Elsevier

Transplantation Proceedings

Volume 51, Issue 1, January–February 2019, Pages 9-11
Transplantation Proceedings

26th Congress of the Spanish Liver Transplantation Society
Organ procurement
“Non-Touch” Vena Cava Technique as an Improvement in Combined Lung and Liver Procurement in Controlled Donation After Circulatory Death

https://doi.org/10.1016/j.transproceed.2018.02.216Get rights and content

Highlights

  • This is one of the few studies published regarding procurement of lung and liver in DCD donors.

  • Our study was conducted at an established transplant center with a record of more than 1100 liver transplants and 900 lung transplants.

  • The technique described enables an easier, optimized procedure for simultaneous multiple organ procurement. Multiple organ procurement in DCD donors can be complex and difficult, so it is very important to have good surgical protocols.

Abstract

The number of organs retrieved from donation after circulatory death (DCD) donors has continued to rise in recent years. The functional superiority of DCD organs is achieved when the lungs are perfused with cold perfusion and livers with normothermic regional perfusion (NRP). Thus, a precise surgical technique is required to combine thoracic and abdominal organ procurement.

The technique used at our center consists of a rapid laparotomy and middle sternotomy, then the abdominal aorta (Ao) and abdominal inferior vena cava (VC) are cannulated and the descending thoracic Ao is cross-clamped. NRP is started at that point. As a variation of previously described techniques, the thoracic vena cava is not initially clamped in order to improve the return of blood volume to the NRP circuit. The pulmonary artery is cannulated to flush the lungs and the left atrial appendage is opened for drainage. After 120 minutes, NRP perfusion is stopped and the organs are flushed with cold preservation solution.

In 2016, 3 livers and 6 lungs were harvested at our center using the technique described. After a minimum follow-up of 1 year, no evidence of biliary complications was observed.

The combined procurement of lungs after room temperature perfusion and liver after NRP without initial clamping of the thoracic VC is feasible, with excellent function post-transplantation.

Section snippets

Surgical Technique

Withdrawal of life support and confirmation of death take place in the operating room. A total of 500–1000 units/kg of sodium heparin are administered before cardiac arrest. After the standard 5 minutes stand-off period, a rapid laparotomy is performed. The abdominal suprailiac aorta (Ao) is cannulated using a 20F-22F cannula and the abdominal suprailiac inferior vena cava (IVC) with a 28F cannula. Simultaneously, the donor is reintubated and the lungs are inflated with a recruitment maneuver.

Results

During 2016, 3 donors underwent NRP for liver procurement simultaneously with room-temperature perfusion for lung retrieval. Donor characteristics and timings for NRP are shown in Table 1. In all 3 donors, the addition of extra volume and blood to the circuit was required. No hemodynamic instability occurred during the NRP.

All allografts, lungs, and livers presented excellent immediate function. Postoperative results of livers are described in Table 1.

In the lungs cases, postoperative stays

Discussion

Taking into account that NRP is preferred for the abdomen and simultaneous cold perfusion followed by a rapid procurement technique for the lungs, a precise and combined technique is required in multiorgan DCD. Two surgical techniques combining thoracic hypothermia and abdominal normothermia have been described. “Bithermia preservation” [4] has been described in uncontrolled DCD and consists of a thoracic closed circuit connected to a roller pump that recirculates cold Perfadex and an abdominal

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