Increasing the Donor Pool: Consideration of Prehospital Cardiac Arrest in Controlled Donation After Circulatory Death for Liver Transplantation

Elaffandi, Ahmed; Bonney, Glenn Kunnath; Gunson, Bridget K.; Scalera, Irene; Mergental, Hynek; Isaac, John; Bramhall, Simon R.; Mirza, Darius F.; Perera, M Thamara P R; Muiesan, Paolo

doi:10.1002/lt.23772

Cited by 15 publications

(9 citation statements)

References 35 publications

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“…The mechanism of warm ischemia is not clearly demonstrated . When studying prehospital cardiac arrest in DCD LT, Elaffandi et al did not observe any ischemic‐type biliary lesions. On the other hand, Otero et al and Suárez et al pointed out that cardiopulmonary support was associated with less PNF than were normothermic or hypothermic cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

First experience of liver transplantation with type 2 donation after cardiac death in France

et al. 2015

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Organ donation after unexpected cardiac death [type 2 donation after cardiac death (DCD)] is currently authorized in France and has been since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation (LT) with type 2 DCD donors. After the declaration of death, abdominal normothermic oxygenated recirculation was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 LTs were performed in 3 French centers. Six patients had a rapid and uneventful postoperative recovery. However, primary nonfunction occurred in 3 patients, with each requiring urgent retransplantation, and 4 early allograft dysfunctions were observed. One patient developed a nonanastomotic biliary stricture after 3 months, whereas 8 patients showed no sign of ischemic cholangiopathy at their 1-year follow-up. In comparison with a control group of patients receiving grafts from braindead donors (n 5 41), donor age and cold ischemia time were significantly lower in the type 2 DCD group. Time spent on Additional Supporting Information may be found in the online version of this article.

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Section: Discussionmentioning

confidence: 99%

First experience of liver transplantation with type 2 donation after cardiac death in France

et al. 2015

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“…Liver donation with a history of prehospital cardiac arrest was accepted if transaminase levels were ≤ 4 times the normal range and presenting an improving trend. Interestingly, the authors found no significant difference in graft or patient survival with even better short-term results for organs with prehospital cardiac arrest [ 33 ]. Faucher et al reported in a descriptive study about a series of successful organ transplantations of donor grafts with out-of-hospital traumatic cardiac arrest [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Donor liver quality after hypovolemic shock and venous systemic oxygen persufflation in an experimental animal model

et al. 2018

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BackgroundThe ever growing demand for liver transplantation inevitably necessitates an expansion of the donor pool. Utilization of “shock organs” is considered suboptimal to date while the associated outcome has hardly been investigated.Materials and methodsMale Wistar rats underwent a period of 30 min of hypovolemic shock. After 24 h livers were explanted and prior to reperfusion underwent either 18 h of cold storage (CS; N = 6) or 17 h of CS followed by 60 min venous systemic oxygen persufflation (VSOP; N = 6). The outcome of “shock organs (SHBD)” was compared to heart-beating donor (HBD; N = 12) as positive control and non-heart-beating donor (NHBD; N = 12) as negative control animal groups. Liver function was assessed by measuring enzyme release (AST, ALT, LDH), bile production, portal vein pressure and hepatic oxygen uptake during reperfusion. For reperfusion, the isolated perfused rat liver system was used.ResultsLiver function was severely limited in NHBD group compared to HBD organs after 18 h of CS (e.g., AST; HBD: 32.25 ± 7.25 U/l vs. NHBD: 790 ± 414.56 U/l; p < 0.005). VSOP improved liver function of NHBD organs significantly (AST; NHBD + VSOP: 333.6 ± 149.1 U/l; p < 0.005). SHBD organs showed a comparable outcome to HBD and clearly better results than NHBD organs after 18 h of CS (AST; SHBD: 76.4 ± 21.9 U/l). After 17 h of CS accompanied by 60 min VSOP, no improvement concerning liver function and integrity of SHBD organs was observed while the results were severely deteriorated by VSOP resulting in higher enzyme release (AST; SHBD + VSOP: 213 ± 61 U/l, p < 0.001), higher portal vein pressure (SHBD: 10.8 ± 1.92 mm Hg vs. SHBD + VSOP: 21.6 ± 8.8 mm Hg; p < 0.05) and lower hepatic oxygen uptake (SHBD: 321.75 ± 3.87 ml/glw/min vs. SHBD + VSOP: 395.8 ± 46.64 ml/glw/min, p < 0.05) at 24 h.ConclusionsOur data suggest that the potential of “shock organs” within liver transplantation may be underestimated. If our findings are reproducable in humans, SHBD grafts should be considered as a valuable source for expanding the thus far limited donor pool.

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“…In times of dramatic donor organ shortage, DCD livers are of increasing interest for extending the available organ pool. In contrast to DBD, these allografts suffer from enhanced I/R injury induced by prolonged warm ischemia time because of hypoperfusion and hypoxia during the agonal phase [ 240 ]. These organs are consistently exposed to a dual injury by prolonged warm ischemia time and subsequent cold ischemia period.…”

Section: Perioperative Approachmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria: Multidisciplinary Approach to Improve Outcome

Kornberg

2014

ISRN Hepatology

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The implementation of the Milan criteria (MC) in 1996 has dramatically improved prognosis after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Liver transplantation has, thereby, become the standard therapy for patients with “early-stage” HCC on liver cirrhosis. The MC were consequently adopted by United Network of Organ Sharing (UNOS) and Eurotransplant for prioritization of patients with HCC. Recent advancements in the knowledge about tumor biology, radiographic imaging techniques, locoregional interventional treatments, and immunosuppressive medications have raised a critical discussion, if the MC might be too restrictive and unjustified keeping away many patients from potentially curative LT. Numerous transplant groups have, therefore, increasingly focussed on a stepwise expansion of selection criteria, mainly based on tumor macromorphology, such as size and number of HCC nodules. Against the background of a dramatic shortage of donor organs, however, simple expansion of tumor macromorphology may not be appropriate to create a safe extended criteria system. In contrast, rather the implementation of reliable prognostic parameters of tumor biology into selection process prior to LT is mandatory. Furthermore, a multidisciplinary approach of pre-, peri-, and posttransplant modulating of the tumor and/or the patient has to be established for improving prognosis in this special subset of patients.

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Increasing the Donor Pool: Consideration of Prehospital Cardiac Arrest in Controlled Donation After Circulatory Death for Liver Transplantation

Cited by 15 publications

References 35 publications

First experience of liver transplantation with type 2 donation after cardiac death in France

First experience of liver transplantation with type 2 donation after cardiac death in France

Donor liver quality after hypovolemic shock and venous systemic oxygen persufflation in an experimental animal model

Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria: Multidisciplinary Approach to Improve Outcome

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