Early outcome of liver transplantation performed with organs procured from brain death donors with transient or sustained cardio-circulatory collapse

BACKGROUND:
Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio--circulatory collapse.
METHODS:
We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio--circulatory arrest before organ procurement (RCA); those who experienced sustained cardio--circulatory collapse, treated with extra--corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non--Function (PNF), and complications during the first 30 days were analysed.

RESULTS:
102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor's death was post--anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17--43], 54 [34--92], 716 [190--962] respectively, SGPT 17 [12--34], 46 [27--73], 84 [51--175] UI/L respectively, both P< 0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End--Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar.
CONCLUSION:
The use of livers procured from donors after brain death that experienced transient or sustained cardio--circulatory collapse was associated with early graft function comparable to that of standard donors.