Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report
Baroni S, Marudi A, Rinaldi S, Ghedini S, Magistri P, Piero Guerrini G, Olivieri T, Dallai C, Talamonti M, Maccieri J, Benedetto FD, Bertellini E. Int J Artif Organs 2022: epub
04/2022
Summary
This observational case series includes 8 patients who were assessed for the donation after circulatory death (DCD) program for donation of either liver or kidneys. All DCD donor subjects were of a similar age (<60), without critical conditions, and had no known liver or kidney dysfunction. CytoSorb was added to the extracorporeal membrane oxygenator (ECMO) prior to transplantation. Several inflammatory cytokine levels (interleukin – IL6, IL8, IL10, TNF-alpha) were measured before and after the CytoSorb cartridge at various time points over nearly 3hrs, during the normothermic regional perfusion (NPR). Results showed a substantial reduction in IL-10 and TNF-alpha levels during the NPR period with hemoadsorption suggesting effective removal by the device with no evidence of a saturation effect. All livers and kidneys were transplanted from the DCD donors. Receiving patients spent less than 3 days in the intensive care unit and the mean number of days of hospitalization wasbelow 14 days. None of these organs presented with signs of primary non-function or histological necrosis. None of the patients underwent renal replacement therapy during their hospital stay. No apparent device-related adverse events occurred during normothermic perfusion. At the 1-year follow- up, there were no significant complications such as graft rejection or liver stenosis ducts. In summary, this study confirms the use of CytoSorb during normothermic reperfusion in DCD donors where all donor organs could be transplanted without complications or primary non function, and, as the authors write, “may serve as a first in human validation towards a strategy to improve organs and to increase organ availability for donation and reduce the waiting list”.
