Steven A Wisel, Justin A Steggerda, Carrie Thiessen, Garrett R Roll, Qiudong Chen, Jason Thomas, Bhupinder Kaur, Pedro Catarino, Joanna Chikwe, Irene K Kim
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Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival.</p><p><strong>Results: </strong>One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; <i>P</i> < 0.0001) with lower body mass index (mean 26.61; <i>P</i> < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( <i>P</i> = 0.893) and superior graft survival (<i>P</i> = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; <i>P</i> < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%).</p><p><strong>Conclusions: </strong>Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. NRP procurements resulted in the lowest rate of organ discard after DCD donation and may represent an optimal strategy to maximize organ utilization.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1528"},"PeriodicalIF":1.9000,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10593259/pdf/","citationCount":"0","resultStr":"{\"title\":\"Preserved 2-y Liver Transplant Outcomes Following Simultaneous Thoracoabdominal DCD Organ Procurement Despite Effects on Liver Utilization Rate.\",\"authors\":\"Steven A Wisel, Justin A Steggerda, Carrie Thiessen, Garrett R Roll, Qiudong Chen, Jason Thomas, Bhupinder Kaur, Pedro Catarino, Joanna Chikwe, Irene K Kim\",\"doi\":\"10.1097/TXD.0000000000001528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Current techniques for donation after circulatory determination of death (DCD) heart procurement, through either direct procurement and machine perfusion or thoracoabdominal normothermic regional perfusion (NRP), have demonstrated excellent heart transplant outcomes. However, the impact of thoracoabdominal DCD (TA-DCD) heart procurement on liver allograft outcomes and utilization is poorly understood.</p><p><strong>Methods: </strong>One hundred sixty simultaneous heart and liver DCD donors were identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between December 2019 and July 2021. Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival.</p><p><strong>Results: </strong>One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; <i>P</i> < 0.0001) with lower body mass index (mean 26.61; <i>P</i> < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( <i>P</i> = 0.893) and superior graft survival (<i>P</i> = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; <i>P</i> < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%).</p><p><strong>Conclusions: </strong>Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. 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引用次数: 0
摘要
背景：目前通过直接获取和机器灌注或胸腹常温区域灌注（NRP）获得心脏的循环死亡确定（DCD）后捐赠技术已经证明了良好的心脏移植结果。然而，胸腹DCD（TA-DCD）心脏采购对肝移植结果和利用率的影响尚不清楚。方法：在2019年12月至2021年7月期间，使用器官共享联合网络/器官采购和移植网络数据库确定了160名同时进行心脏和肝脏DCD捐献者。通过心脏获取技术对TADCD供体的肝脏结果进行分层，并评估器官利用率、移植物存活率和患者存活率。结果与仅腹部DCD（A-DCD；n = 1332）和脑死亡后的捐赠（DBD；n = 12 891）肝移植。Kaplan-Meier方法和对数秩检验用于评估患者和移植物的生存率。结果：从TADCD供体获得的160个肝脏中有133个进行了移植。TADCD供体较年轻（平均28.26岁；P P P = 0.893）和优良移植物存活率（P = 0.009）。TA-DCD肝在长时间热缺血时的器官丢弃率（37.0%）高于A-DCD（20.5%）和DBD（0.5%）；P 结论：TA-DCD捐献后的肝移植显示出同等的患者结果和良好的移植物结果。NRP采购导致DCD捐赠后器官丢弃率最低，可能代表了最大限度利用器官的最佳策略。
Preserved 2-y Liver Transplant Outcomes Following Simultaneous Thoracoabdominal DCD Organ Procurement Despite Effects on Liver Utilization Rate.
Background: Current techniques for donation after circulatory determination of death (DCD) heart procurement, through either direct procurement and machine perfusion or thoracoabdominal normothermic regional perfusion (NRP), have demonstrated excellent heart transplant outcomes. However, the impact of thoracoabdominal DCD (TA-DCD) heart procurement on liver allograft outcomes and utilization is poorly understood.
Methods: One hundred sixty simultaneous heart and liver DCD donors were identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between December 2019 and July 2021. Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival.
Results: One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; P < 0.0001) with lower body mass index (mean 26.61; P < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( P = 0.893) and superior graft survival (P = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; P < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%).
Conclusions: Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. NRP procurements resulted in the lowest rate of organ discard after DCD donation and may represent an optimal strategy to maximize organ utilization.
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