title: Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion.
abstract: The role of donation after cardiac death (DCD) in expanding the donor pool is mainly limited by the incidence of primary nonfunction (PNF) and ischemia-related complications. Even greater concern exists toward uncontrolled DCD, which represents the largest potential pool of DCD donors. We recently started the first Italian series of DCD liver transplantation, using normothermic regional perfusion (NRP) in 6 uncontrolled donors and in 1 controlled case to deal with the legally required no-touch period of 20 minutes. We examined our first 7 cases for the incidence of PNF, early graft dysfunction, and biliary complications. Acceptance of the graft was based on the trend of serum transaminase and lactate during NRP, the macroscopic appearance, and the liver biopsy. Hypothermic machine perfusion (HMP) was associated in selected cases to improve cold storage. Most notably, no cases of PNF were observed. Median posttransplant transaminase peak was 1014 IU/L (range, 393-3268 IU/L). Patient and graft survival were both 100% after a mean follow-up of 6.1 months (range, 3-9 months). No cases of ischemic cholangiopathy occurred during the follow-up. Only 1 anastomotic stricture completely resolved with endoscopic stenting. In conclusion, DCD liver transplantation is feasible in Italy despite the protracted no-touch period. The use of NRP and HMP seems to earn good graft function and proves safe in these organs. Liver Transplantation 23 166-173 2017 AASLD.
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.|Departments of Surgical Sciences, University of Pavia, Pavia, Italy.
authors: Riccardo
authors: R
authors: De Carlis
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.|Departments of Experimental Medicine, University of Pavia, Pavia, Italy.
authors: Stefano
authors: S
authors: Di Sandro
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Andrea
authors: A
authors: Lauterio
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Fabio
authors: F
authors: Ferla
authors: Anestesia e Rianimazione, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy.
authors: Antonio
authors: A
authors: Dell'Acqua
authors: Anestesia e Rianimazione 1, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy.
authors: Marinella
authors: M
authors: Zanierato
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.|School of Medicine, University of Milano-Bicocca, Milan, Italy.
authors: Luciano
authors: L
authors: De Carlis
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D064591:Allografts / Q000473:pathology; D001706:Biopsy; D051799:Delayed Graft Function / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000601:surgery*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007558:Italy; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013696:Temperature; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D052096:Warm Ischemia / Q000009:adverse effects*
chemical_list: D000410:Alanine Transaminase