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Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic structure

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Hepatobiliary & Pancreatic Diseases International 2023年第6期22卷 577-583页

作者： Tian Shen Shan-Hua Zheng Jun Chen Zhi-Sheng Zhou Meng-Fan Yang Xiang-Yan Liu Jun-Li Chen Shu-Sen Zheng Xiao Xu Department of Hepatobiliary and Pancreatic Surgery Shulan(Hangzhou)HospitalHangzhou 310022China Division of Hepatobiliary Pancreatic Surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province Department of Hepatobiliary and Pancreatic SurgeryAffiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhou 310006China China Liver Transplant Registry Hangzhou 310003China NHC Key Laboratory of Combined Multi-organ Transplantation Hangzhou 310003China Institute of Organ Transplantation Zhejiang UniversityHangzhou 310003China

Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(ageafter circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts

关键词： Older donor Liver transplantation Survival Biliary stricture donation after circulatory death

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Severity of early allograft dysfunction following donation after circulatory death liver transplantation:a multicentre study

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 9-19页

作者： Kun Wang Di Lu Yuhui Liu Wangyao Li Li Zhuang Zhenyu Ma Qinfen Xie Binhua Pan Yichao Wu Junli Chen Lidan Lin Xiaowen Feng Qiang Wei Xuyong Wei Haiyang Xie Zhengxin Wang Shusen Zheng Xiao Xu Department of Hepatobiliary and Pancreatic Surgery First Affiliated HospitalZhejiang University School of MedicineHangzhouChina Key Lab of Combined Multi-Organ Transplantation Ministry of Public HealthHangzhouChina Department of Surgery Dezhou People’s HospitalDezhouChina Department of Hepatobiliary and Pancreatic Surgery Shulan(Hangzhou)HospitalHangzhouChina Department of General Surgery Huashan HospitalFudan UniversityShanghaiChina China Liver Transplant Registry HangzhouChina

Background:Early allograft dysfunction(EAD)is associated with decreased graft and patient survival rates.This study aimed to identify the severity of EAD and develop a predictive model for EAD after donation after circulatory death(DCD)liver transplantation(LT).Furthermore,the influence of operative time on EAD incidence was also evaluated.Methods:In this retrospective,multicentre cohort study,nomograms were established based on a single-centre training cohort(n=321)and validated in a 3-center validation cohort(n=501).Results:The incidence rate of EAD was 46.4%(149/321)in the training cohort and 40.5%(203/501)in the validation cohort.Of the 149 EAD patients in the training cohort,77 patients with either elevated alanine aminotransferase(ALT)or aspartate aminotransferase(AST)were classified as having EAD type A,and the rest of the EAD patients were classified as having EAD type B.Recipients with EAD type B had lower graft and patient survival rates than recipients with EAD type A(P=0.043 and 0.044,respectively).We further developed a nomogram to predict EAD(graft weight,cold ischemia time,donor age,model for end-stage liver disease(MELD)score)and another nomogram to predict EAD type B(graft weight,cold ischemia time,MELD score).The nomograms for the prediction of EAD and EAD type B had good discrimination[concordance index(C-index)=0.712(0.666-0.758),0.707(0.641-0.773)]and calibration[Hosmer-Lemeshow(HL)P=0.384,P=0.425]in the validation cohort.An increased operative time(>6 h)was associated with increased EAD and EAD type B incidence in the high-risk group(P=0.005,P=0.020,respectively).Conclusions:EAD type B was associated with decreased graft and patient survival rates.The novel nomograms effectively predicted the incidence of EAD and EAD type B in DCD LT patients.

关键词： Liver transplantation donation after circulatory death early allograft dysfunction(EAD)

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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael Calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of Liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion donation after circulatory death

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Machine perfusion for liver transplantation:A concise review of clinical trials

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 387-391页

作者： Jun-Jun Jia Jian-Hui Li Hao Yu Yu Nie Li Jiang Hao-Yu Li Lin Zhou Shu-Sen Zheng Division of Hepatobiliary and Pancreatic Surgery First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Key Laboratory of Combined Multi-organ Transplantation Ministry of Public HealthHangzhou 310003China Collaborative Innovation Centers for Diagnosis Treatment of Infectious Diseases First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Background: With the increased use of extended-criteria donors, static cold storage has failed to provide optimal preservation of liver grafts, resulting in early allograft dysfunction and long-term complications Machine perfusion(MP) is a beneficial alternative preservation strategy for donor livers, particularly fo those considered to be of suboptimal quality, and could expand the limited donor pool. Data sources: A comprehensive search in Pub Med, EMBASE, Ovid databases and Clinical Trials.gov website was conducted using the medical subject heading terms "machine perfusion", "machine preservation""liver transplantation", combined with free text terms such as "hypothermic", "normothermic" and "sub normothermic". The deadline for the search was September 30, 2017. Results: MP can be classified as hypothermic, subnormothermic, and normothermic with the tempera ture maintained at 0–12 °C, 25–34 °C and 35–38 °C, respectively. Twelve clinical trials of MP have been reported in recent years. MP effectively decreased AST/ALT level and the incidence of early allograft dys function. However, the graft and patient survival rate after MP were similar to static cold storage. The detailed clinical characteristics such as liver function, graft survival, patient survival and early allograf dysfunction were reviewed.Conclusions: Clinical trial results showed that MP improves delayed graft function, primary non-function and biliary strictures. However, MP still requires validation in large clinical trials and the key parameters during MP still require optimization.

关键词： Liver transplantation Machine perfusion donation after circulatory death

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