title: Liver transplantation using suboptimal grafts: impact of donor harvesting technique.
abstract: In recent years, an increasing number of suboptimal grafts has been used to reduce the gap between the supply and demand of organs for liver transplantation (LT). In this randomized prospective study, we tested the impact of donor harvesting technique on the posttransplantation outcome of suboptimal donor livers. A modified double perfusion (MDP) technique (aortic and portal cooling with tourniquet clamping of splenomesenteric vein inflow) was compared with the single aortic perfusion (SAP) technique. Between February and November 2005, 35 suboptimal grafts were randomly assigned to either technique (18 MDP livers and 17 SAP livers). Donor and recipient variables were comparable in the 2 study groups. The SAP group had significantly higher blood transaminases and bilirubin levels after LT. The prevalence of graft primary dysfunction (PDF) was also significantly higher (P=0.01) in the SAP group (35%) than in the MDP group (5%). In 5 cases, all in the SAP group (P=0.02), early re-LT (<30 days) was needed. The 6-month patient and graft survival rates were significantly higher in the MDP (100% in both cases) than in the SAP group (68% and 58%, respectively). The study was stopped in November 2005, when the interim analysis revealed such markedly significant differences between the two groups. In conclusion, the present study showed a very low prevalence of PDF, death, and re-LT after transplantation with suboptimal liver when a MDP technique was used to harvest the donor graft.
authors: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento assistenziale di Chirurgia Generale e Trapianti d'Organo - Università, Ospedaliera di Padova, Padova, Italy.
authors: Francesco
authors: F
authors: D'Amico
authors: Alessandro
authors: A
authors: Vitale
authors: Enrico
authors: E
authors: Gringeri
authors: Michele
authors: M
authors: Valmasoni
authors: Amedeo
authors: A
authors: Carraro
authors: Alberto
authors: A
authors: Brolese
authors: Giacomo
authors: G
authors: Zanus
authors: Patrizia
authors: P
authors: Boccagni
authors: Davide Francesco
authors: DF
authors: D'Amico
authors: Umberto
authors: U
authors: Cillo
mesh_terms: D005500:Follow-Up Studies; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome