Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-03-16 DOI:10.1111/ctr.70133

Xingjie Li, Yu-Hui Chang, Stephanie Y. Ohara, Kunam S. Reddy, Caroline C. Jadlowiec, Amit K. Mathur, Michelle C. Nguyen

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Abstract

Introduction

Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).

Methods

This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.

Results

Among 68 DCD LT with tDWIT ≥ 30, 64.7% (n = 44) were preserved with NMP and 35.3% (n = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (p < 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, p < 0.01) and IC (2.3% vs. 29.2%, p < 0.01). One-year graft survival was higher in NMP (p < 0.01), and 1-year patient survival was comparable between groups (p = 0.18).

Conclusion

NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.

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导言：由于并发症风险增加，循环死亡后捐献（DCD）异体移植物在肝移植（LT）中未得到充分利用。这些风险源于在整个供体热缺血时间（tDWIT）内遭受的缺血性损伤，而这一时间历来被限制在30分钟内。常温机器灌注（NMP）可以减轻这些风险，并有助于延长tDWIT的DCD移植物的LT。我们的目的是比较在 NMP 和静态冷藏（SCS）中保存的具有延长 tDWIT 的 DCD 异体移植物的预后。方法这项单中心研究纳入了2019年至2023年tDWIT≥30的成人DCD LT。比较了 NMP 和 SCS 的结果，包括 EAD、IC、移植物存活率和患者存活率。结果在68例tDWIT≥30的DCD LT中，64.7%（n = 44）通过NMP保存，35.3%（n = 24）通过SCS保存。供体和受体的人口统计学特征没有差异。NMP 的中位 tDWIT 为 33 分钟，SCS 为 30.5 分钟（p < 0.01）。尽管 tDWIT 较长，但 NMP 组的 EAD（4.5% 对 66.7%，p < 0.01）和 IC（2.3% 对 29.2%，p < 0.01）发生率较低。NMP 的一年移植物存活率更高（p <0.01），两组患者的一年存活率相当（p = 0.18）。结论 NMP 挑战了传统的 tDWIT 限制，可以增加用于移植的可行 DCD 同种异体移植物的数量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.