Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience
BackgroundDonation after circulatory death (DCD) liver allografts are associated with higher rates of primary non-function (PNF) and ischemic cholangiopathy (IC). Advanced recovery techniques, including thoracoabdominal normothermic regional perfusion (TA-NRP), may improve organ utilization and pati...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Transplantation |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/frtra.2023.1184620/full |
| _version_ | 1797688790174662656 |
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| author | Aleah L. Brubaker Raeda Taj Brandon Jackson Arielle Lee Catherine Tsai Jennifer Berumen Justin R. Parekh Kristin L. Mekeel Alexander R. Gupta James M. Gardner Thomas Chaly Amit K. Mathur Caroline Jadlowiec Sudhakar Reddy Rafael Nunez Janet Bellingham Elizabeth M. Thomas Jason R. Wellen Jenny H. Pan Mark Kearns Victor Pretorius Gabriel T. Schnickel |
| author_facet | Aleah L. Brubaker Raeda Taj Brandon Jackson Arielle Lee Catherine Tsai Jennifer Berumen Justin R. Parekh Kristin L. Mekeel Alexander R. Gupta James M. Gardner Thomas Chaly Amit K. Mathur Caroline Jadlowiec Sudhakar Reddy Rafael Nunez Janet Bellingham Elizabeth M. Thomas Jason R. Wellen Jenny H. Pan Mark Kearns Victor Pretorius Gabriel T. Schnickel |
| author_sort | Aleah L. Brubaker |
| collection | DOAJ |
| description | BackgroundDonation after circulatory death (DCD) liver allografts are associated with higher rates of primary non-function (PNF) and ischemic cholangiopathy (IC). Advanced recovery techniques, including thoracoabdominal normothermic regional perfusion (TA-NRP), may improve organ utilization and patient and allograft outcomes. Given the increasing US experience with TA-NRP DCD recovery, we evaluated outcomes of DCD liver allografts transplanted after TA-NRP.MethodsLiver allografts transplanted from DCD donors after TA-NRP were identified from 5/1/2021 to 1/31/2022 across 8 centers. Donor data included demographics, functional warm ischemic time (fWIT), total warm ischemia time (tWIT) and total time on TA-NRP. Recipient data included demographics, model of end stage liver disease (MELD) score, etiology of liver disease, PNF, cold ischemic time (CIT), liver function tests, intensive care unit (ICU) and hospital length of stay (LOS), post-operative transplant related complications.ResultsThe donors' median age was 32 years old and median BMI was 27.4. Median fWIT was 20.5 min; fWIT exceeded 30 min in two donors. Median time to initiation of TA-NRP was 4 min and median time on bypass was 66 min. The median recipient listed MELD and MELD at transplant were 22 and 21, respectively. Median allograft CIT was 292 min. The median length of follow up was 257 days. Median ICU and hospital LOS were 2 and 7 days, respectively. Three recipients required management of anastomotic biliary strictures. No patients demonstrated IC, PNF or required re-transplantation.ConclusionLiver allografts from TA-NRP DCD donors demonstrated good early allograft and recipient outcomes. |
| first_indexed | 2024-03-12T01:36:49Z |
| format | Article |
| id | doaj.art-068368d8f8604a35b627a558c44a0c07 |
| institution | Directory Open Access Journal |
| issn | 2813-2440 |
| language | English |
| last_indexed | 2024-03-12T01:36:49Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Transplantation |
| spelling | doaj.art-068368d8f8604a35b627a558c44a0c072023-09-11T05:23:36ZengFrontiers Media S.A.Frontiers in Transplantation2813-24402023-09-01210.3389/frtra.2023.11846201184620Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experienceAleah L. Brubaker0Raeda Taj1Brandon Jackson2Arielle Lee3Catherine Tsai4Jennifer Berumen5Justin R. Parekh6Kristin L. Mekeel7Alexander R. Gupta8James M. Gardner9Thomas Chaly10Amit K. Mathur11Caroline Jadlowiec12Sudhakar Reddy13Rafael Nunez14Janet Bellingham15Elizabeth M. Thomas16Jason R. Wellen17Jenny H. Pan18Mark Kearns19Victor Pretorius20Gabriel T. Schnickel21Department of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Cardiothoracic Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant Surgery, UC San Francisco, San Francisco, CA, United StatesDepartment of Surgery, Division of Transplant Surgery, UC San Francisco, San Francisco, CA, United StatesArizona Transplant Associates, Phoenix, AZ, United StatesDepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United StatesDepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United StatesDepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United StatesDepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United StatesDepartment of Transplantation, California Pacific Medical Center, San Francisco, CA, United StatesDepartment of Surgery, University Transplant Center, University of Texas Health San Antonio, San Antonio, TX, United StatesDepartment of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO, United StatesDepartment of Surgery, Division of Abdominal Transplantation, Stanford University, Stanford, CA, United StatesDepartment of Surgery, Division of Cardiothoracic Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Cardiothoracic Surgery, UC San Diego, San Diego, CA, United StatesDepartment of Surgery, Division of Transplant and Hepatobiliary Surgery, UC San Diego, San Diego, CA, United StatesBackgroundDonation after circulatory death (DCD) liver allografts are associated with higher rates of primary non-function (PNF) and ischemic cholangiopathy (IC). Advanced recovery techniques, including thoracoabdominal normothermic regional perfusion (TA-NRP), may improve organ utilization and patient and allograft outcomes. Given the increasing US experience with TA-NRP DCD recovery, we evaluated outcomes of DCD liver allografts transplanted after TA-NRP.MethodsLiver allografts transplanted from DCD donors after TA-NRP were identified from 5/1/2021 to 1/31/2022 across 8 centers. Donor data included demographics, functional warm ischemic time (fWIT), total warm ischemia time (tWIT) and total time on TA-NRP. Recipient data included demographics, model of end stage liver disease (MELD) score, etiology of liver disease, PNF, cold ischemic time (CIT), liver function tests, intensive care unit (ICU) and hospital length of stay (LOS), post-operative transplant related complications.ResultsThe donors' median age was 32 years old and median BMI was 27.4. Median fWIT was 20.5 min; fWIT exceeded 30 min in two donors. Median time to initiation of TA-NRP was 4 min and median time on bypass was 66 min. The median recipient listed MELD and MELD at transplant were 22 and 21, respectively. Median allograft CIT was 292 min. The median length of follow up was 257 days. Median ICU and hospital LOS were 2 and 7 days, respectively. Three recipients required management of anastomotic biliary strictures. No patients demonstrated IC, PNF or required re-transplantation.ConclusionLiver allografts from TA-NRP DCD donors demonstrated good early allograft and recipient outcomes.https://www.frontiersin.org/articles/10.3389/frtra.2023.1184620/fullthoracoabdominal normothermic regional perfusion (TA-NRP)donation after circulatory deathliver transplantorgan procurementtransplant outcomes |
| spellingShingle | Aleah L. Brubaker Raeda Taj Brandon Jackson Arielle Lee Catherine Tsai Jennifer Berumen Justin R. Parekh Kristin L. Mekeel Alexander R. Gupta James M. Gardner Thomas Chaly Amit K. Mathur Caroline Jadlowiec Sudhakar Reddy Rafael Nunez Janet Bellingham Elizabeth M. Thomas Jason R. Wellen Jenny H. Pan Mark Kearns Victor Pretorius Gabriel T. Schnickel Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience Frontiers in Transplantation thoracoabdominal normothermic regional perfusion (TA-NRP) donation after circulatory death liver transplant organ procurement transplant outcomes |
| title | Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience |
| title_full | Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience |
| title_fullStr | Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience |
| title_full_unstemmed | Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience |
| title_short | Early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional: a multi-center observational experience |
| title_sort | early patient and liver allograft outcomes from donation after circulatory death donors using thoracoabdominal normothermic regional a multi center observational experience |
| topic | thoracoabdominal normothermic regional perfusion (TA-NRP) donation after circulatory death liver transplant organ procurement transplant outcomes |
| url | https://www.frontiersin.org/articles/10.3389/frtra.2023.1184620/full |
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