Utilization, Outcomes, and Retransplantation of Liver Allografts From Donation After Cardiac Death

Selck, F. W.; Grossman, E.; Ratner, Lloyd E.; Renz, John F.

doi:10.1097/sla.0b013e31818a080e

Cited by 135 publications

(141 citation statements)

References 27 publications

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“…(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.…”

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confidence: 99%

“…(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.…”

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confidence: 99%

“…(1)(2)(3)(4) One method for increasing the number of transplantable organs has been to use organs from patients who die after circulatory death. (5)(6)(7)(8)(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.…”

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confidence: 99%

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confidence: 99%

“…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.…”

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confidence: 99%

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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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confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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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Liver Transplantation Using Organ Donation After Cardiac Death

Yersiz²,

et al. 2011

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The mean follow-up was 2 years. Independent risk factors for graft failure after OLT were identified using Cox model and assigned risk score points. Points were summed and assigned to predictive index categories: 0 or 1 for low risk, 2 to 4 for intermediate risk, and 5 to 9 for high risk. Results: Six multivariate factors predictive for graft failure after OLT using DCD grafts included the following: for recipients, (1) diagnosis of hepatitis C virus with malignancy, non-hepatitis C virus with malignancy, or hepatitis C virus only, (2) previous OLT, and (3) body mass

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Liver Transplantation in Children Using Organ Donation After Circulatory Death

et al. 2014

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Utilization, Outcomes, and Retransplantation of Liver Allografts From Donation After Cardiac Death

Abstract: DCD utilization is impeded by early outcomes and a temporally different failure pattern that limits access to ReTx. Allocation policy that recognizes these limitations and increases access to ReTx is necessary for expansion of this donor population.

Cited by 135 publications

References 27 publications

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

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

Liver Transplantation Using Organ Donation After Cardiac Death

Liver Transplantation in Children Using Organ Donation After Circulatory Death

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