title: Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse.
abstract: BACKGROUND
  Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio-circulatory collapse.
  
  
  METHODS
  We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio-circulatory arrest before organ procurement (RCA); those who experienced sustained cardio-circulatory collapse, treated with extra-corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non-Function (PNF), and complications during the first 30 days were analysed.
  
  
  RESULTS
  102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor's death was post-anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17-43], 54 [34-92], 716 [190-962] respectively, SGPT 17 [12-34], 46 [27-73], 84 [51-175] UI/L respectively, both P<0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End-Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar.
  
  
  CONCLUSIONS
  The use of livers procured from donors after brain death that experienced transient or sustained cardio-circulatory collapse was associated with early graft function comparable to that of standard donors.
authors.affiliation: Dipartimento di Anestesia Rianimazione (Intensiva e Subintensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italia - franco.valenza@unimi.it.
authors.forename: F
authors.initials: F
authors.lastname: Valenza
authors.forename: A
authors.initials: A
authors.lastname: Villa
authors.forename: S
authors.initials: S
authors.lastname: Froio
authors.forename: S
authors.initials: S
authors.lastname: Coppola
authors.forename: F
authors.initials: F
authors.lastname: Barretta
authors.forename: E
authors.initials: E
authors.lastname: Melada
authors.forename: S
authors.initials: S
authors.lastname: Gatti
authors.forename: L
authors.initials: L
authors.lastname: Avalli
authors.forename: G
authors.initials: G
authors.lastname: Citerio
authors.forename: G E
authors.initials: GE
authors.lastname: Rossi
authors.forename: L
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock; D014019:Tissue Donors; D016896:Treatment Outcome