Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-Center Experience

Background Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy (IC) and other perioperative complications. In an attempt to avoid these complications, we implemented an active protocol of cDCD liver transplant (LT) with normothermic regional perfusion (NRP) preservation. Methods This is a descriptive analysis of data collected from a prospective date base of cDCD LT preserved with NRP, from January 2015 to June 2017 with a minimum follow up of 9 months. Results Fifty-seven potential cDCD donors were connected to the NRP system. Of these, 46 livers were transplanted over a 30-months period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220–6683 U/L). Seven patients (15%) presented postreperfusion syndrome and eleven (23%) showed early allograft dysfunction. No cases of ischemic cholangiopathy were diagnosed and no graft loss was observed over a medium follow-up period of 19 months. Of note, 13 donors were older than 65 years, achieving comparable perioperative and midterm results to younger donors. Conclusions As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique. CORRESPONDING AUTHOR CONTACT INFORMATION: Patricia Ruiz Ordorica, Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital., Plaza de Cruces s/n. 48903. Baracaldo. Vizcaya. Spain, Phone: +34946006372, Fax: +34946006590. E-mail: patruor@gmail.com AUTHORSHIP PAGE Patricia Ruiz MD • Participated in the writing of the paper • Participated in the performance of the research • Contributed new reagents or analytic tools • Participated in data analysis Mikel Gastaca MD* • Participated in the writing of the paper • Participated in the performance of the research Francisco Javier Bustamante, MD** • Participated in the writing of the paper • Participated in the performance of the research Alberto Ventoso MD* • Participated in the writing of the paper • Participated in the performance of the research Ibone Palomares MD* • Participated in the writing of the paper • Participated in the performance of the research Mikel Prieto MD* • Participated in the writing of the paper • Participated in the performance of the research Jose Ramón Fernández MD ** • Participated in the writing of the paper • Participated in the performance of the research Patricia Salvador MD** • Participated in the writing of the paper • Participated in the performance of the research Jose Ignacio Pijuan MD*** • Contributed new reagents or analytic tools • Participated in data analysis Andres Valdivieso MD* • Participated in the writing of the paper • Participated in the performance of the research DISCLOSURE The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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