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

Autores: Hessheimer, A. J.; Rosa, G.; Gastaca, M.; Ruiz, P.; Otero, A.; Gómez, M.; Alconchel, F.; Ramírez, P.; Bosca, A.; López-Andújar, R.; Atutxa, L.; Royo-Villanova, M.; Sánchez, B.; Santoyo, J.; Marín, L. M.; Gómez-Bravo, M. A.; Mosteiro, F.; Villegas Herrera, M. T.; Villar del Moral, J.; González-Abós, C.; Vidal, B.; López-Domínguez, J.; Llado, L.; Roldán, J.; Justo, I.; Jiménez, C.; López-Monclus, J.; Sánchez-Turrión, V.; Rodríguez-Laiz, G.; Velasco Sánchez, E.; López-Baena, J. A.; Caralt, M.; Charco, R.; Tome, S.; Varo, E.; Martí Cruchaga, Pablo; Rotellar Sastre, Fernando; Varona, M. A.; Barrera, M.; Rodríguez-Sanjuan, J. C.; Briceño, J.; López, D.; Blanco, G.; Nuno, J.; Pacheco, D.; Coll, E.; Domínguez-Gil, B.; Fondevila, C. (Autor de correspondencia)
Título de la revista: AMERICAN JOURNAL OF TRANSPLANTATION
ISSN: 1600-6135
Volumen: 22
Número: 4
Páginas: 1169 - 1181
Fecha de publicación: 2022
Resumen:
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.
DOI: https://doi.org/10.1111/ajt.16899
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