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.

Donation after the circulatory determination of death (DCDD) has emerged as a valuable strategy to increase the availability of organs for transplantation. 1 In 2018, 23% of the 39 357 deceased organ donors reported to the Global Observatory on Donation and Transplantation had been declared dead by circulatory criteria. 2,3 DCDD also provides the opportunity of posthumous donation when patients die following an unsuccessfully-resuscitated cardiac arrest (uncontrolled DCDD [uDCDD]) or the decision to withdraw of life-sustaining therapies (WLSTs) that are no longer deemed beneficial to the patient (controlled DCDD [cDCDD]). 4cDCDD programs already exist in 17 countries throughout the world. 2,3,5 In cDCDD, the effects of warm ischemia during the agonal period after the WLST and following the cessation of circulation are further exacerbated during the later phase of cold

No abstract

No abstract

No abstract