Implementation of Normothermic Regional Perfusion in The Netherlands

V.A.L. Huurman, D.E.M.A. Detillon, L.J.M. Habets, F.E.M. van de Leemkolk, I.J. Schurink, M. van der Hoeven, J. de Jonge

Wednesday 13 march 2019

14:16 - 14:18h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: Organ shortage still causes waiting list morbidity and mortality in the Netherlands. Increasing donor utilisation and donor organ quality may lead to a decrease in waiting lists. Normothermic Regional Perfusion (NRP) of abdominal organs may achieve this, by allowing macroscopic and laboratory value assessment of extended criteria donation after circulatory death (DCD) organs during perfusion. A program for NRP was initiated in the western part of The Netherlands.

Methods: A project organization was established by the combined Erasmus MC and LUMC procurement teams, supported by the Ministry of Health and the Dutch Transplant Foundation. Necessary legal and logistic arrangements were made. Four organ perfusion specialists were trained by clinical perfusionists in the Netherlands and at expert centres abroad. Animal experiments and training programs were performed for training of procurement teams. A perfusion and assessment protocol was developed and implemented in a selected group of extended criteria DCD donors.

Results: Since the start of the project on October 1st2018, multiple potential NRP donors were identified, of which three could be effectively included in the protocol. From these donors, six kidneys were successfully transplanted. One liver, which was not accepted for regular transplantation, was positively assessed during NRP and successfully transplanted. Two other livers were negatively assessed and declined for transplantation. One pancreas was retrieved for islet isolation. No adverse events were noted. The duration of the procedures was comparable to regular donation after brain death (DBD) procedures. All recipients have good clinical function of the organ transplanted.

Conclusions: Establishment of a NRP protocol by the combined Erasmus MC/LUMC procurement teams was successful. In the first procedures, no adverse events were noted. Despite the short duration of the project, already one liver was transplanted that otherwise would not have been used for transplantation. These promising first results may ultimately lead to an increase in donor utilisation and less waiting list mortality.