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