In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival.

Abstract

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.