In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival

Autor: Andrew J. Butler, Simon Messer, Sara Upponi, Elisa Allen, Ian Currie, John D. Terrace, Gabriel C. Oniscu, Stephen J. Wigmore, Andrew P. R. Sutherland, Christopher J.E. Watson, Sorina Cornateanu, Rhiannon Taylor, Keziah Crick, Stephen R. Large, Fiona Hunt, Lucy V. Randle, Corrina Fear
Přispěvatelé: Watson, Christopher JE [0000-0002-0590-4901], Large, Stephen [0000-0002-3201-6344], Oniscu, Gabriel C [0000-0003-1714-920X], Apollo - University of Cambridge Repository
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Extracorporeal Circulation
Tissue and Organ Procurement
Adolescent
Delayed Graft Function
Bile Duct Diseases
030230 surgery
Anastomosis
Graft loss
clinical research/practice
Gastroenterology
surgical technique
03 medical and health sciences
Young Adult
0302 clinical medicine
Ischemia
Internal medicine
extracorporeal membrane oxygenation (ECMO)
medicine
Retrospective analysis
Immunology and Allergy
Humans
Pharmacology (medical)
Child
Aged
Retrospective Studies
Transplantation
business.industry
Extracorporeal circulation
Graft Survival
Temperature
Organ Preservation
donors and donation: donation after circulatory death (DCD)
Middle Aged
Circulatory death
Liver Transplantation
Death
Perfusion
Normothermic perfusion
Tissue and Organ Harvesting
Graft survival
Blood supply
Female
Bile Ducts
business
liver transplantation/hepatology
Zdroj: Watson, C J E, Hunt, F, Messer, S, Currie, I, Large, S, Sutherland, A, Crick, K, Wigmore, S J, Fear, C, Cornateanu, S, Randle, L V, Terrace, J D, Upponi, S, Taylor, R, Allen, E, Butler, A J & Oniscu, G C 2019, ' In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival ', American Journal of Transplantation . https://doi.org/10.1111/ajt.15241
ISSN: 1600-6143
DOI: 10.1111/ajt.15241
Popis: Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of nonfunction, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from whom 43 livers were transplanted. These were compared with 187 non-NRP DCD donor livers transplanted at the same two UK centers in the same period. The use of NRP was associated with a reduction in early allograft dysfunction (12% for NRP vs. 32% for non-NRP livers, P = .0076), 30-day graft loss (2% NRP livers vs. 12% non-NRP livers, P = .0559), freedom from ischemic cholangiopathy (0% vs. 27% for non-NRP livers, P < .0001), and fewer anastomotic strictures (7% vs. 27% non-NRP, P = .0041). After adjusting for other factors in a multivariable analysis, NRP remained significantly associated with freedom from ischemic cholangiopathy (P < .0001). These data suggest that NRP during organ recovery from DCD donors leads to superior liver outcomes compared to conventional organ recovery.
Databáze: OpenAIRE
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