Liver transplantation from donation after cardiac death: a single center experience.
BACKGROUND
Liver transplantation (LT) from controlled donation after cardiac death (DCD) donors has increased steadily during the past decade because of the donor shortage in the United States. Although early reports of LT from DCD donors provided evidence for acceptable outcomes, long-term graft and patient survival rates from these procedures have been reviewed only recently.


METHODS
From February 1990 to June 2006, 1209 LTs were performed from donation after brain death (DBD) donors, and 24 were performed from DCD donors at our institution. Detailed review of donor and recipient characteristics, and survival rates were evaluated in the two groups.


RESULTS
One- and 3-year patient survival was similar in both groups, (DCD 86.8%, 81.7% vs. DBD 84.0%, 76.0%, respectively; P=0.713). Graft survival appeared inferior in the DCD group compared with the DBD group at 1 year (69.1% vs. 78.7%) and 3 years (58.6% vs. 70.2%), but there was no statistical difference (P=0.082). There were no significant differences in hepatic artery thrombosis, portal vein thrombosis, primary nonfunction, and biliary stricture between the two groups. All cases with biliary stricture in DCD group finally led to graft loss, and all survived with retransplantation.


CONCLUSIONS
The outcome of LT from DCD donors remains acceptable in our institution. Although biliary complication rate was similar in two groups, the consequence of this complication in DCD was more severe and often led to graft loss. Close observation of biliary complications after LT from DCD donors would be beneficial.
Fujita
Shiro
S
Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. fujita@surgery.ufl.edu
Mizuno
Shugo
S
Fujikawa
Takahisa
T
Reed
Alan I
AI
Kim
Robin D
RD
Howard
Richard J
RJ
Hemming
Alan W
AW
D000328:Adult; D001926:Brain Death; D002779:Cholestasis / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D003643:Death; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012720:Severity of Illness Index; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome