title: 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.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D016757:Death, Sudden, Cardiac; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*