Long‐term outcomes of donation after cardiac death liver allografts from a single center

Abstract

Organ shortage continues to be a major challenge in transplantation. Recent experience with controlled non-heart-beating or donation after cardiac death (DCD) are encouraging. However, long-term outcomes of DCD liver allografts are limited. In this study, we present outcomes of 19 DCD liver allografts with follow-up >4.5 years. During 1998-2001, 19 (4.1%) liver transplants (LT) with DCD allografts were performed at our center. Conventional heart-beating donors included 234 standard criteria donors (SCD) and 214 extended criteria donors (ECD). We found that DCD allografts had equivalent rates of primary non-function and biliary complications as compared with SCD and ECD. The overall one-, two-, and five-yr DCD graft and patient survival was 73.7%, 68.4%, and 63.2%, and 89.5%, 89.5%, and 89.5%, respectively. DCD graft survival was similar to graft survival of SCD and ECD in non hepatitis C virus (HCV) recipients (p > 0.370). In contrast, DCD graft survival was significantly reduced in HCV recipients (p = 0.007). In conclusion, DCD liver allografts are durable and have acceptable long-term outcomes. Further research is required to assess the impact of HCV on DCD allograft survival.

Liver Transplant Using Donors After Cardiac Death: A Single-Center Approach Providing Outcomes Comparable to Donation After Brain Death

“…34 Many retrospective, single-center studies of DCD liver allograft outcomes also suggest the use of this practice. 3,4,12,26 In contrast, 1 study argued that higher risk patients on life support or with MELD scores > 30 transplanted with DCD donors have a greater survival benefit than lower risk patients. This conclusion is based upon similar survival rates when compared with higher risk patients transplanted with DBD donors.…”

“…4,6,7,12,26,27 There was 1 primary nonfunction in our study among the recipients of DCD donors, which led to death before retransplant. The recipient's morbid obesity made OLT difficult and contributed to a prolonged operative time.…”

“…4,6,7,12,26,27 Biliary complications, which have been the Achilles' heel of DCD donor liver allograft use, showed a trend to be more common for DCD recipients. However, IHBS, which are the complication of greatest concern because of their effects on patient and graft survival rates, were not statistically more common in recipients of DCD donors versus the matched recipients of DBD donors (7.9% and 1.3%; P = .107).…”

“…Many of these groups showed poorer graft and/or patient survival when compared with recipients of DBD donors. 3,4,9,12,13,[25][26][27][28] A comprehensive approach allows our center to control for factors like donor age, WIT, CIT, asystole-to-flush time, and preservation solution that previously have been shown to contribute to IHBS. 3,4,10,26,[29][30][31] Each DCD donor offered to our center is critically assessed regarding donor age, location, serologies, and probability of timely death, by assessing respiratory effort and the need for vasopressors.…”

“…[8][9][10][11] Despite the series of studies finding poorer outcomes with DCD as compared with DBD donors, several single-center studies have demonstrated that similar results can be achieved in recipients regardless of the donor source. [12][13][14] If concerns regarding DCD donors can be resolved, they could remain a resource to help address the growing demand for liver allografts. The aim of this study was to provide additional evidence that outcomes of orthotopic liver transplant (OLT) with DCD donors can be equivalent to outcomes with DBD donors by using a comprehensive approach that controls for careful donor and recipient matching, warm and cold ischemia times, surgical technique, and preservation solution.…”