Department of Digestive Surgery & Liver Transplantation, Croix-Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance.
Department of Hepatopancreatobiliary and Liver Transplant SurgeryRoyal Free HospitalLondonUK.
Liver Transpl. 2022 Nov;28(11):1716-1725. doi: 10.1002/lt.26522. Epub 2022 Jun 29.
In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) aim to improve the outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly. In this international observational study, outcomes of LT performed between 2015 and 2019 for organs procured from cDCD donors subjected to NRP or NMP commenced at the donor center were compared using propensity score matching (PSM). Of the 224 cDCD donations in the NRP cohort that proceeded to asystole, 193 livers were procured, resulting in 157 transplants. In the NMP cohort, perfusion was commenced in all 40 cases and resulted in 34 transplants (use rates: 70% vs. 85% [p = 0.052], respectively). After PSM, 34 NMP liver recipients were matched with 68 NRP liver recipients. The two cohorts were similar for donor functional warm ischemia time (21 min after NRP vs. 20 min after NMP; p = 0.17), UK-Donation After Circulatory Death risk score (5 vs. 5 points; p = 0.38), and laboratory Model for End-Stage Liver Disease scores (12 vs. 12 points; p = 0.83). The incidence of nonanastomotic biliary strictures (1.5% vs. 2.9%; p > 0.99), early allograft dysfunction (20.6% vs. 8.8%; p = 0.13), and 30-day graft loss (4.4% vs. 8.8%; p = 0.40) were similar, although peak posttransplant aspartate aminotransferase levels were higher in the NRP cohort (872 vs. 344 IU/L; p < 0.001). NRP livers were more frequently allocated to recipients suffering from hepatocellular carcinoma (HCC; 60.3% vs. 20.6%; p < 0.001). HCC-censored 2-year graft and patient survival rates were 91.5% versus 88.2% (p = 0.52) and 97.9% versus 94.1% (p = 0.25) after NRP and NMP, respectively. Both perfusion techniques achieved similar outcomes and appeared to match benchmarks expected for donation after brain death livers. This study may inform the design of a definitive trial.
在使用控制性心脏死亡后捐献（cDCD）的情况下，原位常温区域灌注（NRP）和离体常温机器灌注（NMP）旨在改善肝移植（LT）的结果。NRP 和 NMP 尚未直接进行比较。在这项国际观察性研究中，对 2015 年至 2019 年期间进行的 LT 结果进行了比较，这些 LT 是为接受 NRP 或 NMP 的 cDCD 供体器官进行的，这些供体器官在供体中心开始进行。使用倾向评分匹配（PSM）比较了 224 例 cDCD 捐赠者在进入心脏停搏前进行的 NRP 队列中的结果。在进展为心脏停搏的 224 例 cDCD 捐赠中，有 193 个肝脏被采集，导致 157 例移植。在 NMP 队列中，在所有 40 例病例中开始灌注，导致 34 例移植（使用率：70%对 85%[p=0.052]）。进行 PSM 后，34 例 NMP 肝受体与 68 例 NRP 肝受体相匹配。两个队列的供体功能温缺血时间（NRP 后 21 分钟与 NMP 后 20 分钟；p=0.17）、英国捐赠后循环死亡风险评分（5 分与 5 分；p=0.38）和实验室终末期肝病模型评分（12 分与 12 分；p=0.83）相似。非吻合胆道狭窄（1.5%对 2.9%；p>0.99）、早期移植物功能障碍（20.6%对 8.8%；p=0.13）和 30 天移植物丢失（4.4%对 8.8%；p=0.40）的发生率相似，尽管 NRP 队列中移植后天冬氨酸转氨酶峰值较高（872 对 344IU/L；p<0.001）。NRP 肝脏更频繁地分配给患有肝细胞癌（HCC）的受体（60.3%对 20.6%；p<0.001）。NRP 和 NMP 后 HCC 校正 2 年移植物和患者存活率分别为 91.5%对 88.2%（p=0.52）和 97.9%对 94.1%（p=0.25）。两种灌注技术均获得了相似的结果，并且似乎符合脑死亡供体肝脏的预期基准。本研究可能为确定试验的设计提供信息。
