ImportanceNormothermic regional perfusion (NRP) is an emerging recovery modality for transplantable allografts from controlled donation after circulatory death (cDCD) donors. In the US, only 11.4% of liver recipients who are transplanted from a deceased donor receive a cDCD liver. NRP has the potential to safely expand the US donor pool with improved transplant outcomes as compared with standard super rapid recovery (SRR).ObjectiveTo assess outcomes of US liver transplants using controlled donation after circulatory death livers recovered with normothermic regional perfusion vs standard super rapid recovery.Design, Setting, and ParticipantsThis was a retrospective, observational cohort study comparing liver transplant outcomes from cDCD donors recovered by NRP vs SRR. Outcomes of cDCD liver transplant from January 2017 to May 2023 were collated from 17 US transplant centers and included livers recovered by SRR and NRP (thoracoabdominal NRP [TA-NRP] and abdominal NRP [A-NRP]). Seven transplant centers used NRP, allowing for liver allografts to be transplanted at 17 centers; 10 centers imported livers recovered via NRP from other centers.ExposurescDCD livers were recovered by either NRP or SRR.Main Outcomes and MeasuresThe primary outcome was ischemic cholangiopathy (IC). Secondary end points included primary nonfunction (PNF), early allograft dysfunction (EAD), biliary anastomotic strictures, posttransplant length of stay (LOS), and patient and graft survival.ResultsA total of 242 cDCD livers were included in this study: 136 recovered by SRR and 106 recovered by NRP (TA-NRP, 79 and A-NRP, 27). Median (IQR) NRP and SRR donor age was 30.5 (22-44) years and 36 (27-49) years, respectively. Median (IQR) posttransplant LOS was significantly shorter in the NRP cohort (7 [5-11] days vs 10 [7-16] days; P < .001). PNF occurred only in the SRR allografts group (n = 2). EAD was more common in the SRR cohort (123 of 136 [56.1%] vs 77 of 106 [36.4%]; P = .007). Biliary anastomotic strictures were increased 2.8-fold in SRR recipients (7 of 105 [6.7%] vs 30 of 134 [22.4%]; P = .001). Only SRR recipients had IC (0 vs 12 of 133 [9.0%]; P = .002); IC-free survival by Kaplan-Meier was significantly improved in NRP recipients. Patient and graft survival were comparable between cohorts.Conclusion and RelevanceThere was comparable patient and graft survival in liver transplant recipients of cDCD donors recovered by NRP vs SRR, with reduced rates of IC, biliary complications, and EAD in NRP recipients. The feasibility of A-NRP and TA-NRP implementation across multiple US transplant centers supports increasing adoption of NRP to improve organ use, access to transplant, and risk of wait-list mortality.

中文翻译：

---

常温区域灌注与标准超快速恢复后的美国肝脏移植结果

重要性常温区域灌注（NRP）是一种新兴的可移植同种异体移植物的恢复方式，该移植物来自循环死亡后受控捐赠（cDCD）供体。在美国，从已故捐赠者移植的肝脏受者中，只有 11.4% 接受了 cDCD 肝脏。与标准超快速恢复 (SRR) 相比，NRP 有潜力安全地扩大美国供体库，并改善移植结果。 目的评估循环死亡肝脏通过常温局部灌注恢复与标准超快速恢复后使用控制性捐献的美国肝脏移植的结果设计、设置和参与者这是一项回顾性、观察性队列研究，比较了通过 NRP 与 SRR 恢复的 cDCD 供体的肝移植结果。 2017 年 1 月至 2023 年 5 月 cDCD 肝移植的结果来自 17 个美国移植中心，包括通过 SRR 和 NRP（胸腹 NRP [TA-NRP] 和腹部 NRP [A-NRP]）恢复的肝脏。 7 个移植中心使用了 NRP，允许在 17 个中心进行同种异体肝移植； 10个中心通过NRP从其他中心进口肝脏。暴露scDCD肝脏通过NRP或SRR回收。主要结果和措施主要结果是缺血性胆管病（IC）。次要终点包括原发性无功能 (PNF)、早期同种异体移植物功能障碍 (EAD)、胆道吻合口狭窄、移植后住院时间 (LOS) 以及患者和移植物存活率。 结果 本研究总共纳入 242 个 cDCD 肝脏：其中 136 个通过治疗恢复SRR 和 106 由 NRP 回收（TA-NRP，79 和 A-NRP，27）。 NRP 和 SRR 捐献者年龄中位数 (IQR) 分别为 30.5 (22-44) 岁和 36 (27-49) 岁。 NRP 队列中的移植后 LOS 中位数 (IQR) 显着缩短（7 [5-11] 天 vs 10 [7-16] 天；磷< .001）。 PNF 仅发生在 SRR 同种异体移植组中 (n = 2)。 EAD 在 SRR 队列中更为常见（136 人中的 123 人 [56.1%] vs 106 人中的 77 人 [36.4%]；磷=.007)。 SRR 接受者中胆道吻合口狭窄增加了 2.8 倍（105 人中的 7 人 [6.7%] vs 134 人中的 30 人 [22.4%]；磷= .001)。只有 SRR 接受者出现 IC（133 例中 0 例与 12 例 [9.0%]；磷= .002); Kaplan-Meier 显着改善了 NRP 接受者的无 IC 生存率。队列之间的患者和移植物存活率具有可比性。结论和相关性通过 NRP 与 SRR 恢复的 cDCD 供体肝移植受者的患者和移植物存活率具有可比性，并且 NRP 受者中 IC、胆道并发症和 EAD 的发生率降低。在美国多个移植中心实施 A-NRP 和 TA-NRP 的可行性支持越来越多地采用 NRP，以改善器官使用、移植机会和等待名单死亡率风险。