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"Non-Touch" Vena Cava Technique as an Improvement in Combined Lung and Liver Procurement in Controlled Donation After
M Caralt1, I Bello2, A Sandiumenge3
1HBP Surgery and Transplant Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Organ retrieval from donation after circulatory death (DCD) donors is increasing. A novel surgical technique for combined thoracic and abdominal organ procurement, utilizing normothermic regional perfusion (NRP) for livers, enables excellent post-transplant function.
Area of Science:
- Transplantation Surgery
- Organ Procurement
- Donor Management
Background:
- Donation after circulatory death (DCD) organ retrieval is rising.
- Optimizing DCD organ function requires specific perfusion techniques (cold perfusion for lungs, normothermic regional perfusion (NRP) for livers).
- Combined thoracic and abdominal organ procurement necessitates precise surgical approaches.
Purpose of the Study:
- To describe a modified surgical technique for combined lung and liver procurement from DCD donors.
- To evaluate the feasibility and outcomes of this technique, focusing on normothermic regional perfusion (NRP) without initial thoracic vena cava clamping.
Main Methods:
- A surgical technique involving rapid laparotomy and sternotomy, aortic and vena cava cannulation, and descending thoracic aorta cross-clamping.
- Initiation of normothermic regional perfusion (NRP) for the liver, with a modification of not initially clamping the thoracic vena cava.
- Pulmonary artery cannulation for lung flush and left atrial appendage opening for drainage, followed by cold preservation solution flush after 120 minutes of NRP.
Main Results:
- In 2016, 3 livers and 6 lungs were procured using this technique.
- Post-transplant follow-up of at least 1 year showed no evidence of biliary complications.
- The described method demonstrated feasibility for combined lung and liver procurement.
Conclusions:
- Combined procurement of lungs via room temperature perfusion and livers via NRP, without initial thoracic vena cava clamping, is feasible.
- This technique facilitates excellent post-transplantation organ function, particularly for livers from DCD donors.
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.
