In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death

被引：23

作者：

Mohkam, Kayvan ^{[1
]}

Nasralla, David ^{[2
]}

Mergental, Hynek ^{[3
]}

Muller, Xavier ^{[1
]}

Butler, Andrew ^{[4
]}

Jassem, Wayel ^{[5
]}

Imber, Charles ^{[2
]}

Monbaliu, Diethard ^{[6
]}

Perera, M. Thamara P. R. ^{[3
]}

Laing, Richard W. ^{[3
]}

Garcia-Valdecasas, Juan Carlos ^{[7
]}

Paul, Andreas ^{[8
]}

Dondero, Federica ^{[9
]}

Cauchy, Francois ^{[9
]}

Savier, Eric ^{[10
]}

Scatton, Olivier ^{[10
]}

Robin, Fabien ^{[11
]}

Sulpice, Laurent ^{[11
]}

Bucur, Petru ^{[12
]}

Salame, Ephrem ^{[12
]}

Pittau, Gabriella ^{[13
]}

Allard, Marc-Antoine ^{[13
]}

Pradat, Pierre ^{[14
]}

Rossignol, Guillaume ^{[1
]}

Mabrut, Jean-Yves ^{[1
]}

Ploeg, Rutger J. ^{[15
]}

Friend, Peter J. ^{[15
]}

Mirza, Darius F. ^{[3
]}

Lesurtel, Mickael ^{[1
]}

机构：

[1] Claude Bernard Lyon 1 Univ, Croix Rousse Hosp, Hosp Civils Lyon, Dept Digest Surg & Liver Transplantat, 103 grande Rue Croix Rousse, F-69317 Lyon 4, France

[2] Univ Hosp Birmingham, Queen Elizabeth Hosp, Liver Unit, Bisrmingham, England

[3] Royal Free Hosp, Dept Hepatopancreatobiliary & Liver Transplant Su, London, England

[4] Univ Cambridge, Addenbrookes Hosp, Dept Surg, Cambridge, England

[5] Kings Coll Hosp London, Inst Liver Studies, London, England

[6] Univ Hosp Leuven, Dept Surg, Abdominal Transplant Surg Unit, Leuven, Belgium

[7] Hosp Clin Barcelona, Dept Hepatobiliopancreat & Transplant Surg, Barcelona, Spain

[8] Univ Hosp Essen, Dept Gen Visceral & Transplantat Surg, Essen, Germany

[9] Univ Paris Cite, Beaujon Hosp, Assitance Publ Hop Paris AP HP, Dept Hepatobiliopancreat Surg,Dept Hepatopancreat, Clichy, France

[10] Sorbonne Univ, Pitie Salpetriere Hosp, Dept Hepatobiliary Surg & Liver Transplantat, Paris, France

[11] Pontchaillou Univ Hosp, Dept Hepatobiliary & Digest Surg, Rennes, France

[12] Trousseau Hosp, Hepato Biliary Pancreat & Liver Transplant Surg, Dept Digest Oncol Endocrine, Tours, France

[13] Univ Paris Sud, Hop Paul Brousse, Assistance Publ Hop Paris AP HP, Ctr Hepato Biliaire, Villejuif, France

[14] Claude Bernard Lyon 1 Univ, Hosp Civils Lyon, Clin Res Ctr, Lyon, France

[15] Univ Oxford, Nuffield Dept Surg Sci, Oxford, England

来源：

LIVER TRANSPLANTATION | 2022年 / 28卷 / 11期

关键词：

EARLY ALLOGRAFT DYSFUNCTION; BILIARY COMPLICATIONS; RISK SCORE; DONORS; RECIPIENTS; OUTCOMES; GRAFTS; LIFE;

D O I：

10.1002/lt.26522

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) aim to improve the outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly. In this international observational study, outcomes of LT performed between 2015 and 2019 for organs procured from cDCD donors subjected to NRP or NMP commenced at the donor center were compared using propensity score matching (PSM). Of the 224 cDCD donations in the NRP cohort that proceeded to asystole, 193 livers were procured, resulting in 157 transplants. In the NMP cohort, perfusion was commenced in all 40 cases and resulted in 34 transplants (use rates: 70% vs. 85% [p = 0.052], respectively). After PSM, 34 NMP liver recipients were matched with 68 NRP liver recipients. The two cohorts were similar for donor functional warm ischemia time (21 min after NRP vs. 20 min after NMP; p = 0.17), UK-Donation After Circulatory Death risk score (5 vs. 5 points; p = 0.38), and laboratory Model for End-Stage Liver Disease scores (12 vs. 12 points; p = 0.83). The incidence of nonanastomotic biliary strictures (1.5% vs. 2.9%; p > 0.99), early allograft dysfunction (20.6% vs. 8.8%; p = 0.13), and 30-day graft loss (4.4% vs. 8.8%; p = 0.40) were similar, although peak posttransplant aspartate aminotransferase levels were higher in the NRP cohort (872 vs. 344 IU/L; p < 0.001). NRP livers were more frequently allocated to recipients suffering from hepatocellular carcinoma (HCC; 60.3% vs. 20.6%; p < 0.001). HCC-censored 2-year graft and patient survival rates were 91.5% versus 88.2% (p = 0.52) and 97.9% versus 94.1% (p = 0.25) after NRP and NMP, respectively. Both perfusion techniques achieved similar outcomes and appeared to match benchmarks expected for donation after brain death livers. This study may inform the design of a definitive trial.

引用

页码：1716 / 1725

页数：10

共 25 条

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