title: Liver transplantation using organ donation after cardiac death: a clinical predictive index for graft failure-free survival.
abstract: OBJECTIVE
  To define a prognostic scoring system for risk stratification of patients undergoing orthotopic liver transplantation (OLT) using grafts from donation after cardiac death (DCD).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University transplant center.
  
  
  METHODS
  Eighty-one patients underwent OLT using DCD grafts from March 1, 1994, to November 30, 2010. The mean follow-up was 2 years. Independent risk factors for graft failure after OLT were identified using Cox model and assigned risk score points. Points were summed and assigned to predictive index categories: 0 or 1 for low risk, 2 to 4 for intermediate risk, and 5 to 9 for high risk.
  
  
  RESULTS
  Six multivariate factors predictive for graft failure after OLT using DCD grafts included the following: for recipients, (1) diagnosis of hepatitis C virus with malignancy, non-hepatitis C virus with malignancy, or hepatitis C virus only, (2) previous OLT, and (3) body mass index (calculated as weight in kilograms divided by height in meters squared) greater than 30; for donors, (4) hepatitis B core antibody positivity and (5) mean arterial pressure lower than 60 mm Hg for longer than 20 minutes after withdrawal of life support; and for grafts, (6) cold ischemia time longer than 6 hours. Five-year graft failure-free survival was significantly higher for the low-risk group (83%) compared with the intermediate-risk (62%) and high-risk (0%) groups (P < .001). Overall biliary complications occurred in 24 patients (29%), with ischemic cholangiopathy in 8 patients (9.9%).
  
  
  CONCLUSIONS
  Our study showed superior long-term patient survival with liver transplantation using DCD organs in highly selected donors and recipients. We propose a practical risk stratification system highly predictive of long-term survival outcomes after OLT using DCD grafts. Application of this predictive index for transplant candidates receiving DCD liver grafts would improve patients' outcomes and optimize use of scarce resources.
authors.affiliation: Dumont-UCLA Liver Cancer Center, Pfleger Liver Institute, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-7054, USA. johnnyhong@mednet.ucla.edu
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.forename: Prawat
authors.initials: P
authors.lastname: Kositamongkol
authors.forename: Victor W
authors.initials: VW
authors.lastname: Xia
authors.forename: Fady M
authors.initials: FM
authors.lastname: Kaldas
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Gerald
authors.initials: G
authors.lastname: Lipshutz
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D055815:Young Adult