• Amelia J Hessheimer, Elisabeth Coll, Ferrán Torres, Patricia Ruíz, Mikel Gastaca, José Ignacio Rivas, Manuel Gómez, Belinda Sánchez, Julio Santoyo, Pablo Ramírez, Pascual Parrilla, Luis Miguel Marín, Miguel Ángel Gómez-Bravo, Juan Carlos García-Valdecasas, Javier López-Monclús, Andrea Boscá, Rafael López-Andújar, Jiliam Fundora-Suárez, Jesús Villar, Álvaro García-Sesma, Carlos Jiménez, Gonzalo Rodríguez-Laíz, Laura Lladó, Juan Carlos Rodríguez, Manuel Barrera, Ramón Charco, Jose Ángel López-Baena, Javier Briceño, Fernando Pardo, Gerardo Blanco, David Pacheco, Beatriz Domínguez-Gil, Víctor Sánchez Turrión, and Constantino Fondevila.
• Department of General & Digestive Surgery, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
• J. Hepatol. 2019 Apr 1; 70 (4): 658-665.

Background & AimsAlthough there is increasing interest in its use, definitive evidence demonstrating a benefit for postmortem normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation is lacking. The aim of this study was to compare results of cDCD liver transplants performed with postmortem NRP vs. super-rapid recovery (SRR), the current standard for cDCD.MethodsThis was an observational cohort study including all cDCD liver transplants performed in Spain between June 2012 and December 2016, with follow-up ending in December 2017. Each donor hospital determined whether organ recovery was performed using NRP or SRR. The propensity scores technique based on the inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups; logistic and Cox regression models were used for binary and time-to-event outcomes.ResultsDuring the study period, there were 95 cDCD liver transplants performed with postmortem NRP and 117 with SRR. The median donor age was 56 years (interquartile range 45-65 years). After IPTW analysis, baseline covariates were balanced, with all absolute standardised differences <0.15. IPTW-adjusted risks were significantly improved among NRP livers for overall biliary complications (odds ratio 0.14; 95% CI 0.06-0.35, p <0.001), ischaemic type biliary lesions (odds ratio 0.11; 95% CI 0.02-0.57; p = 0.008), and graft loss (hazard ratio 0.39; 95% CI 0.20-0.78; p = 0.008).ConclusionsThe use of postmortem NRP in cDCD liver transplantation appears to reduce postoperative biliary complications, ischaemic type biliary lesions and graft loss, and allows for the transplantation of livers even from cDCD donors of advanced age.Lay SummaryThis is a propensity-matched nationwide observational cohort study performed using livers recovered from donors undergoing cardiac arrest provoked by the intentional withdrawal of life support (controlled donation after circulatory death, cDCD). Approximately half of the livers were recovered after a period of postmortem in situ normothermic regional perfusion, which restored warm oxygenated blood to the abdominal organs, whereas the remainder were recovered after rapid preservation with a cold solution. The study results suggest that the use of postmortem normothermic regional perfusion helps reduce rates of post-transplant biliary complications and graft loss and allows for the successful transplantation of livers from older cDCD donors.Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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