NORMOTHERMIC WITH OR WITHOUT HYPOTHERMIC OXYGENATED PERFUSION FOR DCD BEFORE LIVER TRANSPLANTATION: EUROPEAN MULTI-CENTRIC EXPERIENCE.

Abstract

Grafts from donors with cardiac death (DCD) are subject to warm ischemia time (WIT) due to the no-touch-period (20 min. in Italy and 5 min. in France). These livers (LT) have higher rates of early allograft dysfunction (EAD), primary non-function (PNF), and ischemic cholangiopathy (IC) compared to LT from brain dead donors (DBD). Normothermic regional perfusion (NRP) is a beneficial strategy to mitigate organ damage; a further approach is the application of ex-vivo hypothermic oxygenated perfusion (HOPE) after cold storage (CS). We retrospectively analyzed LTs performed from 2016 to 2019 at three transplant centers using NRP-DCD grafts: Bologna and Milan treated with HOPE (group A), Rennes preserved using CS (group B). No-flow period, total and functional WIT were significantly higher in group A than in group B (30.5±7.7 vs. 20.5±4.1; 56.5±20.4 vs. 39.1±21.6; 41.9±12.5 vs. 25.5±3.7; respectively, p<0.05), without differences in the postoperative course. In particular, the two groups had similar rates of EAD (21.1%vs.25.0%), PNF (5.3%vs.6.3%), IC (0%vs.12.5%, p = 0.112) and non-IC biliary complications (0%vs.6.3%, p = 0.457), re-LT (10.5%vs.12.5%). This occurred despite a high rate of UK DCD risk score >10 (63.2% A vs.17.6% B, p = 0.000) which theoretically would make a large number of these transplants futile . In conclusion, Italian and French groups had similar post-LT outcomes, probably related to the use of HOPE after CS in the case of long WIT. This article is protected by copyright. All rights reserved.