Liver transplantation with donation after cardiac death donors: A comprehensive update

Theresa R. Harring, N. Thao T. Nguyen, Ronald T. Cotton, Jacfranz J. Guiteau, Ismael A. Salas De Armas, Hao Liu, John A. Goss, Christine A. O'Mahony

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Background: Use of donation after cardiac death (DCD) donors has been proposed as an effective way to expand the availability of hepatic allografts used in orthotopic liver transplantation (OLT); yet, there remains no consensus in the medical literature as to how to choose optimal recipients and donors based on available information. Methods: We queried the United Network of Organ Sharing/Organ Procurement and Transplantation Network database for hepatic DCD allografts used in OLT. As of March 31, 2011, 85,148 patients received hepatic allografts from donation-after-brain-death (DBD) donors, and 2351 patients received hepatic allografts from DCD donors. We performed survival analysis using log-rank and Kaplan-Meier tests. We performed univariate and multivariate analyses using the Cox proportional hazards model. All statistics were performed with SPSS 15.0. Results: Patients receiving hepatic DCD allografts had significantly worse survival compared with patients receiving hepatic DBD allografts. Pediatric patients who received a hepatic DCD allograft had similar survival to those who received a hepatic DBD allograft. The optimal recipient-related characteristics were age <50 y, International Normalized Ratio <2.0, albumin >3.5 gm/dL, and cold ischemia time <8 h; optimal donor-related characteristics included age <50 y and donor warm ischemia time <20 min. Conclusions: By identifying certain characteristics, the transplant clinician's decision-making process can be assisted so that similar survival outcomes after OLT can be achieved with the use of hepatic DCD allografts.

Original languageEnglish (US)
Pages (from-to)502-511
Number of pages10
JournalJournal of Surgical Research
Volume178
Issue number1
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

Keywords

  • Brain death
  • DCD
  • Deceased donor
  • Extended criteria donor
  • Outcomes

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    Harring, T. R., Nguyen, N. T. T., Cotton, R. T., Guiteau, J. J., Salas De Armas, I. A., Liu, H., Goss, J. A., & O'Mahony, C. A. (2012). Liver transplantation with donation after cardiac death donors: A comprehensive update. Journal of Surgical Research, 178(1), 502-511. https://doi.org/10.1016/j.jss.2012.04.044