Clinical effect of extracorporeal membrane oxygenation in donor liver protection during donation after brain and cardiac death

Objective To investigate the application of extracorporeal membrane oxygenation(ECMO) in donor liver protection during donation after death,and to summarize the preliminary experience in the application of ECMO in donor liver protection. Methods Clinical data were collected from liver transplantation donors/recipients who received ECMO during donation after brain and cardiac death(DBCD)and those who received conventional DBCD liver transplantation,and a comparative analysis was performed for donor liver protection and outcome of transplantation. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results A total of 32 donors with similar general status and liver function were enrolled and divided into control group(conventional DBCD liver transplantation) and experimental group(DBCD liver transplantation with ECMO),with 16 donors in each group. A total of 32 liver transplantation recipients were divided into corresponding control group and experimental group,with 16 recipients in each group. There were significant differences between the donor control group and the donor experimental group in heart rate,systolic pressure,diastolic pressure,partial pressure of blood oxygen,lactate level,central venous pressure,total bilirubin(TBil),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(t = 14. 121,-17. 817,-19. 187,-8. 927,4. 559,-3. 495,3. 357,4. 111,and 3. 553,all P < 0. 05). Compared with the recipient control group on day 7 after surgery,the recipient experimental group had significantly faster recovery of liver function after liver transplantation using the ECMO technique,and there were significant differences between the two groups in TBil,DBil,ALT,AST,alkaline phosphatase,and gamma-glutamyl transpeptidase(t =9. 309,4. 783,5. 067,2. 203,4. 774,and 5. 257,all P < 0. 05). The recipient experimental group had a significantly shorter length of hospital stay than the recipient control group(20. 87 ± 4. 98 d vs 12. 65 ± 2. 86 d,t = 5. 756,P < 0. 001). Conclusion Liver transplantation using the ECMO technique has a good clinical effect,and scientific and rational use of ECMO can effectively improve the quality of donor liver. Therefore,it plays an active role in organ donation after Chinese citizen death.