Hypothermic Machine Perfusion in Liver Transplantation — A Randomized Trial: a randomized trial
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| Titel: | Hypothermic Machine Perfusion in Liver Transplantation — A Randomized Trial: a randomized trial |
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| Autoren: | Rijn, R. van, Schurink, I.J., Vries, Y. de, Berg, A.P. van den, Cerisuelo, M.C., Murad, S.D., Erdmann, J.I., Gilbo, N., Haas, R.J. de, Heaton, N., Hoek, B. van, Huurman, V.A.L., Jochmans, I., Leeuwen, O.B. van, Meijer, V.E. de, Monbaliu, D., Polak, W.G., Slangen, J.J.G., Troisi, R.I., Vanlander, A., Jonge, J. de, Porte, R.J., DHOPE DCD Trial Investigators |
| Weitere Verfasser: | Surgery |
| Quelle: | New England Journal of Medicine. 384:1391-1401 |
| Verlagsinformationen: | Massachusetts Medical Society, 2021. |
| Publikationsjahr: | 2021 |
| Schlagwörter: | Adult, Male, Constriction, Pathologic, Sciences de la santé humaine, perfusion, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, General & Internal Medicine, Reperfusion Injury/prevention & control, Humans, Human health sciences, Chirurgie, Biliary Tract, 11 Medical and Health Sciences, Constriction, Pathologic/prevention & control, Science & Technology, 42 Health sciences, liver transplantation, Cold Ischemia, Organ Preservation/methods, 32 Biomedical and clinical sciences, Organ Preservation, Middle Aged, Biliary Tract/pathology, Liver Transplantation, 3. Good health, Cold Temperature, Perfusion, DHOPE-DCD Trial Investigators, Reperfusion Injury, Surgery, Female, Life Sciences & Biomedicine |
| Beschreibung: | Transplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.In this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.A total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P = 0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.Hypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage. (Funded by Fonds NutsOhra; DHOPE-DCD ClinicalTrials.gov number, NCT02584283.). |
| Publikationsart: | Article |
| Dateibeschreibung: | application/pdf |
| Sprache: | English |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa2031532 |
| Zugangs-URL: | https://pubmed.ncbi.nlm.nih.gov/33626248 http://hdl.handle.net/11588/880645 https://research.rug.nl/en/publications/7fa64493-0fc6-4b85-a4c2-d51cb7c4fded https://hdl.handle.net/11370/7fa64493-0fc6-4b85-a4c2-d51cb7c4fded https://doi.org/10.1056/NEJMoa2031532 https://research.rug.nl/en/publications/hypothermic-machine-perfusion-in-liver-transplantation-a-randomiz https://www.nejm.org/doi/full/10.1056/NEJMoa2031532 https://europepmc.org/article/MED/33626248 https://www.nejm.org/doi/suppl/10.1056/NEJMoa2031532/suppl_file/nejmoa2031532_data-sharing.pdf https://www.ncbi.nlm.nih.gov/pubmed/33626248 https://pubmed.ncbi.nlm.nih.gov/33626248/ https://hdl.handle.net/1887/3270941 https://pure.amsterdamumc.nl/en/publications/86a1d5e6-dd77-4a46-bc39-f908477279a4 https://doi.org/10.1056/NEJMoa2031532 https://hdl.handle.net/2268/311978 https://doi.org/10.1056/NEJMoa2031532 https://biblio.vub.ac.be/vubir/hypothermic-machine-perfusion-in-liver-transplantation--a-randomized-trial(c42ce8b8-9f51-46a7-aa36-cfb5e028afb1).html |
| Rights: | taverne CC BY URL: http://www.nejmgroup.org/legal/terms-of-use.htm |
| Dokumentencode: | edsair.doi.dedup.....1a2a0e0e5417bddf675d9df991c51766 |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Transplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.In this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.A total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P = 0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.Hypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage. (Funded by Fonds NutsOhra; DHOPE-DCD ClinicalTrials.gov number, NCT02584283.). |
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| ISSN: | 15334406 00284793 |
| DOI: | 10.1056/nejmoa2031532 |