One-year liver graft survival from brain-dead donors treated with ECPR for out-of-hospital cardiac arrest.

Abstract

Among patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OHCA), some ultimately progress to brain death and may become organ donors. This study aimed to evaluate one-year liver graft survival from donors in brain death after ECPR for refractory OHCA. A retrospective, single-centre, observational study was conducted between January 2011 and June 2024. All included patients were in brain death and donated at least one organ. Actual liver donors were divided into two groups: an "ECPR group" (donors treated with ECPR for refractory OHCA) and a "Control group" (donors not treated with ECPR, predominantly admitted for stroke and OHCA). The primary outcome was one-year liver graft survival. Liver retrieval was performed in 15/38 (39%) potential donors treated with ECPR for refractory OHCA, compared with 27/34 (79%) potential donors not treated with ECPR (P < 0.01). Actual liver donors in the ECPR group were younger (47 [36-54] vs. 70 [48-79] years, P < 0.01) with greater initial severity: for instance peak lactate was higher (9.4 [6.9-12.4] vs. 3.0 [2-5.7] mmol/L, P < 0.01). In univariate analysis, one-year liver graft survival did not differ significantly between groups: 12/15 (80%; 95% CI, 55-93) in the ECPR group vs. 24/27 (89%; 95% CI 72-96) in the control group, (P = 0.65). There was no statistically significant difference in one-year liver graft survival between donors treated with ECPR for refractory OHCA and other donors. Given the limited sample size, this lack of statistical significance should not be interpreted as evidence of equivalence.