DCD Liver Transplant: a Meta-review of the Evidence and Current Optimization Strategies

AbstractPurposeIn the current era of liver transplantation (LT), there is a large discrepancy between waiting list demand and organ donor availability. Increased utilization of donation after circulatory death (DCD) donors continues to expand the donor pool and improve access; however, concerns regarding recipient outcomes have limited wider adoption of these donor livers. This review will describe the current evidence regarding recipient outcomes and strategies that may help to optimize them.Recent FindingsHistorical outcomes of DCD LT are somewhat inferior to the DBD LT, yet new emerging evidence suggests that this outcome disparity may only be marginal at most; however, ischemic cholangiopathy remains a concern. Ideal donor selection criteria and optimizing recipient operative times appear to mitigate some of this risk. Extracorporeal membrane oxygenation (ECMO), hypothermic machine perfusion (HMP), and normothermic machine perfusion (NMP) are promising strategies to further improve graft resilience and performance.SummaryCardiac death donors continue to expand the donor pool but may carry an increased risk of biliary complications. Graft reconditioning techniques, donor selection, and recipient optimization appear to mitigate this risk; however, these strategies need further investigation before generalized adoption.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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Condition:   Liver Diseases Intervention:   Procedure: Liver transplantation of a graft after assessment by normothermic perfusion Sponsor:   Assistance Publique - Hôpitaux de Paris Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
A new optimized method for revascularizing bioengineered livers provides up to 15 days of continuous perfusion after transplantation into immunosuppressed pigs.Reuters Health Information
Source: Medscape Pathology Headlines - Category: Pathology Tags: Transplantation News Source Type: news
Conclusions: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.
Source: Annals of Surgery - Category: Surgery Tags: ESA PAPERS Source Type: research
Objective: The aim of this study was to evaluate sequential hypothermic and normothermic machine perfusion (NMP) as a tool to resuscitate and assess viability of initially declined donor livers to enable safe transplantation. Summary Background Data: Machine perfusion is increasingly used to resuscitate and test the function of donor livers. Although (dual) hypothermic oxygenated machine perfusion ([D]HOPE) resuscitates livers after cold storage, NMP enables assessment of hepatobiliary function. Methods: In a prospective clinical trial, nationwide declined livers were subjected to ex situ NMP (viability assessment ...
Source: Annals of Surgery - Category: Surgery Tags: ESA PAPERS Source Type: research
This study evaluated the application of normothermic regional perfusion to protect the liver grafts from these donors from warm ischemia in a large transplant center in China. MATERIALS AND METHODS: This prospective study involved 19 liver transplants from brain death followed by circulatory death donors that were conducted between December 2014 and June 2017. We evaluated the baseline characteristics of the donors and recipients and compared outcomes of both groups. Graft and recipient survival and postoperative complications were also analyzed. RESULTS: Although the normothermic regional perfusion group consist...
Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation - Category: Transplant Surgery Authors: Tags: Exp Clin Transplant Source Type: research
Publication date: Available online 9 October 2019Source: The Lancet Respiratory MedicineAuthor(s): Marcelo Cypel, Jordan J Feld, Marcos Galasso, Rafaela V Pinto Ribeiro, Nikki Marks, Magdalena Kuczynski, Deepali Kumar, Ilona Bahinskaya, Vanderlei S Bagnato, Cristina Kurachi, Arthur S S.sky, Jonathan C Yeung, Laura Donahoe, Marc de Perrot, Kazuhiro Yasufuku, Andrew Pierre, Matthew Binnie, Cecilia Chaparro, Tereza Martinu, Manyin ChenSummaryBackgroundA substantial proportion of organ donors test positive for hepatitis C virus (HCV) infection. To date, only a few studies have evaluated the safety of using lungs from these don...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Authors: Martins RM, Teodoro JS, Furtado E, Oliveira RC, Tralhão JG, Rolo AP, Palmeira CM Abstract The organ preservation paradigm has changed following the development of new ways to preserve organs. The use of machine perfusion to preserve organs appears to have several advantages compared with conventional static cold storage. For liver transplants, the temperature control provided by machine perfusion improves organ preservation. In this experimental study, we measured the effects of different temperatures on mitochondrial bioenergetics during the reperfusion phase. An experimental model of ex-vivo liver...
Source: International Journal of Medical Sciences - Category: Biomedical Science Tags: Int J Med Sci Source Type: research
AbstractPurposeTo compare the diagnostic value of apparent diffusion coefficient (ADC) and intravoxel incoherent motion metrics in discriminating histologic grades of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) infection.Methods117 chronic HBV patients with 120 pathologically confirmed HCCs after surgical resection or liver transplantation were enrolled in this retrospective study. Diffusion-weighted imaging was performed using elevenb values (0 –1500 s/mm2) and twob values (0, 800  s/mm2) successively on a 3.0 T system. ADC0, 800, ADCtotal, diffusion coefficient (D), pseudodiffu...
Source: Abdominal Imaging - Category: Radiology Source Type: research
The disparity between the number of available donor livers and patients awaiting a liver transplant has led transplant centers to accept suboptimal livers. There has been no universally accepted tool to predict the posttransplant function of these organs to safely increase the donor pool, protect these livers against ischemia-reperfusion injury, or improve their quality before implantation. Ex situ liver machine preservation has emerged as a promising novel graft protective strategy in the field of liver transplantation, with remarkable ongoing research and evolving clinical trials within Europe and the United States. This...
Source: Transplantation - Category: Transplant Surgery Tags: Reviews Source Type: research
Conclusions. Machine perfusion with portal perfusion via the umbilical vein is feasible. Portal venous flows were similar to those obtained after cannulation of the portal vein main stem. This technique enables continuous oxygenated perfusion of liver grafts during procurement, splitting, and implantation.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science–Liver Source Type: research
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