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Using extracorporeal membrane oxygenation in donations after cardiac death or brain death: A single-center experience
Chia-En Hsieh1, Ya-Lan Hsu1, Yao-Li Chen2,3
1Department of Nursing, Liver Transplantation Center Chung Shan Medical University Hospital Taichung Taiwan.
Insights
Extracorporeal membrane oxygenation (ECMO) use in deceased donor liver transplantation, including donation after cardiac death (DCD) and donation after brain death (DBD), shows promising results. ECMO support in DCD liver grafts did not significantly impact 5-year survival rates.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Cardiopulmonary Support
Background:
- Extended criteria donors are increasingly utilized in liver transplantation.
- Extracorporeal membrane oxygenation (ECMO) is sometimes employed in donors after cardiac death (DCD) and brain death (DBD).
Purpose of the Study:
- To evaluate the impact of ECMO use on outcomes in liver transplantation from DCD and DBD donors.
- To compare graft and patient survival rates between DBD and DCD donors with and without ECMO support.
Main Methods:
- Retrospective study of 90 deceased donor liver transplants (Jan 2006-Dec 2019).
- Patients categorized into three groups: DBD (n=58), DBD with ECMO (n=11), and DCD with ECMO (n=21).
- Statistical analysis including repeated measures ANOVA to compare outcomes.
Main Results:
- No significant differences in outcomes between DBD and DBD with ECMO groups.
- DCD with ECMO group showed significant differences in warm and cold ischemia times, split liver transplantation, and poorer bilirubin recovery compared to DBD.
- Five-year survival rates were 78.1% (DBD), 90.9% (DBD with ECMO), and 75.6% (DCD with ECMO), with no significant difference between groups.
Conclusions:
- ECMO is a valuable technology for deceased donor liver transplantation, supporting both DBD and DCD pathways.
- ECMO utilization contributed to 35.6% of the liver graft pool in this study.
- The use of ECMO in DCD liver donors did not significantly compromise long-term graft survival.
Aims:
The use of extended criteria donors is a routine practice that sometimes involves extracorporeal membrane oxygenation (ECMO) in donations after cardiac death or brain death.
Methods:
We performed a retrospective study in a single center from January 2006 to December 2019. The study included 90 deceased donor liver transplants. The patients were divided into three groups: the donation after brain death (DBD) group (n = 58, 64.4%), the DBD with ECMO group (n = 11, 12.2%) and the donation after cardiac death (DCD) with ECMO group (n = 21, 23.3%).
Results:
There were no significant differences between the DBD with ECMO group and the DBD group. When comparing the DCD with ECMO group and the DBD group, there were statistically significant differences for total warm ischemia time (p < 0.001), total cold ischemia time (p = 0.023), and split liver transplantation (p < 0.001), and there was significantly poor recovery in regard to total bilirubin level (p = 0.027) for the DCD with ECMO group by repeated measures ANOVA. The 5-year survival rates of the DBD, DBD with ECMO, and DCD with ECMO groups were 78.1%, 90.9%, and 75.6%, respectively. The survival rate was not significantly different when comparing the DBD group to either the DBD with ECMO group (p = 0.435) or the DCD with ECMO group (p = 0.310).
Conclusions:
Using ECMO in donations after cardiac death or brain death is a good technology, and it contributed to 35.6% of the liver graft pool.
