Does Normothermic Regional Perfusion Improve the Results of Donation After Circulatory Death Liver Transplantation?

In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/ 88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.

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“…Liver: Eight primary studies were identified [38,53,[62][63][64]91,93,108] (Tables S19 and S20; Fig. 3).…”

Section: Normothermic Regional Perfusion In Cdcdmentioning

confidence: 99%

A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation

et al. 2021

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“…Miñambres, 2020 43 Retrospective Comparative Cohort 16 DCD NRP 29 SCS DBD 44 Prospective Comparative Cohort…”

Section: Recommendationsmentioning

confidence: 99%

Does machine perfusion improve immediate and short‐term outcomes by enhancing graft function and recipient recovery after liver transplantation? A systematic review of the literature, meta‐analysis and expert panel recommendations

Val

Guarrera

Porte

et al. 2022

Clinical Transplantation

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Background: Recent evidence supports the use of machine perfusion technologies (MP) for marginal liver grafts. Their effect on enhanced recovery, however, remains uncertain.Objectives: To identify areas in which MP might contribute to an ERAS program and to provide expert panel recommendations.Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.Methods: Systematic review and meta-analysis following PRISMA guidelines and recommendations using the GRADE approach. CRD42021237713 Results: Both hypothermic (HMP) and normothermic (NMP) machine perfusion demonstrated significant benefits in preventing postreperfusion syndrome (PRS)

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“…In addition to the use of machine perfusion, experienced donor surgeons use the super rapid organ retrieval (SRR) techniques to reduce the time needed for donor cannulation and hepatectomy, with the application of a meticulous liver flush and cooling, with a particular focus on the biliary tree [30,31]. Another strategy, applied for example in Spain, is the cannulation of donor vessels for later normothermic regional perfusion before treatment withdrawal [7,18,32]. In Italy premortem placement of guidewires in femoral vessels is routinely performed, whereas cannulation is permitted only after treatment withdrawal [29].…”

Section: Key Pointsmentioning

confidence: 99%

Liver perfusion strategies: what is best and do ischemia times still matter?

Panconesi

Carvalho

Muiesan

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewThis review describes recent developments in the field of liver perfusion techniques.Recent findingsDynamic preservation techniques are increasingly tested due to the urgent need to improve the overall poor donor utilization. With their exposure to warm ischemia, livers from donors after circulatory death (DCD) transmit additional risk for severe complications after transplantation. Although the superiority of dynamic approaches compared to static-cold-storage is widely accepted, the number of good quality studies remains limited. Most risk factors, particularly donor warm ischemia, and accepted thresholds are inconsistently reported, leading to difficulties to assess the impact of new preservation technologies. Normothermic regional perfusion (NRP) leads to good outcomes after DCD liver transplantation, with however short ischemia times. While randomized controlled trials (RCT) with NRP are lacking, results from the first RCTs with ex-situ perfusion were reported. Hypothermic oxygenated perfusion was shown to protect DCD liver recipients from ischemic cholangiopathy. In contrast, endischemic normothermic perfusion seems to not impact on the development of biliary complications, although this evidence is only available from retrospective studies.SummaryDynamic perfusion strategies impact posttransplant outcomes and are increasingly commissioned in various countries along with more evidence from RCTs. Transparent reporting of risk and utilization with uniform definitions is required to compare the role of different preservation strategies in DCD livers with prolonged ischemia times.

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Does Normothermic Regional Perfusion Improve the Results of Donation After Circulatory Death Liver Transplantation?

Cited by 21 publications

References 14 publications

A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation

A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation

Does machine perfusion improve immediate and short‐term outcomes by enhancing graft function and recipient recovery after liver transplantation? A systematic review of the literature, meta‐analysis and expert panel recommendations

Liver perfusion strategies: what is best and do ischemia times still matter?

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