Aortic Versus Dual Perfusion for Retrieval of the Liver After Brain Death: A National Registry Analysis

Abstract

There is lack of consensus in the literature regarding the comparative efficacy of in situ aortic-only compared with dual (aortic and portal venous) perfusion for retrieval and transplantation of the liver. Recipient outcomes from the Australia/New Zealand Liver Transplant Registry (2007-2016), including patient and graft survival and causes of graft loss, were stratified by perfusion route. Subgroup analyses were conducted for higher-risk donors. A total of 1382 liver transplantation recipients were analyzed (957 aortic-only; 425 dual perfusion). There were no significant differences in 5-year graft and patient survivals between the aortic-only and dual cohorts (80.1% versus 84.6% and 82.6% versus 87.8%, respectively) or in the odds ratios of primary nonfunction, thrombotic graft loss, or graft loss secondary to biliary complications or acute rejection. When analyzing only higher-risk donors (n = 369), multivariate graft survival was significantly less in the aortic-only cohort (hazard ratio, 0.49; 95% confidence interval, 0.26-0.92). Overall, there was a trend toward improved outcomes when dual perfusion was used, which became significant when considering higher-risk donors alone. Inferences into the ideal perfusion technique in multiorgan procurement will require further investigation by way of a randomized controlled trial, and outcomes after the transplantation of other organs will also need to be considered.

Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society

“…Overall, there was a trend toward improved outcomes when dual-vessel preservation was used, which became significant when extended criteria donors were considered. 7…”

Donor hepatectomy time influences ischemia-reperfusion injury of the biliary tree in donation after circulatory death liver transplantation

“…17 In a recent published study, Hameed et al concluded that in high-risk DBD donors, dual perfusion is superior. 27 Furthermore, Ghinolfi et al concluded recently that dual perfusion has a protective effect on the development of ischemic type biliary lesions after LT with grafts from octogenarian donors. 28 However, a randomized controlled trial comparing aortic flush only and combined aortic and portal flush in DBD-LT, showed no difference in the incidence of post-transplant cholangiopathy.…”