title: Longterm results of liver transplantation from donation after circulatory death.
abstract: Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P < 0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD.
authors.affiliation: Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Blok
authors.affiliation: Department of Abdominal Surgery and Transplantation, University Hospital of Liège, Liège, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Detry
authors.affiliation: Department of Medical Statistics, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: Department of Surgery, Ghent University Hospital Medical School, Ghent, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.affiliation: Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.affiliation: Starzl Unit of Abdominal Transplantation, Department of Abdominal Surgery and Transplantation, University Hospitals Saint Luc, Brussels, Belgium.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Lerut
authors.affiliation: Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp University, Belgium.
authors.forename: Dirk K
authors.initials: DK
authors.lastname: Ysebaert
authors.affiliation: Department of Abdominal Surgery, Hepatobiliary and Liver Transplantation Unit, Erasme Hospital ULB, Brussels, Belgium.
authors.forename: Valerio
authors.initials: V
authors.lastname: Lucidi
authors.affiliation: Department of Surgery, Ghent University Hospital Medical School, Ghent, Belgium.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Troisi
authors.affiliation: Eurotransplant International Foundation, Leiden, the Netherlands.
authors.forename: Undine
authors.initials: U
authors.lastname: Samuel
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: A Claire
authors.initials: AC
authors.lastname: den Dulk
authors.affiliation: Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.affiliation: Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
authors.forename: Andries E
authors.initials: AE
authors.lastname: Braat
mesh_terms: D000328:Adult; D000367:Age Factors; D001530:Belgium; D046148:Donor Selection / Q000379:methods; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods; D052096:Warm Ischemia / Q000009:adverse effects*