Incidence and risk factors of primary non‐function after liver transplantation using grafts from uncontrolled donors after circulatory death

Abstract

Background Graft primary non‐function (PNF) is the most severe complication after orthotopic liver transplantation (OLT) and is frequently associated with livers from uncontrolled circulatory death (uDCD). Methods We reviewed retrospectively the incidence, risk factors, and outcome of patients showing PNF after receiving uDCD liver grafts. The series comprises 75 OLT performed during 11 years. Results The incidence of PNF using uDCD livers was 8%. We compared patients who developed PNF (n = 6) vs. patients without PNF (n = 69). Mean pump flow of donors during normothermic regional perfusion (NRP) was significantly lower in PNF (p = .032). Day 1 post‐OLT levels of transaminases and the incidence of renal complications and postoperative mortality were also significantly higher in the PNF group, but 5‐year patient survival was similar in both groups (66.7% in PNF and 68.5% in non‐PNF). All PNF patients underwent re‐OLT, and 2 died. PNF incidence has decreased in the last 5‐years. Binary logistic regression analysis confirmed final ALT value >4 times the normal value as risk factor for PNF, and median donor pump flow >3700 ml/min as protective effect. Conclusions Adequate donor pump flow during NRP was a protective.

Liver transplantation for hepatocellular carcinoma using grafts from uncontrolled circulatory death donation

“…Regarding the use of uDCD livers, an increase in PNF has been linked to the longer period of ischemia. The incidence of PNF is 1.1–7.2% for DBD OLT, 1.8–11.8% when using cDCD livers, and 5–25% for uDCD OLT 22 . However, on the 30 th post-OLT day, liver function of our uDCD recipients was equivalent to that of DBD recipients, reflecting the good recovery of uDCD livers.…”

“…PNF was defined as severe clinical deterioration requiring retransplantation or progressing to death, which was the consequence of irreversible liver graft failure within 10 days after OLT, in the absence of vascular complications 22 . Among BCs, non-anastomotic biliary strictures (NABS) were defined as any stricture, dilation, or irregularity of the intrahepatic or extrahepatic bile ducts of the liver (hilum), whereas anastomotic biliary strictures (ABS) were defined as lesions localized to the anastomosis site 23 .…”

Donation after circulatory death and liver transplantation: a cohort study

“…Previous studies regarding DCD were focused on surgical and technical issues or presented limited donor-related data (sex, age, BMI, cause of death, and tWIT) or were published before the introduction of the nRP and MP [8][9][10][11][12][13][14][19][20][21]. The aim of our study was instead to provide a complete picture about both type II and III DCD evaluation process from a potential donor to organ transplantation, as well as highlight how complex is the DCD process and management.…”

“…However, the Italian scenario is quite different from worldwide because the Italian law imposes that cardiac death is declared after 20 min of flat line electrocardiographic activity. This forced "notouch period" provides a longer ischemic injury time than in other countries, where it is generally 5 min [14][15][16][17]. Furthermore, as liver from DCD is already considered marginal, a specific recipient's consent is also required before transplantation.…”

“…Moreover, the hypothermic machine perfusion (HMP) assesses the viability and quality of the graft before transplantation, once recovered [5–8]. Recent studies from centers with high‐volume DCD programs demonstrated that livers from DCD had an equivalent graft survival than DBD’s, after the introduction of these devices [9–14]. However, the Italian scenario is quite different from worldwide because the Italian law imposes that cardiac death is declared after 20 min of flat line electrocardiographic activity.…”