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Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Macchine da perfusione ipotermica nel prelievo di fegato da donatori a cuore non battente

Vengono pubblicati sulla rivista The New England Journal of Medicine i risultati dello studio DHOPE-DCD ClinicalTrials.gov number, NCT02584283.

Lo studio ha valutato l’uso delle macchine da perfusione ipotermica nel prelievo di fegato da donatori a cuore non battente.

I dati hanno rilevato la riduzione del rischio di complicanze biliari post-trapianto negli organi che erano stati perfusi in questa maniera, rispetto a quelli perfusi in maniera standard.

La referenza bibliografica per questo evento è:

Rianne Rijn, Ivo J. Schurink, Yvonne Vries, Aad P. Berg, Miriam Cortes Cerisuelo, Sarwa Darwish Murad, Joris I. Erdmann, Nicholas Gilbo, Robbert J. Haas, Nigel Heaton, Bart Hoek, Volkert A. L. Huurman, Ina Jochmans, Otto B. Leeuwen, Vincent E. Meijer, Diethard Monbaliu, Wojciech G. Polak, Jules J. G. Slangen, Roberto I. Troisi, Aude Vanlander, Jeroen Jonge, Robert J. Porte: Hypothermic machine perfusion in liver transplantation — A randomized trial. In: New England Journal of Medicine, vol. 384, no. 15, pp. 1391 – 1401, 2021, ISSN: 00284793, (Cited by: 130; All Open Access, Bronze Open Access, Green Open Access).

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. METHODS 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. RESULTS 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. CONCLUSIONS 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). Copyright © 2021 Massachusetts Medical Society.

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