REVIEW   Free access

Minerva Anestesiologica 2020 February;86(2):196-204

DOI: 10.23736/S0375-9393.19.13746-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Uncontrolled donation after circulatory death and liver transplantation: evidence and unresolved issues

Chiara LAZZERI ¹ ✉, Manuela BONIZZOLI ¹, Fabio MARRA ², Paolo MUIESAN ^{3, 4}, Davide GHINOLFI ⁵, Paolo DE SIMONE ⁵, Maria G. NESI ¹, Maria L. MIGLIACCIO ⁶, Adriano PERIS ¹

¹ Intensive Care Unit and Regional ECMO Referral Center, Careggi University Hospital, Florence, Italy; ² Department of Experimental and Clinical Medicine, Research Center Denothe, University of Florence, Florence, Italy; ³ Hepatobiliary Unit, Careggi University Hospital, University of Florence, Florence, Italy; ⁴ Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; ⁵ Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy; ⁶ Tuscany Authority for Transplantation (Centro Regionale Allocazione Organi e Tessuti CRAOT), Florence, Italy

This review aimed at summarizing the available evidence on liver transplantation from uncontrolled donation after circulatory death (uDCD) on differences in protocols, donor management, in and ex vivo perfusion techniques from center to center. Uncontrolled DCDs represent a unique, complex model of ischemia-reperfusion injury, so far not completely understood. Nevertheless, results on liver transplantation from uDCDs are promising in terms of long-term graft survival. True difficulties still remain since common/shared protocols are not achievable due to legal differences between countries (i.e. no touch period duration). To date, there is no reliable metrics to determine whether a liver is safe to be ex situ perfused or to be transplanted since existing criteria, as stated by investigators themselves, are so far arbitrary. Values and kinetics of transaminanes during normothermic regional perfusion (nRP) should not considered absolute contraindication at least for ex vivo perfusion. Intraoperative evaluation at organ recovery remains pivotal since macroscopic alterations (i.e. hepatic rupture, an abnormal appearance of gall bladder and choledocus) still represent contraindications for organ retrieval. Concerning ex vivo perfusion, the debate is still open, since the choice of type of machine perfusion (mainly hypothermic vs. normothermic) varies from center to center, mainly relying to the single center experience (especially in controlled DCD), surgeons’ believes and/or criteria translated from animal models.

KEY WORDS: Liver transplantation; Extracorporeal membrane oxygenation; Review