How to Preserve Liver Grafts From Circulatory Death With Long Warm Ischemia? A Retrospective Italian Cohort Study With Normothermic Regional Perfusion and Hypothermic Oxygenated Perfusion.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
01 11 2021
01 11 2021
Historique:
pubmed:
23
2
2021
medline:
1
4
2022
entrez:
22
2
2021
Statut:
ppublish
Résumé
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). 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. 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). These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
Sections du résumé
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.
Identifiants
pubmed: 33617211
pii: 00007890-202111000-00022
doi: 10.1097/TP.0000000000003595
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2385-2396Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
Références
O’Neill S, Roebuck A, Khoo E, et al. A meta-analysis and meta-regression of outcomes including biliary complications in donation after cardiac death liver transplantation. Transpl Int. 2014;27:1159–1174.
Jay CL, Lyuksemburg V, Ladner DP, et al. Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta-analysis. Ann Surg. 2011;253:259–264.
Schlegel A, Muller X, Kalisvaart M, et al. Outcomes of DCD liver transplantation using organs treated by hypothermic oxygenated perfusion before implantation. J Hepatol. 2019;70:50–57.
Hessheimer AJ, Coll E, Torres F, et al. Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation. J Hepatol. 2019;70:658–665.
Magliocca JF, Magee JC, Rowe SA, et al. Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005;58:1095–1101. Discussion 1101.
van Rijn R, Karimian N, Matton APM, et al. Dual hypothermic oxygenated machine perfusion in liver transplants donated after circulatory death. Br J Surg. 2017;104:907–917.
van de Leemkolk FEM, Schurink IJ, Dekkers OM, et al. Abdominal normothermic regional perfusion in donation after circulatory death: a systematic review and critical appraisal. Transplantation. 2020;104:1776–1791.
Friend PJ. Strategies in organ preservation—a new golden age. Transplantation. 2020;104:1753–1755.
De Carlis L, Lauterio A, De Carlis R, et al. Donation after cardiac death liver transplantation after more than 20 minutes of circulatory arrest and normothermic regional perfusion. Transplantation. 2016;100:e21–e22.
De Carlis L, De Carlis R, Muiesan P. Past, present, and future of donation after circulatory death in Italy. Updates Surg. 2019;71:7–9.
De Carlis R, Di Sandro S, Lauterio A, et al. Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion. Liver Transpl. 2017;23:166–173.
De Carlis R, Di Sandro S, Lauterio A, et al. Liver grafts from donors after circulatory death on regional perfusion with extended warm ischemia compared with donors after brain death. Liver Transpl. 2018;24:1523–1535.
Ghinolfi D, Dondossola D, Rreka E, et al. Sequential use of normothermic regional and ex-situ machine perfusion in donation after circulatory death liver transplant. Liver Transpl. 2021;27:385–402.
Thuong M, Ruiz A, Evrard P, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016;29:749–759.
Kompanje EJ, van der Hoven B, Bakker J. Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med. 2008;34:1593–1599.
Italian National Transplant Center. Position paper—Determination of death based on circulatory criteria. Organ recovery for transplantation from the asystolic donor. 2016. Available at http://www.salute.gov.it/imgs/C_17_cntPubblicazioni_60_allegato.pdf . Accessed March 26, 2020.
Italian RepublicDecree of the Ministry of Health n. 136, 11 April 2008. Gazzetta Ufficiale. 2008. Available at https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2008-06-12&atto.codiceRedazionale=08A04067&elenco30giorni=false . Accessed March 20, 2020.
DeOliveira ML, Jassem W, Valente R, et al. Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center. Ann Surg. 2011;254:716–722. Discussion 722–723.
Cillo U, Burra P, Mazzaferro V, et al.; I-BELT (Italian Board of Experts in the Field of Liver Transplantation). A multistep, consensus-based approach to organ allocation in liver transplantation: toward a “Blended Principle Model”. Am J Transplant. 2015;15:2552–2561.
op den Dries S, Karimian N, Sutton ME, et al. Ex vivo normothermic machine perfusion and viability testing of discarded human donor livers. Am J Transplant. 2013;13:1327–1335.
Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470.
KDIGO AKI Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.
Kalisvaart M, Schlegel A, Umbro I, et al. The impact of combined warm ischemia time on development of acute kidney injury in donation after circulatory death liver transplantation: stay within the golden hour. Transplantation. 2018;102:783–793.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.
Mone T, Heldens J, Niemann CU. Deceased organ donor research: the last research frontier? Liver Transpl. 2013;19:118–121.
Schlegel A, Kalisvaart M, Scalera I, et al. The UK DCD Risk Score: a new proposal to define futility in donation-after-circulatory-death liver transplantation. J Hepatol. 2018;68:456–464.
Savier E, Dondero F, Vibert E, et al.; Donation After Cardiac Death Study Group. First experience of liver transplantation with type 2 donation after cardiac death in France. Liver Transpl. 2015;21:631–643.
Watson CJE, Hunt F, Messer S, et al. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant. 2019;19:1745–1758.
Miñambres E, Suberviola B, Dominguez-Gil B, et al. Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion. Am J Transplant. 2017;17:2165–2172.
Savier E, Lim C, Rayar M, et al. Favorable outcomes of liver transplantation from controlled circulatory death donors using normothermic regional perfusion compared to brain death donors. Transplantation. 2020;104:1943–1951.
Italian National Transplant Center. Annual activity report 2019. 2020. Available at http://www.trapianti.salute.gov.it/imgs/C_17_cntPubblicazioni_351_allegato.pdf . Accessed March 20, 2020.
Dutkowski P, Polak WG, Muiesan P, et al. First comparison of hypothermic oxygenated PErfusion versus static cold storage of human donation after cardiac death liver transplants: an international-matched case analysis. Ann Surg. 2015;262:764–770; discussion 770–771.
Narvaez JRF, Nie J, Noyes K, et al. Transplant outcomes of donation after circulatory death livers recovered with versus without premortem heparin administration. Liver Transpl. 2020;26:247–255.
Taner CB, Bulatao IG, Willingham DL, et al. Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors. Liver Transpl. 2012;18:100–111.
Net M, Valero R, Almenara R, et al. The effect of normothermic recirculation is mediated by ischemic preconditioning in NHBD liver transplantation. Am J Transplant. 2005;5:2385–2392.
Fondevila C, Hessheimer AJ, Flores E, et al. Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation. Am J Transplant. 2012;12:162–170.
Schlegel A, de Rougemont O, Graf R, et al. Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts. J Hepatol. 2013;58:278–286.
Oniscu GC, Randle LV, Muiesan P, et al. In situ normothermic regional perfusion for controlled donation after circulatory death—the United Kingdom experience. Am J Transplant. 2014;14:2846–2854.
Muller X, Schlegel A, Würdinger M, et al. Can hypothermic oxygenated perfusion (HOPE) rescue futile DCD liver grafts? HPB (Oxford). 2019;21:1156–1165.
Patrono D, Surra A, Catalano G, et al. Hypothermic oxygenated machine perfusion of liver grafts from brain-dead donors. Sci Rep. 2019;9:9337.
Umbro I, Tinti F, Scalera I, et al. Acute kidney injury and post-reperfusion syndrome in liver transplantation. World J Gastroenterol. 2016;22:9314–9323.
Jochmans I, Meurisse N, Neyrinck A, et al. Hepatic ischemia/reperfusion injury associates with acute kidney injury in liver transplantation: prospective cohort study. Liver Transpl. 2017;23:634–644.