title: A comprehensive risk assessment of mortality following donation after cardiac death liver transplant - an analysis of the national registry.
abstract: OBJECTIVE
  Organ scarcity has resulted in increased utilization of donation after cardiac death (DCD) donors. Prior analysis of patient survival following DCD liver transplantation has been restricted to single institution cohorts and a limited national experience. We compared the current national experience with DCD and DBD livers to better understand survival after transplantation.
  
  
  METHODS
  We compared 1113 DCD and 42,254 DBD recipients from the Scientific Registry of Transplant Recipients database between 1996 and 2007. Patient survival was analyzed using the Kaplan-Meier methodology and Cox regression.
  
  
  RESULTS
  DCD recipients experienced worse patient survival compared to DBD recipients (p<0.001). One and 3 year survival was 82% and 71% for DCD compared to 86% and 77% for DBD recipients. Moreover, DCD recipients required re-transplantation more frequently (DCD 14.7% vs. DBD 6.8%, p<0.001), and re-transplantation survival was markedly inferior to survival after primary transplant irrespective of graft type. Amplification of mortality risk was observed when DCD was combined with cold ischemia time >12h (HR = 1.81), shared organs (HR = 1.69), recipient hepatocellular carcinoma (HR=1.80), recipient age >60 years (HR = 1.92), and recipient renal insufficiency (HR = 1.82).
  
  
  CONCLUSIONS
  DCD recipients experience significantly worse patient survival after transplantation. This increased risk of mortality is comparable in magnitude to, but often exacerbated by other well-established risk predictors. Utilization decisions should carefully consider DCD graft risks in combination with these other factors.
authors.affiliation: Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Jay
authors.forename: Daniela
authors.initials: D
authors.lastname: Ladner
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: Vadim
authors.initials: V
authors.lastname: Lyuksemburg
authors.forename: Raymond
authors.initials: R
authors.lastname: Kang
authors.forename: Yaojen
authors.initials: Y
authors.lastname: Chang
authors.forename: Joseph
authors.initials: J
authors.lastname: Feinglass
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Anton I
authors.initials: AI
authors.lastname: Skaro
mesh_terms: D000328:Adult; D017677:Age Distribution; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000401:mortality / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000401:mortality; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology