Dynamic Preservation of Donation After Circulatory Death Liver Grafts From Donors Aged 60 y and Older

Joris Blondeel; Otto B van Leeuwen; Ivo J Schurink; Veerle A Lantinga; Nicholas Gilbo; Femke H C de Goeij; Jacques Pirenne; Volkert A L Huurman; Vincent E de Meijer; Jeroen de Jonge; Robert J Porte; Diethard Monbaliu

doi:10.1097/TP.0000000000005297

Dynamic Preservation of Donation After Circulatory Death Liver Grafts From Donors Aged 60 y and Older

Transplantation. 2024 Dec 20. doi: 10.1097/TP.0000000000005297. Online ahead of print.

Authors

Joris Blondeel^{1

2}, Otto B van Leeuwen³, Ivo J Schurink⁴, Veerle A Lantinga³, Nicholas Gilbo^{1

5}, Femke H C de Goeij⁴, Jacques Pirenne^{1

2}, Volkert A L Huurman⁶, Vincent E de Meijer³, Jeroen de Jonge⁴, Robert J Porte⁴, Diethard Monbaliu^{1

2}

Affiliations

¹ Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
² Department of Abdominal Transplantation Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium.
³ Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
⁵ Department of Abdominal Surgery and Transplantation, CHU Liege, Liege, Belgium.
⁶ Department of Surgery, Leiden University Medical Center Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 39702514
DOI: 10.1097/TP.0000000000005297

Abstract

Background: Donor livers from older donation after circulatory death (DCD) donors are frequently discarded for transplantation because of the high risk of graft failure. It is unknown whether DCD livers from older donors benefit from dynamic preservation.

Methods: In a multicenter study, we retrospectively compared graft and patient outcomes after transplantation of livers from DCD donors older than 60 y, preserved with either static cold storage (SCS), ex situ sequential dual hypothermic perfusion, controlled oxygenated rewarming, and normothermic perfusion (DHOPE-COR-NMP), or in situ abdominal normothermic regional perfusion (aNRP).

Results: Fifty-six liver transplants were included in the SCS cohort, 33 in the DHOPE-COR-NMP cohort, and 27 in the aNRP cohort. Donor warm ischemia time was significantly shorter in the SCS group than in DHOPE-COR-NMP (P < 0.001) and aNRP (P < 0.001) groups. Cold ischemia times were similar. One-year incidence of nonanastomotic biliary strictures was lower after DHOPE-COR-NMP (3%, P = 0.03) or aNRP (7%, P = 0.13), compared with SCS alone (21%). Anastomotic strictures were less frequent in aNRP (19%) compared with DHOPE-COR-NMP (52%; P = 0.015). One-year graft and patient survival were similar.

Conclusions: Dynamic preservation allows safe transplantation of livers from DCD donors aged 60 y or older. The risk of nonanastomotic strictures was significantly lower after DHOPE-COR-NMP than after SCS, despite longer donor warm ischemia times.