title: Survival of recipients of livers from donation after circulatory death who are relisted and undergo retransplant for graft failure.
abstract: Use of grafts from donation after circulatory death (DCD) as a strategy to increase the pool of transplantable livers has been limited due to poorer recipient outcomes compared with donation after brain death (DBD). We examined outcomes of recipients of failed DCD grafts who were selected for relisting with regard to waitlist mortality and patient and graft survival after retransplant. From the Scientific Registry of Transplant Recipients database, we identified 1820 adults who underwent first deceased donor liver transplant January 1, 2004 to June 30, 2011, and were relisted due to graft failure; 12.7% were DCD recipients. Compared with DBD recipients, DCD recipients had better waitlist survival (90-day mortality: 8%, DCD recipients; 14-21%, DBD recipients). Of 950 retransplant patients, 14.5% were prior DCD recipients. Graft survival after second liver transplant was similar for prior DCD (28% graft failure within 1 year) and DBD recipients (30%). Patient survival was slightly better for prior DCD (25% death within 1 year) than DBD recipients (28%). Despite higher overall graft failure and morbidity rates, survival of prior DCD recipients who were selected for relisting and retransplant was not worse than survival of DBD recipients.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: A M
authors.initials: AM
authors.lastname: Allen
authors.forename: W R
authors.initials: WR
authors.lastname: Kim
authors.forename: H
authors.initials: H
authors.lastname: Xiong
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.forename: P G
authors.initials: PG
authors.lastname: Stock
authors.forename: J R
authors.initials: JR
authors.lastname: Lake
authors.forename: S
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: J J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: A K
authors.initials: AK
authors.lastname: Israni
authors.forename: B L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014850:Waiting Lists
keywords: Graft survival; liver transplantation; outcomes; patient survival; waitlist mortality
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