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A “made in Spain” preservation technique improves the outcome of non-heart beating donor kidney transplants

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The success of Spanish Donation and Transplant System not only based on its high donation activity, but also on the quality of the procedures and their good post-transplant results. And innovation plays a fundamental role in this. A organ preservation technique designed in Spain and used in various European countries in controlled asystole donation, reduces the need for dialysis in kidney graft recipients during the first week after transplantation and improves the survival of the transplanted organ After one year. This is clear from an extensive retrospective and multicenter analysis carried out by the Spanish transplant network, the National Transplantation Organization (ONT) and the IMAS Foundation, and which has just been published in the prestigious American Journal of Transplantation.

In asystole donation, donor death occurs after cardio-respiratory arrest. Controlled asystole donors are people who die from catastrophic brain damage after the decision to adapt life support measures that are no longer considered beneficial. Controlled asystole donation programs I know have developed in 17 countries of the world, including Spain, and have allowed to increase the volume of organs destined for transplantation, in addition to making it possible for more people can donate organs after their death if they so wish. In our country, donation in asystole controlled began in 2009. Today, 35% of donors are in asystole, according to the latest data from the ONT.

In this type of donation, the cessation of blood flow to the organs after death (warm ischemia) causes cell damage that can compromise its viability and function after transplantation. Therefore, it is important to reduce the time that elapses from when the donor’s death is certified until the organs are removed for transplantation and / or apply techniques that minimize cell damage caused by ischemia.

Currently two techniques are used for the extraction of donor organs in controlled asystole: super fast extraction, in which organs are rapidly cooled by infusing preservative fluid during extraction; Y normothermic regional perfusion (NRP), a procedure conceived in our country, which allows the reperfusion of the organs with oxygenated blood at body temperature before their extraction. PRN regenerates damaged tissue, reduces the urgency of removal, and allows the viability of organs to be assessed prior to transplantation. In PRN, an extracorporeal blood circulation system is used by means of a membrane oxygenation device (extracorporeal membrane oxygenation; ECMO). Although in other countries the most widely used technique is super-rapid extraction, in Spain both coexist, although the use of PRN is the majority.

The study now presented by the Spanish transplant network, the ONT and the IMAS Foundation allows us to conclude, for the first time, that PRN improves outcomes of controlled asystole donor kidney transplantation compared to super-rapid extraction. Specifically, PRN is associated with a lower incidence of delayed graft function, which means that the need for dialysis is less frequent during the first week after transplantation. Furthermore, kidney graft survival one year after transplantation is also superior when PRN is used.

In the study the evolution of 2,302 kidney transplants was analyzed in adult patients of donors with controlled asystole performed in Spain between 2012 and 2018 in 40 hospitals. These transplants they represent 13% of the total of the 20,264 kidney transplants carried out in our country in that period of time. The evolution of 1,437 kidney transplants obtained by super-rapid extraction was compared with that of 865 obtained by PRN.

This study highlights a double objective of our transplantation system: increase our patients’ access to this therapy and work to improve the quality of transplants performed. As the director of the ONT, Beatriz Domínguez-Gil, highlights, “the Spanish Donation and Transplant Program is not only a leader in donation, but also works on the progressive improvement of the results obtained after transplantation, which is essential when the Donation expansion depends on more complex donors, such as non-heart beating donors ”.

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