Liver transplantation with grafts obtained after cardiac death-current advances in mastering the challenge

Table 1 Major studies that compared donation after cardiac death vs donation after brain death liver transplantation outcomes

Ref.	Year	DCD transplants number	Recipient survival rate (%) at 1 yr, 3 yr, and 5 yr post-transplant			Graft survival rate (%) at 1 yr, 3 yr, and 5 yr post-transplant			ITBS rate	Retransplants rate
Croome et al[98]	2013	HCC DCD = 242				76	64	56
		Non-HCC DCD = 2117				86	77	71
Abt et al[33]	2013	110						47		14%
Callaghan et al[99]	2013	352		81			73
Vanatta et al[100]	2013	38	92	80		92	74		7%	2%
Elaffandi et al[101]	2012	108	84							2%
Taner et al[28]	2012	200	93	85	81	81	73	69	12%	5%
Meurisse et al[52]	2012	30	93	85	85	90	82	82		3%
DeOliveira et al[30]	2011	167	87	85	81	85	83	78	2%
Hong et al[102]	2011	81				78	62	53	10%	12%
Mathur et al[53]	2011	1567					65			13%
Dubbled et al[46]	2010	55	85	80		74	68		14%	18%
Yamamoto et al[45]	2010	24	62	43	43	54	37	38
Detry et al[103]	2010	58	83	67		72	49		38%
de Vera et al[27]	2009	141	79		70	69		56	16%	18%
Grewal et al[43]	2009	108	92	88	88	79	74	71	8%	15%
Jiménez-Galanes et al[104]	2009	20	86			80			5%
Pine et al[105]	2009	39	82	68		80	64		20%
Nguyen et al[42]	2009	19	90		90	74		63	10%	16%
Fujita et al[106]	2007	24	87	82		69	56			21%

DCD: Donation after cardiac death.

Table 2 Hypothermic vs normothermic machine perfusion of liver grafts

Hypothermic machine perfusion HMP	Normothermic machine perfusion NMP
Temperature 0 °C-4 °C	Temperature 37 °C
Logistically easier	Logistically demanding
Modest resumption of energy production with low perfusion rate
Improves the state of mitochondria during preservation	Recreates the physiological milieu by maintenance of normal temperature
Performed at sub-physiologic pressures[107]	Performed at physiological pressures[70,82]
Requires low perfusion rates[108]	Requires high perfusion rates[108]
No requirement for a specific oxygen carrier in the perfusate as demand for O2 is low[108]	Oxygen is provided by using blood, modified hemoglobin, or using a high oxygen tension in special preservation solutions[70,82,84,88,109]
Less occurrence of graft infection considering the hypothermic state More tendency for endothelial cell, kupffer cell, and macrophage cell damage due to shear stress and hypothermic activation[110-113]	Reduces IRI
When compared to SCS it decreases inflammatory cytokines but no difference in graft or patient survival was found[77,114]	Provides nutrients (glucose, amino acids, etc.), medications to prevent micro-circulatory failure (e.g., prostacyclin, heparin, antibiotics), and oxygen
May help protect marginal livers by converting PNF into allograft dysfunction[71]	Allows the assessment of organ viability (e.g., Galactose elimination, factor V production, bile flow)
	May allow the use of gene therapy prior to transplantation, to reduce the risk of rejection, or decrease the ischemia-reperfusion injury[115-117]

HMP: Hypothermic machine perfusion; SCS: Static cold storage; NMP: Normothermic perfusion.