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How useful is the machine perfusion in liver transplantation? An answer from a national survey

Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger po...

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Autores principales: Scalera, Irene, De Carlis, R., Patrono, D., Gringeri, E., Olivieri, T., Pagano, D., Lai, Q., Rossi, M., Gruttadauria, S., Di Benedetto, F., Cillo, U., Romagnoli, R., Lupo, L. G., De Carlis, L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535084/
https://www.ncbi.nlm.nih.gov/pubmed/36211259
http://dx.doi.org/10.3389/fsurg.2022.975150
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author Scalera, Irene
De Carlis, R.
Patrono, D.
Gringeri, E.
Olivieri, T.
Pagano, D.
Lai, Q.
Rossi, M.
Gruttadauria, S.
Di Benedetto, F.
Cillo, U.
Romagnoli, R.
Lupo, L. G.
De Carlis, L.
author_facet Scalera, Irene
De Carlis, R.
Patrono, D.
Gringeri, E.
Olivieri, T.
Pagano, D.
Lai, Q.
Rossi, M.
Gruttadauria, S.
Di Benedetto, F.
Cillo, U.
Romagnoli, R.
Lupo, L. G.
De Carlis, L.
author_sort Scalera, Irene
collection PubMed
description Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard after the MP treatment. On the other hand, the MP seems to be useful in reducing the donor and graft weight in the development of EAD.
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spelling pubmed-95350842022-10-07 How useful is the machine perfusion in liver transplantation? An answer from a national survey Scalera, Irene De Carlis, R. Patrono, D. Gringeri, E. Olivieri, T. Pagano, D. Lai, Q. Rossi, M. Gruttadauria, S. Di Benedetto, F. Cillo, U. Romagnoli, R. Lupo, L. G. De Carlis, L. Front Surg Surgery Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard after the MP treatment. On the other hand, the MP seems to be useful in reducing the donor and graft weight in the development of EAD. Frontiers Media S.A. 2022-09-22 /pmc/articles/PMC9535084/ /pubmed/36211259 http://dx.doi.org/10.3389/fsurg.2022.975150 Text en © 2022 Scalera, De Carlis, Patrono, Gringeri, Olivieri, Pagano, Lai, Rossi, Gruttadauria, Di Benedetto, Cillo, Romagnoli, Lupo and De Carlis. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Scalera, Irene
De Carlis, R.
Patrono, D.
Gringeri, E.
Olivieri, T.
Pagano, D.
Lai, Q.
Rossi, M.
Gruttadauria, S.
Di Benedetto, F.
Cillo, U.
Romagnoli, R.
Lupo, L. G.
De Carlis, L.
How useful is the machine perfusion in liver transplantation? An answer from a national survey
title How useful is the machine perfusion in liver transplantation? An answer from a national survey
title_full How useful is the machine perfusion in liver transplantation? An answer from a national survey
title_fullStr How useful is the machine perfusion in liver transplantation? An answer from a national survey
title_full_unstemmed How useful is the machine perfusion in liver transplantation? An answer from a national survey
title_short How useful is the machine perfusion in liver transplantation? An answer from a national survey
title_sort how useful is the machine perfusion in liver transplantation? an answer from a national survey
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535084/
https://www.ncbi.nlm.nih.gov/pubmed/36211259
http://dx.doi.org/10.3389/fsurg.2022.975150
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