Normothermic Regional Perfusion of Donors Following Circulatory Death Improves Outcomes in Liver Transplantation.
1Cambridge Transplant Unit, Addenbrookes Hospital, Cambridge, United Kingdom
2OrganOx Ltd, Oxford, United Kingdom
3Dept of Surgery, University of Cambridge, Cambridge, United Kingdom
4Papworth Hospital, Cambridge, United Kingdom
Meeting: 2017 American Transplant Congress
Abstract number: 140
Keywords: Bile duct, Donors, Liver preservation, Liver transplantation, non-heart-beating
Session Information
Session Name: Concurrent Session: Liver Allocation, Utilization, and Machine Perfusion
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Location: E451a
Introduction: Donation after Circulatory Death (DCD) provides 23% of UK livers for transplantation, but such transplants are associated with more primary graft function and early graft loss, particularly from ischaemic cholangiopathy. Normothermic regional perfusion (NRP), where a circulation of oxygenated blood at 37[deg]C is restored to the abdominal organs after circulatory arrest but before retrieval, has been suggested to improve outcomes. Here we review our experience of NRP.
Methods: Data on all patients who had received liver transplants from circulatory death donors who had undergone NRP were reviewed, and compared to a cohort of twice the number of patients transplanted one before and one after each NRP case. Livers that underwent normothermic preservation were excluded.
Results: 20 NRP liver transplants were compared to 40 contemporaneous “controls”. Full data on 3 recipients that were not transplanted by us were not available, although some follow up data was obtained via the UK Transplant Registry.
| NRP livers
(n=20) |
non-NRP livers
(n=40) |
|
| 1y actuarial graft survival (censored for death) | 100% | 87% |
| 1 year actuarial patient survival | 93% | 94% |
| 1y actuarial graft survival (not death censored) | 93% | 81% |
| Peak ALT (iu/L) in week one (median (IQR)) | 480 (349-1016) | 840 (437-1443) |
| Biliary anastomotic leaks | 6% (n=17) | 5% |
| Biliary anastomotic strictures | 12% (n=17) | 5% |
| Ischaemic cholangiopathy | 0 (n=17) | 15% |
Discussion:
NRP is associated with less early graft damage (ALT rise) and better graft survival compared to contemporaneous DCD liver transplants without NRP. Moreover no ischaemic cholangiopathy was seen post NRP, compared to a 15% incidence in “controls”.
CITATION INFORMATION: Mowlem E, Randle L, Fear C, Crick K, Messer S, Large S, Butler A, Watson C. Normothermic Regional Perfusion of Donors Following Circulatory Death Improves Outcomes in Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Mowlem E, Randle L, Fear C, Crick K, Messer S, Large S, Butler A, Watson C. Normothermic Regional Perfusion of Donors Following Circulatory Death Improves Outcomes in Liver Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/normothermic-regional-perfusion-of-donors-following-circulatory-death-improves-outcomes-in-liver-transplantation/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress