title: Hospital Resource Use with Donation after Cardiac Death Allografts in Liver Transplantation: A Matched Controlled Analysis from 2007 to 2011.
abstract: BACKGROUND
  Although donation after cardiac death (DCD) liver allografts have been used to expand the donor pool, concerns exist regarding primary nonfunction and biliary complications. Our aim was to compare resource use and outcomes of DCD allografts with donation after brain death (DBD) liver allografts.
  
  
  METHODS
  Using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases, we identified 11,856 patients who underwent deceased donor liver transplantation (LT) from 2007 to 2011. Patients were divided into 2 cohorts based on type of allograft (DCD vs DBD). Matched pair analysis (n = 613 in each group) was used to compare outcomes of the 2 donor types.
  
  
  RESULTS
  Donation after cardiac death allografts comprised 5.2% (n = 613) of all LTs in the studied cohort; DCD allograft recipients were healthier and had lower median Model of End-Stage Liver Disease (MELD) score (17 vs 19; p < 0.0001). Post LT, there was no significant difference in length of stay, perioperative mortality, and discharge to home rates. However, DCD allografts were associated with higher direct cost ($110,414 vs $99,543; p < 0.0001) and 30-day readmission rates (46.4% vs 37.1%; p < 0.0001). Matched analysis revealed that DCD allografts were associated with higher direct cost, readmission rates, and inferior graft survival.
  
  
  CONCLUSIONS
  While confirming the previous reports of inferior graft survival associated with DCD allografts, this is the first national report to show increased financial and resource use associated with DCD compared with DBD allografts in a matched recipient cohort.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Ashish
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: R Cutler
authors.initials: RC
authors.lastname: Quillin
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH. Electronic address: Shimul.shah@uc.edu.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000191:economics; D001926:Brain Death; D003643:Death; D058625:End Stage Liver Disease / Q000191:economics / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000191:economics* / Q000379:methods; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult