Background Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center.Methods We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021.Results The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types.Conclusion This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy.[GRAPHICS].
Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy / De Carlis, Riccardo; Lauterio, Andrea; Centonze, Leonardo; Buscemi, Vincenzo; Schlegel, Andrea; Muiesan, Paolo; De Carlis, Luciano, Amedeo Carraro, Davide Ghinolfi, Paolo De Simone, Matteo Ravaioli, Matteo Cescon, Daniele Dondossola, Marco Bongini, Vincenzo Mazzaferro, Duilio Pagano, Salvatore Gruttadauria, Enrico Gringeri, Umberto Cillo, Damiano Patrono, Renato Romagnoli, Stefania Camagni, Michele Colledan, Tiziana Olivieri, Fabrizio Di Benedetto, Giovanni Vennarecci, Umberto Baccarani, Quirino Lai, Massimo Rossi, Tommaso Maria Manzia, Giuseppe Tisone, Marco Vivarelli, Irene Scalera, Luigi Giovanni Lupo, Enzo Andorno, Roberto Luca Meniconi, Giuseppe Maria Ettorre, Alfonso Wolfango Avolio, Salvatore Agnes, Roberta Anna Pellegrino, Fausto Zamboni. - In: UPDATES IN SURGERY. - ISSN 2038-131X. - STAMPA. - 74:2(2022), pp. 501-510. [10.1007/s13304-022-01259-9]
Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy
Matteo Ravaioli;Matteo Cescon;
2022
Abstract
Background Normothermic regional perfusion (NRP) and machine perfusion (MP) are variously used in many European centers to improve the outcomes after liver transplantation from donation after circulatory death (DCD). In Italy, a combination of NRP and subsequent MP has been used since the start of the activity. While NRP is mandatory for every DCD recovery, the subsequent use of MP is left to each center.Methods We have designed a national survey to investigate practices and policies of these techniques. The questionnaire included 46 questions and was distributed to all the 21 Italian centers using an online form between June and July 2021.Results The overall response rate was 100%. A local NRP program for controlled Maastricht type 3 DCD was active in 11/21 (52.4%) centers. Organization and availability of personnel were perceived as the main difficulties in starting such a program. Between 2015 and 2020, 119 DCD livers were transplanted, with an overall utilization rate of 69.2%. Pump flow and gross aspect were considered the most reliable parameters in liver selection during NRP. Eight (72.7%) centers adopted subsequent hypothermic MP, 1 (9.1%) center normothermic MP, and the remaining 2 (18.2%) used both MP types.Conclusion This first snapshot survey shows that NRP with subsequent MP is the most used protocol in Italy for DCD livers, although some heterogeneity exists in the type and purpose of MP between centers. Overall, this policy ensures a high utilization rate, considering the high risk of the DCD donor population in Italy.[GRAPHICS].I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
