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Utilization of livers donated after circulatory death for transplantation - An international comparison.
Eden, Janina; Sousa Da Silva, Richard; Cortes-Cerisuelo, Miriam; Croome, Kristopher; De Carlis, Riccardo; Hessheimer, Amelia J; Muller, Xavier; de Goeij, Femke; Banz, Vanessa; Magini, Giulia; Compagnon, Philippe; Elmer, Andreas; Lauterio, Andrea; Panconesi, Rebecca; Widmer, Jeannette; Dondossola, Daniele; Muiesan, Paolo; Monbaliu, Diethard; de Rosner van Rosmalen, Marieke; Detry, Olivier; Fondevila, Constantino; Jochmans, Ina; Pirenne, Jacques; Immer, Franz; Oniscu, Gabriel C; de Jonge, Jeroen; Lesurtel, Mickaël; De Carlis, Luciano G; Taner, C Burcin; Heaton, Nigel; Schlegel, Andrea; Dutkowski, Philipp.
Afiliação
  • Eden J; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
  • Sousa Da Silva R; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
  • Cortes-Cerisuelo M; Institute of Liver Studies, King's College Hospital, London, United Kingdom.
  • Croome K; Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States.
  • De Carlis R; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Hessheimer AJ; Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain.
  • Muller X; Department of Digestive Surgery & Liver Transplantation, Croix-Rousse Hospital, University of Lyon I, Lyon, France.
  • de Goeij F; Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Banz V; Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, University of Berne, Berne, Switzerland.
  • Magini G; Division of Transplantation, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
  • Compagnon P; Division of Transplantation, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
  • Elmer A; Swisstransplant, The Swiss National Foundation for Organ Donation and Transplantation Effingerstrasse 1, 3011 Bern, Switzerland.
  • Lauterio A; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
  • Panconesi R; General Surgery 2U-Liver Transplant Unit, Department of Surgery, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, 10124 Turin, Italy.
  • Widmer J; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
  • Dondossola D; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Centre of Preclinical Research, 20122, Italy.
  • Muiesan P; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Centre of Preclinical Research, 20122, Italy.
  • Monbaliu D; Department of Microbiology, Immunology and Transplantation, Transplantation Research Group, Lab of Abdominal Transplantation, KU Leuven, Belgium; Department of Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.
  • de Rosner van Rosmalen M; Eurotransplant International Foundation, Leiden, the Netherlands.
  • Detry O; Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium.
  • Fondevila C; Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain.
  • Jochmans I; Department of Microbiology, Immunology and Transplantation, Transplantation Research Group, Lab of Abdominal Transplantation, KU Leuven, Belgium; Department of Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.
  • Pirenne J; Department of Microbiology, Immunology and Transplantation, Transplantation Research Group, Lab of Abdominal Transplantation, KU Leuven, Belgium; Department of Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.
  • Immer F; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
  • Oniscu GC; Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
  • de Jonge J; Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Lesurtel M; Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France.
  • De Carlis LG; Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
  • Taner CB; Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States.
  • Heaton N; Institute of Liver Studies, King's College Hospital, London, United Kingdom.
  • Schlegel A; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Centre of Preclinical Research, 20122, Italy.
  • Dutkowski P; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland. Electronic address: philipp.dutkowski@usz.ch.
J Hepatol ; 78(5): 1007-1016, 2023 05.
Article em En | MEDLINE | ID: mdl-36740047
BACKGROUND & AIMS: Liver graft utilization rates are a hot topic due to the worldwide organ shortage and the increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially enable the assessment of livers before use. METHODS: Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht type III) arising during the past decade in eight countries, including Belgium, France, Italy, the Netherlands, Spain, Switzerland, the UK, and the US. Initial type-III DCD liver offers were correlated with accepted, recovered and implanted livers. RESULTS: A total number of 34,269 DCD livers were offered, resulting in 9,780 liver transplants (28.5%). The discard rates were highest in the UK and US, ranging between 70 and 80%. In contrast, much lower DCD liver discard rates, e.g. between 30-40%, were found in Belgium, France, Italy, Spain and Switzerland. In addition, we observed large differences in the use of various machine perfusion techniques, as well as in graft and donor risk factors. For example, the median donor age and functional donor warm ischemia time were highest in Italy, e.g. >40 min, followed by Switzerland, France, and the Netherlands. Importantly, such varying risk profiles of accepted DCD livers between countries did not translate into large differences in 5-year graft survival rates, which ranged between 60-82% in this analysis. CONCLUSIONS: Overall, DCD liver discard rates across the eight countries were high, although this primarily reflects the situation in the Netherlands, the UK and the US. Countries where in situ and ex situ machine perfusion strategies were used routinely had better DCD utilization rates without compromised outcomes. IMPACT AND IMPLICATIONS: A significant number of Maastricht type III DCD livers are discarded across Europe and North America today. The overall utilization rate among eight Western countries is 28.5% but varies significantly between 18.9% and 74.2%. For example, the median DCD-III liver utilization in five countries, e.g. Belgium, France, Italy, Switzerland, and Spain is 65%, in contrast to 24% in the Netherlands, UK and US. Despite this, and despite different rules and strategies for organ acceptance and preservation, 1- and 5-year graft survival rates remain fairly similar among all participating countries. A highly varying experience with modern machine perfusion technology was observed. In situ and ex situ liver perfusion concepts, and application of assessment tools for type-III DCD livers before transplantation, may be a key explanation for the observed differences in DCD-III utilization.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obtenção de Tecidos e Órgãos / Sistema Cardiovascular / Transplante de Fígado Tipo de estudo: Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obtenção de Tecidos e Órgãos / Sistema Cardiovascular / Transplante de Fígado Tipo de estudo: Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article