Normothermic Regional Perfusion in Controlled Donation After Circulatory Death and its Impact on Postreperfusion Syndrome in Liver Transplantation Compared With Brain-dead Donors: A Retrospective Comparative Study.

Abstract

Background: Controlled donation after circulatory death (cDCD) increases graft availability but may carry higher perioperative risk, which in situ normothermic regional perfusion (NRP) may mitigate by reducing ischemia-reperfusion injury. Evidence remains limited regarding NRP impact on PRS during liver transplantation (LT). The objective of this study was to compare the incidence of PRS and early postoperative outcomes between cDCD LT with NRP and donation after brain death (DBD) LT.

Methods: This was a retrospective, single-center observational study comparing cDCD LT with NRP versus DBD LT. The primary endpoint was PRS (≥30% mean arterial pressure decrease for ≥1 min within 5 min of reperfusion). Secondary endpoints included early allograft dysfunction, acute kidney injury (AKI), rejection, biliary/vascular complications, and survival. Associations between graft type and outcomes were assessed using logistic regression (binary) and linear regression (continuous), and Cox models (time-to-event), with multivariable adjustment for clinically relevant covariates.

Results: Among 106 recipients (cDCD n = 47; DBD n = 59), PRS occurred 27 patients (25.5% versus 25.4%). Graft type was not associated with PRS after adjustment (odds ratio, 1.13; 95% confidence interval, 0.41-3.10; P = 0.81). No significant differences were observed in early allograft dysfunction, acute rejection, AKI, or biliary and vascular complications. There was 1 death in the cDCD group and 5 in the DBD group (2.1% versus 8.5%).

Conclusions: In a standardized program using routine NRP, cDCD LT did not increase PRS risk and achieved early outcomes comparable to DBD LT. These findings suggest clinical feasibility and short-term safety of Maastricht III protocols incorporating NRP.