Dual aortic and portal perfusion at procurement prevents ischaemic-type biliary lesions in liver transplantation when using octogenarian donors: a retrospective cohort study

Abstract

Several risk factors for ischaemic-type biliary lesions (ITBL) after liver transplantation (LT) have been identified, but the role of portal vein perfusion at graft procurement is still unclear. This was a prospective study on double aortic and portal perfusion (DP) of liver grafts stratified by donor's decade (<60 yo; 60-69 yo; 70-79 yo and ≥80 yo) versus similar historical cohorts of primary, adult grafts procured with single aortic perfusion (SP) only. The primary study aim was to assess the role of DP on the incidence of ITBL. There was no difference in the incidence of overall biliary complications according to procurement technique for recipients of grafts <80 years. A higher incidence of ITBL was observed for patients receiving grafts ≥80 years and perfused through the aorta only (1.9 vs. 13.4%; P = 0.008). When analysing octogenarian grafts, donor male gender (HR = 6.4; P = 0.001), haemodynamic instability (HR = 4.9; P = 0.008), and type-2 diabetes mellitus (DM2) (HR = 3.0; P = 0.03) were all independent risk factors for ITBL, while double perfusion at procurement (HR = 0.1; P = 0.04) and longer donor intensive care unit (ICU) stay (HR = 0.7; P = 0.04) were protective factors. Dual aortic and portal perfusion has the potential to reduce post-transplant ITBL incidence for recipients of octogenarian donor grafts. Larger series are needed to confirm this preliminary experience.

Pilot, Open, Randomized, Prospective Trial for Normothermic Machine Perfusion Evaluation in Liver Transplantation From Older Donors

“…Others postulated that ischemic cholangiopathy (IC) might be predicted by a bile pH <7.4. In agreement with Watson et al, we believe that bile production and pH is a complex process dependent on the integrity of many facets of liver function, but several other parameters may play a fundamental role in the development of IC such as the type of donor (DCD versus DBD), the warm ischemia time, or the procurement technique (single versus dual perfusion) …”

Advanced donor age does not increase risk of hepatocellular carcinoma recurrence after liver transplantation: a retrospective two‐centre analysis using competing risk analysis

“…As a consequence, HCC candidate seemed to be the most suitable candidate for elderly grafts since they usually present compensated liver disease. These policies are also supported by the contribution of machine perfusion, which reduces the risk of primary nonfunction of ECD grafts by improving the quality of conservation and reducing the consequences brought on by ischaemia-reperfusion [26]. However, the present study has some limitations.…”

Early Allograft Dysfunction Increases Hospital Associated Costs After Liver Transplantation—A Propensity Score–Matched Analysis

“…(33) Other technologies such as ex vivo machine perfusion appear, at this time, to be more feasible and readily applicable as a potential evaluation and reconditioning tool. (34,35) Studies for renal transplantation have shown hypothermic perfusion to be superior to static cold storage in outcome and costs. (36,37) We are not of aware of any such comparisons for liver transplantation at time of writing.…”