Shifting from donor to donor-recipient matching perspective in defining indications for machine perfusion in liver trans
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LETTER TO THE EDITOR
Shifting from donor to donor‑recipient matching perspective in defining indications for machine perfusion in liver transplantation Damiano Patrono1 · Francesco Lupo1 · Renato Romagnoli1 Received: 26 May 2020 / Accepted: 10 June 2020 © Italian Society of Surgery (SIC) 2020
Abstract Optimization of donor-recipient matching is a common concept in liver transplantation. In emergency transplant for acute liver failure, outcome is influenced by timing, patient clinical condition, and graft quality. Although factors like advanced donor age have been linked to a poorer outcome, use of suboptimal or marginal grafts can be inevitable in very unstable patients, if no other graft is available. We present a case of a liver transplant performed in an extremely sick patient suffering from HBV-related fulminant hepatitis, in which a compatible graft from a 76-year-old deceased donor became available only after 3 days of waiting time, during which his conditions further deteriorated. Given the suboptimal matching, normothermic machine perfusion was applied to minimize ischemia-reperfusion injury. Use of machine perfusion could find an indication to modulate the risk associated with an unfavorable donor-recipient matching in high-risk cases. Keywords Acute liver failure · Extended criteria donor · Normothermic machine perfusion
To the editor Optimization of donor-recipient matching is a concept liver transplant (LT) physicians are very familiar with. Optimal outcome can be achieved by allocating high-risk grafts to low-risk recipients, or vice versa, whereas coupling a highrisk donor and recipient may result in a futile transplant. Unfortunately, if the “right” graft is not timely available for a very sick recipient, the choice is between accepting an unfavorable match or declining organ offer, possibly missing the therapeutic window. Acute liver failure (ALF) represents a paradigm scenario in which LT outcome is influenced by timing, patient clinical condition, and graft quality. Donor age > 60 years and use of non-whole, ABO-incompatible or steatotic grafts have been linked to poorer outcome after LT for ALF [1, 2]. Unfortunately, these parameters are beyond manipulation. In November 2019, a 39-year-old gentleman with HBVrelated ALF was waitlisted for emergency LT with grade four encephalopathy and MELD 41 (creatinine 1.86 mg/dL; * Renato Romagnoli [email protected] 1
General Surgery 2U ‑ Liver Transplant Unit, A.O.U. Città Della Salute E Della Scienza Di Torino, University of Turin, Corso Bramante 88‑90, 10126 Turin, Italy
bilirubin 43.1 mg/dL; INR 3.60). An ABO-compatible graft became available three days later, during which he required escalating vasopressors support and developed oliguria and respiratory insufficiency. Donor was a 76-year-old braindead female with severe atheromatosis and a previous cardiac arrest, but normal liver function. Graft was accepted feeling that it represented patient’s last chance, with a plan to use normothermic machine perfusion (NMP) to minimize ischemia–re
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