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

Fecha de publicación: 01/04/2022 Fecha Ahead of Print: 02/12/2021

Autores de IIS La Fe

Andrea Boscà Robledo

Autor
Rafael López Andújar

Autor

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

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

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.

Datos de la publicación

ISSN/ISSNe:: 1600-6135, 1600-6143
Tipo:: Article
Páginas:: 1169-1181
DOI:: 10.1111/ajt.16899
Factor de Impacto:: 3,311 SCImago ℠
Cuartil:: Q1 SCImago ℠

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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