Liver Transpl. 2023 Jul 17. doi: 10.1097/LVT.0000000000000219. Online ahead of print.
ABSTRACT
BACKGROUND: In Italy, 20 minutes of continuous, flat-line electrocardiogram are required for death declaration, which significantly increase the risks of DCD LT. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled DCD (cDCD) LT by combining normothermic regional and end-ischemic machine perfusion. However, data on uncontrolled DCD (uDCD) LT performed by this approach are lacking.
PATIENTS AND METHODS: This was a multicenter, retrospective study performed at three large volume centers comparing clinical outcomes of uncontrolled versus controlled DCD LT. The aim of the study was to assess outcomes of sequential normothermic regional perfusion (NRP) and end-ischemic machine perfusion in uncontrolled DCD liver transplantation (LT) Results: Of 153 DCD donors evaluated during study period, 40 uDCD and 59 cDCD grafts were transplanted (utilization rate 52% vs. 78%, p = 0.004). Recipients of uDCD grafts had higher MEAF (4.9 vs. 3.5, p < 0.001) and CCI score at discharge (24.4 vs. 8.7, p = 0.026), longer ICU stay (5 vs. 4 d, p = 0.047) and a trend towards more severe AKI. At multivariate analysis, 90-days graft loss was associated with recipient BMI and lactate downtrend during NRP. One-year graft survival was lower in uDCD (75% vs. 90%, p = 0.007) but became comparable when non-liver-related graft losses were treated as censors (77% vs. 90%, p = 0.100). Incidence of ischemic cholangiopathy was 10% in uDCD versus 3% in cDCD, p = 0.356.
CONCLUSIONS: uDCD LT with prolonged warm ischemia is feasible by the sequential use of NRP and end-ischemic machine perfusion. Proper donor and recipient selection are key in achieving good outcomes in this setting.
PMID:37450659 | DOI:10.1097/LVT.0000000000000219
