Donation after Cardiac Death Liver Transplantation: Predictors of Outcome

Mathur, Amit K.; Heimbach, J.; Steffick, Diane; Sonnenday, Christopher J.; Goodrich, Nathan P.; Merion, Robert M.

doi:10.1111/j.1600-6143.2010.03293.x

Cited by 209 publications

(215 citation statements)

References 30 publications

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“…The clinical picture is similar to NAS of other etiology, but it manifests regularly within 3 months after LT (78). Its clinical course is often more severe and retransplantation required in a significant percentage (79,80). Analysis of the UNOS database of 2351 DCD-LT revealed a significantly decreased patient and graft survival with a 5-year graft survival rate of 56% (81).…”

Section: Special Issues Of Dcdmentioning

confidence: 94%

“…Thereby the authors have calculated that each minute of additional WIT increases the odds ratio for the development of ischemic cholangiopathy or hepatic necrosis by 16% (79). Also other risk factors, known from donation after brain death, have been confirmed in a US cohort of 1567 DCD-LT including donor age, donor weight and CIT (80). In view of the high biliary complication risk routine surveillance might be important in the early period after LT.…”

Section: Special Issues Of Dcdmentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

257

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Special Issues Of Dcdmentioning

confidence: 94%

Section: Special Issues Of Dcdmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

257

233

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show abstract

“…[10][11][12] For this type of donor, the declaration of death is based on cardiopulmonary criteria rather than the cessation of brain and brainstem function. Procurement in this setting subjects the liver allograft to warm ischemia, which may result in increased rates of primary nonfunction (PNF), hepatic artery thrombosis (HAT), and ischemic cholangiopathy (IC).…”

mentioning

confidence: 99%

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

et al. 2014

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Donation after cardiac death (DCD) liver allografts have been associated with increased morbidity from primary nonfunction, biliary complications, early allograft failure, cost, and mortality. Early allograft dysfunction (EAD) after liver transplantation has been found to be associated with inferior patient and graft survival. In a cohort of 205 consecutive liver-only transplant patients with allografts from DCD donors at a single center, the incidence of EAD was found to be 39.5%. The patient survival rates for those with no EAD and those with EAD at 1, 3, and 5 years were 97% and 89%, 79% and 79%, and 61% and 54%, respectively (P 5 0.009). Allograft survival rates for recipients with no EAD and those with EAD at 1, 3, and 5 years were 90% and 75%, 72% and 64%, and 53% and 43%, respectively (P 5 0.003). A multivariate analysis demonstrated a significant association between the development of EAD and the cold ischemia time [odds ratio (OR) 5 1.26, 95% confidence interval (CI) 5 1.01-1.56, P 5 0.037] and hepatocellular cancer as a secondary diagnosis in recipients (OR 5 2.26, 95% CI 5 1.11-4.58, P 5 0.025). There was no correlation between EAD and the development of ischemic cholangiopathy. In conclusion, EAD results in inferior patient and graft survival in recipients of DCD liver allografts. Understanding the events that cause EAD and developing preventive or early therapeutic approaches should be the focus of future investigations. Liver Transpl 20:1447-1453, 2014. V C 2014 AASLD.Received March 28, 2014; accepted August 7, 2014.The success of liver transplantation (LT) has expanded its therapeutic utility and necessitated the increased use of marginal donors to meet the growing demand. To understand the impact of these marginal organs, a clinical tool for identifying early allograft dysfunction (EAD) has been previously described by multiple groups. 1-4 A simple definition (characterized by high early aminotransferase levels, persistent cholestasis, and prolonged coagulopathy in the first week after LT) has previously been validated in a multicenter retrospective review of 297 LT recipients of liver allografts from both donation after brain death (DBD) and donation after cardiac death (DCD) donors. 5 This clinical tool has served as a marker for an increased risk of mortality, morbidity, allograft failure, and cost. 6 EAD has also become a target for therapeutic intervention to reduce morbidity and mortality in LT. [7][8][9] To date, there has been no published study delineating the incidence of and risk factors for EAD specifically in the recipients of liver allografts from DCD donors.Liver allografts from DCD donors are considered inferior because of an overall increased rate of allograft failure. [10][11][12] For this type of donor, the declaration of death is based on cardiopulmonary criteria

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“…Accumulating evidence has identified several recipient, donor, and transplant factors as predictors of graft failure following DCD transplant (Table 3). 12,21,26,27 Mateo and coworkers 21 reported that among the recipient risk factors, a history of previous liver transplant (relative risk [RR] = 1.84 for revision vs primary; P < .001), being hospitalized or in an intensive care unit (ICU) (RR = 1.19 for hospital or ICU vs others; P < .001), being on life support (RR = 1.54 for being with vs without life support), having a serum creatinine level > 2.0 mg/dL (RR = 1.23 for > 2.0 vs ≤ 2.0 mg/dL; P < .001), a history of dialysis (RR = 1.26 for dialysis vs no dialysis; P < .001), and age > 60 years (RR = 1.17 for > vs < 60 y; P < .001) had deleterious effects on graft survival after adjusting for all other factors. Relevant to this investigation, Hong and associates 27 defined a prognostic scoring system for risk stratification of patients undergoing orthotopic liver transplant using grafts from DCD donors.…”

Section: Risk Factors For Graft Survivalmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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There are increasing numbers of patients on liver transplant waiting lists, and there is a continuing organ shortage crisis. Therefore, more centers and organ procurement organizations are developing protocols for donation after cardiac death. However, the effect of donation after cardiac death allografts on overall patient survival remains controversial, with some centers reporting equivalent patient posttransplant survival but many others indicating increased rates of complications, retransplant, utilization of resources, and death. Several potential risk factors that predict graft loss and recipient complications have been identified. To improve patient outcomes and reduce dropouts, experimental strategies that target both donors and recipients at various phases of the transplant process have focused on attenuating ischemia-reperfusion injury and have achieved encouraging results. In the present article, our goal is to provide an overview of the current status of, and recent advances in, liver transplant from donation after cardiac death, to better understand the risks and potential benefits of donation after cardiac death liver transplant.

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Donation after Cardiac Death Liver Transplantation: Predictors of Outcome

Cited by 209 publications

References 30 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

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