title: Hypothermic machine preservation facilitates successful transplantation of "orphan" extended criteria donor livers.
abstract: Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region ("orphan livers"). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for End-Stage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-8 °C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p = 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p = NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p = 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 ± 10.9 vs. 20.14 ± 11.12 days in the SCS group, p = 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: J V
authors.initials: JV
authors.lastname: Guarrera
authors.forename: S D
authors.initials: SD
authors.lastname: Henry
authors.forename: B
authors.initials: B
authors.lastname: Samstein
authors.forename: E
authors.initials: E
authors.lastname: Reznik
authors.forename: C
authors.initials: C
authors.lastname: Musat
authors.forename: T I
authors.initials: TI
authors.lastname: Lukose
authors.forename: L E
authors.initials: LE
authors.lastname: Ratner
authors.forename: R S
authors.initials: RS
authors.lastname: Brown
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: J C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D050377:Cold Ischemia; D015925:Cryopreservation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008107:Liver Diseases / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D011182:Postoperative Care; D011379:Prognosis; D012107:Research Design; D055815:Young Adult
keywords: Clinical research/practice; donors and donation: extended criteria, liver allograft function/dysfunction; ischemia reperfusion injury (IRI); liver transplantation/hepatology; organ perfusion and preservation; organ procurement; organ procurement and allocation