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

30 Citations (Scopus)

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

Fingerprint

Liver Transplantation
Allografts
Tissue Donors
Liver
Brain Death
Survival
Cold Ischemia
Warm Ischemia
Tissue and Organ Procurement
Kaplan-Meier Estimate
Organ Transplantation
Survival Analysis
Proportional Hazards Models
Consensus
Decision Making
Multivariate Analysis
Databases
Pediatrics
Transplants

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Harring, T. R., Nguyen, N. T. T., Cotton, R. T., Guiteau, J. J., Salas De Armas, I. A., Liu, H., ... 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

Liver transplantation with donation after cardiac death donors : A comprehensive update. / Harring, Theresa R.; Nguyen, N. Thao T.; Cotton, Ronald T.; Guiteau, Jacfranz J.; Salas De Armas, Ismael A.; Liu, Hao; Goss, John A.; O'Mahony, Christine A.

In: Journal of Surgical Research, Vol. 178, No. 1, 01.11.2012, p. 502-511.

Research output: Contribution to journalArticle

Harring, TR, Nguyen, NTT, Cotton, RT, Guiteau, JJ, Salas De Armas, IA, Liu, H, Goss, JA & O'Mahony, CA 2012, 'Liver transplantation with donation after cardiac death donors: A comprehensive update', Journal of Surgical Research, vol. 178, no. 1, pp. 502-511. https://doi.org/10.1016/j.jss.2012.04.044
Harring, Theresa R. ; Nguyen, N. Thao T. ; Cotton, Ronald T. ; Guiteau, Jacfranz J. ; Salas De Armas, Ismael A. ; Liu, Hao ; Goss, John A. ; O'Mahony, Christine A. / Liver transplantation with donation after cardiac death donors : A comprehensive update. In: Journal of Surgical Research. 2012 ; Vol. 178, No. 1. pp. 502-511.
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