Sequential Normothermic Regional Perfusion and End-ischemic Ex Situ Machine Perfusion Allow the Safe Use of Very Old DCD Donors in Liver Transplantation

医学 机器灌注 灌注 移植 缺血 肝移植 热缺血 外科 麻醉 内科学 再灌注损伤
作者
Francesco Torri,E Balzano,Fabio Melandro,Paolo Maremmani,Pietro Bertini,Paolo Lo Pane,Matilde Masini,Maria Isabella Rotondo,Serena Babboni,Serena Del Turco,Stefano Antonelli,Vincenzo De Tata,Gíanni Biancofiore,Fabio Guarracino,Aldo Paolicchi,Paolo De Simone,Giuseppina Basta,Davide Ghinolfi
出处
期刊:Transplantation [Ovid Technologies (Wolters Kluwer)]
被引量:1
标识
DOI:10.1097/tp.0000000000004963
摘要

Background. In Italy, 20 min of continuous, flat-line electrocardiogram are required for death declaration. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled donation after circulatory death (cDCD) liver transplantation by combining normothermic regional and end-ischemic machine perfusion (MP). The aim of this study was to evaluate the safety and feasibility of the use of septuagenarian and octogenarian cDCD donors with this approach. Methods. All cDCD older than 70 y were evaluated during normothermic regional perfusion and then randomly assigned to dual hypothermic or normothermic MP. Results. In the period from April 2021 to December 2022, 17 cDCD older than 70 y were considered. In 6 cases (35%), the graft was not considered suitable for liver transplantation, whereas 11 (65%) were evaluated and eventually transplanted. The median donor age was 82 y, being 8 (73%) older than 80. Median functional warm ischemia and no-flow time were 36 and 28 min, respectively. Grafts were randomly assigned to ex situ dual hypothermic oxygenated MP in 6 cases (55%) and normothermic MP in 5 (45%). None was discarded during MP. There were no cases of primary nonfunction, 1 case of postreperfusion syndrome (9%) and 2 cases (18%) of early allograft dysfunction. At a median follow-up of 8 mo, no vascular complications or ischemic cholangiopathy were reported. No major differences were found in terms of postoperative hospitalization or complications based on the type of MP. Conclusions. The implementation of sequential normothermic regional and end-ischemic MP allows the safe use of very old donation after circulatory death donors.

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