Catherine Go1, Moataz Elsisy2, Brian Frenz3, J B Moses4, Amit D Tevar5, Anthony J Demetris5, Youngjae Chun2, Bryan W Tillman6. 1. Division of Vascular Surgery, University of Pittsburgh Medical Center, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA. 2. Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, PA. 3. McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA. 4. Department of Surgery, University of Pittsburgh Medical Center, PA. 5. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA. 6. Division of Vascular Surgery, University of Pittsburgh Medical Center, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA; Department of Surgery, University of Pittsburgh Medical Center, PA; Division of Vascular Surgery, Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: bryan.tillman@osumc.edu.
Abstract
BACKGROUND: Ischemic injury during the agonal period of donation after circulatory death donors remains a significant barrier to increasing abdominal transplants. A major obstacle has been the inability to improve visceral perfusion, while at the same time respecting the ethics of the organ donor. A retrievable dual-chamber stentgraft could potentially isolate the organ perfusion from systemic hypotension and hypoxia, without increasing cardiac work or committing the donor. METHODS: Retrievable dumbbell-shaped stents were laser welded from nitinol wire and covered with polytetrafluoroethylene. Yorkshire pigs were assigned to either agonal control or dumbbell-shaped dual-chamber stentgraft. A central lumen maintained aortic flow, while an outer visceral chamber was perfused with oxygenated blood. A 1-hour agonal phase of hypoxia and hypotension was simulated. Stents were removed by simple sheath advancement. Cardiac monitoring, labs, and visceral flow were recorded followed by recovery of the animal to a goal of 48 hours. RESULTS: Cardiac stress did not increase during stent deployment. Visceral pO2 and flow were dramatically improved in stented animal relative to control animals. Five of 7 control animals were killed after renal failure complications, whereas all stent animals survived. Histology confirmed increased ischemic changes among control kidneys compared to stented animals. CONCLUSION: A dual-chamber stent improved outcomes after a simulated agonal phase. The stent did not increase cardiac work, thus respecting a key ethical consideration. The ability of a dual-chamber stent to prevent ischemia during organ recovery may become a powerful tool to address the critical donor organ shortage.
BACKGROUND: Ischemic injury during the agonal period of donation after circulatory death donors remains a significant barrier to increasing abdominal transplants. A major obstacle has been the inability to improve visceral perfusion, while at the same time respecting the ethics of the organ donor. A retrievable dual-chamber stentgraft could potentially isolate the organ perfusion from systemic hypotension and hypoxia, without increasing cardiac work or committing the donor. METHODS: Retrievable dumbbell-shaped stents were laser welded from nitinol wire and covered with polytetrafluoroethylene. Yorkshire pigs were assigned to either agonal control or dumbbell-shaped dual-chamber stentgraft. A central lumen maintained aortic flow, while an outer visceral chamber was perfused with oxygenated blood. A 1-hour agonal phase of hypoxia and hypotension was simulated. Stents were removed by simple sheath advancement. Cardiac monitoring, labs, and visceral flow were recorded followed by recovery of the animal to a goal of 48 hours. RESULTS: Cardiac stress did not increase during stent deployment. Visceral pO2 and flow were dramatically improved in stented animal relative to control animals. Five of 7 control animals were killed after renal failure complications, whereas all stent animals survived. Histology confirmed increased ischemic changes among control kidneys compared to stented animals. CONCLUSION: A dual-chamber stent improved outcomes after a simulated agonal phase. The stent did not increase cardiac work, thus respecting a key ethical consideration. The ability of a dual-chamber stent to prevent ischemia during organ recovery may become a powerful tool to address the critical donor organ shortage.
Authors: Joseph R Scalea; Robert R Redfield; Michael D Rizzari; Ryan Bennett; Michael E Anderson; James E Anderson; Dixon B Kaufman; Hans W Sollinger; Luis A Fernandez; Anthony M D'Alessandro; Joshua Mezrich Journal: Ann Surg Date: 2016-02 Impact factor: 12.969
Authors: J C Rodríguez-Sanjuán; N Ruiz; E Miñambres; E Toledo; M González-Noriega; R Fernández-Santiago; F Castillo Journal: Transplant Proc Date: 2018-06-28 Impact factor: 1.066
Authors: Bryan W Tillman; Youngjae Chun; Sung Kwon Cho; Yanfei Chen; Nathan Liang; Timothy Maul; Anthony Demetris; Xinzhu Gu; William R Wagner; Amit D Tevar Journal: Surgery Date: 2016-08-11 Impact factor: 3.982
Authors: G C Oniscu; L V Randle; P Muiesan; A J Butler; I S Currie; M T P R Perera; J L Forsythe; C J E Watson Journal: Am J Transplant Date: 2014-10-03 Impact factor: 8.086