Transient Cold Storage Prior to Normothermic Liver Perfusion May Facilitate Adoption of a Novel Technology

Autor: Keziah Crick, A. M. James Shapiro, Andrew J. Butler, Annemarie Weissenbacher, Joerg M. Pollok, Simon R. Knight, Carlo D L Ceresa, Hynek Mergental, Alberto Quaglia, D Nasralla, Christopher J.E. Watson, Wayel Jassem, Leanne Hodson, Charles Imber, Constantin C. Coussios, Peter J. Friend, Rutger J. Ploeg
Rok vydání: 2018
Předmět:
Male
Liver perfusion
Time Factors
medicine.medical_treatment
030230 surgery
Liver transplantation
Severity of Illness Index
0302 clinical medicine
Postoperative Complications
Clinical endpoint
Prospective Studies
Warm Ischemia
Prospective cohort study
Graft Survival
Organ Preservation
Middle Aged
Allografts
Cold Temperature
Perfusion
Intensive Care Units
Liver
Anesthesia
Cardiology
030211 gastroenterology & hepatology
Female
Adult
medicine.medical_specialty
Adolescent
Cold storage
Anastomosis
End Stage Liver Disease
03 medical and health sciences
Young Adult
Text mining
Internal medicine
Severity of illness
medicine
Humans
Transient (computer programming)
Adverse effect
Aged
Cryopreservation
Transplantation
Machine perfusion
Hepatology
business.industry
Length of Stay
Liver Transplantation
Feasibility Studies
Surgery
business
Follow-Up Studies
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation SocietyReferences. 25(10)
ISSN: 1527-6473
Popis: Clinical adoption of normothermic machine perfusion (NMP) may be facilitated by simplifying logistics and reducing costs. This can be achieved by cold storage of livers for transportation to recipient centers before commencing NMP. The purpose of this study was to assess the safety and feasibility of post–static cold storage normothermic machine perfusion (pSCS‐NMP) in liver transplantation. In this multicenter prospective study, 31 livers were transplanted. The primary endpoint was 30‐day graft survival. Secondary endpoints included the following: peak posttransplant aspartate aminotransferase (AST), early allograft dysfunction (EAD), postreperfusion syndrome (PRS), adverse events, critical care and hospital stay, biliary complications, and 12‐month graft survival. The 30‐day graft survival rate was 94%. Livers were preserved for a total of 14 hours 10 minutes ± 4 hours 46 minutes, which included 6 hours 1 minute ± 1 hour 19 minutes of static cold storage before 8 hours 24 minutes ± 4 hours 4 minutes of NMP. Median peak serum AST in the first 7 days postoperatively was 457 U/L (92‐8669 U/L), and 4 (13%) patients developed EAD. PRS was observed in 3 (10%) livers. The median duration of initial critical care stay was 3 days (1‐20 days), and median hospital stay was 13 days (7‐31 days). There were 7 (23%) patients who developed complications of grade 3b severity or above, and 2 (6%) patients developed biliary complications: 1 bile leak and 1 anastomotic stricture with no cases of ischemic cholangiopathy. The 12‐month overall graft survival rate (including death with a functioning graft) was 84%. In conclusion, this study demonstrates that pSCS‐NMP was feasible and safe, which may facilitate clinical adoption.
Databáze: OpenAIRE
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