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Loforte A, Odaldi F, Berardi M, Boschi S, Potena L, Gliozzi G, Cavalli GG, Ravaioli M, Cescon M, Pacini D. Multiple organ retrieval in a brain dead left ventricular assist device donor. J Artif Organs 2021; 25:155-157. [PMID: 34652561 PMCID: PMC8517934 DOI: 10.1007/s10047-021-01298-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
Left ventricular assist device (LVAD) support in donors may contribute in preserving proper haemodynamics and systemic perfusion during organ retrieval thus decreasing the risk of multiple organ injury. This is an option to expand the current organ supply. We report on intra-abdominal organs procurement strategy in a selected LVAD recipient who suffered a fatal cerebrovascular accident at the time of COVID-19 pandemic outbreak. The liver and kidneys grafts have been successfully transplanted.
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Affiliation(s)
- Antonio Loforte
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Federica Odaldi
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Marianna Berardi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Silvia Boschi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Luciano Potena
- Cardiology Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
| | - Matteo Ravaioli
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Matteo Cescon
- General Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Division, S. Orsola University Hospital, IRCCS Bologna, Via Massarenti n.9, 40138, Bologna, Italy
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De Carlis R, Buscemi V, Checchini G, Frassoni S, Bagnardi V, Pagnanelli M, Lauterio A, De Carlis L. Liver transplantation from brain-dead donors on mechanical circulatory support: a systematic review of the literature. Transpl Int 2021; 34:5-15. [PMID: 33037727 DOI: 10.1111/tri.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Mechanical circulatory support (MCS) refers to a range of rescue devices to assist circulation for the treatment of heart failure, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and ventricular assist devices (VADs). This review aims at evaluating the transplant outcome of the livers procured from brain-dead donors on MCS, who are currently considered as having extended criteria. We identified 22 records (17 on VA-ECMO and 5 on VADs), most of which (68.2%) were case reports. We performed a meta-analysis only when the outcome was reported homogeneously among studies; otherwise, we illustrated the results with narrative synthesis. A total of 156 liver transplants (LTs) have been reported, where VA-ECMO was initiated in the donor with resuscitative intent or as a bridge to donation. Early graft survival approached 100% in most studies. The pooled rate of primary nonfunction was 1% (95% CI: 0-3%). Only three successful LTs from VAD donors have been reported. Particular attention should be paid to cardiological history, biochemical tests, and imaging, as well as MCS parameters, to determine graft eligibility for transplantation. Although further analysis is needed in this field, the results of this review advocate a more systematic consideration of brain-dead patients on MCS as potential liver donors.
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Affiliation(s)
- Riccardo De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Buscemi
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuliana Checchini
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Pavia, Pavia, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michele Pagnanelli
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of General Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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