BACKGROUND: To increase the number of livers available for transplantation a non-heartbeating donor (NHBD) liver transplant program was started after obtaining hospital ethical committee approval. METHODS: Controlled donors with a warm ischemia of <30 minutes were considered. A 5-minute stand-off period was observed from asystole to skin incision. A super-rapid technique was used for the retrieval. Methods used to assess the suitability for transplantation included liver function tests, morphologic and histologic assessment, and hepatocyte viability testing. RESULTS: Sixty livers were retrieved from NHBDs. Of these, 33 were judged suitable for transplantation. Of these one was exported and transplanted, and one could not be matched to a suitable recipient. A further 27 were not used because of liver appearance in 21, prolonged hypoxia and hypotension in 4, poor perfusion in 1, and donor malignancy in 1. Mean donor age was 39.4 years (range, 0.75-67 years). Causes of death were head trauma in 10 donors, intracranial bleed in 24, and anoxic/ischemic brain injury in 26. Mean warm ischemia time was 14.7 minutes (range, 7-40 minutes). Thirty-two patients were transplanted (one split liver), and the mean age of the recipients was 38.4 years (range, 0.7-72 years). All grafts had good early function except one right lobe split. There were 4 deaths resulting from ischemic brain injury, chronic rejection, biliary sepsis, and multiorgan failure following retransplantation for primary nonfunction. Overall patient and graft survival is 87% and 84%, respectively, at a median follow-up of 15 months. CONCLUSIONS: Early results suggest that controlled NHBDs are a significant new source of grafts, but careful donor selection and short cold ischemia are mandatory.
BACKGROUND: To increase the number of livers available for transplantation a non-heartbeating donor (NHBD) liver transplant program was started after obtaining hospital ethical committee approval. METHODS: Controlled donors with a warm ischemia of <30 minutes were considered. A 5-minute stand-off period was observed from asystole to skin incision. A super-rapid technique was used for the retrieval. Methods used to assess the suitability for transplantation included liver function tests, morphologic and histologic assessment, and hepatocyte viability testing. RESULTS: Sixty livers were retrieved from NHBDs. Of these, 33 were judged suitable for transplantation. Of these one was exported and transplanted, and one could not be matched to a suitable recipient. A further 27 were not used because of liver appearance in 21, prolonged hypoxia and hypotension in 4, poor perfusion in 1, and donormalignancy in 1. Mean donor age was 39.4 years (range, 0.75-67 years). Causes of death were head trauma in 10 donors, intracranial bleed in 24, and anoxic/ischemic brain injury in 26. Mean warm ischemia time was 14.7 minutes (range, 7-40 minutes). Thirty-two patients were transplanted (one split liver), and the mean age of the recipients was 38.4 years (range, 0.7-72 years). All grafts had good early function except one right lobe split. There were 4 deaths resulting from ischemic brain injury, chronic rejection, biliary sepsis, and multiorgan failure following retransplantation for primary nonfunction. Overall patient and graft survival is 87% and 84%, respectively, at a median follow-up of 15 months. CONCLUSIONS: Early results suggest that controlled NHBDs are a significant new source of grafts, but careful donor selection and short cold ischemia are mandatory.
Authors: Markus Weber; Daniel Dindo; Nicholas Demartines; Patrice M Ambühl; Pierre-Alain Clavien Journal: N Engl J Med Date: 2002-07-25 Impact factor: 91.245
Authors: Peter L Abt; Niraj M Desai; Michael D Crawford; Lisa M Forman; Joseph W Markmann; Kim M Olthoff; James F Markmann Journal: Ann Surg Date: 2004-01 Impact factor: 12.969
Authors: A M D'Alessandro; R M Hoffmann; S J Knechtle; D E Eckhoff; R B Love; M Kalayoglu; H W Sollinger; F O Belzer Journal: Transplantation Date: 1995-04-15 Impact factor: 4.939
Authors: Peter Abt; Michael Crawford; Niraj Desai; James Markmann; Kim Olthoff; Abraham Shaked Journal: Transplantation Date: 2003-05-27 Impact factor: 4.939
Authors: A Casavilla; C Ramirez; R Shapiro; D Nghiem; K Miracle; O Bronsther; P Randhawa; B Broznick; J J Fung; T Starzl Journal: Transplantation Date: 1995-01-27 Impact factor: 4.939
Authors: Emre A Eren; Nicholas Latchana; Eliza Beal; Don Hayes; Bryan Whitson; Sylvester M Black Journal: Exp Clin Transplant Date: 2016-10 Impact factor: 0.945
Authors: Laura Erker; Hisaya Azuma; Andrew Y Lee; Changsheng Guo; Susan Orloff; Laura Eaton; Eric Benedetti; Bryan Jensen; Milton Finegold; Holger Willenbring; Markus Grompe Journal: Gastroenterology Date: 2010-06-02 Impact factor: 22.682
Authors: Hieu Le Dinh; Arnaud de Roover; Abdour Kaba; Séverine Lauwick; Jean Joris; Jean Delwaide; Pierre Honoré; Michel Meurisse; Olivier Detry Journal: World J Gastroenterol Date: 2012-09-07 Impact factor: 5.742