In this letter to the editor, the authors describe a recent new application of the use of CytoSorb with extracorporeal membrane oxygenation (ECMO) in cases of Donation after Circulatory Death (DCD). Particular to Italy, determination of death requires a 20-minute flat electrocardiogram, resulting in absence of circulation, so that any subsequent “Warm Ischemia Time (WIT)” results in high levels of cytokines, such as Tumor Necrosis Factor-Alpha (TNFα). This is a case report of three DCD donors. The abdominal organs were re-perfused using normothermic regional perfusion (nRP) in combination with CytoSorb (included in the side arm of the regional ECMO circuit) in an attempt to increase the number of organs suitable for transplantation (liver and kidneys). Kidneys and liver were re-perfused with a blood flow always higher than 3 L/min. Blood sampling from the circuit showed an important reduction in TNFα levels over time. During the first week after transplantation the creatinine serum mean value was almost 1.0 mg/dl, bilirubin 3.0 mg/dl, INR 1.2, only serum transaminase reached value upper 2000 U/L followed by physiological decrease. No cases of liver or kidney graft syndrome or recipient death at day 30 were reported. The authors state that nRP in combination with CytoSorb has the potential to limit irreversible organ damage, to restore organ function and to be used as a bridge to transplantation, potentially mitigating cytokine release and harmful inflammatory mediators, especially TNFα, thereby reducing the risk of any adverse scenarios or graft dysfunction.
Open-access publication: https://pubmed.ncbi.nlm.nih.gov/32339334/