OBJECTIVE: To determine whether the outcomes of liver transplantation (LTx) from donation after cardiac death (DCD) donors are equivalent to those from donation after brain death (DBD) donors. SUMMARY BACKGROUND DATA: Because of the significant donor organ shortage, more transplant centers are using livers recovered from DCD donors. However, long-term, single-center outcomes of liver transplantation from DCD donors are limited. METHODS: From January 1, 1993, to July 31, 2002, 553 liver transplants were performed from DBD donors and 36 were performed from DCD donors. Differences in event rates between the groups were compared with Kaplan-Meier estimates and the log-rank test. Differences in proportion and differences of means between the groups were compared with Fisher exact test and the Wilcoxon rank sum test, respectively. RESULTS: Mean warm ischemic time at recovery in the DCD group was 17.8 +/- 10.6 minutes. The overall rate of biliary strictures was greater in the DCD group at 1 year (33% versus 10%) and 3 years (37% versus 12%; P = 0.0001). The incidence of hepatic artery thrombosis, portal vein stenosis/thrombosis, ischemic-type biliary stricture (ITBS), and primary nonfunction were similar between groups. However, the incidence of both hepatic artery stenosis (16.6% versus 5.4%; P = 0.001) and hepatic abscess and biloma formation (16.7% versus 8.3%; P = 0.04) were greater in the DCD group. Trends toward worse patient and graft survival and increased incidence of ITBS were seen in DCD donors greater than 40 years compared with DCD donors less than 40 years. Overall patient survival at 1 year (DCD, 80%; versus DBD, 91%) and 3 years (DCD, 68%; versus DBD, 84%) was significantly less in the DCD group (P = 0.002). Similarly, graft survival at 1 year (DCD, 67%; versus DBD, 86%) and 3 years (DCD, 56%; versus DBD, 80%) were significantly less in the DCD group (P = 0.0001). CONCLUSIONS: Despite similar rates of primary nonfunction, LTx after controlled DCD resulted in worse patient and graft survival compared with LTx after DBD and increased incidence of biliary complications and hepatic artery stenosis. However, overall results of LTx after controlled DCD are encouraging; and with careful donor and recipient selection, LTx after DCD may successfully increase the donor liver pool.
OBJECTIVE: To determine whether the outcomes of liver transplantation (LTx) from donation after cardiac death (DCD) donors are equivalent to those from donation after brain death (DBD) donors. SUMMARY BACKGROUND DATA: Because of the significant donor organ shortage, more transplant centers are using livers recovered from DCD donors. However, long-term, single-center outcomes of liver transplantation from DCD donors are limited. METHODS: From January 1, 1993, to July 31, 2002, 553 liver transplants were performed from DBD donors and 36 were performed from DCD donors. Differences in event rates between the groups were compared with Kaplan-Meier estimates and the log-rank test. Differences in proportion and differences of means between the groups were compared with Fisher exact test and the Wilcoxon rank sum test, respectively. RESULTS: Mean warm ischemic time at recovery in the DCD group was 17.8 +/- 10.6 minutes. The overall rate of biliary strictures was greater in the DCD group at 1 year (33% versus 10%) and 3 years (37% versus 12%; P = 0.0001). The incidence of hepatic artery thrombosis, portal vein stenosis/thrombosis, ischemic-type biliary stricture (ITBS), and primary nonfunction were similar between groups. However, the incidence of both hepatic artery stenosis (16.6% versus 5.4%; P = 0.001) and hepatic abscess and biloma formation (16.7% versus 8.3%; P = 0.04) were greater in the DCD group. Trends toward worse patient and graft survival and increased incidence of ITBS were seen in DCD donors greater than 40 years compared with DCD donors less than 40 years. Overall patient survival at 1 year (DCD, 80%; versus DBD, 91%) and 3 years (DCD, 68%; versus DBD, 84%) was significantly less in the DCD group (P = 0.002). Similarly, graft survival at 1 year (DCD, 67%; versus DBD, 86%) and 3 years (DCD, 56%; versus DBD, 80%) were significantly less in the DCD group (P = 0.0001). CONCLUSIONS: Despite similar rates of primary nonfunction, LTx after controlled DCD resulted in worse patient and graft survival compared with LTx after DBD and increased incidence of biliary complications and hepatic artery stenosis. However, overall results of LTx after controlled DCD are encouraging; and with careful donor and recipient selection, LTx after DCD may successfully increase the donor liver pool.
Authors: J Alvarez; R del Barrio; J Arias; F Ruiz; J Iglesias; R de Elías; C Yébenes; J Matesanz; C Caniego; J Elvira Journal: Transplantation Date: 2000-07-27 Impact factor: 4.939
Authors: A M D'Alessandro; J S Odorico; S J Knechtle; Y T Becker; R M Hoffmann; M Kalayoglu; H W Sollinger Journal: Cell Transplant Date: 2000 Nov-Dec Impact factor: 4.064
Authors: D J Reich; S J Munoz; K D Rothstein; H M Nathan; J M Edwards; R D Hasz; C Y Manzarbeitia Journal: Transplantation Date: 2000-10-27 Impact factor: 4.939
Authors: A M D'alessandro; R M Hoffmann; S J Knechtle; J S Odorico; Y T Becker; A Musat; J D Pirsch; H W Sollinger; M Kalayoglu Journal: Surgery Date: 2000-10 Impact factor: 3.982
Authors: A M D'Alessandro; R M Hoffmann; S J Knechtle; D E Eckhoff; R B Love; M Kalayoglu; H W Sollinger; F O Belzer Journal: Transplantation Date: 1995-04-15 Impact factor: 4.939
Authors: Peter Abt; Michael Crawford; Niraj Desai; James Markmann; Kim Olthoff; Abraham Shaked Journal: Transplantation Date: 2003-05-27 Impact factor: 4.939
Authors: Janet M Bellingham; Chandrasekar Santhanakrishnan; Nikole Neidlinger; Philip Wai; Jim Kim; Silke Niederhaus; Glen E Leverson; Luis A Fernandez; David P Foley; Joshua D Mezrich; Jon S Odorico; Robert B Love; Nilto De Oliveira; Hans W Sollinger; Anthony M D'Alessandro Journal: Surgery Date: 2011-10 Impact factor: 3.982
Authors: Roberto Hernandez-Alejandro; Yves Caumartin; Cameron Chent; Mark A Levstik; Douglas Quan; Norman Muirhead; Andrew A House; Vivian McAlister; Anthony M Jevnikar; Patrick P W Luke; William Wall Journal: Can J Surg Date: 2010-04 Impact factor: 2.089
Authors: Kristopher P Croome; Amit K Mathur; David D Lee; Adyr A Moss; Charles B Rosen; Julie K Heimbach; C Burcin Taner Journal: Transplantation Date: 2018-07 Impact factor: 4.939
Authors: Malcolm Wells; Kris M Croome; Toni Janik; Roberto M Hernandez-Alejandro; Natasha M Chandok Journal: Can J Gastroenterol Hepatol Date: 2013-11-28