Preliminary Experience With Hypothermic Oxygenated Machine Perfusion in an Italian Liver Transplant Center |
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Authors: | D. Dondossola C. Lonati A. Zanella M. Maggioni B. Antonelli P. Reggiani S. Gatti G. Rossi |
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Affiliation: | 1. Liver Transplant and General Surgery Unit, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;2. Center for Preclincial Research, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;3. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;4. Department of Pathology, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy |
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Abstract: | BackgroundMachine perfusion is increasingly utilized in liver transplantation to face the detrimental consequences of the use of extended-criteria donors. Hypothermic oxygenated machine perfusion (HOPE) appears to be more protective relative to static cold storage. Conversely, normothermic machine perfusion (NMP) allows a better graft evaluation. We describe a pilot prospective study on machine perfusion in selected grafts.MethodsHOPE was executed for all the grafts procured from donors after cardiac death (DCDs) and for livers from donors after brain death (DBDs) requiring prolonged preservation time. NMP was used when a more precise evaluation was needed. Both HOPE and NMP were performed through the portal vein and hepatic artery.ResultsFrom July 2016 to November 2017, we performed 7 HOPE procedures: 5 for DCD and 2 for DBD grafts. Two livers presented with macrovesicular steatosis >30% (1 DCD and 1 DBD). HOPE lasted 240 minutes (180–320 min) with a total ischemia time of 575 minutes (410–810 min). Six grafts were successfully transplanted. One DCD graft required additional evaluation using NMP. The graft was then discarded due to extensive hepatocellular necrosis. In the post-transplant course, acute and chronic renal failure were the main complications affecting 3 and 2 recipients, respectively. In our series, steatosis was the main risk factor for kidney injury. Patient and graft survival rate was 100% and no ischemic cholangiopathies were observed after 270 days (106–582 days).ConclusionsOur study confirms HOPE safety and efficacy for DCD and DBD grafts. These data are particularly significant for DCD management in the Italian setting where the mandatory 20-minute hands-off interval before death declaration further prolongs warm ischemia time. |
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Keywords: | Address correspondence to Daniele Dondossola, Liver Transplant and General Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35 Milan, Italy. Tel: +393337572868 Fax: +390255035800. |
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