Abstract 279: Ecpr, A New Source Of Organs

Purpose: The scarcity of renal grafts is a major public health problem. New strategies are sought to overcome the problem of organ shortage. Organ donation after brain death is a major source of renal grafts. In our center, extracorporeal cardiopulmonary resuscitation (ECPR) is used as a 2nd line of treatment for refractory cardiac arrest. Despite this treatment, some patients present brain death and become eligible to organ donation. To this day, information is scarce on the long-term outcome of renal grafts from these patients. The objective of this study was to evaluate this outcome. Methods: We conducted a monocentric retrospective observational study between 2011 and 2017. The study was validated by the local ethics committee. We included patients who were eligible to organ donation after diagnosis of brain death and from whom at least one organ graft was procured and transplanted. Among these patients we compared those who were treated by ECPR for refractory cardiac arrest (ECPR group) and those who were not (control group). Results: During the study period, 45 patients were included, respectively 23 and 22 in the control and ECPR groups. Patients from the ECPR group were younger with less comorbidities (respectively 41+/-13 vs 63+/-19 years in the ECPR and control groups, p<0,044). However, they were more severe during their ICU stay, as shown by their SAPS II score which was significantly higher (80+/-13 vs 61+/-15 in the ECPR and control groups respectively, p<0,001). A total of 68 renal grafts were procured, transplanted, and studied (34 in each group). There was no difference between the 2 groups in terms of graft survival at 1 year (94.1 vs 82.4% in the ECPR and control group respectively, p=0,52). Discussion-Conclusion: Our study outlines that kidneys harvested from patients treated with ECPR have similar long-term outcome to organs retrieved from patients developing brain death without ECPR. Younger age and absence of comorbidities seem to compensate patient severity after cardiac arrest. One could hypothesize on a protective effect of ECPR on kidney function due to continuous blood flow delivered in the descending aorta. With the increase of ECPR cases, this strategy could be an increasing source of organs to address the issue of organ shortage.