 20140721
LR  - 20220318
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 19
IP  - 12
DP  - 2013 Dec
TI  - Regional perfusion by extracorporeal membrane oxygenation of abdominal organs 
      from donors after circulatory death: a systematic review.
PG  - 1292-303
LID - 10.1002/lt.23771 [doi]
AB  - 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.
CI  - (c) 2013 American Association for the Study of Liver Diseases.
FAU - Shapey, Iestyn M
AU  - Shapey IM
AD  - Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester, 
      United Kingdom.
FAU - Muiesan, Paolo
AU  - Muiesan P
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
MH  - Brain Death
MH  - Cause of Death
MH  - Delayed Graft Function/etiology/prevention & control
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Graft Survival
MH  - Humans
MH  - Kidney Transplantation/adverse effects/*methods/mortality
MH  - Liver Transplantation/adverse effects/*methods/mortality
MH  - Organ Preservation/adverse effects/*methods
MH  - Perfusion/adverse effects/*methods
MH  - Reperfusion Injury/etiology/prevention & control
MH  - Risk Factors
MH  - Time Factors
MH  - Tissue Donors/*supply & distribution
MH  - Tissue and Organ Harvesting/adverse effects/*methods
MH  - Treatment Outcome
MH  - Warm Ischemia/adverse effects
EDAT- 2013/10/19 06:00
MHDA- 2014/07/22 06:00
CRDT- 2013/10/19 06:00
PHST- 2013/05/18 00:00 [received]
PHST- 2013/09/10 00:00 [accepted]
PHST- 2013/10/19 06:00 [entrez]
PHST- 2013/10/19 06:00 [pubmed]
PHST- 2014/07/22 06:00 [medline]
AID - 10.1002/lt.23771 [doi]
PST - ppublish
SO  - Liver Transpl. 2013 Dec;19(12):1292-303. doi: 10.1002/lt.23771.