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Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss

2021; Elsevier BV; Volume: 22; Issue: 4 Linguagem: Inglês

10.1111/ajt.16899

1600-6143

Amelia J. Hessheimer, Gloria de la Rosa, Mikel Gastaca, P. Ruíz, Alejandra Otero, Manuel Arias, Felipe Alconchel, Pablo Ramı́rez, Andrea Boscá, Rafael López‐Andújar, Lánder Atutxa, Mario Royo-Villanova, Belinda Sánchez Pérez, Julio Santoyo Santoyo, Luis Miguel Marín Gómez, Miguel Ángel Gómez Bravo, Fernando Mosteiro, María Trinidad Villegas Herrera, Jesús Villar, Carolina González‐Abós, B. Vidal, Josefina López-Domínguez, Laura Lladó, José María Domínguez Roldán, Iago Justo, C. Jiménez, Javier López‐Monclús, Víctor Sánchez-Turrión, G. Rodríguez-Laiz, Enrique Velasco Sánchez, José Ángel López‐Baena, M. Caralt, R. Charco, Santiago Tomé, Evaristo Varó, Pablo Martí‐Cruchaga, Fernando Rotellar, María A. Varona, Manuel Barrera, Juan Carlos Rodríguez-Sanjuán, Javier Briceño, Diego A. López, Gerardo Blanco‐Fernández, Javier Nuño, David Pacheco, Elisabeth Coll, Beatriz Domínguez‐Gil, Constantino Fondevila,

Organ Donation and Transplantation

Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p < .001), ischemic type biliary lesions (OR 0.112, 95% CI 0.042-0.299, p < .001), graft loss (HR 0.371, 95% CI 0.267-0.516, p < .001), and patient death (HR 0.540, 95% CI 0.373-0.781, p = .001). Cold ischemia time (HR 1.004, 95% CI 1.001-1.007, p = .021) and re-transplantation indication (HR 9.552, 95% CI 3.519-25.930, p < .001) were significant independent predictors for graft loss among cDCD livers with A-NRP. While use of A-NRP helps overcome traditional limitations in cDCD liver transplantation, opportunity for improvement remains for cases with prolonged cold ischemia and/or technically complex recipients, indicating a potential role for complimentary ex situ perfusion preservation techniques.