Liver transplantation using uncontrolled non–heart-beating donors under normothermic extracorporeal membrane oxygenation

Authors

  • Santos Jiménez-Galanes,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Marchán Juan Carlos Meneu-Diaz,

    Corresponding author
    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
    • Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain 28109
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    • Telephone: 91-390-8264; FAX: 91-390-8523

  • Almudena Moreno Elola-Olaso,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Baltasar Pérez-Saborido,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Fundora-Suarez Yiliam,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Alberto Gimeno Calvo,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Manuel Abradelo Usera,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Mercedes Catalán González,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Juan Carlos Montejo González,

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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  • Enrique Moreno González

    1. Digestive Surgery and Abdominal Organ Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain
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Abstract

Because of the organ shortage, non–heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non–heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non–heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 ± 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs. Liver Transpl 15:1110–1118, 2009. © 2009 AASLD.

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