Antonini Marta Velia, Martin-Suàrez Sofia, Botta Luca, Circelli Alessandro, Cordella Erika, Zani Gianluca, Terzitta Marina, Agnoletti Vanni, Pacini Davide
From the Anesthesia and Intensive Care Department, Bufalini Hospital-Azienda Unità Sanitaria Locale (AUSL) della Romagna, Cesena, Italy.
PhD program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy.
ASAIO J. 2025 Apr 1;71(4):e61-e65. doi: 10.1097/MAT.0000000000002282. Epub 2024 Aug 13.
Thoracoabdominal normothermic regional perfusion (TA-NRP) is increasingly implemented in donation after circulatory determination of death (DCD). Thoracoabdominal normothermic regional perfusion allows thoracic and abdominal organs to be perfused with warm, oxygenated blood after declaration of death, interrupting ischemia. Evidence is accumulating supporting the use of TA-NRP to improve the outcome of grafts from DCD donors. Thoracoabdominal normothermic regional perfusion may restore and maintain a near-physiological environment during procurement. Moreover, during TA-NRP it is feasible to evaluate the heart in situ . Thoracoabdominal normothermic regional perfusion could be performed through different cannulation techniques, central or peripheral, and, with different extracorporeal circuits. The use of conventional cardiopulmonary bypass and extracorporeal life support (ECLS) devices equipped with open circuits has been described. We report the use of a fully mobile, closed ECLS circuit to implement TA-NRP. The procedure was successfully performed in a peripheral center without a cardiac surgery program through a percutaneous cannulation approach. This strategy resulted in combined heart, liver, and kidney recovery despite a significantly prolonged functional warm ischemia time. The feasibility of TA-NRP using modified but still closed fully mobile ECLS circuits could furtherly support the expansion of DCD programs, increasing the availability of heart for transplantation, and the quality of the grafts, improving recipients' outcome.
胸腹常温区域灌注（TA-NRP）在循环判定死亡（DCD）后的器官捐献中应用越来越广泛。胸腹常温区域灌注可在宣布死亡后用温热的含氧血液灌注胸腹部器官，中断缺血过程。越来越多的证据支持使用TA-NRP来改善DCD供体移植物的结局。胸腹常温区域灌注在获取器官期间可能恢复并维持接近生理的环境。此外，在TA-NRP过程中对心脏进行原位评估是可行的。胸腹常温区域灌注可通过不同的插管技术进行，包括中心或外周插管，并可使用不同的体外循环。已有关于使用配备开放回路的传统体外循环和体外生命支持（ECLS）设备的描述。我们报告了使用完全可移动的闭合ECLS回路实施TA-NRP的情况。该操作通过经皮插管方法在一个没有心脏外科项目的外周中心成功完成。尽管功能性热缺血时间显著延长，但该策略实现了心脏、肝脏和肾脏的联合获取。使用改良但仍为闭合的完全可移动ECLS回路进行TA-NRP的可行性可能进一步支持DCD项目的扩展，增加心脏移植的可获得性以及移植物的质量，改善受者的结局。
