Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

Abstract

Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.

Machine Perfusions in Liver Transplantation: The Evidence‐Based Position Paper of the Italian Society of Organ and Tissue Transplantation

“…A total of 16 out of 25 studies reported selection criteria for DCD liver grafts during NRP. (55)(56)(57)(58)(59)(61)(62)(63)65,(67)(68)(69)(70)(72)(73)(74) Graft survival ranged from 42.9% to 100%, and follow-up ranged from 3 to 32 months.…”

Donation after Circulatory Death: Potential Mechanisms of Injury and Preventative Strategies

“…A study from Italy investigated outcomes in 20 DCD donors that underwent NRP. 75 In Italy DCD donors experienced a prolonged DWIT as a 20-minute no-touch period is required following circulatory arrest. PNF was seen in two patients (10%), IC was seen in two patients (10%), and 1-year graft and patient survival were 85 and 95%, respectively.…”

Comparative proteomics analysis identifies L-FABP as a putative biomarker of graft injury during liver transplantation

“…According to differences in postoperative liver function and patient recovery, grafts are divided into three categories: early allograft dysfunction (EAD), primary non-function (PNF) and optimal graft function (OG). Lower quality liver allografts are associated with severe ischemia reperfusion injury (IRI), resulting in the occurrence of EAD or PNF, which significantly affect patient survival and allograft survival (1, 2). The incidence of EAD is up to 39.5% in patients with allografts from DCD donors (1).…”

“…The incidence of EAD is up to 39.5% in patients with allografts from DCD donors (1). A high rate of PNF (10%) and retransplantation (15%) in liver transplant patients was reported in a transplant center in Italy (2).…”