M Pitarch Martínez1, B Sánchez Pérez2, F J León Díaz3, J L Fernández Aguilar3, J A Pérez Daga3, M C Montiel Casado3, J M Aranda Narváez3, M Á Suárez Muñoz3, J Santoyo Santoyo2. 1. Department of Surgery, Obstetrics and Ginecology, Faculty of Medicine, Universidad de Málaga, Málaga, Spain; Hepatobiliopancreatic Surgery and Transplant Unit, General and Digestive Surgery Service, Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: maria.pitarchmartinez@gmail.com. 2. Department of Surgery, Obstetrics and Ginecology, Faculty of Medicine, Universidad de Málaga, Málaga, Spain; Hepatobiliopancreatic Surgery and Transplant Unit, General and Digestive Surgery Service, Hospital Regional Universitario de Málaga, Málaga, Spain. 3. Hepatobiliopancreatic Surgery and Transplant Unit, General and Digestive Surgery Service, Hospital Regional Universitario de Málaga, Málaga, Spain.
Abstract
BACKGROUND: As new sources of organs are needed, liver transplantation using donors after cardiac death (DCD) is progressively increasing, but outcomes with this method are still questioned. This study was accomplished to verify that DCD outcomes are comparable to those seen in donation after brain death (DBD). METHODS: This was a prospective cohort study including 100 liver transplantation performed between 2014 and 2017, divided according to donor type in 75 DBD and 25 DCD. RESULTS: DCD donors were younger (mean age: DCD 56 years, DBD 59 years; P = .009). Mean Modified End-stage Liver Disease (MELD) score was lower for DCD (DCD 16, DBD 19; P < .001). No differences were found regarding ischemia times and development of postreperfusion syndrome or coagulopathy. Primary graft dysfunction was more frequent in DCD (60%, DCD 29.3%; P = .006). Rates of primary graft nonfunction (DCD 0%, DBD 1.3%; P = .562) and acute rejection (DCD 20%, DBD 16.4%; P = .685) were similar. Acute kidney injury occurred more often in DBD (DCD 32%, DBD 12%; P = .051). Length of stay was comparable. Rates of biliary complications (DCD 20%, DBD 26.7%; P = .505) were similar, unlike ischemic cholangiopathy (DCD 12%, DBD 1.3%; P = .018). Retransplantation rates were also similar (DCD 8%, DBD 4%; P = .427) as was survival rate after 3 years (DCD 84%, DBD 86.7%; P = .739). CONCLUSION: DCD represents an additional graft source with results that are encouraging and may be comparable to DBD with a careful donor and recipient selection.
BACKGROUND: As new sources of organs are needed, liver transplantation using donors after cardiac death (DCD) is progressively increasing, but outcomes with this method are still questioned. This study was accomplished to verify that DCD outcomes are comparable to those seen in donation after brain death (DBD). METHODS: This was a prospective cohort study including 100 liver transplantation performed between 2014 and 2017, divided according to donor type in 75 DBD and 25 DCD. RESULTS:DCD donors were younger (mean age: DCD 56 years, DBD 59 years; P = .009). Mean Modified End-stage Liver Disease (MELD) score was lower for DCD (DCD 16, DBD 19; P < .001). No differences were found regarding ischemia times and development of postreperfusion syndrome or coagulopathy. Primary graft dysfunction was more frequent in DCD (60%, DCD 29.3%; P = .006). Rates of primary graft nonfunction (DCD 0%, DBD 1.3%; P = .562) and acute rejection (DCD 20%, DBD 16.4%; P = .685) were similar. Acute kidney injury occurred more often in DBD (DCD 32%, DBD 12%; P = .051). Length of stay was comparable. Rates of biliary complications (DCD 20%, DBD 26.7%; P = .505) were similar, unlike ischemic cholangiopathy (DCD 12%, DBD 1.3%; P = .018). Retransplantation rates were also similar (DCD 8%, DBD 4%; P = .427) as was survival rate after 3 years (DCD 84%, DBD 86.7%; P = .739). CONCLUSION:DCD represents an additional graft source with results that are encouraging and may be comparable to DBD with a careful donor and recipient selection.
Authors: Natalie M Bath; Glen Leverson; David P Al-Adra; Anthony M D'Alessandro; Joshua D Mezrich; David P Foley Journal: Liver Transpl Date: 2020-09 Impact factor: 5.799
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