Tsui Steven S L, Oniscu Gabriel C
aTransplant Unit, Papworth Hospital, Cambridge bTransplant Unit, Royal Infirmary of Edinburgh & University of Edinburgh, Edinburgh, United Kingdom.
Curr Opin Organ Transplant. 2017 Jun;22(3):245-250. doi: 10.1097/MOT.0000000000000413.
Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement.
The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded.The application of extracorporeal circulation technology to DCD organ retrieval in the form of abdominal normothermic regional perfusion (NRP) made a significant impact on organ procurement. DCD heart transplantation has been made possible by technological developments of ex-situ preservation. Extending NRP to include cardio-thoracic organs is a recent development enabling conversion from a DCD to a donor after brain death-type procurement.NRP offers the opportunity for a dynamic assessment of function and may lead to expansion of acceptance criteria as well as allowing for early interventions to modulate organ function.
Thoraco-abdominal NRP may become the new gold standard for DCD organ retrieval. Further research and education are required to streamline logistics, define organ function markers and increase acceptance and utilization.
尽管心脏死亡后器官捐献（DCD）的供体利用率显著增加，但获取的器官数量及其功能在很大程度上仍逊于脑死亡供体的器官。本综述总结了在获取DCD器官之前原位常温区域灌注方面的最新进展。
DCD捐献中热缺血和冷缺血的联合对器官功能有害。因此，接受标准更为严格，许多器官被丢弃。以腹部常温区域灌注（NRP）的形式将体外循环技术应用于DCD器官获取对器官捐献产生了重大影响。通过体外保存技术的发展，DCD心脏移植已成为可能。将NRP扩展至包括心胸器官是最近的一项进展，可实现从DCD获取转变为脑死亡供体类型的获取。NRP提供了动态评估功能的机会，可能会扩大接受标准，并允许进行早期干预以调节器官功能。
胸腹NRP可能成为DCD器官获取的新金标准。需要进一步的研究和培训来优化流程、定义器官功能标志物并提高接受率和利用率。
