In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival.
Wigmore, Stephen J
Randle, Lucy V
Terrace, John D
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
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Watson, C., Hunt, F., Messer, S., Currie, I., Large, S., Sutherland, A., Crick, K., et al. (2019). In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival.. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 19 (6), 1745-1758. https://doi.org/10.1111/ajt.15241
Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of non-function, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from which 43 livers were transplanted. These were compared with 187 non-NRP DCD donor livers transplanted at the same two UK centers in the same period. The use of NRP was associated with a reduction in early allograft dysfunction (12% for NRP vs 32% for non-NRP livers, p=0.0076), 30-day graft loss (2% NRP livers vs. 12% non-NRP livers, p=0.0559), freedom from ischemic cholangiopathy (0% vs. 27% for non-NRP livers, p<0.0001), and fewer anastomotic strictures (7% vs. 27% non-NRP, p=0.0041). After adjusting for other factors in a multivariable analysis, NRP remained significantly associated with freedom from ischemic cholangiopathy (p<0.0001). These data suggest that NRP during organ recovery from DCD donors leads to superior liver outcomes compared to conventional organ recovery.
Bile Ducts, Humans, Bile Duct Diseases, Ischemia, Death, Organ Preservation, Tissue and Organ Harvesting, Liver Transplantation, Extracorporeal Circulation, Retrospective Studies, Perfusion, Temperature, Graft Survival, Adolescent, Adult, Aged, Middle Aged, Child, Tissue and Organ Procurement, Female, Male, Delayed Graft Function, Young Adult
The work in Cambridge was supported by grants from the Evelyn Trust and the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT). The Joan Kendrick legacy supported the purchase of a near patient blood chemistry analyzer. The University of Cambridge has received salary support in respect of Professor Watson from the NHS in the East of England through the Clinical Academic Reserve. The work in Edinburgh was supported by grants from the Scottish Government Health and Social Care Directorate and The Edinburgh and Lothian Health Foundation, which enabled the purchase of the NRP equipment. Mr. Oniscu and Mr. Currie are supported by NHS Research Scotland (NRS) Fellowships from the Chief Scientist Office. Both Cambridge and Edinburgh were supported by NHS Blood and Transplant to further evaluate NRP.
Evelyn Trust (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (NIHR BTRU-2014-10027)
External DOI: https://doi.org/10.1111/ajt.15241
This record's URL: https://www.repository.cam.ac.uk/handle/1810/287680