INTRODUCTION: Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. PATIENTS AND METHODS: Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze biliary complications, retransplantation rates, and patient/graft survivals. RESULTS: Median donor age was similar for DCD and DBD-OLT: 51 versus 53 years (P = .244). Median donor warm ischemia time (stop ventilation to cold perfusion in DCD donors) was 24 minutes. Median cold ischemia time was shorter for DCD (6 hours 54 minutes) compared with DBD-OLT (8 hours 36 minutes; P < .0001). Median laboratory model of end-stage liver disease score was 15 for DCD, and 16 for DBD-OLT (P = .59). Median post-OLT Aspartate Aminotransferase (AST) peak was higher after DCD: 1178 versus DBD-OLT 651 IU/L (P = .005). The incidence of nonanastomotic strictures was different: 33.3% for DCD versus 12.5% for DBD-OLT (P = .001). The overall retransplantation rate was 3% after both DCD and DBD-OLT. After DCD-LTx actuarial 1, 3- and 5-year patient survivals were 93, 85 and 85%, and corresponding graft survivals, 90%, 82%, and 82% respectively, and not different compared with DBD-OLT: 88%, 78%, and 72% (P = .348) and 85%, 74%, and 68% (P = .524) respectively. CONCLUSION: Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted.
INTRODUCTION: Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. PATIENTS AND METHODS: Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze biliary complications, retransplantation rates, and patient/graft survivals. RESULTS: Median donor age was similar for DCD and DBD-OLT: 51 versus 53 years (P = .244). Median donor warm ischemia time (stop ventilation to cold perfusion in DCD donors) was 24 minutes. Median cold ischemia time was shorter for DCD (6 hours 54 minutes) compared with DBD-OLT (8 hours 36 minutes; P < .0001). Median laboratory model of end-stage liver disease score was 15 for DCD, and 16 for DBD-OLT (P = .59). Median post-OLT Aspartate Aminotransferase (AST) peak was higher after DCD: 1178 versus DBD-OLT 651 IU/L (P = .005). The incidence of nonanastomotic strictures was different: 33.3% for DCD versus 12.5% for DBD-OLT (P = .001). The overall retransplantation rate was 3% after both DCD and DBD-OLT. After DCD-LTx actuarial 1, 3- and 5-year patient survivals were 93, 85 and 85%, and corresponding graft survivals, 90%, 82%, and 82% respectively, and not different compared with DBD-OLT: 88%, 78%, and 72% (P = .348) and 85%, 74%, and 68% (P = .524) respectively. CONCLUSION: Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted.
Authors: Emre A Eren; Nicholas Latchana; Eliza Beal; Don Hayes; Bryan Whitson; Sylvester M Black Journal: Exp Clin Transplant Date: 2016-10 Impact factor: 0.945
Authors: Thomas J Chirichella; C Michael Dunham; Michael A Zimmerman; Elise M Phelan; M Susan Mandell; Kendra D Conzen; Stephen E Kelley; Trevor L Nydam; Thomas E Bak; Igal Kam; Michael E Wachs Journal: World J Gastroenterol Date: 2016-03-28 Impact factor: 5.742
Authors: Alix P M Matton; Jasmijn W Selten; Henk P Roest; Jeroen de Jonge; Jan N M IJzermans; Vincent E de Meijer; Robert J Porte; Luc J W van der Laan Journal: Clin Transplant Date: 2020-02-20 Impact factor: 2.863
Authors: Alix P M Matton; Yvonne de Vries; Laura C Burlage; Rianne van Rijn; Masato Fujiyoshi; Vincent E de Meijer; Marieke T de Boer; Ruben H J de Kleine; Henkjan J Verkade; Annette S H Gouw; Ton Lisman; Robert J Porte Journal: Transplantation Date: 2019-07 Impact factor: 4.939
Authors: Rebecca Panconesi; Mauricio Flores Carvalho; Matteo Mueller; David Meierhofer; Philipp Dutkowski; Paolo Muiesan; Andrea Schlegel Journal: Biomedicines Date: 2021-02-07
Authors: Sanna Op den Dries; Michael E Sutton; Negin Karimian; Marieke T de Boer; Janneke Wiersema-Buist; Annette S H Gouw; Henri G D Leuvenink; Ton Lisman; Robert J Porte Journal: PLoS One Date: 2014-02-14 Impact factor: 3.240
Authors: Angus Hann; Daniel-Clement Osei-Bordom; Desley A H Neil; Vincenzo Ronca; Suz Warner; M Thamara P R Perera Journal: Front Immunol Date: 2020-06-22 Impact factor: 7.561