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dc.contributor.authorWatson, Christopheren
dc.contributor.authorHunt, Fionaen
dc.contributor.authorMesser, Simonen
dc.contributor.authorCurrie, Ianen
dc.contributor.authorLarge, Stephenen
dc.contributor.authorSutherland, Andrewen
dc.contributor.authorCrick, Keziahen
dc.contributor.authorWigmore, Stephen Jen
dc.contributor.authorFear, Corrinaen
dc.contributor.authorCornateanu, Sorinaen
dc.contributor.authorRandle, Lucy Ven
dc.contributor.authorTerrace, John Den
dc.contributor.authorUpponi, Saraen
dc.contributor.authorTaylor, Rhiannonen
dc.contributor.authorAllen, Elisaen
dc.contributor.authorButler, Andrewen
dc.contributor.authorOniscu, Gabriel Cen
dc.date.accessioned2019-01-09T00:31:23Z
dc.date.available2019-01-09T00:31:23Z
dc.date.issued2019-06en
dc.identifier.issn1600-6135
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/287680
dc.description.abstractLivers 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.
dc.description.sponsorshipThe 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.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherWiley-Blackwell
dc.subjectBile Ductsen
dc.subjectHumansen
dc.subjectBile Duct Diseasesen
dc.subjectIschemiaen
dc.subjectDeathen
dc.subjectOrgan Preservationen
dc.subjectTissue and Organ Harvestingen
dc.subjectLiver Transplantationen
dc.subjectExtracorporeal Circulationen
dc.subjectRetrospective Studiesen
dc.subjectPerfusionen
dc.subjectTemperatureen
dc.subjectGraft Survivalen
dc.subjectAdolescenten
dc.subjectAdulten
dc.subjectAgeden
dc.subjectMiddle Ageden
dc.subjectChilden
dc.subjectTissue and Organ Procurementen
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectDelayed Graft Functionen
dc.subjectYoung Adulten
dc.titleIn situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival.en
dc.typeArticle
prism.endingPage1758
prism.issueIdentifier6en
prism.publicationDate2019en
prism.publicationNameAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeonsen
prism.startingPage1745
prism.volume19en
dc.identifier.doi10.17863/CAM.34994
dcterms.dateAccepted2018-12-16en
rioxxterms.versionofrecord10.1111/ajt.15241en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-06en
dc.contributor.orcidWatson, Christopher [0000-0002-0590-4901]
dc.contributor.orcidLarge, Stephen [0000-0002-3201-6344]
dc.contributor.orcidOniscu, Gabriel C [0000-0003-1714-920X]
dc.identifier.eissn1600-6143
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idEvelyn Trust (unknown)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NIHR BTRU-2014-10027)
rioxxterms.freetoread.startdate2019-12-27


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