Successful Multiple Organ Transplantation from donor with prior Veno Arterial ECMO and compartment syndrome
Nicolas Brozzi, Renzo Cifuentes, Tom Defarias, Ali Ghodsizad, Ronald Serred, Akin Tekin, Rodrigo Vianna, Jose Frigerio, Matthias Loebe.
University of Miami, Miami, FL, USA.
OBJECTIVE: Describe outcome of multiple organ transplantation from donor with prior veno-arterial (VA) ECMO support.
METHODS: Description of clinical cases.
RESULTS: A 31 year old male patient was admitted to local hospital with diagnosis of drowning after seizure episode. Patient received two rounds of CPR for 15 and 10 minutes, and required emergency insertion of VA ECMO. ECMO was removed within 48 hours as cardiac function recovered. Patient was declared brain death and become organ donor. Patient developed compartment syndrome of right lower extremity with CPK = 30,720. Multiple organ procurement was performed 3 days after ECMO decanulation, and 3 patients received successful organ transplantation, including combined heart-kidney, combined heart-pancreas, and liver. Both kidneys were perfused on ex-vivo system, and responded well, with no evidence of damage from donor myoglobinuria. Postoperative outcomes of all 3 recipients of 5 organs is described in table, reflecting uneventful pop recoveries, with normal function of all implanted allografts.
CONCLUSIONS: Our experience supports the concept that VA ECMO is not a contraindication for solid organ donation. Individual evaluation of organ function can lead to successful transplantation of multiple organs from donors with recent history of ECMO support.
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