title: Outcomes of liver transplantations using donations after circulatory death: a single-center experience.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT.
  
  
  METHODS
  Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze biliary complications, retransplantation rates, and patient/graft survivals.
  
  
  RESULTS
  Median donor age was similar for DCD and DBD-OLT: 51 versus 53 years (P = .244). Median donor warm ischemia time (stop ventilation to cold perfusion in DCD donors) was 24 minutes. Median cold ischemia time was shorter for DCD (6 hours 54 minutes) compared with DBD-OLT (8 hours 36 minutes; P < .0001). Median laboratory model of end-stage liver disease score was 15 for DCD, and 16 for DBD-OLT (P = .59). Median post-OLT Aspartate Aminotransferase (AST) peak was higher after DCD: 1178 versus DBD-OLT 651 IU/L (P = .005). The incidence of nonanastomotic strictures was different: 33.3% for DCD versus 12.5% for DBD-OLT (P = .001). The overall retransplantation rate was 3% after both DCD and DBD-OLT. After DCD-LTx actuarial 1, 3- and 5-year patient survivals were 93, 85 and 85%, and corresponding graft survivals, 90%, 82%, and 82% respectively, and not different compared with DBD-OLT: 88%, 78%, and 72% (P = .348) and 85%, 74%, and 68% (P = .524) respectively.
  
  
  CONCLUSIONS
  Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted.
authors.affiliation: Leuven Liver Transplant Team, University Hospitals Leuven, Leuven, Belgium. nicolas.meurisse@med.kuleuven.be
authors.forename: N
authors.initials: N
authors.lastname: Meurisse
authors.forename: S
authors.initials: S
authors.lastname: Vanden Bussche
authors.forename: I
authors.initials: I
authors.lastname: Jochmans
authors.forename: J
authors.initials: J
authors.lastname: Francois
authors.forename: B
authors.initials: B
authors.lastname: Desschans
authors.forename: W
authors.initials: W
authors.lastname: Laleman
authors.forename: S
authors.initials: S
authors.lastname: Van der Merwe
authors.forename: W
authors.initials: W
authors.lastname: Van Steenbergen
authors.forename: D
authors.initials: D
authors.lastname: Cassiman
authors.forename: C
authors.initials: C
authors.lastname: Verslype
authors.forename: R
authors.initials: R
authors.lastname: Aerts
authors.forename: F
authors.initials: F
authors.lastname: Nevens
authors.forename: J
authors.initials: J
authors.lastname: Pirenne
authors.forename: D
authors.initials: D
authors.lastname: Monbaliu
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium; D002423:Cause of Death; D016009:Chi-Square Distribution; D050377:Cold Ischemia / Q000009:adverse effects; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects