The role of sequential normothermic regional perfusion and end‐ischemic normothermic machine perfusion in liver transplantation from very extended uncontrolled donation after cardiocirculatory death

The use of pre‐procurement normothermic regional perfusion (NRP) allowed us to implement controlled DCD liver transplantation with results comparable to brain death donors, but the use of uncontrolled DCD is declining due to logistic challenges and the high incidence of post‐transplant complications...

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Veröffentlicht in:Artificial organs 2023-02, Vol.47 (2), p.432-440
Hauptverfasser: Ghinolfi, Davide, Melandro, Fabio, Torri, Francesco, Esposito, Massimo, Bindi, Maria, Biancofiore, Giandomenico, Basta, Giuseppina, Del Turco, Serena, Lazzeri, Chiara, Rotondo, Maria Isabella, Peris, Adriano, De Simone, Paolo
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container_end_page 440
container_issue 2
container_start_page 432
container_title Artificial organs
container_volume 47
creator Ghinolfi, Davide
Melandro, Fabio
Torri, Francesco
Esposito, Massimo
Bindi, Maria
Biancofiore, Giandomenico
Basta, Giuseppina
Del Turco, Serena
Lazzeri, Chiara
Rotondo, Maria Isabella
Peris, Adriano
De Simone, Paolo
description The use of pre‐procurement normothermic regional perfusion (NRP) allowed us to implement controlled DCD liver transplantation with results comparable to brain death donors, but the use of uncontrolled DCD is declining due to logistic challenges and the high incidence of post‐transplant complications. In Italy, the mandatory stand‐off period of 20 min for DCD donors has driven the combined use of NRP and ex‐situ machine perfusion with the intent to counterbalance the negative impact of prolonged warm ischemia. Organ viability during NRP is based on duration of warm ischemia, regional perfusion flow, lactate, transaminases values and histology, and those used in Italy are the widest worldwide. However, this evaluation can be difficult, especially when the acute damage is particularly severe. The use of ex‐situ NRP could provide a safe organ evaluation. In the period from 06/2020 to 06/2022, all DCD grafts exceeding NRP viability criteria at a single center were eventually evaluated using ex‐situ normothermic machine perfusion. Machine perfusion viability criteria were based on lactate clearance, irrespectively to bile production, unless 1‐h transaminases perfusate level were not exceeding 5000 IU/L. Three cases of uncontrolled DCD grafts in excess of NRP viability criteria underwent ex‐situ graft evaluation. Two matched ex‐situ normothermic machine perfusion viability criteria and were successfully transplanted. Both recipients are doing well after 26 and 5 months after surgery with no signs of ischemic cholangiopathy. This experience suggests that the sequential use of NRP and normothermic machine perfusion may further expand the boundaries of organ viability in uncontrolled DCD liver transplantation. The sequential use of normothermic regional perfusion (NRP) and ex‐situ normothermic machine perfusion (NMP) could promote the expansion of uncontrolled DCD (uDCD) acceptance criteria, but the assessment of liver grafts viability is critical Three cases of uDCD grafts in excess of NRP viability criteria underwent ex‐situ NMP re‐evaluation. Two organs matched our ex‐situ NMP viability criteria and were successfully transplanted The sequential use of NRP and NMP may further expand the boundaries of organ viability in uDCD liver transplantation
doi_str_mv 10.1111/aor.14468
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Two organs matched our ex‐situ NMP viability criteria and were successfully transplanted The sequential use of NRP and NMP may further expand the boundaries of organ viability in uDCD liver transplantation</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36461895</pmid><doi>10.1111/aor.14468</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7933-8941</orcidid><orcidid>https://orcid.org/0000-0003-4056-9245</orcidid></addata></record>
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source MEDLINE; Access via Wiley Online Library
subjects Complications
Criteria
donation after cardiac death
Donors
ex‐situ normothermic machine perfusion
Graft Survival
Grafting
Histology
Humans
Ischemia
Ischemia - surgery
Lactates
Lactic acid
Liver
Liver Transplantation
Liver transplants
normothermic regional perfusion
Organ Preservation - methods
Perfusion
Perfusion - methods
Tissue and Organ Procurement
Transaminases
Transplantation
Transplants & implants
Viability
title The role of sequential normothermic regional perfusion and end‐ischemic normothermic machine perfusion in liver transplantation from very extended uncontrolled donation after cardiocirculatory death
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