Improving ECS-DCD Assisted Donation: Are Thrombolytics a

Beneficial Strategy?

Spurlock D; Koch KL; Sall LE; Ranney D; El-Sabbagh A; Ceballos C; Mira JC; Cook KE; Bartlett RH; Pelletier SG;

Punch JD; Rojas A

University of Michigan Health SystemDepartment of Surgery, Section of Transplantation and the

Extracorporeal Life Support Program

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DCD Limitation in the US

Most potential DCD are unable to donate due to unexpected death

Long time periods: death to organ procurement = WIT & clot formation

ECS

(cDCD) / Can be used in the uDCD?.

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Hypothesis

Unexpected (uDCD) donation could be improved with the use of thrombolytics during extracorporeal support (ECS) assisted donation

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DCD Animal model - Swine

DCD sustained 30 or 60 minutes of WI followed by 3hr of ECS at 30˚C

Four Study Groups

Group N = WIT STK ECS

30-No STK 6 30 min NO 3hr

60-No STK 4 60 min NO 3hr

30-STK 4 30 min YES 3hr

60-STK 5 60 min YES 3hr

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Transplant ModelRojas A, et al. American Journal of Transplantation, 2010; 10: 1365-74

Renal artery flow >50mL/min

Organs procured, flushed and cold storage with HTK for 4-5hrs.

Transplanted in healthy nephrectomized swine and perfused for 4hrs.

• Data collection for DCD and recipients:– Hemodynamics (systemic, renal, ECS) and

renal function

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UM Lab – ECS circuit

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Donor Results

ECS was able to be implemented in both the STK and NO-STK groups, but:

60min NO-STK group poor abdominal organ perfusion indicators at procurement

Low ECS flow

(42.1+/-1.0mL/kg/min)

Low renal artery flow

(40.8+/-4.3mL/min)

High renal vascular resistance

(1.54+/-0.14mmHg/mL/min)

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Donor Results

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Recovered and TransplantedGrafts

All grafts from the STK groups regardless of WI time met criteria for transplantation.

60min NO-STK group only 33.5% (3 of 8)

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Graft Survival & End of Study RRI

Only grafts from No-STK were lost

Adequate UO, abnormal CrCl

RRI decreased over time no significant differences

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Take Home Message

1. Successful ECS assisted donation can be achieved with the use of STK in this model (WI up to 60min)

2. The addition of STK to ECS run during uDCD donation results in renal grafts suitable for transplantation after 60min of WI in this model.

• However, proper renal function is still limited, and long term outcomes need to be studied.

3. Based on this study, we propose:

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Criteria for Organ Procurement & Transplantation in an ECS-uDCD model:

1. Renal artery flow >50mL/min or

renal vascular resistance <1.2mmHg/mL/min

2. ECS flows (ECS-f): > 45mL/min/Kg

3. ECS perfusion pressure: >60mmHg

4. Blood pH: 7.30 – 7.5

5. Macroscopic signs of poor perfusion, or NONE severe graft ischemia

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Acknowledgments

Mentors: • Dr. Jeff Punch• Dr. Robert H. Bartlett

UM- ECS Lab Staff• Techs / Research – Surgical Fellows

UM- Medical & Undergraduate Students

UM – Transplant team• Larry Slate II

Chief Transplant perfusionist