Extracorporeal membrane oxygenation-assisted liver transplantation of organ donation after cardiac death: report of 9 cases and literature review

Abstract

Objective To evaluate the clinical efficacy of extracorporeal membrane oxygenation (ECMO)-assisted liver transplantation of donation after cardiac death (DCD). Methods Clinical data of 36 donors of DCD and 26 recipients undergoing liver transplantation from May 2015 to September 2016 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Among 36 donors, 29 cases were male and 7 female, aged 11-65 years with a median age of 39 years. Primary diseases: 14 cases of severe craniocerebral trauma, 16 cerebrovascular accidents and 6 ischemic and anoxic diseases. According to whether ECMO was employed, all donors were divided into the ECMO group (n=9) and non-ECMO group (n=27). In the ECMO group, 9 cases presented with obvious hemodynamic instability. All the recipients underwent liver transplantation for the first time. The informed consents of all patients were obtained and the local ethical committee approval was received. All donors completed the liver and kidney donation successfully which were met the Guidelines for Donation after Cardiac Death in China. The warm ischemia time between two groups was statistically compared by t test. The liver and kidney functions were compared by rank sum test. Results One donor in the ECMO group was excluded due to mechanical failure of ECMO, whereas 2 donors in the non-ECMO group were excluded due to prolonged warm ischemia time. The warm ischemia time of donor liver in the ECMO group was (4.8±0.4) min, significantly shorter than (24.1±8.0) minin the non-ECMO group (t=-7.89, P<0.05). The ALT levels at postoperative 5, 7 d, and Scr level at postoperative 7 d in the ECMO group were remarkably lower compared with those in the non-ECMO group (Z=-2.10, -2.14, -2.03; P<0.05). Conclusions ECMO support can shorten the warm ischemia time of the liver and kidney of DCD donors with unstable hemodynamics. The recipients undergoing liver transplantation may obtain good clinical efficacy. Key words: Donor after cardiac death; Liver transplantation; Extracorporeal membrane oxygenation; Prognosis