Are there any benefits of prolonged hypothermic oxygenated perfusion?: Results from a national retrospective study.

Autor:	De Carlis R; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Ph.D. Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy., Lauterio A; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Schlegel A; Transplantation Center at Digestive Disease and Surgery Institute and Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA., Gringeri E; General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy., Patrono D; General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino University of Turin, Turin, Italy., Camagni S; Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy., Dondossola D; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Pezzati D; Division of Hepatic Surgery and Liver Transplantation, University of Pisa Hospital, Pisa, Italy., Olivieri T; Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy., Pagano D; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, University of Pittsburgh Medical Center, Palermo, Italy., Bongini M; Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy., Montanelli P; Liver Transplantation Unit, San Martino Polyclinic Hospital, Genoa, Italy., Ravaioli M; General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy., Bernasconi D; Bicocca Bioinformatics Biostatistics and Bioimaging Centre, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.; Department of Clinical Research and Innovation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Valsecchi MG; Bicocca Bioinformatics Biostatistics and Bioimaging Centre, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy., Baccarani U; General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy., Cescon M; General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy., Andorno E; Liver Transplantation Unit, San Martino Polyclinic Hospital, Genoa, Italy., Mazzaferro V; Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.; Department of Oncology, University of Milan, Milan, Italy., Gruttadauria S; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, University of Pittsburgh Medical Center, Palermo, Italy.; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy., Di Benedetto F; Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy., Ghinolfi D; Division of Hepatic Surgery and Liver Transplantation, University of Pisa Hospital, Pisa, Italy., Caccamo L; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Pinelli D; Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy., Romagnoli R; General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino University of Turin, Turin, Italy., Cillo U; General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy., De Carlis L; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2025 Jan 01; Vol. 31 (1), pp. 70-84. Date of Electronic Publication: 2024 Sep 18.
DOI:	10.1097/LVT.0000000000000476
Abstrakt:	Dual hypothermic oxygenated perfusion (DHOPE) is increasingly being used to extend liver preservation to improve transplant logistics. However, little is known about its benefits in high-risk liver grafts. This study aimed to investigate whether prolonged DHOPE provides benefits other than improved logistics in all liver types. We performed a national retrospective cohort study of 177 liver transplants from 12 Italian centers preserved with DHOPE for ≥4 hours between 2015 and 2022. A control group of 177 DHOPEs of <4 hours during the same period was created using 1:1 propensity score matching. The impact of risk profiles and preservation times on the outcomes was assessed using univariable and multivariable regression models. No significant differences in posttransplant outcomes were found between prolonged and short DHOPEs. However, the prolonged group had a significantly lower incidence of posttransplant acute kidney injury (AKI) compared to the short group (30.5% vs. 44.6%, p = 0.008). Among prolonged DHOPEs, no differences in transplant outcomes were observed according to donor risk index, Eurotransplant definition for marginal grafts, and balance of risk score. DHOPE duration was associated with a lower risk of AKI in multivariable models adjusted for donor risk index, Eutrotransplant marginal grafts, and balance of risk score. Prolonged hypothermic oxygenated perfusion confirmed its protective effect against AKI in a multivariable model adjusted for donor and recipient risk factors [OR: 0.412, 95% CI: 0.200-0.850, p = 0.016]. Prolonged DHOPE is widely used to improve transplant logistics, provides good results with high-risk grafts, and appears to be associated with a lower risk of posttransplant AKI. These results provide further insight into the important role of DHOPE in preventing posttransplant complications. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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