Riccardo De Carlis1, Andrea Schlegel2, Samuele Frassoni3, Tiziana Olivieri4, Matteo Ravaioli5, Stefania Camagni6, Damiano Patrono7, Domenico Bassi8, Duilio Pagano9, Stefano Di Sandro4, Andrea Lauterio1, Vincenzo Bagnardi3, Salvatore Gruttadauria9, Umberto Cillo8, Renato Romagnoli7, Michele Colledan6, Matteo Cescon5, Fabrizio Di Benedetto4, Paolo Muiesan2,10, Luciano De Carlis1,11. 1. Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 2. Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom. 3. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy. 4. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. 5. UO Chirurgia Generale e dei Trapianti, AOU Sant'Orsola-Malpighi, Alma Mater Studiorum Università di Bologna, Bologna, Italy. 6. Division of Liver Transplantation, AO Papa Giovanni XXIII, Bergamo, Italy. 7. General Surgery 2U, Liver Transplant Center, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy. 8. Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy. 9. Abdominal Surgery and Organ Transplantation Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy. 10. Hepatobiliary Unit, Careggi University Hospital, University of Florence, Florence, Italy. 11. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Abstract
BACKGROUND: Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). METHODS: We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. RESULTS: In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). CONCLUSIONS: These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
BACKGROUND: Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). METHODS: We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. RESULTS: In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). CONCLUSIONS: These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
Authors: David Andrijevic; Zvonimir Vrselja; Taras Lysyy; Shupei Zhang; Mario Skarica; Ana Spajic; David Dellal; Stephanie L Thorn; Robert B Duckrow; Shaojie Ma; Phan Q Duy; Atagun U Isiktas; Dan Liang; Mingfeng Li; Suel-Kee Kim; Stefano G Daniele; Khadija Banu; Sudhir Perincheri; Madhav C Menon; Anita Huttner; Kevin N Sheth; Kevin T Gobeske; Gregory T Tietjen; Hitten P Zaveri; Stephen R Latham; Albert J Sinusas; Nenad Sestan Journal: Nature Date: 2022-08-03 Impact factor: 69.504
Authors: Isabel M A Brüggenwirth; Matteo Mueller; Veerle A Lantinga; Stefania Camagni; Riccardo De Carlis; Luciano De Carlis; Michele Colledan; Daniele Dondossola; Moritz Drefs; Janina Eden; Davide Ghinolfi; Dionysios Koliogiannis; Georg Lurje; Tommaso M Manzia; Diethard Monbaliu; Paolo Muiesan; Damiano Patrono; Johann Pratschke; Renato Romagnoli; Michel Rayar; Federico Roma; Andrea Schlegel; Philipp Dutkowski; Robert J Porte; Vincent E de Meijer Journal: Am J Transplant Date: 2022-04-05 Impact factor: 9.369