Effect of Aprotinin on Liver Injury after Transplantation of Extended Criteria Donor Grafts in Humans: A Retrospective Propensity Score Matched Cohort Analysis.

Anna B Roehl,Marc Hein,Anne Andert,Karsten Junge,Ulf P Neumann,Felix Kork

doi:10.3390/jcm10225232

Anna B Roehl, Marc Hein + Show 4 more

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https://doi.org/10.3390/jcm10225232

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Abstract

The number of patients awaiting liver transplantation still widely exceeds the number of donated organs available. Patients receiving extended criteria donor (ECD) organs are especially prone to an aggravated ischemia reperfusion syndrome during liver transplantation leading to massive hemodynamic stress and possible impairment in organ function. Previous studies have demonstrated aprotinin to ameliorate reperfusion injury and early graft survival. In this single center retrospective analysis of 84 propensity score matched patients out of 274 liver transplantation patients between 2010 and 2014 (OLT), we describe the association of aprotinin with postreperfusion syndrome (PRS), early allograft dysfunction (EAD: INR 1,6, AST/ALT > 2000 within 7–10 days) and recipient survival. The incidence of PRS (52.4% vs. 47.6%) and 30-day mortality did not differ (4.8 vs. 0%; p = 0.152) but patients treated with aprotinin suffered more often from EAD (64.3% vs. 40.5%, p = 0.029) compared to controls. Acceptable or poor (OR = 3.3, p = 0.035; OR = 9.5, p = 0.003) organ quality were independent predictors of EAD. Our data do not support the notion that aprotinin prevents nor attenuates PRS, EAD or mortality.

Highlights

The number of patients awaiting liver transplantation still widely exceeds the number of donated organs available
Whether the patient was treated with aprotinin to attenuate postreperfusion syndrome (PRS) and early allograft dysfunction (EAD) had been a joint decision of the attending anesthesiologist and the transplant surgeon based on the following criteria: i) organ quality, ii) cold ischemia time and iii) age of the donor
Patients who were treated with aprotinin intraoperatively during a liver graft transplantation were of similar age and sex and had a similar BMI compared to controls

Summary

Introduction

The number of patients awaiting liver transplantation still widely exceeds the number of donated organs available. Patients receiving extended criteria donor (ECD) organs are especially prone to an aggravated ischemia reperfusion syndrome during liver transplantation leading to massive hemodynamic stress and possible impairment in organ function. Increasing organ shortage for liver transplantation is a major challenge to transplant hepatology To address this situation and to overcome the discrepancy between organ demand and supply, marginal donors or extended criteria donors (ECD) are more often accepted to increase the number of available donor organs.[1, 2]. Patients with a special urgency are exempted from the MELD-based allocation (e.g. acute liver failure, primary organ nonfunction). This leads to an increased acceptancy of organs from extended criteria donors being transplanted to increasingly sick patients[4],[5]

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