First Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ results

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail.

Biomechanical Properties of Bioabsorbable Fixation for Osteochondral Shell Allografts

This study compares bioabsorbable nail to metal screw fixation of shell osteochondral allograft (OCAs) for compression and shear strength. Cadaveric distal femurs (n = 5) yielding six 1.5 cm shell grafts (n = 30) were used. Three different fixation methods (2.0 and 2.4 mm headed screws, and copolymer absorbable nail) were compared for statistically significant differences (p < 0.05) in contact area, contact pressure, and shear load-to-failure. No significant differences in contact areas existed among groups (224 ± 33.5 mm2; 233.9 ± 20.8 mm2, 220.6 ± 22.7 mm2; p = 0.509 for 2.4, 2.0 mm screw, and nail, respectively). No significant differences in contact pressures existed (1.7 ± 0.6 MPa/mm2, 1.5 ± 0.8 MPa/mm2, 1.4 ± 0.9 MPa/mm2; p = 0.73 for 2.4, 2.0 mm screw, and nail, respectively). Load-to-failure for each was: 280.7 ± 48.4 N for 2.4 mm screws, 245.1 ± 70.6 N for 2.0 mm screws, and 215.2 ± 39.4 N for nails. There were no statistically significant differences in load-to-failure between 2.4 and 2.0 mm screws (p = 0.29) or between 2.0 mm screws and nails (p = 0.23); however, load-to-failure in shear was significantly higher for 2.4 mm screws compared with nails (p = 0.036). Fixation of shell OCAs using a copolymer headed nail provides initial graft-recipient compression similar to fixation using 2.0 and 2.4 mm headed screws. Nails failed in shear at significantly lower load than 2.4 mm screws but not 2.0 mm screws which have proven adequate for clinical healing. This study has clinical relevance, as a copolymer bioabsorbable headed nail (SmartNail) has graft-recipient compression and shear load-to-failure properties that suggest it is viable for shell OCA fixation.