Navigating new frontiers: onsite machine perfusion in US liver transplantation.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-02-21 DOI:10.1016/j.hpb.2025.02.011

Miho Akabane, Yuki Bekki, Allison J Kwong, Carlos O Esquivel, W R Kim, Marc L Melcher, Kazunari Sasaki

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引用次数: 0

Abstract

Background: The increasing demand for liver transplantation (LT) necessitates optimal utilization of marginal donors including donation after cardiac death (DCD), older, and steatotic donors. Onsite machine perfusion (OMP) might make previously non-utilized organs useable. Comprehensive studies on OMP's safety in LT, using the US national database, are lacking.

Methods: This study aimed to assess OMP usage and implications in LT, using the UNOS database (2016-2023). The impact on recipient outcomes of marginal donor quality as assessed by the donor organ discard index (DSRI) was examined.

Results: Of 50,458 LT cases identified, 1263 (2.5 %) utilized OMP. OMP usage had surged since 2022, exceeding a 10.0 % proportion in early 2023 (Jan-June). In DBD, OMP livers had higher median DSRI than non-OMP livers (2.33vs1.73, P < 0.01) but had comparable graft survival (GS). DCD livers had better 90-day/1-year GS when OMP was used despite having a higher DSRI (24.3vs18.6, P < 0.01). For DCD donors with high DSRI (>13), OMP utilization correlated with a significantly lower hazard ratio (HR) than non-utilization. OMP cases with macrosteatosis≥30 % reported no graft failures. OMP did not exhibit a linear increase in HR with donor age.

Conclusion: OMP's usage in LT significantly increased after its commercialization, offering comparable outcomes with non-OMP despite higher DSRI. It holds promise in optimizing marginal donor use, potentially expanding the donor pool.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).