Scientific publications

Abdominal normothermic regional perfusion in controlled DCD liver transplantation: outcomes and risk factors for graft loss. Scientific Publication

Dec 2, 2021 | Magazine: American Journal of Transplantation

Amelia J Hessheimer  1   2   3 , Gloria de la Rosa  4 , Mikel Gastaca  5 , Patricia Ruíz  5 , Alejandra Otero  6 , Manuel Gómez  6 , Felipe Alconchel  7 , Pablo Ramírez  7 , Andrea Bosca  8 , Rafael López-Andújar  8 , Lánder Atutxa  9 , Mario Royo-Villanova  7 , Belinda Sánchez  10 , Julio Santoyo  10 , Luís Miguel Marín  11 , Miguel Ángel Gómez-Bravo  11 , Fernando Mosteiro  6 , María Trinidad Villegas Herrera  12 , Jesús Villar Del Moral  12 , Carolina González-Abos  2 , Bárbara Vidal  13 , Josefina López-Domínguez  14 , Laura Lladó  14 , José Roldán  15 , Iago Justo  16 , Carlos Jiménez  16 , Javier López-Monclús  17 , Víctor Sánchez-Turrión  17 , Gonzalo Rodríguez-Laíz  18 , Enrique Velasco Sánchez  19 , Jose Ángel López-Baena  19 , Mireia Caralt  20 , Ramón Charco  20 , Santiago Tomé  21 , Evaristo Varo  21 , Pablo Martí-Cruchaga  22 , Fernando Rotellar  22 , María Aranzazu Varona  23 , Manuel Barrera  23 , Juan Carlos Rodríguez-Sanjuan  24 , Javier Briceño  25 , Diego López  26 , Gerardo Blanco  26 , Javier Nuño  27 , David Pacheco  28 , Elisabeth Coll  4 , Beatriz Domínguez-Gil  4 , Constantino Fondevila  1   2   3


Abstract

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 12/31/2020. 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 59y [interquartile range 49-67y]. Adjusted risks estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, P<0.001), ischemic type biliary lesions (OR 0.112, 95% CI 0.042-0.299, P<0.001), graft loss (HR 0.371, 95% CI 0.267-0.516, P<0.001), and patient death (HR 0.540, 95% CI 0.373-0.781, P=0.001).

Cold ischemia time (HR 1.004, 95% CI 1.001-1.007, P=0.021) and re-transplantation indication (HR 9.552, 95% CI 3.519-25.930, P<0.001) 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.

CITATION Am J Transplant. 2022 Apr;22(4):1169-1181. doi: 10.1111/ajt.16899. Epub 2021 Dec 21.