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Karangwa SA, Adelmeijer J, Burgerhof JGM, Lisman T, de Meijer VE, de Kleine RH, Reyntjens KMEM, van den Berg AP, Porte RJ, de Boer MT. Controlled DCD Liver Transplantation Is Not Associated With Increased Hyperfibrinolysis and Blood Loss After Graft Reperfusion. Transplantation 2022; 106:308-317. [PMID: 33606482 DOI: 10.1097/tp.0000000000003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The specific effect of donation after circulatory death (DCD) liver grafts on fibrinolysis, blood loss, and transfusion requirements after graft reperfusion is not well known. The aim of this study was to determine whether transplantation of controlled DCD livers is associated with an elevated risk of hyperfibrinolysis, increased blood loss, and higher transfusion requirements upon graft reperfusion, compared with livers donated after brain death (DBD). METHODS A retrospective single-center analysis of all adult recipients of primary liver transplantation between 2000 and 2019 was performed (total cohort n = 628). Propensity score matching was used to balance baseline characteristics for DCD and DBD liver recipients (propensity score matching cohort n = 218). Intraoperative and postoperative hemostatic variables between DCD and DBD liver recipients were subsequently compared. Additionally, in vitro plasma analyses were performed to compare the intraoperative fibrinolytic state upon reperfusion. RESULTS No significant differences in median (interquartile range) postreperfusion blood loss (1.2 L [0.5-2.2] versus 1.3 L [0.6-2.2]; P = 0.62), red blood cell transfusion (2 units [0-4] versus 1.1 units [0-3]; P = 0.21), or fresh frozen plasma transfusion requirements (0 unit [0-2.2] versus 0 unit [0-0.9]; P = 0.11) were seen in DCD compared with DBD recipients, respectively. Furthermore, plasma fibrinolytic potential was similar in both groups. CONCLUSIONS Transplantation of controlled DCD liver grafts does not result in higher intraoperative blood loss or more transfusion requirements, compared with DBD liver transplantation. In accordance with this, no evidence for increased hyperfibrinolysis upon reperfusion in DCD compared with DBD liver grafts was found.
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Affiliation(s)
- Shanice A Karangwa
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jelle Adelmeijer
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincent E de Meijer
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruben H de Kleine
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Koen M E M Reyntjens
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert J Porte
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marieke T de Boer
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Karangwa SA, Lisman T, Porte RJ. Anticoagulant Management and Synthesis of Hemostatic Proteins during Machine Preservation of Livers for Transplantation. Semin Thromb Hemost 2020; 46:743-750. [DOI: 10.1055/s-0040-1715452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractLiver transplantation remains the only curative treatment for patients with end-stage liver disease. Despite a steadily increasing demand for suitable donor livers, the current pool of donor organs fails to meet this demand. To resolve this discrepancy, livers traditionally considered to be of suboptimal quality and function are increasingly utilized. These marginal livers, however, are less tolerant to the current standard cold preservation of donor organs. Therefore, alternative preservation methods have been sought and are progressively applied into clinical practice. Ex situ machine perfusion is a promising alternative preservation modality particularly for suboptimal donor livers as it provides the ability to resuscitate, recondition, and test the viability of an organ prior to transplantation. This review addresses the modalities of machine perfusion currently being applied, and particularly focuses on the hemostatic management employed during machine perfusion. We discuss the anticoagulant agents used, the variation in dosage, and administration, as well as the implications of perfusion for extended periods of time in terms of coagulation activation associated with production of coagulation factors during perfusion. Furthermore, in regard to viability testing of an organ prior to transplantation, we discuss the possibilities and limitations of utilizing the synthesis of liver-derived coagulation factors as potential viability markers.
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Affiliation(s)
- Shanice A. Karangwa
- Department of Surgery, Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ton Lisman
- Department of Surgery, Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J. Porte
- Section of HPB Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Karangwa SA, Adelmeijer J, Matton APM, de Meijer VE, Lisman T, Porte RJ. Production of Physiologically Relevant Quantities of Hemostatic Proteins During Ex Situ Normothermic Machine Perfusion of Human Livers. Liver Transpl 2018; 24:1298-1302. [PMID: 30125455 DOI: 10.1002/lt.25290] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Shanice A Karangwa
- Surgical Research Laboratory , Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jelle Adelmeijer
- Surgical Research Laboratory , Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alix P M Matton
- Surgical Research Laboratory , Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Vincent E de Meijer
- Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Surgical Research Laboratory , Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert J Porte
- Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Matton APM, Burlage LC, van Rijn R, de Vries Y, Karangwa SA, Nijsten MW, Gouw ASH, Wiersema‐Buist J, Adelmeijer J, Westerkamp AC, Lisman T, Porte RJ. Normothermic machine perfusion of donor livers without the need for human blood products. Liver Transpl 2018; 24:528-538. [PMID: 29281862 PMCID: PMC5900573 DOI: 10.1002/lt.25005] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/28/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022]
Abstract
Normothermic machine perfusion (NMP) enables viability assessment of donor livers prior to transplantation. NMP is frequently performed by using human blood products including red blood cells (RBCs) and fresh frozen plasma (FFP). Our aim was to examine the efficacy of a novel machine perfusion solution based on polymerized bovine hemoglobin-based oxygen carrier (HBOC)-201. Twenty-four livers declined for transplantation were transported by using static cold storage. Upon arrival, livers underwent NMP for 6 hours using pressure-controlled portal and arterial perfusion. A total of 12 livers were perfused using a solution based on RBCs and FFPs (historical cohort), 6 livers with HBOC-201 and FFPs, and another 6 livers with HBOC-201 and gelofusine, a gelatin-based colloid solution. Compared with RBC + FFP perfused livers, livers perfused with HBOC-201 had significantly higher hepatic adenosine triphosphate content, cumulative bile production, and portal and arterial flows. Biliary secretion of bicarbonate, bilirubin, bile salts, and phospholipids was similar in all 3 groups. The alanine aminotransferase concentration in perfusate was lower in the HBOC-201-perfused groups. In conclusion, NMP of human donor livers can be performed effectively using HBOC-201 and gelofusine, eliminating the need for human blood products. Perfusing livers with HBOC-201 is at least similar to perfusion with RBCs and FFP. Some of the biomarkers of liver function and injury even suggest a possible superiority of an HBOC-201-based perfusion solution and opens a perspective for further optimization of machine perfusion techniques. Liver Transplantation 24 528-538 2018 AASLD.
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Affiliation(s)
- Alix P. M. Matton
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Laura C. Burlage
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Rianne van Rijn
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Yvonne de Vries
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Shanice A. Karangwa
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Maarten W. Nijsten
- Department of Critical CareUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Annette S. H. Gouw
- Department of Pathology, University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Janneke Wiersema‐Buist
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Jelle Adelmeijer
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Andrie C. Westerkamp
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands,Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Ton Lisman
- Surgical Research LaboratoryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Robert J. Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Departments of SurgeryUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
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Burlage LC, Karangwa SA, Lisman T, Martins PNA, Porte RJ. Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors. Liver Transpl 2015; 21:1231-2. [PMID: 26045355 DOI: 10.1002/lt.24185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Laura C Burlage
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Shanice A Karangwa
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Paulo N A Martins
- Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University of Massachusetts Medical School, University of Massachusetts Medical Center, University of Massachusetts, Worcester, MA
| | - Robert J Porte
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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