Reducing Non-Anastomotic Biliary Strictures in Donation After Circulatory Death Liver Transplantation

Gilbo, Nicholas; Jochmans, Ina; Sainz, M.; Pirenne, Jacques; Meurisse, Nicolas; Monbaliu, Diethard

doi:10.1097/sla.0000000000001949

Cited by 15 publications

(21 citation statements)

References 8 publications

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“…Interventions include, for example, the use of thrombolytics in the donor or recipient, normothermic perfusion after procurement, and use of extracorporeal membrane oxygenation after cardiac arrest . Additional modifiable recipient risk factors include the following: Hepatectomy time. Recipient WIT. CIT. …”

Section: Discussionmentioning

confidence: 99%

“…(8,9,24) The modifiable donor risk factors are as follows: Interventions include, for example, the use of thrombolytics in the donor or recipient, normothermic perfusion after procurement, and use of extracorporeal membrane oxygenation after cardiac arrest. (8,9,13,(25)(26)(27)(28)(29) Additional modifiable recipient risk factors include the following (30)(31)(32) :…”

Section: Expanding the Dcd Donor Poolmentioning

confidence: 99%

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Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

et al. 2019

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Use of donation after circulatory death (DCD) donor livers for transplantation has remained cautious in the United States. The aim of this study was to demonstrate the expansion of a DCD liver transplantation (LT) program with the use of extended criteria donor (ECD) DCD livers. After institutional review board approval, 135 consecutive DCD LTs were retrospectively studied. ECD DCD livers were defined as those with 1 of the following factors: donor age >50 years, donor body mass index >35 kg/m2, donor functional warm ischemia time >30 minutes, and donor liver macrosteatosis >30%. An optimization protocol was introduced in July 2011 to improve outcomes of DCD LT, which included thrombolytic donor flush and efforts to minimize ischemia times. The impact of this protocol on outcomes was evaluated in terms of graft loss, ischemic cholangiopathy (IC), and change in DCD LT volume. Of 135 consecutive DCD LTs, 62 were ECD DCDs. In total, 24 ECD DCD LTs were performed before (era 1) and 38 after the institution of optimization protocol (era 2), accounting for an increase in the use of ECD DCD livers from 39% to 52%. Overall outcomes of ECD DCD LT improved in era 2, with a significantly lower incidence of IC (5% versus 17% in era 1; P = 0.03) and better 1‐year graft survival (93% versus 75% in era 1; P = 0.07). Survival outcomes for ECD DCD LT in era 2 were comparable to matched deceased donor LT. With the expansion of the DCD donor pool, the number of DCD LTs performed at our center gradually increased in era 2 to account for >20% of the center's LT volume. In conclusion, with the optimization of perioperative conditions, ECD DCD livers can be successfully transplanted to expand the donor pool for LT.

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Section: Discussionmentioning

confidence: 99%

Section: Expanding the Dcd Donor Poolmentioning

confidence: 99%

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

et al. 2019

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“…Although the etiology of NAS is not fully understood, the duration of cold and warm ischemia during transplantation has been recognized as a major risk factor for NAS . Ischemic conditions lead to a complex cascade of events resulting in ischemia/reperfusion injury (IRI) .…”

mentioning

confidence: 99%

“…(6,7) Although the etiology of NAS is not fully understood, the duration of cold and warm ischemia during transplantation has been recognized as a major risk factor for NAS. (8)(9)(10) Ischemic conditions lead to a complex cascade of events resulting in ischemia/reperfusion injury (IRI). (11) Three independent clinical studies recently demonstrated that the majority of donor livers have histological evidence of extensive biliary IRI at the time of transplantation.…”

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confidence: 99%

Hypothermic oxygenated machine perfusion reduces bile duct reperfusion injury after transplantation of donation after circulatory death livers

et al. 2018

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Dual hypothermic oxygenated machine perfusion (DHOPE) of the liver has been advocated as a method to reduce ischemia/reperfusion injury (IRI). This study aimed to determine whether DHOPE reduces IRI of the bile ducts in donation after circulatory death (DCD) liver transplantation. In a recently performed phase 1 trial, 10 DCD livers were preserved with DHOPE after static cold storage (SCS; http://www.trialregister.nl NTR4493). Bile duct biopsies were obtained at the end of SCS (before DHOPE; baseline) and after graft reperfusion in the recipient. Histological severity of biliary injury was graded according to an established semiquantitative grading system. Twenty liver transplantations using DCD livers not preserved with DHOPE served as controls. Baseline characteristics and the degree of bile duct injury at baseline (end of SCS) were similar between both groups. In controls, the degree of stroma necrosis (P = 0.002) and injury of the deep peribiliary glands (PBG; P = 0.02) increased after reperfusion compared with baseline. In contrast, in DHOPE‐preserved livers, the degree of bile duct injury did not increase after reperfusion. Moreover, there was less injury of deep PBG (P = 0.04) after reperfusion in the DHOPE group compared with controls. In conclusion, this study suggests that DHOPE reduces IRI of bile ducts after DCD liver transplantation. Liver Transplantation 24 655–664 2018 AASLD.

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“…30,31 Based on their pioneering work, the Columbia group has concluded that HMP is safe and feasible and holds the potential to successfully rescue nontransplantable grafts. The HMP assists with recovery of mitochondrial function, reconstitution of ATP levels, and elimination of catabolic by-products from the endothelial space.…”

Section: Current S Tate Of E X S Itu Machine Pr E S E Rvati O Nmentioning

confidence: 99%

Implementing an innovated preservation technology: The American Society of Transplant Surgeons’ (ASTS) Standards Committee White Paper on Ex Situ Liver Machine Perfusion

Quintini

Martins²,

Shah

et al. 2018

American Journal of Transplantation

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The pervasive shortage of deceased donor liver allografts contributes to significant waitlist mortality despite efforts to increase organ donation. Ex vivo liver perfusion appears to enhance preservation of donor organs, extending viability and potentially evaluating function in organs previously considered too high risk for transplant. These devices pose novel challenges for organ allocation, safety, training, and finances. This white paper describes the American Society of Transplant Surgeons' belief that organ preservation technology is a vital advance, but its use should not change fundamental aspects of organ allocation. Additional data elements need to be collected, made available for organ assessment by transplant professionals to allow determination of organ suitability in the case of reallocation and incorporated into risk adjustment methodology. Finally, further work is needed to determine the optimal strategy for management and oversight of perfused organs prior to transplantation.

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Reducing Non-Anastomotic Biliary Strictures in Donation After Circulatory Death Liver Transplantation

Cited by 15 publications

References 8 publications

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

Hypothermic oxygenated machine perfusion reduces bile duct reperfusion injury after transplantation of donation after circulatory death livers

Implementing an innovated preservation technology: The American Society of Transplant Surgeons’ (ASTS) Standards Committee White Paper on Ex Situ Liver Machine Perfusion

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