Background: Normothermic regional perfusion (NRP) is currently explored as a method to recover organs from Maastricht category I-III Donors after circulatory death (DCD). This study presents a single centre experience with NRP in category III DCD donors.

Methods: NRP was established postasystole via rapid laparotomy, aortic and caval cannulation. Blood gases and biochemistry were monitored every 30 minutes throughout the two hours duration of NRP. The outcome were compared with a contemporaneous cohort of standard DCD livers transplanted in the unit.

Results: 45 standard DCD and 14 NRP DCD livers were transplanted between February 2013 and August 2016. The median follow-up was 17 months (range: 0.23-42 months). The median donor age for the NRP livers was 51 years (range:28-69 years) whilst the functional warm ischemic time was 23 minutes. The cold ischemic time was 480 min (range:253-726 min). The median peak ALT in the NRP DCD livers in the first week was 549 iu/L (range:58-3043). None of the NRP livers developed ischemic biliary strictures compared with 11 patients (24%) in the standard DCD group. There was no primary non-function (PNF) in the NRP group whilst 4 patients had PNF in the standard DCD group (two re-transplated and two died). All recipients of the NRP livers are alive whilst two patients died in the standard DCD group. Two NRP DCD livers had biliary complications (one bile leak and one anastomotic stricture that resolved with stenting). 8 patients (18%) had biliary complications in the standard DCD group requiring stenting (7) and Roux-en-Y hepatico-jejunostomy (1).

Conclusions: Early results indicate the NRP minimises the ischemia reperfusion injury and leads to a significant reduction in the incidence of ischemic biliary strictures. Larger studies are needed to confirm these findings and explore the mechanisms of action.

CITATION INFORMATION: Oniscu G, Hunt F, Herries W, Currie I, Sutherland A, Beattie C, Thomson E. Improved Outcomes After Liver Transplantation from Controlled DCD Donors with Normothermic Regional Perfusion. Am J Transplant. 2017;17 (suppl 3).

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