Article (Scientific journals)
Utilization of livers donated after circulatory death for transplantation - An international comparison.
Eden, Janina; Da Silva, Richard Sousa; Cortes-Cerisuelo, Miriam et al.
2023In Journal of Hepatology, 78 (5), p. 1007-1016
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Keywords :
assessment of liver quality; donor risk; liver utilization; machine perfusion; outcome; Hepatology
Abstract :
[en] [en] BACKGROUND AND AIM: Liver graft utilization rates are a hot topic due to the worldwide organ shortage and an 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 allow 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, UK, and US. Initial DCD-type-III 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 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, large differences were recognized in the use of various machine perfusion techniques, and in terms of risk factors in the cohorts of implanted livers. For example, the median donor age and functional donor warm ischemia were highest in Italy, e.g., >40minutes, 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 five-year graft survival rates, which ranged between 60-82% in this analysis. CONCLUSIONS: We highlight a significant number of discarded and consequently unused DCD liver offers. Countries with more routine use of in- and ex-situ machine perfusion strategies showed better DCD utilization rates without compromised outcome. 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, the one and five-year graft survival remains currently relatively comparable among all participating countries. Factors which impact on DCD liver acceptance rates include the national pre-selections of donors, before the offer is made, as well as cutoffs for key risk factors, including donor age and donor warm ischemia time. In addition, a highly varying experience with modern machine perfusion technology is noticed. In situ and ex situ liver perfusion concepts, and assessment tools for type III DCD livers before transplantation may be one key part for the observed differences in better DCD III utilization.
Disciplines :
Surgery
Gastroenterology & hepatology
Author, co-author :
Eden, Janina ;  Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
Da Silva, Richard Sousa ;  Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
Cortes-Cerisuelo, Miriam;  Institute of Liver Studies, King's College Hospital, London, United Kingdom
Croome, Kristopher;  Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States
De Carlis, Riccardo ;  Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Hessheimer, Amelia J ;  Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
Muller, Xavier ;  Department of Digestive Surgery & Liver Transplantation, Croix-Rousse Hospital, University of Lyon I, Lyon, France
de Goeij, Femke ;  Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
Banz, Vanessa;  Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, University of Berne, Berne, Switzerland
Magini, Giulia ;  Division of Transplantation, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
Compagnon, Philippe;  Division of Transplantation, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
Elmer, Andreas;  Swisstransplant, The Swiss National Foundation for Organ Donation and Transplantation Effingerstrasse 1, 3011 Bern, Switzerland
Lauterio, Andrea ;  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, Rebecca;  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, Jeannette ;  Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
Dondossola, Daniele ;  General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Centre of Preclinical Research, 20122, Italy
Muiesan, Paolo;  General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Centre of Preclinical Research, 20122, Italy
Monbaliu, Diethard;  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, Marieke;  Eurotransplant International Foundation, Leiden, the Netherlands
Detry, Olivier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Fondevila, Constantino ;  Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
Jochmans, Ina ;  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, Jacques ;  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, Franz;  Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
Oniscu, Gabriel C;  Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
de Jonge, Jeroen;  Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
Lesurtel, Mickaël ;  Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
De Carlis, Luciano G ;  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, C Burcin ;  Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States
Heaton, Nigel;  Institute of Liver Studies, King's College Hospital, London, United Kingdom
Schlegel, Andrea ;  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, Philipp;  Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland. Electronic address: philipp.dutkowski@usz.ch
More authors (22 more) Less
Language :
English
Title :
Utilization of livers donated after circulatory death for transplantation - An international comparison.
Publication date :
03 May 2023
Journal title :
Journal of Hepatology
ISSN :
0168-8278
eISSN :
1600-0641
Publisher :
Elsevier BV, Netherlands
Volume :
78
Issue :
5
Pages :
1007-1016
Peer reviewed :
Peer Reviewed verified by ORBi
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