Liver Transplant After Normothermic Regional Perfusion From Controlled Donors After Circulatory Death: The Norwegian Experience

Abstract

Background: In order to meet the increasing demand for donor organs the concept of donation after circulatory death (DCD) was reintroduced in Norway. First a pilot study, followed by the use of DCD as an institutional practice. We here report the current Norwegian experience with liver transplantation following DCD. Methods: After acceptance from next of kin, life support was withdrawn and cardiac arrest observed. After a five minute "no-touch" period, extracorporeal membrane oxygenation for post mortem normothermic perfusion (NRP) by ECMO circuit was established. Data from all liver transplant recipients receiving cDCD livers in Oslo were analyzed. Results: From 2015 to 2017, 8 patients underwent liver transplantation with cDCD and NRP livergrafts in Norway. Median MELD was 26, (range 6-40). There were no cases of delayed graft function or graft loss. Seven patients have reached 1 year of follow-up, 1 patient has reached 6 months. Two patients have recurrence of primary disease (PSC and steatohepatitis). All patients had normalized liver function at last follow-up. Two patients underwent procedures for the biliary complications: One with leakage from the cystic duct which was successfully handled endoscopically by stenting. In the other patient, a suspected stricture on MRI led to an ERCP procedure which did not confirm signs of biliary stenosis. There was one instance of hepatic artery stenosis, which was managed with endovascular technique. Conclusion:

Machine Perfusions in Liver Transplantation: The Evidence‐Based Position Paper of the Italian Society of Organ and Tissue Transplantation

“…No RCT comparing normothermic regional perfusion (NRP) with ultrarapid retrieval in DCD LT has been published. To date, 25 studies applying NRP in DCD donors have been published (3 with overlapping data) (53)(54)(55) : 12 considered controlled DCD, (56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67) 4 considered uncontrolled DCD, (68)(69)(70)(71) and 1 considered both. (72) Eight were case-control studies, in which the control group was composed of grafts procured with the ultrarapid technique (59,67) or DBD LT. (61,63,64,68,69,71) In 9 studies, no control group was provided.…”

Trauma and donation after circulatory death: a case series from a major trauma center

“…In fact, NRP through VA-ECMO may help lessen warm ischemia injury and provide continuous flow organ perfusion. 7,26–28 Technically, in our cases, NRP was started following cannulation of the femoral vessels (i.e., artery and vein).…”

Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death: A Systematic Review and Critical Appraisal

“…van de Leemkolk et al abdominal organs included in the studies concerned: kidney (n = 9), 24,[26][27][28]34,36,37,41,45 liver (n = 11), 21,25,29,31,32,39,40,[42][43][44]46 kidney and liver (n = 1), 30 and kidney, liver, and pancreas/islets (n = 3). 33,35,38 The overlap in partly duplicate reporting on the same organ is outlined in Table 2.…”

“…The inclusion period of the studies ranged from 1986 to 2019. Fifteen studies were single-center studies, 25,27,[29][30][31]33,34,[36][37][38][39][41][42][43]46 and 7 multicenter studies 21,28,32,35,40,44,45 were included in this review. Two articles 24,26 used the national registry system to analyze data.…”

“…The articles described results in uDCD type I or II (n = 10), 24,[26][27][28][29]34,37,40,41,43 cDCD type III (n = 12), 21,[30][31][32][33]35,36,38,39,42,44,45 cDCD type IV (n = 1), 42 or both uDCD and cDCD (n = 2). 25,46 Regarding control groups, aNRP was compared with DBD, 25,29,30,33,34,37,40,43,44 uDCD, 24,27,28,41 or cDCD 21,32,42 without aNRP.…”