• Ivo J Schurink, Femke H C de Goeij, Lex J M Habets, Fenna E M van de Leemkolk, Christian A A van Dun, Gabriel C Oniscu, AlwaynIan P JIPJDepartment of Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Wojciech G Polak, Volkert A L Huurman, and Jeroen de Jonge.
• Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
• Ann. Surg. 2022 Oct 1; 276 (4): e223-e230.

ObjectiveThis study investigates whether liver grafts donated after circulatory death (DCD) that are declined by the entire Eurotransplant region can be salvaged with abdominal normothermic regional perfusion (aNRP).BackgroundaNRP is increasingly used for DCD liver grafts because it prevents typical complications. However, it is unclear whether aNRP is capable to rescue pretransplant declined liver grafts by providing the opportunity to test function during donation.MethodsDonor livers from DCD donors, declined by all centers in the Eurotransplant region, were included for this study. The comparator cohort included standard DCD livers and livers donated after brain death, transplanted in the same time period.ResultsAfter the withdrawal of life-sustaining treatment, 28 from the 43 donors had a circulatory death within 2 hours, in which case aNRP was initiated. Of these 28 cases, in 3 cases perfusion problems occurred, 5 grafts were declined based on liver assessment, and 20 liver grafts were transplanted. The main differences during aNRP between the transplanted grafts and the assessed nontransplanted grafts were alanine transaminase levels of 53 U/L (34-68 U/L) versus 367 U/L (318-488 U/L) ( P =0.001) and bile production in 100% versus 50% of the grafts ( P =0.024). The 12-month graft and patient survival were both 95%, similar to the comparator cohort. The incidence of ischemic cholangiopathy was 11%, which was lower than in the standard DCD cohort (18%).ConclusionaNRP can safely select and thus is able to rescue DCD liver grafts that were deemed unsuitable for transplantation, while preventing primary nonfunction and minimizing ischemic cholangiopathy.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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