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Perfusione epatica ipotermica ossigenata Esperienza preliminare di un centro trapianti di fegato italiano
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Perfusione epatica ipotermica ossigenata Esperienza preliminare di un centro trapianti di fegato italiano
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Journal Article
Perfusione epatica ipotermica ossigenata Esperienza preliminare di un centro trapianti di fegato italiano
2019
Overview
Background. Machine perfusion is increasingly utilized in liver transplantation to face the detrimental consequences of the use of extended-criteria-donors. Hypothermic oxygenated machine perfusion (HOPE) appears to be more protective relative to static cold storage. Conversely, normothermic machine perfusion (NMP) allows a better graft evaluation. We describe a pilot prospective study on machine perfusion in selected grafts. Methods. HOPE was executed for all the grafts procured from donors-after-cardiac-death (DCD) and for donors-after-brain-death (DBD) livers requiring prolonged preservation time. NMP was used when a more precise evaluation was needed. Both HOPE and NMP were performed trough portal vein and hepatic artery. Results. From July 2016 to November 2017, we performed 7 HOPE procedures: 5 for DCD and 2 for DBD grafts. Two livers presented macrovesicular steatosis >30% (1 DCD and 1 DBD). HOPE lasted 240min (180-320min) with a total-ischemia-time of 575min (410-810min). Six grafts were successfully transplanted. One DCD graft required additional evaluation using NMP. The graft was then discarded due to extensive hepatocellular necrosis. In the post-transplant course, acute and chronic renal failure were the main complications affecting 3 and 2 recipients, respectively. In our series, steatosis was the main risk factor for kidney injury. Patient and graft survival rate was 100% and no ischemic colangiopathies were observed after 635 days (471-945 days). Conclusions. Our study confirms HOPE safety and efficacy for DCD and DBD grafts. These data are particularly significant for DCD management in the Italian setting where the mandatory 20 min-hands-off interval before death declaration further prolongs warm-ischemia-time.
Publisher
Pensiero Scientifico Editore
Subject
