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. 2022 Apr 22:35:10390.
doi: 10.3389/ti.2022.10390. eCollection 2022.

Normothermic Regional Perfusion and Hypothermic Oxygenated Machine Perfusion for Livers Donated After Controlled Circulatory Death With Prolonged Warm Ischemia Time: A Matched Comparison With Livers From Brain-Dead Donors

Damiano Patrono  1 , Marinella Zanierato  2 , Marco Vergano  3 , Chiara Magaton  1 , Enrico Diale  1 , Giorgia Rizza  1 , Silvia Catalano  1 , Stefano Mirabella  1 , Donatella Cocchis  1 , Raffaele Potenza  4 , Sergio Livigni  3 , Roberto Balagna  5 , Renato Romagnoli  1
Affiliations

Normothermic Regional Perfusion and Hypothermic Oxygenated Machine Perfusion for Livers Donated After Controlled Circulatory Death With Prolonged Warm Ischemia Time: A Matched Comparison With Livers From Brain-Dead Donors

Damiano Patrono et al. Transpl Int. .

Abstract

Prolonged warm ischemia time (WIT) has a negative prognostic value in liver transplantation (LT) using grafts procured after circulatory death (DCD). To assess the value of abdominal normothermic regional perfusion (A-NRP) associated with dual hypothermic oxygenated machine perfusion (D-HOPE) in controlled DCD LT, prospectively collected data on LTs performed between January 2016 and July 2021 were analyzed. Outcome of controlled DCD LTs performed using A-NRP + D-HOPE (n = 20) were compared to those performed with grafts procured after brain death (DBD) (n = 40), selected using propensity-score matching. DCD utilization rate was 59.5%. In the DCD group, median functional WIT, A-NRP and D-HOPE time was 43, 246, and 205 min, respectively. Early outcomes of DCD grafts recipients were comparable to those of matched DBD LTs. In DCD and DBD group, incidence of anastomotic biliary complications and ischemic cholangiopathy was 15% versus 22% (p = 0.73) and 5% versus 2% (p = 1), respectively. One-year patient and graft survival was 100% versus 95% (p = 0.18) and 90% versus 95% (p = 0.82). In conclusion, the association of A-NRP + D-HOPE in DCD LT with prolonged WIT allows achieving comparable outcomes to DBD LT.

Keywords: abdominal normothermic regional perfusion; donation after circulatory death; hypothermic oxygenated machine perfusion; ischemic cholangiopathy; liver transplantation outcome; warm ischemia time.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
DCD procurement protocol. Abbreviations: WLST, withdrawal of life-sustaining treatment; SBP, systemic blood pressure; A-NRP, abdominal normothermic regional perfusion; D-HOPE, dual hypothermic oxygenated machine perfusion; WIT, warm ischemia time; IVC, inferior vena cava.
FIGURE 2
FIGURE 2
Patient selection flowchart. *some patients met more than one exclusion criterium. NMP, normothermic machine perfusion.
FIGURE 3
FIGURE 3
Scatter plot depicting donor age and recipient MELD as a function of study period. During study period, donors of increasing age were considered, and DCD grafts were more frequently allocated to higher-MELD recipients (arrows).
FIGURE 4
FIGURE 4
Kaplan-Meier patient and graft survival curves in the unmatched and matched cohorts.
See this image and copyright information in PMC

References

    1. Blok JJ, Detry O, Putter H, Rogiers X, Porte RJ, van Hoek B, et al. Longterm Results of Liver Transplantation from Donation after Circulatory Death. Liver Transpl (2016) 22:1107–14. 10.1002/lt.24449 - DOI - PubMed
    1. Coffey JC, Wanis KN, Monbaliu D, Gilbo N, Selzner M, Vachharajani N, et al. The Influence of Functional Warm Ischemia Time on DCD Liver Transplant Recipients' Outcomes. Clin Transpl (2017) 31:31. 10.1111/ctr.13068 - DOI - PubMed
    1. Mateo R, Cho Y, Singh G, Stapfer M, Donovan J, Kahn J, et al. Risk Factors for Graft Survival after Liver Transplantation from Donation after Cardiac Death Donors: an Analysis of OPTN/UNOS Data. Am J Transpl (2006) 6:791–6. 10.1111/j.1600-6143.2006.01243.x - DOI - PubMed
    1. Schlegel A, Kalisvaart M, Scalera I, Laing RW, Mergental H, Mirza DF, et al. The UK DCD Risk Score: A New Proposal to Define Futility in Donation-After-Circulatory-Death Liver Transplantation. J Hepatol (2018) 68:456–64. 10.1016/j.jhep.2017.10.034 - DOI - PubMed
    1. Kalisvaart M, Schlegel A, Umbro I, de Haan JE, Scalera I, Polak WG, et al. The Impact of Combined Warm Ischemia Time on Development of Acute Kidney Injury in Donation after Circulatory Death Liver Transplantation. Transplantation (2018) 102:783–93. 10.1097/tp.0000000000002085 - DOI - PubMed