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. 2022 Jun 1;275(6):1156-1164.
doi: 10.1097/SLA.0000000000005428. Epub 2022 Mar 3.

Liver Transplantation Outcomes From Controlled Circulatory Death Donors: SCS vs in situ NRP vs ex situ NMP

Rohit Gaurav  1   2 , Andrew J Butler  1   2   3 , Vasilis Kosmoliaptsis  1   2   3 , Lisa Mumford  4 , Corrina Fear  1 , Lisa Swift  1 , Arturs Fedotovs  1 , Sara Upponi  5 , Samir Khwaja  5 , James Richards  1   2   3 , Michael Allison  3   6 , Christopher J E Watson  1   2   3
Affiliations

Liver Transplantation Outcomes From Controlled Circulatory Death Donors: SCS vs in situ NRP vs ex situ NMP

Rohit Gaurav et al. Ann Surg. .

Abstract

Objective: To compare the outcomes of livers donated after circulatory death (DCD) and undergoing either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion (NMP) with livers undergoing static cold storage (SCS).

Summary of background data: DCD livers are associated with increased risk of primary nonfunction, poor function, and nonanastomotic strictures (NAS), leading to underutilization.

Methods: A single center, retrospective analysis of prospectively collected data on 233 DCD liver transplants performed using SCS, NRP, or NMP between January 2013 and October 2020.

Results: Ninety-seven SCS, 69 NRP, and 67 NMP DCD liver transplants were performed, with 6-month and 3-year transplant survival (graft survival non-censored for death) rates of 87%, 94%, 90%, and 76%, 90%, and 76%, respectively. NRP livers had a lower 6-month risk-adjusted Cox proportional hazard for transplant failure compared to SCS (hazard ratio 0.30, 95% Confidence Interval 0.08-1.05, P = 0.06). NRP and NMP livers had a risk-adjusted estimated reduction in the mean model for early allograft function score of 1.52 (P < 0.0001) and 1.19 (P < 0.001) respectively compared to SCS. Acute kidney injury was more common with SCS (55% vs 39% NRP vs 40% NMP; P = 0.08), with a lower risk-adjusted peak-to-baseline creatinine ratio in the NRP (P = 0.02). No NRP liver had clinically significant NAS in contrast to SCS (14%) and NMP (11%, P = 0.009), with lower risk-adjusted odds of overall NAS development compared to SCS (odds ratio = 0.2, 95%CI 0.06-0.72, P = 0.01).

Conclusion: NRP and NMP were associated with better early liver function compared to SCS, whereas NRP was associated with superior preservation of the biliary system.

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Conflict of interest statement

AJB holds a share of a patent on the circuit used by the OrganOx metra device. CJEW received speaker fees from OrganOx. Rest of the authors declare no conflict of interest.

References

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