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.
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References
Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, Muiesan P, Rela M, Heaton N, Wendon J, O’Grady JG (2009) Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol 50:306–313
Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, Burra P, Senzolo M, Mirza D, Castaing D, Klempnauer J, Pollard S, Paul A, Belghiti J, Tsochatzis E (2012) Burroughs AK. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol 57:288–296
Watson CJE, Kosmoliaptsis V, Pley C, Randle L, Fear C, Crick K, Gimson AE, Allison M, Upponi S, Brais R, Jochmans I, Butler AJ (2018) Observations on the ex situ perfusion of livers for transplantation. Am J Transplant 18:2005–2020
Nasralla D, Coussios CC, Mergental H, Akhtar MZ, Butler AJ, Ceresa CDL, Chiocchia V, Dutton SJ, Garcia-Valdecasas JC, Heaton N, Imber C, Jassem W, Jochmans I, Karani J, Knight SR, Kocabayoglu P, Malago M, Mirza D, Morris PJ, Pallan A, Paul A, Pavel M, Perera M, Pirenne J, Ravikumar R, Russell L, Upponi S, Watson CJE, Weissenbacher A, Ploeg RJ, Friend PJ (2018) Consortium for organ preservation in ex a randomized trial of normothermic preservation in liver transplantation. Nature 557:5–6
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DP, concept and design, machine perfusion procedure, manuscript drafting; FL, manuscript revision; RR, manuscript revision and supervision.
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Patrono, D., Lupo, F. & Romagnoli, R. Shifting from donor to donor-recipient matching perspective in defining indications for machine perfusion in liver transplantation. Updates Surg 72, 913–915 (2020). https://doi.org/10.1007/s13304-020-00834-2
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DOI: https://doi.org/10.1007/s13304-020-00834-2