title: Liver transplantation with donation after cardiac death donors: a comprehensive update.
abstract: BACKGROUND
  Use of donation after cardiac death (DCD) donors has been proposed as an effective way to expand the availability of hepatic allografts used in orthotopic liver transplantation (OLT); yet, there remains no consensus in the medical literature as to how to choose optimal recipients and donors based on available information.
  
  
  METHODS
  We queried the United Network of Organ Sharing/Organ Procurement and Transplantation Network database for hepatic DCD allografts used in OLT. As of March 31, 2011, 85,148 patients received hepatic allografts from donation-after-brain-death (DBD) donors, and 2351 patients received hepatic allografts from DCD donors. We performed survival analysis using log-rank and Kaplan-Meier tests. We performed univariate and multivariate analyses using the Cox proportional hazards model. All statistics were performed with SPSS 15.0.
  
  
  RESULTS
  Patients receiving hepatic DCD allografts had significantly worse survival compared with patients receiving hepatic DBD allografts. Pediatric patients who received a hepatic DCD allograft had similar survival to those who received a hepatic DBD allograft. The optimal recipient-related characteristics were age <50 y, International Normalized Ratio <2.0, albumin >3.5 gm/dL, and cold ischemia time <8 h; optimal donor-related characteristics included age <50 y and donor warm ischemia time <20 min.
  
  
  CONCLUSIONS
  By identifying certain characteristics, the transplant clinician's decision-making process can be assisted so that similar survival outcomes after OLT can be achieved with the use of hepatic DCD allografts.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. th147867@bcm.edu
authors.forename: Theresa R
authors.initials: TR
authors.lastname: Harring
authors.forename: N Thao T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Cotton
authors.forename: Jacfranz J
authors.initials: JJ
authors.lastname: Guiteau
authors.forename: Ismael A
authors.initials: IA
authors.lastname: Salas de Armas
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
authors.forename: Christine A
authors.initials: CA
authors.lastname: O'Mahony
mesh_terms: D000328:Adult; D001926:Brain Death; D002648:Child; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003643:Death; D046148:Donor Selection / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014184:Transplantation, Homologous