CIT clock is ticking…

Multivisceral transplantation consists of the simultaneous transplantation of the liver, stomach, pancreas, duodenum and small intestine. At our center, these organs are procured as a cluster graft and transplanted into a recipient who has had all of these same native organs resected. Though this is a strenuous surgical undertaking, our average cold ischemia time for multivisceral transplantation is less than 10 hours.

One Spring day, we received an offer for a multivisceral donor in San Juan, Puerto Rico. Though this was a long procurement distance, the donor was a healthy teenager and we accepted the organs for an elderly gentleman. Our team traveled to Miami, where we changed planes, and then went on to San Juan. As we arrived, the donor operation was already in progress. We informed the local procurement coordinator that we preferred to use histidine-tryptophan-ketoglutarate (Custodiol® HTK) preservation solution for the organ flush. The other team procuring the kidneys had no objection to this, and the organ procurement went uneventfully.

We then retraced our trip back through Miami, again changed planes, and then went on towards home. Unfortunately, as we approached our home city, we hit a late season snow storm and were diverted to another city. We were picked up at the airport by an ambulance, and we expected to be rushed to our hospital, as the recipient operation was well underway. Within 5 minutes of leaving the airport, the ambulance informed us that they had instructions to take us to the nearest hospital, because the roads were unsafe for travel. They dropped us off at a local emergency room. We then called the state police, and a state highway patrolman was dispatched to assist us. He arrived, but was only willing to take one doctor and the organs. Our 45 minute drive lasted well over two hours as we weaved through snarled traffic caught in a roaring blizzard. I finally arrived at the operating room with the multivisceral graft, which now had 12 hours of cold ischemia time.

We performed the bench preparation of the organs, and then proceeded with the transplant. Reperfusion of the organs occurred with greater than 13 hours of cold ischemia time. Though we had used HTK in multivisceral and intestinal transplantation previously, this was the longest cold ischemia time with which we had tested HTK. The organs reperfused normally, and the patient remained stable throughout the remainder of the transplant. The recipient is now more than 2 years out from his transplant and is doing well. Each time I see this patient, I recall one very long trip to Puerto Rico.

Back to Case Studies