title: Outcomes Using Grafts from Donors after Cardiac Death.
abstract: BACKGROUND
  Previous reports suggest that donation after cardiac death (DCD) liver grafts have increased primary nonfunction (PNF) and cholangiopathy thought to be due to the graft warm ischemia before cold flushing.
  
  
  METHODS
  In this single-center, retrospective study, 866 adult liver transplantations were performed at our institution from January 2005 to August 2014. Forty-nine (5.7%) patients received DCD donor grafts. The 49 DCD graft recipients were compared with all recipients of donation after brain death donor (DBD) grafts and to a donor and recipient age- and size-matched cohort.
  
  
  RESULTS
  The DCD donors were younger (age 28, range 8 to 60 years) than non-DCD (age 44.3, range 9 to 80 years) (p < 0.0001), with similar recipient age. The mean laboratory Model for End-Stage Liver Disease (MELD) was lower in DCD recipients (18.7 vs 22.2, p = 0.03). Mean cold and warm ischemia times were similar. Median ICU and hospital stay were 2 days and 7.5 days in both groups (p = 0.37). Median follow-ups were 4.0 and 3.4 years, respectively. Long-term outcomes were similar between groups, with similar 1-, 3- and 5-year patient and graft survivals (p = 0.59). Four (8.5%) recipients developed ischemic cholangiopathy (IC) at 2, 3, 6, and 8 months. Primary nonfunction and hepatic artery thrombosis did not occur in any patient in the DCD group. Acute kidney injury was more common with DCD grafts (16.3% of DCD recipients required dialysis vs 4.1% of DBD recipients, p = 0.01). An increased donor age (>40 years) was shown to increase the risk of IC (p = 0.006).
  
  
  CONCLUSIONS
  Careful selection of DCD donors can provide suitable donors, with results of liver transplantation comparable to those with standard brain dead donors.
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO. Electronic address: doylem@wustl.edu.
authors.forename: M B Majella
authors.initials: MB
authors.lastname: Doyle
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Kelly
authors.initials: K
authors.lastname: Collins
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Neeta
authors.initials: N
authors.lastname: Vachharajani
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.affiliation: Department of Pathology, Washington University School of Medicine, St Louis, MO.
authors.forename: Ilke
authors.initials: I
authors.lastname: Nalbantoglu
authors.affiliation: Department of Pathology, Washington University School of Medicine, St Louis, MO.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Byrnes
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Garonzik-Wang
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Jason
authors.initials: J
authors.lastname: Wellen
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: Yiing
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death; D002648:Child; D003643:Death; D046148:Donor Selection / Q000379:methods*; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult