title: Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single-center experience.
abstract: The use of donation after cardiac death (DCD) donors may provide a valuable source of organs for liver transplantation. Concerns regarding primary nonfunction (PNF) and intrahepatic biliary stricture (IHBSs) have limited the enthusiasm for their use. A retrospective analysis of 1436 consecutive deceased donor liver transplants performed between December 1998 and October 2006 was conducted. These included 108 DCD liver transplants, which were compared to 1328 transplants performed with organs from donors meeting the criteria for donation after brain death (DBD). The median follow-up was 48 months. The 1-, 3-, and 5-year patient survival and graft survival for DCD donors were 91.5%, 88.1%, and 88.1% and 79.3%, 74.5%, and 71.0%, respectively. The 1-, 3-, and 5-year patient survival and graft survival for DBD donors were 87.3%, 81.1%, and 77.2% and 81.6%, 74.7%, and 69.1%, respectively. Patient survival and graft survival were not significantly different between DCD donors less than 60 years old, DCD donors greater than 60 years old, and DBD donors. Causes of graft loss included IHBSs (n = 9), PNF (n = 4), recurrent hepatitis C virus (n = 4), hepatic artery thrombosis (n = 1), rejection (n = 2), and patient death (n = 13). Contrary to previously published data, excellent long-term patient survival and graft survival can be obtained with DCD allografts, and in our experience, they are equivalent to those obtained from DBD allografts.
authors.affiliation: Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA. grewal.hani@mayo.edu
authors.forename: Hani P
authors.initials: HP
authors.lastname: Grewal
authors.forename: Darrin L
authors.initials: DL
authors.lastname: Willingham
authors.forename: Justin
authors.initials: J
authors.lastname: Nguyen
authors.forename: Winston R
authors.initials: WR
authors.lastname: Hewitt
authors.forename: Bucin C
authors.initials: BC
authors.lastname: Taner
authors.forename: Danielle
authors.initials: D
authors.lastname: Cornell
authors.forename: Barry G
authors.initials: BG
authors.lastname: Rosser
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.forename: Jamie
authors.initials: J
authors.lastname: Aranda-Michel
authors.forename: Raj
authors.initials: R
authors.lastname: Satyanarayana
authors.forename: Denise
authors.initials: D
authors.lastname: Harnois
authors.forename: Rolland C
authors.initials: RC
authors.lastname: Dickson
authors.forename: David J
authors.initials: DJ
authors.lastname: Kramer
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death; D002648:Child; D003643:Death; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult