【体外膜肺ECMO精品课件】 Improving Outcomes in DCD Renal Transplantation.ppt

Improving Outcomes in DCD Renal Transplantation;In end-stage renal disease (ESRD), renal transplantation is the treatment of choice; however, shortage of organ donors creates a major set back. The liberal use of kidneys from donors after cardiac death (DCD) holds the potential to increase the number of organ donors by 2.5–4 times, which is sufficient to reduce or even eliminate the waiting lists for kidney transplantation. Unlike the donation after brain death (DBD), organs from DCD donors inevitably sustain a period of warm ischemia from circulatory arrest until initiation of organ preservation, which causes ischemic acute kidney injury, which results in an increased incidence of delayed graft function (DGF) and primary nonfunction (PNF) as compared with kidney transplantation from conventional brain-dead donors. These early complications associated with DCD kidney transplantation are the reason for the disinclination of using these kidneys for transplantation.;At the first international workshop on DCD donation in Maastricht, 1995, four categories were discussed and accepted to categorize DCD kidneys according to their period of warm ischemia (see Table 1). The longest warm ischemia time occurs in category I donors, whereas categories III and IV have potentially the shortest time. Categories I and II represent ‘uncontrolled’ donors, as these donors are dead on arrival or undergo unsuccessful resuscitation, respectively. ‘Controlled’ donors of the categories III and IV are from the intensive care unit when withdrawal of medical treatment is planned or cardiac arrest in brain-dead patients occurs.;Outcomes of Kidney Transplantationfrom DCD;Standard Preservation Techniques forDCD Renal Transplantation;New Developments in Donor Management Before and During Organ Preservation;New Developments in Donor Management Before and During Organ Preservation;Fig. 2: Chest compression device: AutoPulse