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Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death

A Single-center Experience

Ruiz, Patricia, MD1; Gastaca, Mikel, MD1; Bustamante, Francisco Javier, MD2; Ventoso, Alberto, MD1; Palomares, Ibone, MD1; Prieto, Mikel, MD1; Fernández, Jose Ramón, MD2; Salvador, Patricia, MD2; Pijoan, Jose Ignacio, MD3; Valdivieso, Andres, MD1

doi: 10.1097/TP.0000000000002391
Original Clinical Science—Liver

Background. Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy 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-month period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220-6683 U/L). Seven (15%) patients presented postreperfusion syndrome and 11 (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.

1 Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Baracaldo, Vizcaya, Spain.

2 Department of Gastroenterology and Hepatology, Cruces University Hospital, 48903, Baracaldo, Vizcaya, Spain.

3 Department of Epidemiology and Biostatistics, Cruces University Hospital, 48903, Baracaldo, Vizcaya, Spain.

Received 9 May 2018. Revision received 10 July 2018.

Accepted 18 July 2018.

The authors declare no conflicts of interest.

P.R. participated in the writing of the article, performance of the research, contributed new reagents or analytic tools, and participated indata analysis.M.G., F.J.B., A.V., I.P., M.P., J.R.F., P.S., and A.V. participated in thewriting of the article and the performance of the research. J.I.P. contributed new reagents or analytic tools and participated in data analysis.

Correspondence: Patricia Ruiz Ordorica, MD, Hepatobiliary Surgery and Liver Transplantation Unit Cruces University Hospital, Plaza de Cruces s/n, 48903, Baracaldo, Vizcaya, Spain. (

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