Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation.
Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 +/- 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.
Jiménez-Galanes
Santos
S
Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain.
Meneu-Diaz
Marchán Juan Carlos
MJ
Elola-Olaso
Almudena Moreno
AM
Pérez-Saborido
Baltasar
B
Yiliam
Fundora-Suarez
FS
Calvo
Alberto Gimeno
AG
Usera
Manuel Abradelo
MA
González
Mercedes Catalán
MC
González
Juan Carlos Montejo
JC
González
Enrique Moreno
EM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000209:etiology; D001926:Brain Death; D016022:Case-Control Studies; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D055031:Primary Graft Dysfunction / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D015427:Reperfusion Injury / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult