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Presenter: Joel, Schroering, Indianapolis, United States
Authors: Richard Mangus, Joel Schroering, Chandrashekhar Kubal
Richard Mangus1, Joel Schroering1, Chandrashekhar A. Kubal1.
1Transplant Division, Department of Surgery, Indiana University, School of Medicine, Indianapolis, IN, United States
Introduction: Intestine transplantation has a high risk of post-transplant complications. For this reason, many intestine transplant centers are conservative in their choice of deceased donors, using only standard criteria donors. One reason to exclude a deceased donor intestine graft is because of donor asystole time. This paper reports the routine use of intestine and multivisceral grafts from deceased donors with prolonged asystole.
Methods: The study reviewed the records of all intestine transplant patients from a single center from 2003 to 2015. All donor records were reviewed in detail. Donor asystole was recorded as donor “down time” which comprised the total cumulative number of minutes that the donor received chest compressions during resuscitation before stabilizing to proceed to organ procurement. Clinical graft outcomes included early graft loss and graft complications.
Results: There were 246 transplants included in this study. There were 39% of donors overall with some asystole time recorded, 23% among adult and 62% among pediatric recipients (p<0.01). Asystole time ranged from 1 minute to 60 minutes (2 patients). Median donor age was 18 years. The median donor age decreased with increasing asystole time: 1-14 minutes, 18 years; 15-30 minutes, 15 years; and 30-60 minutes, 3 years. Among pediatric recipients, 22% of donors had asystole time more than 30 minutes. At 1-year post transplant, there was no difference in graft survival when stratified by donor asystole. There was also no difference in recipient length of hospital stay post-transplant.
Conclusions: Donor asystole time alone should not be used to exclude the intestine or multivisceral graft from transplantation. At our center, there is an increased willingness to tolerate donor asystole time with decreasing donor age. Donor asystole is not associated with worse graft survival or longer hospital stay in pediatric or adult patients.
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