Factors affecting graft survival after liver transplantation from donation after cardiac death donors.

Abstract:

BACKGROUND:Liver transplantation from donation after cardiac death (DCD) donors is an increasingly common approach for expansion of the donor organ supply. However, transplantation with DCD livers results in inferior graft survival. In this study, we examined donor and recipient characteristics that are associated with poor allograft outcomes and present a set of criteria that permit allograft survival that is comparable to that of donation after brain death (DBD) grafts in both low- and high-risk recipients. METHODS:The United Network for Organ Sharing/Organ Procurement and Transplantation Network Liver Transplantation Registry between January 1996 and March 2006 was investigated. Adult DCD liver transplants (n = 874) were included. RESULTS:A DCD risk index was developed using the statistically significant factors from a multivariate Cox model: history of previous transplantation, life support status at transplantation, donor age, donor warm ischemia time (DWIT), and cold ischemia time (CIT). Favorable DCD donor criteria were donor age < or =45 years, DWIT < or =15 min, and CIT < or =10 hr. Four risk groups were developed based upon index scores that showed different graft survival. Graft survival of the favorable DCD group (84.9% at 1 year, 75.2% at 3 years, and 69.4% at 5 years) was comparable to that for DBD liver transplantation irrespective of recipient condition. Increasing donor age was more highly predictive of poor outcomes in DCD compared to DBD, especially in recipients in poor preoperative condition. CONCLUSIONS:DCD livers from young donors with short DWIT and CIT should be given greater consideration in order to expand the number of available donor organs.

journal_name

Transplantation

journal_title

Transplantation

authors

Lee KW,Simpkins CE,Montgomery RA,Locke JE,Segev DL,Maley WR

doi

10.1097/01.tp.0000250936.73034.98

subject

Has Abstract

pub_date

2006-12-27 00:00:00

pages

1683-8

issue

12

eissn

0041-1337

issn

1534-6080

pii

00007890-200612270-00031

journal_volume

82

pub_type

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