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Grafts from donors with cardiac death (DCD) are subject to warm ischemia time (WIT) due to the no‐touch‐period (20 min in Italy and 5 min in France). These livers (LT) have higher rates of early allograft dysfunction (EAD), primary non‐function (PNF), and ischemic cholangiopathy (IC) compared to LT from brain dead donors (DBD). Normothermic regional perfusion (NRP) is a beneficial strategy to mitigate organ damage; a further approach is the application of ex vivo hypothermic oxygenated perfusion (HOPE) after cold storage (CS). We retrospectively analyzed LTs performed from 2016 to 2019 at three transplant centers using NRP‐DCD grafts: Bologna and Milan treated with HOPE (group A), Rennes preserved using CS (group B). No‐flow period, total and functional WIT were significantly higher in group A than in group B (30.5±7.7 vs. 20.5±4.1; 56.5±20.4 vs. 39.1±21.6; 41.9±12.5 vs. 25.5±3.7; respectively, P <.05), without differences in the postoperative course. In particular, the two groups had similar rates of EAD (21.1% vs. 25.0%), PNF (5.3% vs. 6.3%), IC (0% vs. 12.5%, P =.112), and non‐IC biliary complications (0% vs. 6.3%, P =.457), re‐LT (10.5% vs.12.5%). This occurred despite a high rate of UK DCD risk score > 10 (63.2% A vs. 17.6% B, P =.000), which theoretically would make a large number of these transplants "futile." In conclusion, Italian and French groups had similar post‐LT outcomes, probably related to the use of HOPE after CS in the case of long WIT. [ABSTRACT FROM AUTHOR]

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT. [ABSTRACT FROM AUTHOR]