ORIGINAL ARTICLE
Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss

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Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012–2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49–67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197–0.459, p < .001), ischemic type biliary lesions (OR 0.112, 95% CI 0.042–0.299, p < .001), graft loss (HR 0.371, 95% CI 0.267–0.516, p < .001), and patient death (HR 0.540, 95% CI 0.373–0.781, p = .001). Cold ischemia time (HR 1.004, 95% CI 1.001–1.007, p = .021) and re-transplantation indication (HR 9.552, 95% CI 3.519–25.930, p < .001) were significant independent predictors for graft loss among cDCD livers with A-NRP. While use of A-NRP helps overcome traditional limitations in cDCD liver transplantation, opportunity for improvement remains for cases with prolonged cold ischemia and/or technically complex recipients, indicating a potential role for complimentary ex situ perfusion preservation techniques.

KEYWORDS

clinical research/practice
complication: surgical/technical
donors and donation: donation after circulatory determination of death (DCD)
extracorporeal membrane oxygenation (ECMO)
ischemia reperfusion injury (IRI)
liver transplantation/hepatology
organ procurement and allocation

Abbreviations

ALT
alanine aminotransferase
AMC
antemortem cannulation
A-NRP
abdominal normothermic regional perfusion
AST
aspartate aminotransferase
AWIT
asystolic warm ischemia time
BMI
body mass index
CD
confluence dominant
cDCD
controlled donation after circulatory determination of death
CI
confidence interval
CIT
cold ischemia time
CVA
cerebrovascular accident
DCD
donation after circulatory determination of death
D-HOPE
dual hypothermic oxygenated perfusion
DN
diffuse necrosis
EAD
early allograft dysfunction
FWIT
functional warm ischemia time
HAT
hepatic artery thrombosis
HCC
hepatocellular carcinoma
HR
hazards ratio
HTK
histidine-tryptophan-ketoglutarate
ICU
intensive care unit
IGL
Institute Georges Lopez
ITBL
ischemic-type biliary lesions
LT
liver transplantation
MELD
model for end-stage liver disease
MF
minor form
MP
multifocal progressive
NRP
normothermic regional perfusion
ONT
Organización Nacional de Trasplantes
OR
odds ratio
PBG
peribiliary glands
PM
postmortem cannulation
PNF
primary non-function
PSC
primary sclerosing cholangitis
RETH
Registro Español de Trasplante Hepático
SETH
Sociedad Española de Trasplante Hepático
SRR
standard rapid recovery
TA-NRP
thoracoabdominal normothermic regional perfusion
TBI
traumatic brain injury
TWIT
total warm ischemia time
UK
United Kingdom
UW
University of Wisconsin
WLST
withdrawal of life-sustaining therapy

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