Intraoperative hemodynamc profile of DCD liver transplantation

Cardiovascular instability after reperfusion of liver grafts is a well-recognised phenomenon in liver transplantation. In theory patients transplanted with DCD liver grafts might experience worse intra-operative hemodynamic variability and greater need of support with inotropes after reperfusion. In fact recipient selection for DCD livers remains often limited to candidates with HCC or low MELD as they could better withstand a severe reperfusion syndrome. Aim of this study was to depict the intra-operative cardiovascular profile after graft reperfusion of DCD grafts compared with DBD. From a prospectively held database of over 4400 liver transplants, 30 consecutive recipients of DBD grafts and 30 patients transplanted with DCD grafts in 2014 were selected. A retrospective analysis of their intraoperative hemodynamic and metabolic data and of inotropic support was conducted relative to donor and recipient characteristics. These were similar in both groups except for an expected higher donor risk index (2.84 vs. 1.85, p=0.001) and lower recipient MELD (12 vs. 16, p=0.009) in DCD group. With similar hemodynamic profile at the start of the operation for both patient groups, DCD recipients had a similar post reperfusion syndrome rate (10% vs. 13%, p> 0.05) a comparable inotrope and blood products requirement compared with DBD patients. After the arterial reperfusion the mean arterial pressure (MAPart) was significantly higher in DCD recipients (76mmHg vs. 69 mmHg, p=0.029). At the end of the transplants the pH was even better in those transplanted with DCD grafts (7.36 vs. 7.31, p=0.026) with a similar amount of bicarbonates infused. The postoperative outcome was similar at 3 and 12 months. Surprisingly the haemodynamic profile of recipients of DCD liver grafts is not significantly worse compared with DBD recipients possibly due to strict selection of grafts and recipients. Larger sample is needed to validate if higher MELD recipients could withstand the post reperfusion phase with DCD grafts.