US Liver Transplant Outcomes After Normothermic Regional Perfusion vs Standard Super Rapid Recovery.

Autor:	Brubaker AL; Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California.; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development., Sellers MT; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Tennessee Donor Services, Nashville., Abt PL; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia., Croome KP; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Department of Transplant, Mayo Clinic Florida, Jacksonville., Merani S; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Department of Surgery, University of Nebraska Medical Center, Omaha., Wall A; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas., Abreu P; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida., Alebrahim M; Department of Surgery, The Ohio State University, Columbus., Baskin R; Methodist Transplant Specialists, Dallas, Texas., Bohorquez H; Department of Surgery, Ochsner School of Medicine, New Orleans, Louisiana., Cannon RM; Department of Surgery, University of Alabama at Birmingham, Birmingham., Cederquist K; Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia., Edwards J; Gift of Life Donor Program, Philadelphia, Pennsylvania., Huerter BG; Department of Surgery, University of Nebraska Medical Center, Omaha., Hobeika MJ; J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas., Kautzman L; Methodist Transplant Specialists, Dallas, Texas., Langnas AN; Department of Surgery, University of Nebraska Medical Center, Omaha., Lee DD; Department of Surgery, Loyola University, Chicago, Illinois.; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Manzi J; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida., Nassar A; Department of Surgery, Emory University, Atlanta, Georgia.; Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan., Neidlinger N; Department of Surgery, University of Wisconsin, Madison., Nydam TL; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Department of Surgery, Division of Transplant Surgery, University of Colorado, Aurora., Schnickel GT; Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California., Siddiqui F; Department of Surgery, The Ohio State University, Columbus.; Department of Surgery, Emory University, Atlanta, Georgia., Suah A; Department of Surgery, Emory University, Atlanta, Georgia.; Department of Surgery, University of Chicago, Chicago, Illinois., Taj R; Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of California San Diego, La Jolla, California.; Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia., Taner CB; Department of Transplant, Mayo Clinic Florida, Jacksonville., Testa G; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas., Vianna R; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, Florida., Vyas F; Department of Surgery, Transplant Division, University of Pennsylvania, Philadelphia., Montenovo MI; CONCORD: Consortium for Donation after Circulatory Death and Normothermic Regional Perfusion Outcomes Research and Development.; Department of Surgery, Vanderbilt University, Nashville, Tennessee.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Jun 01; Vol. 159 (6), pp. 677-685.
DOI:	10.1001/jamasurg.2024.0520
Abstrakt:	Importance: Normothermic regional perfusion (NRP) is an emerging recovery modality for transplantable allografts from controlled donation after circulatory death (cDCD) donors. In the US, only 11.4% of liver recipients who are transplanted from a deceased donor receive a cDCD liver. NRP has the potential to safely expand the US donor pool with improved transplant outcomes as compared with standard super rapid recovery (SRR). Objective: To assess outcomes of US liver transplants using controlled donation after circulatory death livers recovered with normothermic regional perfusion vs standard super rapid recovery. Design, Setting, and Participants: This was a retrospective, observational cohort study comparing liver transplant outcomes from cDCD donors recovered by NRP vs SRR. Outcomes of cDCD liver transplant from January 2017 to May 2023 were collated from 17 US transplant centers and included livers recovered by SRR and NRP (thoracoabdominal NRP [TA-NRP] and abdominal NRP [A-NRP]). Seven transplant centers used NRP, allowing for liver allografts to be transplanted at 17 centers; 10 centers imported livers recovered via NRP from other centers. Exposures: cDCD livers were recovered by either NRP or SRR. Main Outcomes and Measures: The primary outcome was ischemic cholangiopathy (IC). Secondary end points included primary nonfunction (PNF), early allograft dysfunction (EAD), biliary anastomotic strictures, posttransplant length of stay (LOS), and patient and graft survival. Results: A total of 242 cDCD livers were included in this study: 136 recovered by SRR and 106 recovered by NRP (TA-NRP, 79 and A-NRP, 27). Median (IQR) NRP and SRR donor age was 30.5 (22-44) years and 36 (27-49) years, respectively. Median (IQR) posttransplant LOS was significantly shorter in the NRP cohort (7 [5-11] days vs 10 [7-16] days; P < .001). PNF occurred only in the SRR allografts group (n = 2). EAD was more common in the SRR cohort (123 of 136 [56.1%] vs 77 of 106 [36.4%]; P = .007). Biliary anastomotic strictures were increased 2.8-fold in SRR recipients (7 of 105 [6.7%] vs 30 of 134 [22.4%]; P = .001). Only SRR recipients had IC (0 vs 12 of 133 [9.0%]; P = .002); IC-free survival by Kaplan-Meier was significantly improved in NRP recipients. Patient and graft survival were comparable between cohorts. Conclusion and Relevance: There was comparable patient and graft survival in liver transplant recipients of cDCD donors recovered by NRP vs SRR, with reduced rates of IC, biliary complications, and EAD in NRP recipients. The feasibility of A-NRP and TA-NRP implementation across multiple US transplant centers supports increasing adoption of NRP to improve organ use, access to transplant, and risk of wait-list mortality.
Databáze:	MEDLINE
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