Localized Liver Injury During Normothermic Ex Situ Liver Perfusion Has No Impact on Short-term Liver Transplant Outcomes.

Autor:	Martin JL; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Rhodes F; Royal Free Hospital, London, United Kingdom., Upponi S; Department of Radiology, Biomedical Campus, University of Cambridge, Cambridge, United Kingdom., Udeaja Y; Department of Radiology, Biomedical Campus, University of Cambridge, Cambridge, United Kingdom., Swift L; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Fear C; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Webster R; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Webb GJ; Department of Hepatology, Cambridge NIHR Biomedical Research Centre, Biomedical Campus, University of Cambridge, Cambridge, United Kingdom., Allison M; Department of Hepatology, Cambridge NIHR Biomedical Research Centre, Biomedical Campus, University of Cambridge, Cambridge, United Kingdom., Paterson A; Histopathology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom., Gaurav R; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Butler AJ; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom., Watson CJE; Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, and Cambridge NIHR Biomedical Research Centre, Biomedical Campus, Cambridge, United Kingdom.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2024 Jun 01; Vol. 108 (6), pp. 1403-1409. Date of Electronic Publication: 2024 Feb 29.
DOI:	10.1097/TP.0000000000004970
Abstrakt:	Background: Normothermic ex situ liver perfusion (NESLiP) has the potential to increase organ utilization. Radiological evidence of localized liver injury due to compression at the time of NESLiP, termed cradle compression, is a recognized phenomenon but is poorly characterized. Methods: A retrospective analysis of a prospectively collected database was performed of transplanted livers that underwent NESLiP and subsequently had a computed tomography performed within the first 14 d posttransplant. The primary study outcome was 1-y graft survival. Results: Seventy livers (63%) were included in the analysis. Radiological evidence of cradle compression was observed in 21 of 70 (30%). There was no difference in rate of cradle compression between donor after circulatory death and donated after brain death donors ( P  = 0.37) or with duration of NESLiP. Univariate analysis demonstrated younger (area under the receiver operating characteristic, 0.68; P = 0.008; 95% confidence interval [CI], 0.55-0.82) and heavier (area under the receiver operating characteristic, 0.80; P  < 0.001; 95% CI, 0.69-0.91) livers to be at risk of cradle compression. Only liver weight was associated with cradle compression on multivariate analysis (odds ratio, 1.003; P  = 0.005; 95% CI, 1.001-1.005). There was no difference in 1-y graft survival (16/17 [94.1%] versus 44/48 [91.6%]; odds ratio, 0.69; P  = 0.75; 95% CI, 0.07-6.62). Conclusions: This is the first study assessing the impact of cradle compression on outcome. We have identified increased donor liver weight and younger age as risk factors for the development of this phenomenon. Increasing utilization of NESLiP will result in the increased incidence of cradle compression but the apparent absence of long-term sequelae is reassuring. Routine postoperative axial imaging may be warranted. Competing Interests: J.L.M. and L.S. have received consultancy fees from OrganOx. C.J.E.W. has received speaker fees from OrganOx. A.J.B. is coholder of a patent on the circuit used in the OrganOx metra. The other authors declare no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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