Background. One method for increasing the donor pool for orthotopic liver transplantations (OLTs) is to use uncontrolled donation after circulation death (uDCDs). Methods. From January 2006 to December 2016, we performed 75 OLTs using uDCD livers. The control group comprised a sample of 265 OLTs using livers of donations after brain death (DBDs). A comparative study was performed. Results. Of 256 potential uDCD donors cannulated, 75 (29.3%) livers were accepted for OLT. The amount of hemoderivatives transfused was significantly higher in the uDCD group. The rate of primary nonfunction was also significantly higher (P = 0.031) in uDCD recipients (8%) than DBD recipients (1.5%). The overall rate of biliary complications was significantly higher (P = 0.001) in uDCD recipients (23 cases, 30.6%) than DBD recipients (28 cases, 10.6%). In the uDCD group, 1-, 3-, and 5-year patient survival rates were 82.7%, 73%, and 71.5%, respectively; in the DBD group, they were 89%, 83.7%, and 78.8%, respectively (P = 0.180). In the uDCD group, 1-, 3-, and 5-year graft survival rates were 73.3%, 65.1%, and 63.6%, respectively; in the DBD group, they were 87.1%, 81.9%, and 76.5%, respectively (P = 0.013). Multivariate analysis showed that independent risk factors for patient and graft survival were intraoperative transfusion of >6 units of packed red blood cell concentrates and recipients who were older than 60 years. Conclusions. Although graft survival is significantly lower using uDCD livers, 5-year patient survival in recipients of DBD and uDCD livers is similar. After careful selection, the livers of uDCD can be selectively used for OLT.

Background Retransplantation candidates are disadvantaged owing to lack of good-quality liver grafts. Strategies that can facilitate transplantation of suboptimal grafts into retransplant candidates require investigation. The aim was to determine whether late liver retransplantation can be performed safely with suboptimal grafts, following normothermic machine perfusion. Methods A prospectively enrolled group of patients who required liver retransplantation received a suboptimal graft preserved via normothermic machine perfusion. This group was compared with both historical and contemporaneous cohorts of patient who received grafts preserved by cold storage. The primary outcome was 6-month graft and patient survival. Results The normothermic machine perfusion group comprised 26 patients. The historical (cold storage 1) and contemporaneous (cold storage 2) groups comprised 31 and 25 patients respectively. The 6-month graft survival rate did not differ between groups (cold storage 1, 27 of 31, cold storage 2, 22 of 25; normothermic machine perfusion, 22 of 26; P = 0.934). This was despite the normothermic machine perfusion group having significantly more steatotic grafts (8 of 31, 7 of 25, and 14 of 26 respectively; P = 0.006) and grafts previously declined by at least one other transplant centre (5 of 31, 9 of 25, and 21 of 26; P < 0.001). Conclusion In liver retransplantation, normothermic machine perfusion can safely expand graft options without compromising short-term outcomes.

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Background Graft primary non‐function (PNF) is the most severe complication after orthotopic liver transplantation (OLT) and is frequently associated with livers from uncontrolled circulatory death (uDCD). Methods We reviewed retrospectively the incidence, risk factors, and outcome of patients showing PNF after receiving uDCD liver grafts. The series comprises 75 OLT performed during 11 years. Results The incidence of PNF using uDCD livers was 8%. We compared patients who developed PNF (n = 6) vs. patients without PNF (n = 69). Mean pump flow of donors during normothermic regional perfusion (NRP) was significantly lower in PNF (p = .032). Day 1 post‐OLT levels of transaminases and the incidence of renal complications and postoperative mortality were also significantly higher in the PNF group, but 5‐year patient survival was similar in both groups (66.7% in PNF and 68.5% in non‐PNF). All PNF patients underwent re‐OLT, and 2 died. PNF incidence has decreased in the last 5‐years. Binary logistic regression analysis confirmed final ALT value >4 times the normal value as risk factor for PNF, and median donor pump flow >3700 ml/min as protective effect. Conclusions Adequate donor pump flow during NRP was a protective.

Pre-SPKT modality of dialysis does not significantly influence overall or intra-abdominal infection and patient, pancreas, or kidney graft survivals.

The Ann Fox Foundation, under the umbrella of Queen Elizabeth Hospital Charities, provided financial support for normothermic machine perfusion consumables.

The utilization of livers from donation after uncontrolled circulatory death (uDCD) increases the availability of liver grafts, but it is associated with a higher incidence of biliary complications (BCs) and lower graft survival than those organs donated after brain death. From January 2006 to December 2016, we performed 75 orthotopic liver transplantations (OLTs) using uDCD livers. To investigate the relationship of BCs with the use of uDCD OLT, we compared patients who developed BCs (23 patients) with those who did not (non‐BC group, 43 patients) after excluding cases of hepatic artery thrombosis (a known cause of BC) and primary nonfunction. The groups had similar uDCD donor maintenance, donor and recipient characteristics, and perioperative morbidity/mortality rates, but we observed a higher rate of hepatocellular carcinoma and hepatitis C virus in the non‐BC group. Percutaneous transhepatic biliary dilation, endoscopic retrograde cholangiopancreatography dilation, Roux‐en‐Y hepaticojejunostomy (HJ), a T‐tube, and retransplantation were used for BC management. In the BC group, 1‐, 3‐, and 5‐year patient survival rates were 91.3%, 69.6%, and 65.2%, respectively, versus 77.8%, 72.9%, and 72.9%, respectively, in the non‐BC group (P = 0.89). However, 1‐, 3‐, and 5‐year graft survival rates were 78.3%, 60.9%, and 56.5%, respectively, in the BC group versus 77.8%, 72.9%, and 72.9%, respectively, in the non‐BC group (P = 0.38). Multivariate analysis did not indicate independent risk factors for BC development. In conclusion, patient and graft survival rates were generally lower in patients who developed BCs but not significantly so. These complications were managed in the majority of patients through radiological dilation, endoscopic dilation, or Roux‐en‐Y HJ. Retransplantation is necessary in rare cases after the failure of biliary dilation or surgical procedures.

Background: We identify the features of multiple primary colorectal cancer (MPCC), synchronous colorectal cancer (SCRC) and metachronous colorectal cancer (MCRC), and distinguish between the cases that require a more extensive surgery and those where the parameters of SCRC might be important to prevent the development of MCRC. Methods: We gathered up consecutive individuals with MPCC, 50 for each category, and 100 consecutive individuals diagnosed with ‘single' colorectal cancer. Clinical and familiar information was obtained. We classified both SCRC and MCRC according to locations. Results: MPCC were associated with polyps, both in earlier stages and as sporadic forms. SCRC located in the right colon were most frequently of the mucinous type. MCRC developed SCRC in 24%, along the entire colon, with familiar cancer antecedents. SCRC patients undergoing a total colectomy were younger, with the cancer spread throughout the entire colon and a larger number of polyps, whereas MCRC were predominantly adenomatous polyps. We found 2 risk factors for SCRC that led to the development of MCRC: rectal location and higher number of polyps. Conclusions: SCRC possibly involves more than an environmental component. MCRC appears to be the producer of polyps that evolve into cancer at different times, emphasising the idea of a genetic predisposition. Studies are required to find biomarkers that define patients with higher risk of developing MCRC within SCRC.