Normothermic Extracorporeal Membrane Oxygenation Research Articles

Normothermic extracorporeal membrane oxygenation support: Improving the function of intestinal grafts obtained from cardiac death donors.

Extracorporeal membrane oxygenation (ECMO) could ameliorate the energy status and viability of bowel grafts from cardiac death donors. However, the function of these grafts after transplantation is not clear. The purpose of the study was to evaluate the early function of intestinal grafts after transplantation from expected cardiac death donors supported with normothermic extracorporeal support using a porcine allogeneic orthotopic segmental small bowel transplantation model. Eighteen domestic crossbred donor pigs were assigned to living donation (LD), donation after cardiac death (DCD), and ECMO groups. In the LD group, small bowels were harvested and preserved immediately in cold storage. In the other two groups, the donor pigs received conventional rapid recovery treatment or 1-hour normothermic extracorporeal support after 10-minutes expected cardiac arrest. Subsequently, the small bowels were removed and preserved in cold storage. After 5-6hours of preservation, small bowel grafts were transplanted into the recipient pigs that underwent enterectomy. The pathology and electron microscopy results, cell apoptosis rate, tight junction protein expression level in the intestinal mucosa, and plasma endotoxin level were evaluated after transplantation. All grafts functioned on the basis of the maltose absorption test results at day 7 after transplantation. There were no significant differences in the morphological changes in the intestinal mucosa among the three groups at day 7 after transplantation. The cell apoptosis rate and plasma endotoxin level in the ECMO group did not differ significantly than those in the LD group, but were evidently lower than those in the DCD group (P<.001). The intestinal absorptive function improved significantly in the ECMO group in contrast with that in the DCD group (P<.001). Short-term ECMO intervention can alleviate ischemia-reperfusion injuries in intestinal grafts and improve intestinal absorptive function in the early stage after transplantation. Reducing caspase-3 protein expression and cell apoptosis in the intestinal mucosa may be one of the protective mechanisms of ECMO intervention.

Functional Outcomes of the Renal Transplants Obtained from Controlled Donation Following Cardiopulmonary Death (DCD) with Compartmental Normothermic Extracorporeal Membrane Oxygenation Support (NECMO)

Introduction Since the implementation of the DCD protocol at our institution in 2012, some modifications have taken place in order to improve the organ viability. As for this, the NECMO has proven to be an effective method and to help reduce the ischemic organ damages. Objectives To analyse the functional outcomes of the transplanted kidneys (TK) obtained from DCD using NECMO. Methods We have reviewed the results from 15 kidney transplants (KT), whose organs where obtained from 9 DCD using NECMO as the preservation method, from 2015 to 2017 at our institution. Currently, in our protocol, arterial and venous femoral canulae and the aortic occlusion balloon catheter are placed in the operating room, on a premortem and setup. We have assessed the donors and recipient characteristics and also the TK outcomes, using a descriptive method from all our data available. Results From the 9 DCD, we have obtained 15 valid kidney grafts, who were transplanted at our institution, just one was not suitable due to anatomic alterations. The other 2 allografts were offered to other Hospitals. Donor age averaged 52 years and allografts recipients averaged 48 years. Four patients (26%) underwent previous kidney transplant, with an overall kidney allograft survival of 13.4 years. Prior to KT, 13% were on a pre-dyalisis basis and the remaining 86% were on renal replacement therapy for an average of 14 months. Cardiopulmonary death occurred within an average of 12.2 minutes following withdrawal of life support. From the 15 KT, 13 (83%) continue to function, 1 had arterial thrombosis which led to transplantectomy and the other suffered acute rejection. The 6 month average Cr was 1.6mg/dL. Delayed graft function, defined as at least one postoperative episode of dialysis, occurred in 40% of kidneys (6/15). Conclusion 1- The organ quality from DCD is comparable to brain death donors. 2- ECMO supported DCD is feasible and easily implemented if necessary resources are available 3- Helps optimizing the donation-renal transplant process as the medical team responsible is involved.

Functional outcomes of the renal transplants obtained from controlled donation following cardiopulmonary death (DCD) with compartmental normothermic extracorporeal membrane oxygenation support (NECMO).

Functional outcomes of the renal transplants obtained from controlled donation following cardiopulmonary death (DCD) with compartmental normothermic extracorporeal membrane oxygenation support (NECMO).

PD25-01 KIDNEY PRESERVATION TECHNIQUES IN CONTROLLED CIRCULATORY DEATH: NECMO AND ULTRA-RAPID RETRIEVAL

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-01 KIDNEY PRESERVATION TECHNIQUES IN CONTROLLED CIRCULATORY DEATH: NECMO AND ULTRA-RAPID RETRIEVAL Begoña Etcheverry Giadrosich, Maria Fiol Riera, Lluis Riera Canals, Sergi Beato García, José Francisco Suárez Novo, Salvador Gil-Vernet Cebrian, and Francesc Vigués Julià Begoña Etcheverry GiadrosichBegoña Etcheverry Giadrosich More articles by this author , Maria Fiol RieraMaria Fiol Riera More articles by this author , Lluis Riera CanalsLluis Riera Canals More articles by this author , Sergi Beato GarcíaSergi Beato García More articles by this author , José Francisco Suárez NovoJosé Francisco Suárez Novo More articles by this author , Salvador Gil-Vernet CebrianSalvador Gil-Vernet Cebrian More articles by this author , and Francesc Vigués JuliàFrancesc Vigués Julià More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the past decade, kidneys obtained after controlled circulatory death (cDCD) have significantly increased, in order to increase the number of donors. It achieved 24% of total Kidneys transplant during the last year in Spain. However, it implies warm ischemia times, resulting a greater risk for organs. Focusing on graft quality optimization, it has implemented the abdominal Normothermic Extracorporeal Membrane Oxygenation (NECMO) in order to restore blood flow before organ recovery. NECMO perfusion provides promising results for the use of liver grafts for cDCD. The aim of this study is to evaluate cDCD kidneys, obtained from NECMO technique compared with cDCD ultra-rapid retrieval. METHODS We perform a case control study of Maastricht category III DCD kidneys transplanted in one single center, Hospital Universitari de Bellvitge, Barcelona. We compared kidneys of both cDCD ultra-rapid retrieval and NECMO retrieval groups. RESULTS From 2013 to 2017, 109 kidneys transplants from Maastricht category III DCD donors were performed. Out of these, 76% (83) were retrieved from our hospital and the remaining 24% (26), came from other centers. Mean age was 63 years old (CI95%: 61-65), 42% (63) were no-EDC (extended donor criteria) We compared 2 groups: ultra-rapid retrieval versus NECMO retrieval for non-EDC Masstricht category III CDC (data is presented in table 1). From multivariable analysis, NECMO is associated with less DGF than Ultra-rapid retrieval, OR 0.19 (IC95%: 0.038-0.96, p= 0.044). CONCLUSIONS Although the Ultra-rapid retrieval is highly extended with satisfactory results, in our series kidney preservation with NECMO shows less DGF, corroborating that it could be a good way to reverse warm ischemia effects. We have better kidney function in the follow-up. However, it is a small sample, and we need more follow-up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e545-e546 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Begoña Etcheverry Giadrosich More articles by this author Maria Fiol Riera More articles by this author Lluis Riera Canals More articles by this author Sergi Beato García More articles by this author José Francisco Suárez Novo More articles by this author Salvador Gil-Vernet Cebrian More articles by this author Francesc Vigués Julià More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role?

IntroductionPerigraft fluid collection (PFC) is a common complication after kidney transplant. Its etiology is not clear and not all the causes have been identified. The influence of the type of donor has never been evaluated. Our aim was to compare the incidence, severity and management of PFC in recipients of grafts from uncontrolled donors after circulatory death (DCD) with normothermic extracorporeal membrane oxygenation (NECMO) versus recipients of grafts from donors after brain death (DBD).Material and methodsWe conducted a retrospective cohort study of 300 kidney transplants performed in our center between 2007 and 2012. Patients were divided in two groups: 150 recipients of Maastricht II DCD graft and 150 recipients of the DBD graft. Incidence, severity according to Clavien scale and management were analyzed in both groups, and comparison was carried out using Chi-square.ResultsOf the 300 kidney recipients analyzed, 93 (31.4%) suffered PFC, showing no difference between DBD (32.0%) and DCD (30.8%) groups (p = 0.9). Complicated PFC rate (defined as a PFC generating vascular compression, fever or urinary tract obstruction) was 22.9% in the DBD group versus 22.2% in the DCD group (p = 1); most complicated PFC were due to urinary tract obstruction (81%), with no difference between the groups (p = 1). Concerning Clavien scale, 78.5% of the PFC in our series were Clavien I, 19.4% Clavien IIIa and 2.2% Clavien IIIb, with no difference between both groups (p = 1).ConclusionsPFC is a frequent complication that appears in a third of our patients, showing no difference in the incidence or severity between DBD and uncontrolled DCD graft recipients.

Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non-Heart-Beating Animal Model.

The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d-lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO2 were maintained over 60 and 267 mmHg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups (P > 0.05), the levels of intestinal mucosa TJ protein decreased (P < 0.05), and plasma d-lactic acid increased progressively (P < 0.05). With the extension of extracorporeal support, the degree of intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury.

Limits for Adult Liver Donation in Spain

BackgroundLiver donation is the cornerstone for the expansion of liver transplantation. Although big efforts have been performed to release alternatives for increasing the donor pool, only extended-criteria donors have become a feasible option. MethodsThe success of the Spanish Model for organ transplantation is well known. Approximately 5.4% of all the liver transplants (LT) are performed in Spain, with a rate of 22.9 LT per million people (pmp). ResultsApproximately 70 papers on extended-criteria donors have been reported from Spanish LT teams. Pioneering works in donor steatosis, non–heart-beating donors, donor age–hepatitis C virus, ischemia/reperfusion injury, normothermic extracorporeal membrane oxygenation, and donor steatosis–hepatitis C virus are among the main contributions in the field. Considering data from the Spanish National Registry, it can be observed that an accumulation of donor and recipient factors leads to a continuum of risk for liver transplantation. Donors are not “bad” enough to decline a liver offer per se. ConclusionsIn Spain, clear efforts should be made to work on more stable and homogeneous criteria for donor acceptance. In this sense, defining a specific Spanish donor risk index would be helpful.

Fourteen Years of Experience in Uncontrolled Organ Donation After Cardio-Circulatory Death

BackgroundSince 1999, a protocol for uncontrolled donation after cardio-circulatory death (DCD) has been carried out in our institution. We aimed at evaluating those 14 years of local experience. MethodsWe reviewed the charts of uncontrolled donors from 1999 till 2013. Potential donors with a no-flow period less than 30 minutes were considered. Kidneys were perfused by the use of a double balloon triple lumen catheter after at least a 2-minute period of no touch. We analyzed grafts outcome and warm and cold ischemia times. ResultsThirty-nine procedures were initiated: 19 were aborted because of family refusal (n = 7), medical reasons (n = 7), or canulation failures (n = 5) and 20 harvesting procedures were completed. Transplantation was considered for 35 kidneys (cold storage [n = 5] and hypothermic preservation system [n = 30]). The causes of withdrawal from transplantation were mostly macroscopic lesions (poor perfusion, macroscopic parenchyma or vascular lesions, or infectious risk). We transplanted 22 kidneys locally and 3 were shipped to another Eurotransplant center. Mean donor age was 40 ± 13 years. Among the 20 donors, 13 came from the emergency unit and 7 from the intensive care unit. Mean no-flow time for out-hospital management was 8.7 ± 3.6 minutes. Mean time of cardiopulmonary resuscitation was 71 ± 46 minutes. Mean cold ischemia time was 19 ± 5 hours. Primary nonfunction and delayed graft function occurred in 1 and 12 cases (4.5% and 54%), respectively. Graft survival was 86% at 1 year. Causes of graft loss during the entire follow-up were graft rejection (n = 3), ischemically damaged kidney (n = 2), and recurrence of focal segmental glomerulosclerosis (n = 1). ConclusionIn our experience, uncontrolled donors represent a valuable source of kidney grafts, with a prognosis of graft function and survival similar to the literature. To increase the number of available DCD organs, new techniques, such as the use of Normothermic ExtraCorporeal Membrane Oxygenation (NECMO), as well as improvement of recruitment of out of hospital potential donors have to be considered.

Normothermic Extracorporeal Membrane Oxygenation Support: Improves Donor Intestinal Graft Function After Cardiac Death.

Background:Organs from cortrolled donors after cardiac death (CDCD) are particularly susceptible to the effects of warm ischaemic injury. Perfuison by normothermic extracorporeal membrane oxygenation (NECMO) is increasingly advocated as a useful remedy to the effects of ischaemia-reperfusion injury and is reported to enable transplantation of organs from donors previously deemed unsuitable. To our knowledge, no studies are available for small bowel transplantation using DCD supported by NECMO. In an experimental setting of small bowel transplantation, we studied the feasibility of using intestinal grafts retrieved from DCD supported by NECMO. Method: Thirty White piglets underwent segmental orthotopic small bowel transplantation using FK506 (0.1 mg/kg per day, POD 0-7) immunosuppression and were randomly divided as follow: Living donor (LD) group (n =6) received grafts from HBD; DCD group (n=6) received grafts from DCD; E1 group (n =6) received grafts from DCD supported by NECMO for 1 hour; E3 group (n =6) received grafts from DCD supported by NECMO for 3 hours; E5 group (n =6) received grafts from DCD supported by NECMO for 5 hours. The DCD pigs were sacrificed inducing the cardiac death by a lethal atracurium injection. After 10 minutes (no touch period time), they received NECMO support for 1, 3 or 5 hours. Histopathologic and ultrastructural analysis, mucosal tight junction protein and adenosine triphosphate concentrations were determined immediately after NECMO support. At day 7 after the transplantation, maltose absorption test and histopathologic analysis were performed. FK506 was as immunosuppression. Result: NECMO support can aggravate intestinal mucosa injury and reduce the level of mucosal tight junction protein. Energy charge could be partly increased at one hour but decrease rapidly in the subsequent stages of NECMO support. Ischemical reperfusion injury of E1 group is the lighest in all the groups after transplantation. At day 7 after the transplantation, the intestinal absorptive function of E1 group recovered quickly, which is closest to the LD group, while the DCD and E5 group recovered slowest. Conclusion: Normothermic extracorporeal membrane oxygenation support for short term could improve donor intestinal graft function after cardiac death. This is the first study in a reliable large animal transplant model demonstrating the efficacy of NECMO to rescue ischemic injured DCD intestinal grafts.

Protocols for uncontrolled donation after circulatory death

Organ shortages have led some countries, including Spain, France, and the USA, to start programmes of uncontrolled donation after circulatory death. 1 Wall SP Kaufman BJ Gilbert AJ et al. Derivation of the uncontrolled donation after circulatory determination of death protocol for New York City. Am J Transplant. 2011; 11: 1417-1426 Crossref PubMed Scopus (58) Google Scholar In these protocols, donors are people who have had unexpected out-of-hospital cardiac arrest. After ordinary life support attempts (30 min of advanced cardiopulmonary resuscitation [CPR]) by an emergency medical service are judged futile, patients are transported to the hospital with continuing mechanical chest compression and other interventions to preserve the organs, and declared dead at the hospital after a no-touch period of asystole (usually 5 min). Then, normothermic extracorporeal membrane oxygenation (ECMO) or in-situ cooling is started to preserve the organs until authorisation for donation is given by the family. 1 Wall SP Kaufman BJ Gilbert AJ et al. Derivation of the uncontrolled donation after circulatory determination of death protocol for New York City. Am J Transplant. 2011; 11: 1417-1426 Crossref PubMed Scopus (58) Google Scholar

Applicability and Results of Maastricht Type 2 Donation After Cardiac Death Liver Transplantation

Maastricht type 2 donation after cardiac death (DCD) donors suffer sudden and unexpected cardiac arrest, typically outside the hospital; they have significant potential to expand the donor pool. Herein, we analyze the results of transplanted livers and all potential donors treated under our type 2 DCD protocol. Cardiac arrest was witnessed; potential donors arrived at the hospital after attempts at resuscitation had failed. Death was declared based on the absence of cardiorespiratory activity during a 5-min no-touch period. Femoral vessels were cannulated to establish normothermic extracorporeal membrane oxygenation, which was maintained until organ recovery. From April 2002 to December 2010, there were 400 potential donors; 34 liver transplants were performed (9%). Among recipients, median age, model for end-stage liver disease and cold and reperfusion warm ischemic times were 55 years (49-60), 19 (14-21) and 380 (325-430) and 30 min (26-35), respectively. Overall, 236 (59%) and 130 (32%) livers were turned down due to absolute and relative contraindications to donate, respectively. One-year recipient and graft survivals were 82% and 70%, respectively (median follow-up 24 months). The applicability of type 2 DCD liver transplant was <10%; however, with better preservation technology and expanded transplant criteria, we may be able to improve this figure significantly.

Superior Preservation of DCD Livers With Continuous Normothermic Perfusion

Unexpected donation after cardiac death (DCD) donors suffer cardiac arrest suddenly and are maintained with normothermic extracorporeal membrane oxygenation (NECMO) while consent for donation is obtained. The objective of this study was to determine whether ex vivo normothermic machine perfusion (NMP) improves upon the benefits of NECMO in a large-animal model of unexpected DCD liver transplant. Donor pigs underwent 90-minute cardiac arrest and were divided in to 3 groups. In the first, livers were preserved immediately with cold storage (CS, n = 6). In the other 2 groups, donors underwent 60-minute NECMO followed by CS (NECMO+CS, n = 6) or NMP (NECMO+NMP, n = 6). After 4-hour preservation, livers were transplanted into recipient pigs. Five-day survival was 0 in CS, 83% in NECMO+CS, and 100% in NECMO+NMP. After reperfusion, injury, and inflammatory markers rose significantly among CS grafts, all of which developed primary nonfunction. Sixty minutes of NECMO, however, resulted in only 1 death, whereas NECMO followed by NMP led to no deaths and significant improvements in injury, inflammation, and synthetic function in comparison to NECMO and CS. Although 60 minutes recuperative NECMO is better than CS alone, NMP improves further on NECMO and may have a role in preserving DCD livers in the clinical setting.

Preservation techniques for donors after cardiac death kidneys

The purpose of the present review is to describe the techniques currently used to preserve kidneys from donors after cardiac death. Automated chest compression devices may be used to improve organ perfusion between cardiac death and preservation measures. Normothermic extracorporeal membrane oxygenation reduces warm ischemic injury and has the ability to improve organ viability in donors after cardiac death. Kidneys from donors after cardiac death expand the donor pool but are inevitably subjected to a period of warm ischemia. Reduction of warm ischemic injury to the organs improves transplant outcome. To reduce this injury in organs from donors after cardiac death, different preservation techniques are used. Automated chest compression devices improve organ perfusion between cardiac death and the start of organ preservation. In-situ preservation with double-balloon triple-lumen catheter is an easy technique to preserve organs in uncontrolled donors and is used in many centers to cool and flush the organs. In controlled donors, organs can also be flushed after laparotomy and direct cannulation of the aorta. Extracorporeal membrane oxygenation reduces warm ischemic injury and the use of normothermic perfusion seems promising. Optimal preservation is essential to improve the viability of kidneys from donors after cardiac death, to fully utilize this large donor pool.

Liver transplantation from donors after cardiac death

Organ shortage limits the applicability of liver transplantation to treat end-stage liver disease, and the use of extended-criteria donors is a necessity in the current era. Donors after cardiac death (DCD) suffer irreversible cardiac arrest prior to donation and represent a potential source of additional organs if properly maintained. DCD undergo an initial period of warm ischemia that provokes cellular alterations. Experimental and clinical studies performed at our center have demonstrated that normothermic extracorporeal membrane oxygenation (NECMO) is effective at maintaining abdominal organs in DCD. NECMO helps stop and even revert some of the changes that occur during warm ischemia and offers the opportunity to evaluate graft viability prior to implantation. Nonetheless, the percentage of organs arising from DCD that are accepted for transplant remains relatively low due to the co-existence of other factors that prohibit their utilization, namely poor perfusion and hepatic steatosis. The use of dual-pump normothermic machine perfusion (NMP) in the ex vivo phase of DCD liver preservation can offer additional benefits over traditional cold storage. In experimental studies, ischemic injury and hepatocellular function are significantly improved in DCD grafts preserved with NMP. Clinical studies on the use of NMP in DCD liver transplantation are under way.

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 +/- 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Donors after cardiac death (DCD) suffer irreversible cardiac arrest prior to donation. We describe our liver transplant experience with DCD whose cardiac arrest is unexpected, not following the removal of ventilatory support, whom we maintain with normothermic extracorporeal membrane oxygenation (NECMO). A potential donor goes into cardiac arrest outside the hospital and is brought to the hospital under continuous cardiopulmonary resuscitation (CPR). The donor is declared dead and placed on a cardiocompressor. Femoral vessels are cannulated and connected to cardiopulmonary bypass (CPB) to establish NECMO. Blood parameters and CPB pump flow are monitored throughout NECMO, which is continued until cold preservation. From April 2002 to May 2006, 10 of 40 potential DCD livers were transplanted. Only one graft was lost to primary nonfunction (PNF) and another to hepatic artery thrombosis. Posttransplant hepatic function was good. Certain parameters, such as CPR and NECMO times, hepatic transaminases during NECMO, and donor age, determined the viability of DCD liver grafts and were used to establish criteria for their acceptance. Though considered marginal, unexpected DCD can represent an important source of viable livers for transplant if strict acceptance criteria are employed and they are maintained with NECMO prior to recovery.

DIDECMO: a new polymethylpentene oxygenator for pediatric extracorporeal membrane oxygenation.

We reviewed the performance of a new polymethylpentene oxygenator (DIDECMO, Dideco, Mirandola, Italy) in terms of clinical safety and efficiency in priming, oxygenation, and oxygenator resistance in neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. Between March 2005 and January 2006, 14 patients required ECMO in the San Vincenzo Hospital. Of these, 8 (median age, 9 days; range, 3 days to 15 months) received normothermic ECMO for postcardiotomy heart failure after surgery for congenital heart disease. The DIDECMO oxygenator was used in all patients (median weight, 2.4 kg; range, 2 to 7 kg). According to our previous experience, all patients received the same anticoagulation management. DIDECMO is a new phosphorylcholine-coated, polymethylpentene hollow-fiber oxygenator recommended for a maximum blood flow of 2300 ml/min with a membrane surface area of 0.67 m2 and validated to be used up to 5 days. Static priming was 100 ml and mean support time 05 hours (range, 36 to 198 hours). No oxygenators were changed during support. Median pressure drop during overall assistance was 24 mm Hg. Carbon dioxide elimination was obtained with a 1:1 blood flow/air flow ratio. Neither oxygenator-related major nor minor adverse events occurred during support. In our initial experience, the new polymethylpentene DIDECMO oxygenator provided adequate gas exchange and offered technical advantages in terms of low priming volume and acceptable hemodynamic resistance despite pulsatile flow regimen. Also, we used this device for more than 8 days without any technical problems.