Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
Current Gastroenterology Reports
Erschienen in: Current Gastroenterology Reports 12/2023

28.10.2023

Modern-Day Practice of DCD Liver Transplantation: Controversies, Innovations, and Future Directions

verfasst von: Omar J. Haque, Eve M. Roth, David D. Lee

Erschienen in: Current Gastroenterology Reports | Ausgabe 12/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Over the past decade, donation after circulatory death (DCD) liver transplantation has expanded in the United States due to improved surgical experience and perioperative management. Despite these advances, there remains a reluctance towards broader utilization of DCD liver allografts due to lack of standardized donation process, concern for inferior graft survival, and risk of ischemic cholangiopathy associated with temporary lack of oxygenated perfusion during withdrawal of life-supporting treatment during procurement.

Recent Findings

New perfusion technologies offer potential therapeutic options to mitigate biliary complications and expand utilization of marginal DCD grafts. As these modalities enter routine clinical practice, DCD utilization will continue to increase, and liver allocation policies in turn will evolve to reflect this growing practice.

Summary

This review describes recent progress in DCD LT, current challenges with utilization of DCD liver allografts, and how novel technologies and policies could impact the future of the field.
Literatur
1.
Thuong M, Ruiz A, Evrard P, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int Off J Eur Soc Organ Transplant. 2016;29(7):749–59.
2.
Foley DP, Fernandez LA, Leverson G, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242(5):724–31.CrossRefPubMedPubMedCentral
3.
Skaro AI, Jay CL, Baker TB, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surg. 2009;146(4):543–52 (discussion 552–553).CrossRef
4.
Jay C, Ladner D, Wang E, et al. A comprehensive risk assessment of mortality following donation after cardiac death liver transplant - an analysis of the national registry. J Hepatol. 2011;55(4):808–13.CrossRefPubMedPubMedCentral
5.
Haque O, Yuan Q, Uygun K, Markmann JF. Evolving utilization of donation after circulatory death livers in liver transplantation: The day of DCD has come. Clin Transplant. 2021;35(3): e14211.CrossRefPubMedPubMedCentral
6.
Mathur AK, Heimbach J, Steffick DE, Sonnenday CJ, Goodrich NP, Merion RM. Donation after cardiac death liver transplantation: predictors of outcome. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2010;10(11):2512–9.CrossRef
7.
Cappucci SP, Smith WS, Schwartzstein R, White DB, Mitchell SL, Fehnel CR. End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review. The Neurohospitalist. 2023;13(1):61–8.CrossRefPubMed
8.
Haque OJ, Roth EM, Fleishman A, Eckhoff DE, Khwaja K. Long-Term Outcomes of Early Experience in Donation After Circulatory Death Liver Transplantation: Outcomes at 10 Years. Ann Transplant. 2021;26: e930243.CrossRefPubMedPubMedCentral
9.
Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2006;6(4):791–6.CrossRef
10.
11.
Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2009;9(9):2004–11.CrossRef
12.
Andrews PA, Burnapp L, Manas D. British Transplantation Society. Summary of the British Transplantation Society guidelines for transplantation from donors after deceased circulatory death. Transplant. 2014;97(3):265–70.CrossRef
13.
Braat AE, Blok JJ, Putter H, et al. The Eurotransplant donor risk index in liver transplantation: ET-DRI. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2012;12(10):2789–96.CrossRef
14.
Kalisvaart M, Croome KP, Hernandez-Alejandro R, et al. Donor Warm Ischemia Time in DCD Liver Transplantation-Working Group Report From the ILTS DCD, Liver Preservation, and Machine Perfusion Consensus Conference. Transplant. 2021;105(6):1156–64.CrossRef
15.
Schlegel A, van Reeven M, Croome K, et al. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation. J Hepatol. 2022;76(2):371–82.CrossRefPubMed
16.
Croome KP, Lee DD, Perry DK, et al. Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity-matched cohort. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2017;23(3):342–51.
17.
Laing RW, Scalera I, Isaac J, et al. Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score-Matched Study From a Single Center. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2016;16(6):1795–804.CrossRef
18.•
Croome KP, Mathur AK, Aqel B, et al. Classification of Distinct Patterns of Ischemic Cholangiopathy Following DCD Liver Transplantation: Distinct Clinical Courses and Long-term Outcomes From a Multicenter Cohort. Transplantation. 2022;106(6):1206–1214. This article describes the spectrum of ischemic cholangiopathy patterns and clarifies that not all instances of cholangiopathy result in graft failure.
19.
Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation. Dig Dis Basel Switz. 1999;17(3):133–44.CrossRef
20.
Mourad MM, Algarni A, Liossis C, Bramhall SR. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation. World J Gastroenterol. 2014;20(20):6159–69.CrossRefPubMedPubMedCentral
21.
Allen AM, Kim WR, Xiong H, et al. Survival of recipients of livers from donation after circulatory death who are relisted and undergo retransplant for graft failure. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2014;14(5):1120–8.CrossRef
22.
Croome KP, Lee DD, Nguyen JH, Keaveny AP, Taner CB. Waitlist Outcomes for Patients Relisted Following Failed Donation After Cardiac Death Liver Transplant: Implications for Awarding Model for End-Stage Liver Disease Exception Scores. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2017;17(9):2420–7.CrossRef
23.
Hashimoto K, Eghtesad B, Gunasekaran G, et al. Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2010;10(12):2665–72.CrossRef
24.
Seal JB, Bohorquez H, Reichman T, et al. Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2015;21(3):321–8.
25.
Haque O, Raigani S, Rosales I, et al. Thrombolytic Therapy During ex-vivo Normothermic Machine Perfusion of Human Livers Reduces Peribiliary Vascular Plexus Injury. Front Surg. 2021;8: 644859.CrossRefPubMedPubMedCentral
26.
Halldorson JB, Bakthavatsalam R, Montenovo M, et al. Differential rates of ischemic cholangiopathy and graft survival associated with induction therapy in DCD liver transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2015;15(1):251–8.CrossRef
27.
Ig-Izevbekhai K, Goldberg DS, Karp SJ, Foley DP, Abt PL. Immunosuppression in Donation After Circulatory Death Liver Transplantation: Can Induction Modify Graft Survival? Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2020;26(9):1154–66.
28.
29.
Magliocca JF, Magee JC, Rowe SA, et al. Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005;58(6):1095–101 (discussion 1101–1102).CrossRefPubMed
30.
Hunt F, Johnston CJC, Coutts L, et al. From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies. Transpl Int Off J Eur Soc Organ Transplant. 2022;35:10493.
31.•
Hessheimer AJ, de la Rosa G, Gastaca M, et al. Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2022;22(4):1169–1181. This manuscript presents one of the largest experiences from the Spanish transplant registry, demonstrating superior outcomes.
32.
Hessheimer AJ, Coll E, Torres F, et al. Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation. J Hepatol. 2019;70(4):658–65.CrossRefPubMed
33.
Watson CJE, Hunt F, Messer S, et al. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2019;19(6):1745–58.CrossRef
34.
Mergental H, Perera MTPR, Laing RW, et al. Transplantation of Declined Liver Allografts Following Normothermic Ex-Situ Evaluation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2016;16(11):3235–45.CrossRef
35.
Jassem W, Xystrakis E, Ghnewa YG, et al. Normothermic Machine Perfusion (NMP) Inhibits Proinflammatory Responses in the Liver and Promotes Regeneration. Hepatol Baltim Md. 2019;70(2):682–95.CrossRef
36.•
Nasralla D, Coussios CC, Mergental H, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50–56. This paper reports the first randomized controlled trial using ex vivo normothermic perfusion in liver transplantation.
37.•
Markmann JF, Abouljoud MS, Ghobrial RM, et al. Impact of Portable Normothermic Blood-Based Machine Perfusion on Outcomes of Liver Transplant: The OCS Liver PROTECT Randomized Clinical Trial. JAMA Surg. 2022;157(3):189–198. This paper rerports the first american randomized trial using normothermic perfusion in liver transplantation.
38.•
Czigany Z, Schöning W, Ulmer TF, et al. Hypothermic oxygenated machine perfusion (HOPE) for orthotopic liver transplantation of human liver allografts from extended criteria donors (ECD) in donation after brain death (DBD): a prospective multicentre randomised controlled trial (HOPE ECD-DBD). BMJ Open. 2017;7(10):e017558. This paper reports the first randomized trial using hypothermic machine perfusion in liver transplantation.
39.
Schlegel A, Porte R, Dutkowski P. Protective mechanisms and current clinical evidence of hypothermic oxygenated machine perfusion (HOPE) in preventing post-transplant cholangiopathy. J Hepatol. 2022;76(6):1330–47.CrossRefPubMed
40.••
Eden J, Sousa Da Silva R, Cortes-Cerisuelo M, et al. Utilization of livers donated after circulatory death for transplantation - An international comparison. J Hepatol. 2023;78(5):1007–1016. This excellent international comparison outlines some of the challenges that impede broader utilization of DCD.
41.
Hessheimer AJ, Gastaca M, Miñambres E, Colmenero J, Fondevila C. in representation of the SETH Working Group on DCD. Donation after circulatory death liver transplantation: consensus statements from the Spanish Liver Transplantation Society. Transpl Int Off J Eur Soc Organ Transplant. 2020;33(8):902–16.
Metadaten
Titel
Modern-Day Practice of DCD Liver Transplantation: Controversies, Innovations, and Future Directions
verfasst von
Omar J. Haque
Eve M. Roth
David D. Lee
Publikationsdatum
28.10.2023
Verlag
Springer US
Erschienen in
Current Gastroenterology Reports / Ausgabe 12/2023
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-023-00902-8

Weitere Artikel der Ausgabe 12/2023

Current Gastroenterology Reports 12/2023 Zur Ausgabe

ReviewPaper

Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?

ReviewPaper

Esophageal Radiography Interpretation: a Primer for the Gastroenterologist

ReviewPaper

Barrier Dysfunction in Eosinophilic Esophagitis

ReviewPaper

Chronic Liver Disease in the Older Patient—Evaluation and Management

ReviewPaper

ARFID at 10 years: A Review of Medical, Nutritional and Psychological Evaluation and Management

ReviewPaper

Revisiting Proton Pump Inhibitors as Chemoprophylaxis Against the Progression of Barrett’s Esophagus

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Semaglutid bei Herzinsuffizienz: Wie erklärt sich die Wirksamkeit?

17.05.2024 Herzinsuffizienz Nachrichten

Bei adipösen Patienten mit Herzinsuffizienz des HFpEF-Phänotyps ist Semaglutid von symptomatischem Nutzen. Resultiert dieser Benefit allein aus der Gewichtsreduktion oder auch aus spezifischen Effekten auf die Herzinsuffizienz-Pathogenese? Eine neue Analyse gibt Aufschluss.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise