Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

Abstract

In recent years, an increasing number of suboptimal grafts has been used to reduce the gap between the supply and demand of organs for liver transplantation (LT). In this randomized prospective study, we tested the impact of donor harvesting technique on the posttransplantation outcome of suboptimal donor livers. A modified double perfusion (MDP) technique (aortic and portal cooling with tourniquet clamping of splenomesenteric vein inflow) was compared with the single aortic perfusion (SAP) technique. Between February and November 2005, 35 suboptimal grafts were randomly assigned to either technique (18 MDP livers and 17 SAP livers). Donor and recipient variables were comparable in the 2 study groups. The SAP group had significantly higher blood transaminases and bilirubin levels after LT. The prevalence of graft primary dysfunction (PDF) was also significantly higher (P ϭ 0.01) in the SAP group (35%) than in the MDP group (5%). In 5 cases, all in the SAP group (P ϭ 0.02), early re-LT (Ͻ30 days) was needed. The 6-month patient and graft survival rates were significantly higher in the MDP (100% in both cases) than in the SAP group (68% and 58%, respectively). The study was stopped in November 2005, when the interim analysis revealed such markedly significant differences between the two groups. In conclusion, the present study showed a very low prevalence of PDF, death, and re-LT after transplantation with suboptimal liver when a MDP technique was used to harvest the donor graft.

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“…Elderly grafts are more susceptible to ischemia/reperfusion injury because of hemodynamic instability. 13 Shorter cold ischemia time and reduction of long-distance organ travel could contribute to improving their outcomes and overall utilization. Some authors have suggested that minimization of organ manipulation, rapid aortic cannulation and cold perfusion, topical cooling, and rapid hepatectomy have protective effects for older liver grafts.…”

Liver Transplantation Surgery: How we do it Today in Italy

“…The Celsior solution is more used than the UW and requires higher amounts. In situ flushing at cross-clamp is most commonly done through the aorta only, but a considerable number of centres flush the liver in situ also through the portal vein, reflecting probably the increasing amount of marginal livers utilized and the need to optimize flushing and preservation by combined arterial and portal perfusion as reported in the literature [10]. The method of washing the graft at back table is characterized by a wide variety of approaches, and most of the surgeons (78%) are in accordance with flushing the biliary tree in order to better preserve its integrity [11].…”

Strategies to optimize the use of marginal donors in liver transplantation

“…In the SAP group, 5 cases required re-LT (< 30 d). Patient and graft survival rates were higher in the MDP (100% in both cases) than in the SAP group (68% and 58%, respectively) so that the study was stopped [70] .…”