1
|
Viguera L, Blasi A, Reverter E, Arjona B, Caballero M, Chocron I, García-López JA, Gutierrez R, Martin MJ, Pérez-Peña J, Pitera J, Zarragoikoetxea I, Sabaté A, Belmonte C, Bustamante J, Beltran J, Colmenero J, Costa M, Fondevila C, Galan P, García-Palenciano C, Garrido JL, Gomez-Serrano J, Gonzalez S, de la Fuente JC, Jimeno C, Leon A, Lopez-Toribio P, Marín A, Del Mazo A, de Nadal M, Ojinaga G, Padilla J, Tevar J, Torres M, Zaballos M. Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality. Int J Surg 2021; 96:106169. [PMID: 34848373 DOI: 10.1016/j.ijsu.2021.106169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD). METHODS 591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery. RESULTS 447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients. CONCLUSIONS cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.
Collapse
Affiliation(s)
- Laura Viguera
- Anaesthesia Department, Hospital Clinic de Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Reina Sofia, Spain Anaesthesia Department, Hospital Vall d'Hebron, Spain Anaesthesia Department, Hospital Clínico Universitario Virgen de la Arrixaca, Spain Anaesthesia Department, Hospital de Cruces, Spain Anaesthesia Department, Hospital Universitario de Badajoz, Spain Anaesthesia Department, Hospital Universitario de la Fe, Spain Anaesthesia Department, Hospital Universiari Bellvitge, Spain Hepatology Department, Hospital Clinic Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Universitario Gregorio Marañon de Madrid, Spain Surgery Department, Hospital Clinic de Barcelona, IDIBAPS, Spain Anaesthesia Department, Hospital Universitari Bellvitge, Spain Hepatology Department, Hospital Clinic Barcelona, Spain Anaesthesia Department, Complejo Hospitalario Universitario A Coruña, Spain Anaesthesia Department, Hospital Universitario Gregorio Marañón Madrid, Spain Anaesthesia Department, Hospital Universitari Bellvitge, University of Barcelona, IDIBELL, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|