Outcomes in DCD Liver Transplantation

Schlegel, Andrea; Panconesi, Rebecca; Muiesan, Paolo

doi:10.1007/978-3-030-46470-7_10

Cited by 1 publication

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“…Levels of hypoxia are, however, increasingly recognized when falling below a pO2 of 70 or 80 kPa [ 37 ]. Such inhomogeneous guidelines are the one remaining challenge to reliably compare the results of current studies, where the range of specific posttransplant complications appears equally enlarged [ 35 , 39 ]. During a recent consensus conference in 2020, the committee suggested to measure the functional DWIT according to the Spanish guidelines, starting when hypotension with systolic blood pressure of <60 mmHg or saturation below 80 kPa was seen in the donor [ 40 ].…”

Section: Types Of Extended Criteria Donor Livers and Associated Risk ...mentioning

confidence: 99%

Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

Widmer

Eden

Carvalho

et al. 2022

JCM

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Based on the renaissance of dynamic preservation techniques, extended criteria donor (ECD) livers reclaimed a valuable eligibility in the transplantable organ pool. Being more vulnerable to ischemia, ECD livers carry an increased risk of early allograft dysfunction, primary non-function and biliary complications and, hence, unveiled the limitations of static cold storage (SCS). There is growing evidence that dynamic preservation techniques—dissimilar to SCS—mitigate reperfusion injury by reconditioning organs prior transplantation and therefore represent a useful platform to assess viability. Yet, a debate is ongoing about the advantages and disadvantages of different perfusion strategies and their best possible applications for specific categories of marginal livers, including organs from donors after circulatory death (DCD) and brain death (DBD) with extended criteria, split livers and steatotic grafts. This review critically discusses the current clinical spectrum of livers from ECD donors together with the various challenges and posttransplant outcomes in the context of standard cold storage preservation. Based on this, the potential role of machine perfusion techniques is highlighted next. Finally, future perspectives focusing on how to achieve higher utilization rates of the available donor pool are highlighted.

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