Amelia J Hessheimer1, Elisabeth Coll2, Ferrán Torres3, Patricia Ruíz4, Mikel Gastaca4, José Ignacio Rivas5, Manuel Gómez5, Belinda Sánchez6, Julio Santoyo6, Pablo Ramírez7, Pascual Parrilla7, Luis Miguel Marín8, Miguel Ángel Gómez-Bravo8, Juan Carlos García-Valdecasas1, Javier López-Monclús9, Andrea Boscá10, Rafael López-Andújar10, Jiliam Fundora-Suárez11, Jesús Villar11, Álvaro García-Sesma12, Carlos Jiménez12, Gonzalo Rodríguez-Laíz13, Laura Lladó14, Juan Carlos Rodríguez15, Manuel Barrera16, Ramón Charco17, Jose Ángel López-Baena18, Javier Briceño19, Fernando Pardo20, Gerardo Blanco21, David Pacheco22, Beatriz Domínguez-Gil2, Víctor Sánchez Turrión9, Constantino Fondevila23. 1. Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain. 2. Organización Nacional de Trasplantes, Madrid, Spain. 3. Medical Statistics Core Facility, IDIBAPS, Hospital Clínic Barcelona & Biostatistics Unit, Faculty of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. 4. Hospital Universitario Cruces, Bilbao, Spain. 5. Complejo Hospitalario Universitario La Coruña, La Coruña, Spain. 6. Hospital Regional Universitario de Málaga, Málaga, Spain. 7. Hospital Clínico Universitario Virgen de la Arrixaca (IMIB), Murcia, Spain. 8. Hospital Universitario Virgen del Rocío, Seville, Spain. 9. Hospital Universitario Puerta de Hierro, Majadahonda, Spain. 10. Hospital Universitario y Politécnico La Fe, Valencia, Spain. 11. Hospital Universitario Virgen de las Nieves, Granada, Spain. 12. Hospital Universitario 12 de Octubre, Madrid, Spain. 13. Department of General & Digestive Surgery, ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain. 14. Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain. 15. Hospital Universitario Marqués de Valdecilla, Santander, Spain. 16. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. 17. Hospital Universitario Vall d'Hebrón, Barcelona, Spain. 18. Hospital General Universitario Gregorio Marañón, Madrid, Spain. 19. Hospital Universitario Reina Sofía, Córdoba, Spain. 20. Clínica Universitaria de Navarra, Pamplona, Spain. 21. Hospital Universitario Infanta Cristina, Badajoz, Spain. 22. Hospital Universitario Río Hortega, Valladolid, Spain. 23. Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: cfonde@clinic.ub.es.
Abstract
BACKGROUND & AIMS: Although there is increasing interest in its use, definitive evidence demonstrating a benefit for postmortem normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation is lacking. The aim of this study was to compare results of cDCD liver transplants performed with postmortem NRP vs. super-rapid recovery (SRR), the current standard for cDCD. METHODS: This was an observational cohort study including all cDCD liver transplants performed in Spain between June 2012 and December 2016, with follow-up ending in December 2017. Each donor hospital determined whether organ recovery was performed using NRP or SRR. The propensity scores technique based on the inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups; logistic and Cox regression models were used for binary and time-to-event outcomes. RESULTS: During the study period, there were 95 cDCD liver transplants performed with postmortem NRP and 117 with SRR. The median donor age was 56 years (interquartile range 45-65 years). After IPTW analysis, baseline covariates were balanced, with all absolute standardised differences <0.15. IPTW-adjusted risks were significantly improved among NRP livers for overall biliary complications (odds ratio 0.14; 95% CI 0.06-0.35, p <0.001), ischaemic type biliary lesions (odds ratio 0.11; 95% CI 0.02-0.57; p = 0.008), and graft loss (hazard ratio 0.39; 95% CI 0.20-0.78; p = 0.008). CONCLUSIONS: The use of postmortem NRP in cDCD liver transplantation appears to reduce postoperative biliary complications, ischaemic type biliary lesions and graft loss, and allows for the transplantation of livers even from cDCD donors of advanced age. LAY SUMMARY: This is a propensity-matched nationwide observational cohort study performed using livers recovered from donors undergoing cardiac arrest provoked by the intentional withdrawal of life support (controlled donation after circulatory death, cDCD). Approximately half of the livers were recovered after a period of postmortem in situ normothermic regional perfusion, which restored warm oxygenated blood to the abdominal organs, whereas the remainder were recovered after rapid preservation with a cold solution. The study results suggest that the use of postmortem normothermic regional perfusion helps reduce rates of post-transplant biliary complications and graft loss and allows for the successful transplantation of livers from older cDCD donors.
BACKGROUND & AIMS: Although there is increasing interest in its use, definitive evidence demonstrating a benefit for postmortem normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation is lacking. The aim of this study was to compare results of cDCD liver transplants performed with postmortem NRP vs. super-rapid recovery (SRR), the current standard for cDCD. METHODS: This was an observational cohort study including all cDCD liver transplants performed in Spain between June 2012 and December 2016, with follow-up ending in December 2017. Each donor hospital determined whether organ recovery was performed using NRP or SRR. The propensity scores technique based on the inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups; logistic and Cox regression models were used for binary and time-to-event outcomes. RESULTS: During the study period, there were 95 cDCD liver transplants performed with postmortem NRP and 117 with SRR. The median donor age was 56 years (interquartile range 45-65 years). After IPTW analysis, baseline covariates were balanced, with all absolute standardised differences <0.15. IPTW-adjusted risks were significantly improved among NRP livers for overall biliary complications (odds ratio 0.14; 95% CI 0.06-0.35, p <0.001), ischaemic type biliary lesions (odds ratio 0.11; 95% CI 0.02-0.57; p = 0.008), and graft loss (hazard ratio 0.39; 95% CI 0.20-0.78; p = 0.008). CONCLUSIONS: The use of postmortem NRP in cDCD liver transplantation appears to reduce postoperative biliary complications, ischaemic type biliary lesions and graft loss, and allows for the transplantation of livers even from cDCD donors of advanced age. LAY SUMMARY: This is a propensity-matched nationwide observational cohort study performed using livers recovered from donors undergoing cardiac arrest provoked by the intentional withdrawal of life support (controlled donation after circulatory death, cDCD). Approximately half of the livers were recovered after a period of postmortem in situ normothermic regional perfusion, which restored warm oxygenated blood to the abdominal organs, whereas the remainder were recovered after rapid preservation with a cold solution. The study results suggest that the use of postmortem normothermic regional perfusion helps reduce rates of post-transplant biliary complications and graft loss and allows for the successful transplantation of livers from older cDCD donors.
Authors: Catherine Go; Moataz Elsisy; Brian Frenz; J B Moses; Amit D Tevar; Anthony J Demetris; Youngjae Chun; Bryan W Tillman Journal: Surgery Date: 2021-11-25 Impact factor: 3.982
Authors: Fiona Hunt; Chris J C Johnston; Lesley Coutts; Ahmed E Sherif; Lynsey Farwell; Ben M Stutchfield; Avi Sewpaul; Andrew Sutherland; Benoy I Babu; Ian S Currie; Gabriel C Oniscu Journal: Transpl Int Date: 2022-06-03 Impact factor: 3.842
Authors: Isabel M A Brüggenwirth; Willemijn S van der Plas; Otto B van Leeuwen; Adam M Thorne; Michel Rayar; Vincent E de Meijer; Robert J Porte Journal: Artif Organs Date: 2021-12-16 Impact factor: 2.663