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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 Maggio;81(5):507-15
Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse
Valenza F. 1, 6, Villa A. 6, Froio S. 1, Coppola S. 1, Barretta F. 2, 3, Melada E. 4, Gatti S. 4, 5, 6, Avalli L. 7, Citerio G. 8, 9, Rossi G. E. 4, 5, 6, Gattinoni L. 1, 6 ✉
1 Dipartimento di Anestesia Rianimazione (Intensiva e Subintensiva) e Terapia del dolore, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milano, Italia;
2 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;
3 Epidemiology Unit, Department of Preventive Medicine, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy;
4 Unità Operativa di Chirurgia Generale e Trapianti di Fegato-Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milano, Italia;
5 Centro di Ricerche Chirurgiche Precliniche, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italia;
6 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Università degli Studi di Milano, Milano, Italia;
7 Servizio di Anestesia e Rianimazione 1, Unità Operativa Semplice di Anestesia e Terapia Intensiva CCH, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italia;
8 Department of Health Science, University of Milan-Bicocca, Monza, Italy;
9 Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
BACKGROUND: Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio-circulatory collapse.
METHODS: We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio-circulatory arrest before organ procurement (RCA); those who experienced sustained cardio-circulatory collapse, treated with extra-corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non-Function (PNF), and complications during the first 30 days were analysed.
RESULTS: 102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor’s death was post-anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17-43], 54 [34-92], 716 [190-962] respectively, SGPT 17 [12-34], 46 [27-73], 84 [51-175] UI/L respectively, both P<0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End-Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar.
CONCLUSION: The use of livers procured from donors after brain death that experienced transient or sustained cardio-circulatory collapse was associated with early graft function comparable to that of standard donors.