Liver graft from donation after circulatory death donor: Real practice to improve graft viability
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Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while ex vivo machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.
Abstract
Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while ex vivo machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.
참고문헌 (49)
- Reich DJ, "ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation", Am J Transplant, 9, pp.2004~2011 (2009)
- Kootstra G, "Categories of non-heart-beating donors", Transplant Proc, 27, pp.2893~2894 (1995)
- Fondevila C, "Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation", Am J Transplant, 12, pp.162~170 (2012)
- Laing RW, "Liver transplantation using grafts from donors after circulatory death : a propensity score-matched study from a single center", Am J Transplant, 16, pp.1795~1804 (2016)
- Croome KP, "Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensitymatched cohort", Liver Transpl, 23, pp.342~351 (2017)
- Mathur AK, "Donation after cardiac death liver transplantation : predictors of outcome", Am J Transplant, 10, pp.2512~2519 (2010)
- Schlegel A, "The UK DCD Risk Score : a new proposal to define futility in donation-after-circulatory-death liver transplantation", J Hepatol, 68, pp.456~464 (2018)
- Croome KP, "Outcomes of donation after circulatory death liver grafts from donors 50 years or older : a multicenter analysis", Transplantation, 102, pp.1108~1114 (2018)
- Firl DJ, "Impact of donor age in liver transplantation from donation after circulatory death donors : a decade of experience at Cleveland Clinic", Liver Transpl, 21, pp.1494~1503 (2015)
- Schlegel A, "Impact of donor age in donation after circulatory death liver transplantation : is the cutoff"60"still of relevance?", Liver Transpl, 24, pp.352~362 (2018)
- Lee KW, "Factors affecting graft survival after liver transplantation from donation after cardiac death donors", Transplantation, 82, pp.1683~1688 (2006)
- Cao Y, "Donation after circulatory death for liver transplantation : a meta-analysis on the location of life support withdrawal affecting outcomes", Transplantation, 100, pp.1513~1524 (2016)
- Casavilla A, "Experience with liver and kidney allografts from non-heartbeating donors", Transplantation, 59, pp.197~203 (1995)
- Agrawal A, "Correlation of patient age with CT-measured aortasacral promontory distance", Int Urogynecol J, 26, pp.887~891 (2015)
- DuBois JM, "When organ donors are still patients : is premortem use of heparin ethically acceptable?", Am J Crit Care, 16, pp.396~400 (2007)
- Narvaez JRF, "Transplant outcomes of donation after circulatory death livers recovered with versus without premortem heparin administration", Liver Transpl, 26, pp.247~255 (2020)
- Fung JJ, "Using livers from donation after cardiac death donors--a proposal to protect the true Achilles heel", Liver Transpl, 13, pp.1633~1636 (2007)
- Mangus RS, "Comparison of histidine-tryptophan-ketoglutarate solution and University of Wisconsin solution in extended criteria liver donors", Liver Transpl, 14, pp.365~373 (2008)
- Gulsen MT, "HTK preservative solution is associated with increased biliary complications among patients receiving DCD liver transplants : a single center experience", Ann Transplant, 18, pp.69~75 (2013)
- Stewart ZA, "Histidine-Tryptophan-Ketoglutarate(HTK)is associated with reduced graft survival in deceased donor livers, especially those donated after cardiac death", Am J Transplant, 9, pp.286~293 (2009)
- Feng S, "Characteristics associated with liver graft failure : the concept of a donor risk index", Am J Transplant, 6, pp.783~790 (2006)
- Abt P, "Liver transplantation from controlled non-heart-beating donors : an increased incidence of biliary complications", Transplantation, 75, pp.1659~1663 (2003)
- Mateo R, "Risk factors for graft survival after liver transplantation from donation after cardiac death donors : an analysis of OPTN", UNOS data, 2006, pp.6, 791~796
- de Vera ME, "Liver transplantation using donation after cardiac death donors : long-term follow-up from a single center", Am J Transplant, 9, pp.773~781 (2009)
- Chan EY, "Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors", Liver Transpl, 14, pp.604~610 (2008)
- Foley DP, "Biliary complications after liver transplantation from donation after cardiac death donors : an analysis of risk factors and long-term outcomes from a single center", Ann Surg, 253, pp.817~825 (2011)
- Abt PL, "Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation", Liver Transpl, 20, pp.165~172 (2014)
- Firl DJ, "Role of donor hemodynamic trajectory in determining graft survival in liver transplantation from donation after circulatory death donors", Liver Transpl, 22, pp.1469~1481 (2016)
- Taner CB, "Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors", Transpl Int, 25, pp.838~846 (2012)
- Maheshwari A, "Biliary complications and outcomes of liver transplantation from donors after cardiac death", Liver Transpl, 13, pp.1645~1653 (2007)
- Skaro AI, "The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death : the untold story", Surgery, 146, pp.543~552 (2009)
- Yamamoto K, "Three-dimensional observations of the hepatic arterial terminations in rat, hamster and human liver by scanning electron microscopy of microvascular casts", Hepatology, 5, pp.452~456 (1985)
- Hashimoto K, "Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors", Am J Transplant, 10, pp.2665~2672 (2010)
- Du Z, "Warm ischemia may damage peribiliary vascular plexus during DCD liver transplantation", Int J Clin Exp Med, 8, pp.758~763 (2015)
- op den Dries S, "Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures", J Hepatol, 60, pp.1172~1179 (2014)
- Verhoeven CJ, "Liver grafts procured from donors after circulatory death have no increased risk of microthrombi formation", Liver Transpl, 22, pp.1676~1687 (2016)
- Pinna AD, "Urgent revascularization of liver allografts after early hepatic artery thrombosis", Transplantation, 62, pp.1584~1587 (1996)
- Fujiki M, "Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients", Surgery, 162, pp.1101~1111 (2017)
- Eghtesad B, "Use of tissue plasminogen activator(TPA)in liver transplantation from donation after cardiac death(DCD)donors : a controlled randomized trial", Am J Transplant, 15, pp.275~ (2015)
- Seal JB, "Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors", Liver Transpl, 21, pp.321~328 (2015)
- Bohorquez H, "Safety and outcomes in 100 consecutive donation after circulatory death liver transplants using a protocol that includes thrombolytic therapy", Am J Transplant, 17, pp.2155~2164 (2017)
- Kubal C, "Optimization of perioperative conditions to prevent ischemic cholangiopathy in donation after circulatory death donor liver transplantation", Transplantation, 100, pp.1699~1704 (2016)
- Dutkowski P, "First comparison of hypothermic oxygenated perfusion versus static cold storage of human donation after cardiac death liver transplants : an international-matched case analysis", Ann Surg, 262, pp.764~770 (2015)
- van Rijn R, "Dual hypothermic oxygenated machine perfusion in liver transplants donated after circulatory death", Br J Surg, 104, pp.907~917 (2017)
- Schlegel A, "Outcomes of DCD liver transplantation using organs treated by hypothermic oxygenated perfusion before implantation", J Hepatol, 70, pp.50~57 (2019)
- Ravikumar R, "Liver transplantation after ex vivo normothermic machine preservation : a phase 1(first-in-man)clinical trial", Am J Transplant, 16, pp.1779~1787 (2016)
- Selzner M, "Normothermic ex vivo liver perfusion using steen solution as perfusate for human liver transplantation : First North American results", Liver Transpl, 22, pp.1501~1508 (2016)
- Bral M, "Preliminary single-center Canadian experience of human normothermic ex vivo liver perfusion : results of a clinical trial", Am J Transplant, 17, pp.1071~1080 (2017)
- Nasralla D, "A randomized trial of normothermic preservation in liver transplantation", Nature, 557, pp.50~56 (2018)