title: Is it time to extend liver acceptance criteria for controlled donors after cardiac death?
abstract: BACKGROUND
  Donation after cardiac death (DCD) has reemerged as potential way to increase donor liver availability. Earlier, programs with DCD liver transplantation used conservative donor criteria to allow safe results. Successful initial outcomes allowed extended DCD criteria to address transplant demand.
  
  
  METHODS
  A total of 63 DCD liver grafts were used during the study period in carefully selected recipients. These were divided into two groups: "Standard" DCD within conservative criteria (n=33; age ≤60 years, body mass index <30 kg/m(2), donor warm ischemia time ≤30 min, and cold ischemia time ≤8 hr) and "Extended" DCD beyond these criteria (n=30). We compared donor and recipient characteristics and postoperative outcomes, including patient and graft survival.
  
  
  RESULTS
  Both groups had satisfactory initial function; liver graft function at 1, 7, and 30 days after liver transplantation were similar. Median follow-up period was 25 and 18.5 months for Standard and Extended criteria DCD grafts, respectively, with 1-year patient and graft survival of 88% and 82% for the Standard group vs. 90% and 90% for the Extended. Overall, 8 of 63 (13%) patients developed biliary complications; however, the incidence was not different between the Standard and Extended groups. Seven early deaths occurred, four and three in the Standard and Extended groups, respectively.
  
  
  CONCLUSIONS
  Recipients of DCDs beyond conventional acceptance criteria have equivalent early outcomes to standard DCD grafts. With careful selection of donors and recipients, these grafts can be safely used to expand the donor pool.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.forename: Chiara
authors.initials: C
authors.lastname: Rocha
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: John A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: A David
authors.initials: AD
authors.lastname: Mayer
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003643:Death; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D012086:Reoperation; D014019:Tissue Donors; D009927:Tissue and Organ Procurement