Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme

Detry, Olivier; Deroover, Arnaud; Meurisse, Nicolas; Hans, Marie-France; Delwaide, Jean; Lauwick, Séverine; Kaba, Abdourahmane; Joris, Jean; Meurisse, Michel; Honoré, Pierre

doi:10.1002/bjs.9488

Cited by 47 publications

(42 citation statements)

References 31 publications

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“…The 1‐year and 3‐year survival rates for recipients in our study were 89.2% and 81.8%, respectively, which is similar to other studies .…”

Section: Discussionsupporting

confidence: 91%

DCD liver transplant infection: experience from a single centre in China

Xiang

et al. 2016

Int J Clin Pract

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This is the first study that offers detailed data revealing the timing and incidence of bacterial and fungal infection among adult DCD liver transplant recipients. Bacterial and fungal infection occurs at a high rate during the first week after DCD liver transplant, especially in patients with prolonged respiratory support time and renal failure, and infection is related to increased hospital stay.

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“…The 1‐year and 3‐year survival rates for recipients in our study were 89.2% and 81.8%, respectively, which is similar to other studies .…”

Section: Discussionsupporting

confidence: 91%

DCD liver transplant infection: experience from a single centre in China

Xiang

et al. 2016

Int J Clin Pract

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“…However, our presented data along with other recent reports (21)(22)(23) may suggest otherwise. (23) This prompted us to ask the following questions: how many young DCD livers are discarded annually, and would more frequent acceptance of younger DCD livers increase the number of liver transplants in the United States?…”

Section: Scalea Redfield and Foley Liver Transplantation Septembersupporting

confidence: 66%

Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

2016

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Multiple reports have demonstrated that liver transplantation following donation after circulatory death (DCD) is associated with poorer outcomes when compared with liver transplantation from donation after brain death (DBD) donors. We hypothesized that carefully selected, underutilized DCD livers recovered from younger donors have excellent outcomes. We performed a retrospective study of the United Network for Organ Sharing database to determine graft survivals for patients who received liver transplants from DBD donors of age 60 years, DBD donors < 60 years, and DCD donors < 50 years of age. Between January 2002 and December 2014, 52,271 liver transplants were performed in the United States. Of these, 41,181 (78.8%) underwent transplantation with livers from DBD donors of age < 60 years, 8905 (17.0%) from DBD donors 60 years old, and 2195 (4.2%) livers from DCD donors < 50 years of age. DCD livers of age < 50 years with < 6 hours of cold ischemia time (CIT) had superior graft survival when compared with DBD livers age 60 years (P < 0.001). In 2014, there were 133 discarded DCD livers; of these, 111 (83.4%) were from donors < age 50 years old. Young DCD donor livers (age < 50 years old) with short CITs yield results better than that seen with DBD livers > 60 years old. Careful donor organ and recipient selection can lead to excellent results, despite previous reports suggesting otherwise. Increased acceptance of these DCD livers would lead to shorter wait list times and increased national liver transplant rates.Liver Transplantation 22 1197-1204 2016 AASLD. There exists a vast disparity between the number of patients on the liver transplant waiting list and the number of available organs.(1-4) One method for increasing the number of transplantable organs has been to use organs from patients who die after circulatory death.(5-9) Accordingly, large increases in the number of transplantable kidneys have resulted from donation after circulatory death (DCD) protocols. However, only modest increases in DCD liver transplantation have been observed. (5,10,11) In fact, only approximately 6% of liver transplants in the United States are performed using DCD livers.(12) This lack of growth in the DCD liver pool is due, in part, to the technical challenges of the operation and concern for postoperative complications such as ischemic cholangiopathy. (5,6) As described by Feng et al., (13) not all donor livers yield equivalent recipient outcomes. Much like livers that are recovered from donation after brain death (DBD) donors, DCD livers carry a spectrum of risk. That is, there are some livers which likely function better than others. It is known that the age of the DCD donor is a risk factor for graft loss when compared with DBD organs, particularly when the DCD donor is >50 years of age. (13,14) In addition, cold ischemia time (CIT) has been shown to have a greater effect on Abbreviations: BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after circulatory death; ICU, intensive ca...

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“…The LT procedures were regular deceased LT as performed in the authors' centre [20,21]. The following LT recipient characteristics were collected: age, gender, BMI, LT indication, and the laboratory model for end-stage liver disease (MELD) score at admission for transplantation.…”

Section: Liver Transplant Procedures and Postoperative Managementmentioning

confidence: 99%