title: First experience of liver transplantation with type 2 donation after cardiac death in France.
abstract: Organ donation after unexpected cardiac death [type 2 donation after cardiac death (DCD)] is currently authorized in France and has been since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation (LT) with type 2 DCD donors. After the declaration of death, abdominal normothermic oxygenated recirculation was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 LTs were performed in 3 French centers. Six patients had a rapid and uneventful postoperative recovery. However, primary nonfunction occurred in 3 patients, with each requiring urgent retransplantation, and 4 early allograft dysfunctions were observed. One patient developed a nonanastomotic biliary stricture after 3 months, whereas 8 patients showed no sign of ischemic cholangiopathy at their 1-year follow-up. In comparison with a control group of patients receiving grafts from brain-dead donors (n = 41), donor age and cold ischemia time were significantly lower in the type 2 DCD group. Time spent on the national organ wait list tended to be shorter in the type 2 DCD group: 7.5 months [interquartile range (IQR), 4.0-11.0 months] versus 12.0 months (IQR, 6.8-16.7 months; P = 0.08. The 1-year patient survival rates were similar (85% in the type 2 DCD group versus 93% in the control group), but the 1-year graft survival rate was significantly lower in the type 2 DCD group (69% versus 93%; P = 0.03). In conclusion, to treat borderline hepatocellular carcinoma, LT with type 2 DCD donors is possible as long as strict donor selection is observed.
authors: Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique, Transplantation Hépatique, Centre Hospitalier Universitaire Pitié Salpetriere, AP-HP, Université Pierre et Marie Curie, Université Paris 06, Paris, France; Ischémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques (IRTOMIT), INSERM U1082, Poitiers, France.
authors: Eric
authors: E
authors: Savier
authors: Federica
authors: F
authors: Dondero
authors: Eric
authors: E
authors: Vibert
authors: Daniel
authors: D
authors: Eyraud
authors: Hélène
authors: H
authors: Brisson
authors: Bruno
authors: B
authors: Riou
authors: Fabienne
authors: F
authors: Fieux
authors: Salima
authors: S
authors: Naili-Kortaia
authors: Denis
authors: D
authors: Castaing
authors: Jean-Jacques
authors: JJ
authors: Rouby
authors: Olivier
authors: O
authors: Langeron
authors: Safi
authors: S
authors: Dokmak
authors: Laurent
authors: L
authors: Hannoun
authors: Jean-Christophe
authors: JC
authors: Vaillant
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D003643:Death; D046148:Donor Selection / Q000379:methods; D005260:Female; D005602:France; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011184:Postoperative Period; D055031:Primary Graft Dysfunction; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult