Eric Savier1,2, Chetana Lim1, Michel Rayar3, Francesco Orlando3, Karim Boudjema3, Kayvan Mohkam4, Mickael Lesurtel4, Jean Yves Mabrut4, Gabriella Pittau5, Nassiba Begdadi1,5, Daniel Cherqui5, René Adam5, Federica Dondero6, Ailton Sepulveda6, Olivier Soubrane6, Petru Bucur7, Louise Barbier7,8, Ephrem Salame7,8, Carine Jasseron9, Corinne Antoine10, Bruno Riou11, Olivier Scatton1,2. 1. Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, Pitié-Salpêtrière, AP HP, Sorbonne Université, Paris, France. 2. Centre de Recherche Saint-Antoine, CRSA, Sorbonne Université, Paris, France. 3. Service de Chirurgie Hépatobiliaire et Digestive, CHR Pontchaillou, Rennes, France. 4. Service de Chirurgie et Transplantation Hépatique, CHU Croix-Rousse, Université de Lyon, Lyon, France. 5. Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris Sud, Villejuif, France. 6. Service de Chirurgie Hepato-Bilio-Pancréatique, Hôpital Beaujon, AP-HP, Clichy, France. 7. Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France. 8. FHU SUPPORT, INSERM U1082 IRTOMIT, Poitiers, France. 9. Service de Biostatistique, Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine (ABM), Saint Denis, France. 10. Direction Générale Médicale et Scientifique, Agence de la Biomédecine (ABM), Saint Denis, France. 11. Coordination des prélèvement d'organe et de tissus, CHU Pitié-Salpêtrière, AP HP, Sorbonne Université, Paris, France.
Abstract
BACKGROUND: Liver transplantation (LT) from controlled donation after circulatory death (cDCD) was initiated in France in 2015 under a protocol based on the use of normothermic regional perfusion (NRP) before organ procurement. The aim was to compare outcomes following cDCD LT with NRP and donation after brain death (DBD) LT. METHODS: This is a multicenter retrospective study comparing cDCD LT with NRP and DBD LT. A case-matched study (1:2) was performed using the variables such as recipient and donor age, indication of LT. RESULTS: A total of 50 patients from the cDCD group were matched to 100 patients from the DBD group. From postoperative days 1-4, serum transaminase release was significantly lower in the cDCD group compared to the DBD group (P < 0.05). Early allograft dysfunction (cDCD: 18% versus DBD: 32%; P = 0.11), acute kidney injury (26% versus 33%; P = 0.49), 90-d graft loss (2% versus 5%; P = 0.66), and arterial (4% versus 12%; P = 0.19) and biliary (16% versus 17%; P = 0.94) complications were similar between the 2 groups. The 2-y graft survival was 88% for cDCD group and 85% for DBD group (P = 0.91). The 2-y patient survival was 90% for cDCD group and 88% for DBD group (P = 0.68). CONCLUSIONS: This study provides evidence that cDCD LT following postmortem NRP can be safely and effectively performed in selected recipients with similar graft and patient survival outcomes, without increased rates of biliary complications and early graft dysfunction compared to DBD LT.
BACKGROUND: Liver transplantation (LT) from controlled donation after circulatory death (cDCD) was initiated in France in 2015 under a protocol based on the use of normothermic regional perfusion (NRP) before organ procurement. The aim was to compare outcomes following cDCD LT with NRP and donation after brain death (DBD) LT. METHODS: This is a multicenter retrospective study comparing cDCD LT with NRP and DBD LT. A case-matched study (1:2) was performed using the variables such as recipient and donor age, indication of LT. RESULTS: A total of 50 patients from the cDCD group were matched to 100 patients from the DBD group. From postoperative days 1-4, serum transaminase release was significantly lower in the cDCD group compared to the DBD group (P < 0.05). Early allograft dysfunction (cDCD: 18% versus DBD: 32%; P = 0.11), acute kidney injury (26% versus 33%; P = 0.49), 90-d graft loss (2% versus 5%; P = 0.66), and arterial (4% versus 12%; P = 0.19) and biliary (16% versus 17%; P = 0.94) complications were similar between the 2 groups. The 2-y graft survival was 88% for cDCD group and 85% for DBD group (P = 0.91). The 2-y patient survival was 90% for cDCD group and 88% for DBD group (P = 0.68). CONCLUSIONS: This study provides evidence that cDCD LT following postmortem NRP can be safely and effectively performed in selected recipients with similar graft and patient survival outcomes, without increased rates of biliary complications and early graft dysfunction compared to DBD LT.
Authors: Riccardo De Carlis; Andrea Lauterio; Leonardo Centonze; Vincenzo Buscemi; Andrea Schlegel; Paolo Muiesan; Luciano De Carlis Journal: Updates Surg Date: 2022-02-28
Authors: Matthieu Le Dorze; Sara Martouzet; Etienne Cassiani-Ingoni; France Roussin; Alexandre Mebazaa; Lucas Morin; Nancy Kentish-Barnes Journal: Transpl Int Date: 2022-09-06 Impact factor: 3.842