R. E. CASTLE1, A. Rouhi3, D. Yoeli4, H. Moore2, A. Yule2, M. Baimas-George2, M. Wachs2, T. Nydam2, R. Choudhury2 1University Of Colorado Denver, School Of Medicine, Aurora, CO, USA 2University Of Colorado Denver, Transplant Surgery, Aurora, CO, USA 3Hospital Of The University Of Pennsylvania, Transplant Surgery, Philadelphia, PA, USA 4University Of Colorado Denver, Surgery, Aurora, CO, USA
Introduction:
The increased utilization of the Non-Normothermic Regional Perfusion (non-NRP) Organ Care System (OCS) for Donation after Cardiac Death (DCD) Heart transplantation undoubtedly affects the typical DCD procurement process. The requirement of donor whole blood for the non-NRP OCS circuit, and cardiac cannulation related delays to decompressing the suprahepatic vena cava adds warm ischemia time to the intra-abdominal organs during the procurement process. The impact of these delays on the future liver transplant outcomes are unclear.
Methods:
A decision-analytic Markov state transition model was created to simulate the life of recipients of DCD liver allografts following either non-NRP OCS DCD or Standard DCD procurement (S-DCD). Life expectancy and probability of needing to be re-listed due to ischemic cholangiopathy was estimated. It was estimated that non-NRP OCS added 3 minutes on average to the time to cross clamp a typical DCD procurement. All Markov parameters were estimated from literature review.
Results:
Non-NRP OCS procurement recipients on average had 1.2 years of reduced life expectancy compared to S-DCD patients. The rate of ischemic cholangiopathy was higher across all time points of non-NRP OCS patient, which lead to increased need to retransplant and higher risk for mortality.
Conclusion:
The benefits of non-NRP OCS to increased DCD Heart transplantation should be weighed against the negative impact on liver allografts, and the future risk of ischemic cholangiopathy.
