title: Liver transplantation following donation after cardiac death: an analysis using matched pairs.
abstract: Grafts from donation after cardiac death (DCD) donors are used to increase the number of organs available for liver transplantation. There is concern that warm ischemia may impair graft function. We compared our DCD recipients with a case-matched group of donation after brain death (DBD) recipients. Between January 2002 and April 2008, 39 DCD grafts were transplanted. These were matched with 39 DBD recipients on the basis of identified variables that had a significant impact on mortality. These were used to individually match DCD and DBD patients with similar predictive mortality. We compared patient/graft survival, primary non-function (PNF), and rates of complications. Of all liver transplants, 6.1% were DCD grafts. PNF occurred twice in the DCD group. The incidence of nonanastomotic biliary strictures (NABS; 20.5% versus 0%, P = 0.005) and hepatic artery stenosis (HAS; 12.8% versus 0%, P = 0.027) in the DCD group was higher. One-year (79.5% versus 97.4%, P = 0.029) and 3-year (63.6% versus 97.4%, P = 0.001) graft survival was lower in the DCD group. Three-year patient survival was also lower (68.2% versus 100%, P < 0.0001). Our study is the first to use case-matched patients and compare groups with similar predictive mortality. There was a higher incidence of NABS and HAS in the DCD group. NABS were likely a result of warm ischemia. HAS may have been due to ischemia or arterial injury during retrieval. The DCD group had significantly poorer outcomes, but DCD grafts remain a valuable resource. With careful donor/recipient selection, minimization of ischemia, and good postoperative care, acceptable results can be achieved.
authors.affiliation: Department of Hepatobiliary/Transplant Surgery, St. James's University Hospital, Beckett Street, United Kingdom.
authors.forename: James K
authors.initials: JK
authors.lastname: Pine
authors.forename: Amer
authors.initials: A
authors.lastname: Aldouri
authors.forename: Alistair L
authors.initials: AL
authors.lastname: Young
authors.forename: Mervyn H
authors.initials: MH
authors.lastname: Davies
authors.forename: Magdy
authors.initials: M
authors.lastname: Attia
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Pollard
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001660:Biliary Tract Diseases / Q000209:etiology; D001926:Brain Death; D002648:Child; D003251:Constriction, Pathologic; D003643:Death; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D018579:Patient Selection; D055031:Primary Graft Dysfunction / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects; D055815:Young Adult