title: Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score-Matched Study From a Single Center.
abstract: The use of livers from donation after circulatory death (DCD) is increasing, but concerns exist regarding outcomes following use of grafts from "marginal" donors. To compare outcomes in transplants using DCD and donation after brain death (DBD), propensity score matching was performed for 973 patients with chronic liver disease and/or malignancy who underwent primary whole-liver transplant between 2004 and 2014 at University Hospitals Birmingham NHS Foundation Trust. Primary end points were overall graft and patient survival. Secondary end points included postoperative, biliary and vascular complications. Over 10 years, 234 transplants were carried out using DCD grafts. Of the 187 matched DCDs, 82.9% were classified as marginal per British Transplantation Society guidelines. Kaplan-Meier analysis of graft and patient survival found no significant differences for either outcome between the paired DCD and DBD patients (p = 0.162 and p = 0.519, respectively). Aspartate aminotransferase was significantly higher in DCD recipients until 48 h after transplant (p < 0.001). The incidences of acute kidney injury and ischemic cholangiopathy were greater in DCD recipients (32.6% vs. 15% [p < 0.001] and 9.1% vs. 1.1% [p < 0.001], respectively). With appropriate recipient selection, the use of DCDs, including those deemed marginal, can be safe and can produce outcomes comparable to those seen using DBD grafts in similar recipients.
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|NIHR Liver Biomedical Research Unit, University Hospitals Birmingham, Birmingham, UK.
authors.forename: R W
authors.identifier: 0000-0002-8143-4278
authors.initials: RW
authors.lastname: Laing
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Scalera
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|Department of Liver Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Isaac
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: H
authors.identifier: 0000-0001-5480-9380
authors.initials: H
authors.lastname: Mergental
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|Department of Liver Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hodson
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|NIHR Liver Biomedical Research Unit, University Hospitals Birmingham, Birmingham, UK.
authors.forename: R J W
authors.initials: RJ
authors.lastname: Wilkin
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|Department of Liver Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: M T P R
authors.identifier: 0000-0002-5417-3850
authors.initials: MT
authors.lastname: Perera
authors.affiliation: Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|Department of Liver Surgery, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
mesh_terms: D000328:Adult; D001926:Brain Death; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome