Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (Idipaz), La Paz University Hospital, Madrid, Spain; European Reference Network on Transplantation in Children (TransplantChild ERN), Madrid, Spain; Anatomy, Histology and Neuroscience Department, University Autonoma of Madrid, Madrid, Spain.
Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain.
Am J Transplant. 2023 Apr;23(4):577-581. doi: 10.1016/j.ajt.2022.12.021. Epub 2023 Jan 5.
The current shortage of pediatric multivisceral donors accounts for the long time and mortality on the waiting list of pediatric patients. The use of donors after cardiac death, especially after the outbreak of normothermic regional perfusion, has increased in recent years for all solid organs except the intestine, mainly because of its higher susceptibility to ischemia-reperfusion injury. We present the first literature case of multivisceral donors after cardiac death transplantation in a 13-month-old recipient from a 2.5-month-old donor. Once exitus was certified, an extracorporeal membrane oxygenation circuit was established, cannulating the aorta and infrarenal vena cava, while the supra-aortic branches were clamped. The abdominal organs completely recovered from ischemia through normothermic regional perfusion (extracorporeal membrane oxygenation initially and beating heart later). After perfusion with the preservation solution, the multivisceral graft was uneventfully implanted. Two months later, the patient was discharged without any complications. This case demonstrates the possibility of reducing the time spent on the waiting list for these patients.
当前，儿科多器官供体短缺导致儿科患者在等待名单上的时间延长和死亡率增加。近年来，除了肠道之外，所有实体器官都更多地使用了脑死亡后供体，特别是在常温区域灌注爆发后，这主要是因为其更容易发生缺血再灌注损伤。我们报告了首例从 2.5 个月大的供体向 13 个月大的受体进行心脏死亡后多器官供体移植的文献案例。一旦确认死亡，就会建立体外膜氧合回路，将其插入主动脉和肾下腔静脉，同时夹闭主动脉上分支。腹部器官通过常温区域灌注（体外膜氧合最初，然后是心脏跳动）完全从缺血中恢复。用保存液灌注后，多器官移植物顺利植入。两个月后，患者无任何并发症出院。该病例证明了减少这些患者等待时间的可能性。
