Favorable Outcomes of Liver Transplantation from Controlled Circulatory Death Donors Using Normothermic Regional Perfusion Compared to Brain Death Donors

Abstract

Background. Liver transplantation (LT) from controlled donation after circulatory death (cDCD) was initiated in France in 2015 under a protocol based on the use of normothermic regional perfusion (NRP) before organ procurement. The aim was to compare outcomes following cDCD LT with NRP and donation after brain death (DBD) LT. Methods. This is a multicenter retrospective study comparing cDCD LT with NRP and DBD LT. A case-matched study (1:2) was performed using the variables such as recipient and donor age, indication of LT. Results. A total of 50 patients from the cDCD group were matched to 100 patients from the DBD group. From postoperative days 1–4, serum transaminase release was significantly lower in the cDCD group compared to the DBD group (P < 0.05). Early allograft dysfunction (cDCD: 18% versus DBD: 32%; P = 0.11), acute kidney injury (26% versus 33%; P = 0.49), 90-d graft loss (2% versus 5%; P = 0.66), and arterial (4% versus 12%; P = 0.19) and biliary (16% versus 17%; P = 0.94) complications were similar between the 2 groups. The 2-y graft survival was 88% for cDCD group and 85% for DBD group (P = 0.91). The 2-y patient survival was 90% for cDCD group and 88% for DBD group (P = 0.68). Conclusions. This study provides evidence that cDCD LT following postmortem NRP can be safely and effectively performed in selected recipients with similar graft and patient survival outcomes, without increased rates of biliary complications and early graft dysfunction compared to DBD LT.

Impact of the duration of normothermic regional perfusion on the results of liver transplant from controlled circulatory death donors: A retrospective, multicentric study

“…The French experience of NRP-cDCD donors has been recently reported 16,17 and has showed similar results to those with brain-dead donors, especially in terms of graft function and cholangiopathy. In accordance with recent studies, [18][19][20] the choice of routine systematic in situ NRP instead of rapid retrieval remains an on-going question.…”

Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation’s Transplant Learning Journey

“…Current evidence shows, with high certainty, that NRP in cDCD decreases risk of ischaemic cholangiopathy (Table S2) [2]. The risk of anastomotic biliary strictures and early allograft dysfunction is also reduced, with similar graft and patient outcomes, though quality of evidence is low (Table S2) [2, 8]. Spanish national data suggest NRP improves short‐term outcomes of cDCD kidneys compared with ISP (Table S2) [2, 9].…”

“…In the absence of randomized controlled trials, quality of published evidence is limited and risk of publication bias is high [2]. Nevertheless, evidence suggests loss of equipoise for the liver, with data suggesting reduced biliary complications and early allograft dysfunction with NRP and no evidence of detrimental effects for other abdominal organs [2, 8]. Together with challenges related to donor interventional research, this likley explains observed reticence to performing expensive and challenging randomized controlled trials comparing ISP and NRP in cDCD [25, 26].…”

Methods of Attenuating Ischemia-Reperfusion Injury in Liver Transplantation for Hepatocellular Carcinoma

“…Another strategy offered by machine perfusion is its use in donors after their death is determined and before the organ procurement (regional NMP). A study from France compared regional NMP in DCD donors with transplantations from DBD donors [ 47 ]. It was a retrospective matched-control study that included 150 patients.…”