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Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death

Watson, C. J. E. ; Kosmoliaptsis, V. ; Randle, L. V. ; Russell, N. K. ; Griffiths, W. J. H. ; Davies, S. ; Mergental, H. ; Butler, A. J.

American journal of transplantation, 2016-01, Vol.16 (1), p.353-357 [Periódico revisado por pares]

United States

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  • Título:
    Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death
  • Autor: Watson, C. J. E. ; Kosmoliaptsis, V. ; Randle, L. V. ; Russell, N. K. ; Griffiths, W. J. H. ; Davies, S. ; Mergental, H. ; Butler, A. J.
  • Assuntos: donation after circulatory death ; Heart Arrest ; Humans ; Liver - blood supply ; Liver Transplantation ; Male ; Middle Aged ; Organ Preservation ; Perfusion ; Preimplant ex situ normothermic liver perfusion ; Prognosis ; Tissue and Organ Procurement - methods ; Tissue Donors
  • É parte de: American journal of transplantation, 2016-01, Vol.16 (1), p.353-357
  • Notas: ObjectType-Case Study-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-4
    content type line 23
    ObjectType-Report-1
    ObjectType-Article-3
  • Descrição: Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57‐year‐old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life‐supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma‐free red cell–based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia. The authors report a liver transplant where ex situ normothermic machine perfusion was used to reduce cold ischemia and permit functional assessment of a donation after circulatory death liver before implantation.
  • Editor: United States
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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