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Normothermic Machine Perfusion of Donor Livers for Transplantation in the United States: A Randomized Controlled Trial.
Chapman, William C; Barbas, Andrew S; D'Alessandro, Anthony M; Vianna, Rodrigo; Kubal, Chandrashekhar A; Abt, Peter; Sonnenday, Christopher; Barth, Rolf; Alvarez-Casas, Josue; Yersiz, Hasan; Eckhoff, Devin; Cannon, Robert; Genyk, Yuri; Sher, Linda; Singer, Andrew; Feng, Sandy; Roll, Garrett; Cohen, Ari; Doyle, Maria B; Sudan, Debra L; Al-Adra, David; Khan, Adeel; Subramanian, Vijay; Abraham, Nader; Olthoff, Kim; Tekin, Akin; Berg, Lynn; Coussios, Constantin; Morris, Chris; Randle, Lucy; Friend, Peter; Knechtle, Stuart J.
Afiliação
  • Chapman WC; Department of Surgery, School of Medicine, Washington University, St. Louis.
  • Barbas AS; Department of Surgery, Duke University School of Medicine.
  • D'Alessandro AM; Department of Surgery, School of Medicine, University of Wisconsin, Madison.
  • Vianna R; Department of Surgery, University of Miami School of Medicine.
  • Kubal CA; Department of Surgery, Indiana University School of Medicine.
  • Abt P; Department of Surgery, University of Pennsylvania School of Medicine.
  • Sonnenday C; Department of Surgery, University of Michigan School of Medicine.
  • Barth R; Department of Surgery, University of Chicago School of Medicine.
  • Alvarez-Casas J; Department of Surgery, University of Maryland School of Medicine.
  • Yersiz H; Department of Surgery, David Geffen School of Medicine at UCLA.
  • Eckhoff D; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
  • Cannon R; Department of Surgery, University of Alabama School of Medicine.
  • Genyk Y; Department of Surgery, Keck School of Medicine of USC.
  • Sher L; Department of Surgery, Keck School of Medicine of USC.
  • Singer A; Department of Surgery, Mayo Clinic, Arizona.
  • Feng S; Department of Surgery, UCSF School of Medicine.
  • Roll G; Department of Surgery, UCSF School of Medicine.
  • Cohen A; Department of Surgery, Ochsner Clinic.
  • Doyle MB; Department of Surgery, School of Medicine, Washington University, St. Louis.
  • Sudan DL; Department of Surgery, Duke University School of Medicine.
  • Al-Adra D; Department of Surgery, School of Medicine, University of Wisconsin, Madison.
  • Khan A; Department of Surgery, School of Medicine, Washington University, St. Louis.
  • Subramanian V; Department of Surgery, Tampa General Hospital.
  • Abraham N; Department of Surgery, Duke University School of Medicine.
  • Olthoff K; Department of Surgery, University of Pennsylvania School of Medicine.
  • Tekin A; Department of Surgery, University of Miami School of Medicine.
  • Berg L; Department of Surgery, School of Medicine, University of Wisconsin, Madison.
  • Coussios C; Department of Surgery, Ochsner Medical Center, New Orleans, LA.
  • Morris C; Department of Surgery, Ochsner Medical Center, New Orleans, LA.
  • Randle L; Department of Surgery, Ochsner Medical Center, New Orleans, LA.
  • Friend P; Department of Surgery, Ochsner Medical Center, New Orleans, LA.
  • Knechtle SJ; Department of Surgery, Duke University School of Medicine.
Ann Surg ; 278(5): e912-e921, 2023 Nov 01.
Article em En | MEDLINE | ID: mdl-37389552
OBJECTIVE: To compare conventional low-temperature storage of transplant donor livers [static cold storage (SCS)] with storage of the organs at physiological body temperature [normothermic machine perfusion (NMP)]. BACKGROUND: The high success rate of liver transplantation is constrained by the shortage of transplantable organs (eg, waiting list mortality >20% in many centers). NMP maintains the liver in a functioning state to improve preservation quality and enable testing of the organ before transplantation. This is of greatest potential value with organs from brain-dead donor organs (DBD) with risk factors (age and comorbidities), and those from donors declared dead by cardiovascular criteria (donation after circulatory death). METHODS: Three hundred eighty-three donor organs were randomized by 15 US liver transplant centers to undergo NMP (n = 192) or SCS (n = 191). Two hundred sixty-six donor livers proceeded to transplantation (NMP: n = 136; SCS: n = 130). The primary endpoint of the study was "early allograft dysfunction" (EAD), a marker of early posttransplant liver injury and function. RESULTS: The difference in the incidence of EAD did not achieve significance, with 20.6% (NMP) versus 23.7% (SCS). Using exploratory, "as-treated" rather than "intent-to-treat," subgroup analyses, there was a greater effect size in donation after circulatory death donor livers (22.8% NMP vs 44.6% SCS) and in organs in the highest risk quartile by donor risk (19.2% NMP vs 33.3% SCS). The incidence of acute cardiovascular decompensation at organ reperfusion, "postreperfusion syndrome," as a secondary outcome was reduced in the NMP arm (5.9% vs 14.6%). CONCLUSIONS: NMP did not lower EAD, perhaps related to the inclusion of lower-risk liver donors, as higher-risk donor livers seemed to benefit more. The technology is safe in standard organ recovery and seems to have the greatest benefit for marginal donors.

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Risk_factors_studies Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Risk_factors_studies Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article