Superior outcomes using normothermic regional perfusion in cDCD liver transplantation

Abstract

While there is interest in its use, definitive evidence demonstrating superiority of normothermic regional perfusion in cDCD liver transplantation has not been presented. Aim: Analyze the initial Spanish experience with cDCD liver transplantation, in particular regarding the impact NRP has had on organ utilization rates and outcomes. Methods: Data was collected regarding cDCD liver donors and transplants between 2012 and 2016. Results: From 2012 to 2016, 370 potential cDCD liver donors were evaluated (152 NRP, 218 super rapid recovery). Rates of liver transplantation were 64% NRP and 57% SRR (P = 0.102). Among transplanted livers, median donor age was 57 yrs (46–65 IQR). While there were no differences in donor or recipient characteristics, functional warm ischemia was shorter with NRP – 12 min (10–16) NRP vs. 15 min (11–20) SRR – given that femoral cannulae were placed prior to withdrawal of care in the majority of cases. While rates of EAD (22% NRP, 29% SRR) and PNF (2% NRP, 4% SRR) did not vary, rates of biliary complications (9% NRP, 24% SRR, P = 0.006) and ITBL (2% NRP, 12% SRR, P = 0.01) were significantly improved with NRP. One-year graft survival was 87% NRP vs. 78% SRR (P = 0.110). On multivariate analysis analyzing risk factors for ITBL, the only significant factor was the recovery method used. Conclusions: This is the first large series describing application of NRP in cDCD liver transplantation. While results with SRR were acceptable, results using NRP were superior and comparable to those using standard-quality livers, even in spite of advanced donor age.