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  3. Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss.

Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss.

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Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Hessheimer AJ
  • de la Rosa G
  • Gastaca M
  • Ruíz P
  • Otero A
  • Gómez M
  • Alconchel F
  • Ramírez P
  • Atutxa L
  • Royo-Villanova M
  • Sánchez B
  • Santoyo J
  • Marín LM
  • Gómez-Bravo MÁ
  • Mosteiro F
  • Villegas Herrera MT
  • Villar Del Moral J
  • González-Abos C
  • Vidal B
  • López-Domínguez J
  • Lladó L
  • Roldán J
  • Justo I
  • Jiménez C
  • López-Monclús J
  • Sánchez-Turrión V
  • Rodríguez-Laíz G
  • Velasco Sánchez E
  • López-Baena JÁ
  • Caralt M
  • Charco R
  • Tomé S
  • Varo E
  • Martí-Cruchaga P
  • Rotellar F
  • Varona MA
  • Barrera M
  • Rodríguez-Sanjuan JC
  • Briceño J
  • López D
  • Blanco G
  • Nuño J
  • Pacheco D
  • Coll E
  • Domínguez-Gil B
  • Fondevila C

Grupos

Abstract

Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p < .001), ischemic type biliary lesions (OR 0.112, 95% CI 0.042-0.299, p < .001), graft loss (HR 0.371, 95% CI 0.267-0.516, p < .001), and patient death (HR 0.540, 95% CI 0.373-0.781, p = .001). Cold ischemia time (HR 1.004, 95% CI 1.001-1.007, p = .021) and re-transplantation indication (HR 9.552, 95% CI 3.519-25.930, p < .001) were significant independent predictors for graft loss among cDCD livers with A-NRP. While use of A-NRP helps overcome traditional limitations in cDCD liver transplantation, opportunity for improvement remains for cases with prolonged cold ischemia and/or technically complex recipients, indicating a potential role for complimentary ex situ perfusion preservation techniques.

© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.

Datos de la publicación

ISSN/ISSNe:
1600-6135, 1600-6143

AMERICAN JOURNAL OF TRANSPLANTATION  ELSEVIER SCIENCE INC

Tipo:
Article
Páginas:
1169-1181
PubMed:
34856070
Factor de Impacto:
3,311 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 152

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Keywords

  • clinical research/practice; complication: surgical/technical; donors and donation: donation after circulatory determination of death (DCD); extracorporeal membrane oxygenation (ECMO); ischemia reperfusion injury (IRI); liver transplantation/hepatology; organ procurement and allocation

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