Why should we pursue abdominal normothermic regional perfusion in donation after circulatory death donors: a critical appraisal

F.E.M. van de Leemkolk, I.J. Schurink, O.M. Dekkers, G.C. Oniscu, I.P.J. Alwayn, R.J. Ploeg, J.J. de Jonge, V.A.L. Huurman

Wednesday 4 march 2020

16:50 - 17:00h at Joep Nicolas zaal

Parallel session: Parallel sessie VII – Basale- en Klinische abstracts

Background: Abdominal Normothermic Regional Perfusion (aNRP) for Donation after Circulatory Death (DCD) is an emerging organ preservation technique that may lead to increased donor organ utilisation due to better assessment of organ viability, the prospect of reduced ischaemic injury with improved outcomes, and possible decrease of unintentional surgical damage. The aim of this critical appraisal is to evaluate the added value of aNRP when compared to standard techniques before its possible implementation in The Netherlands.

Methods: A systematic literature review was conducted using the PRISMA guidelines and registered with PROSPORO (CRD42019125387). Relevant literature databases were searched. Primary outcomes were donor organ utilisation rate and patient- and graft survival after one year. Secondary outcomes included delayed graft function, primary non-function (PNF), serum creatinine, and estimated or measured glomerular filtration rate for kidneys. With regards to the liver, it included PNF, biliary complications including ischaemic cholangiopathy, and early allograft dysfunction. For pancreas, YIELD after islet isolation was included.

Results: From 1268 hits in the literature, finally a total of 20 articles was included. The results of this review show that aNRP is feasible and safe and all available studies show successful implementation of the technique in clinical practice. Function and outcomes after kidney and liver transplantation using aNRP are at least equivalent to non-aNRP DCD donors. A few studies demonstrated increased survival and lower complication rates. However, it should be noted that the available studies are characterized by considerable bias and heterogeneity as the current definitions and protocols regarding aNRP differ widely between centres and countries, e.g. the possibility of pre-mortem intervention, definition of functional warm ischaemia time and use of continuous versus end-ischaemic ex-situ machine perfusion.

Conclusions: aNRP appears to be an asset to clinical practice but more uniform reporting of definitions and outcome measures is needed for aNRP to refine conclusions on transplant outcomes and organ utilisation. A randomized controlled trial comparing aNRP with standard donation technique in DCD donors seems mandatory to show added value and cost effectiveness of the procedure and determine aNRP’s place amongst modern preservation techniques.