Outcomes using grafts from donors after cardiac death

M. B.Majella Doyle, Kelly Collins, Neeta Vachharajani, Jeffrey A. Lowell, Surendra Shenoy, Ilke Nalbantoglu, Kathleen Byrnes, Jacqueline Garonzik-Wang, Jason Wellen, Yiing Lin, William C. Chapman

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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. Study Design 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.

Original languageEnglish (US)
Pages (from-to)142-152
Number of pages11
JournalJournal of the American College of Surgeons
Volume221
Issue number1
DOIs
StatePublished - Jul 1 2015

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ASJC Scopus subject areas

  • Surgery

Cite this

Doyle, M. B. M., Collins, K., Vachharajani, N., Lowell, J. A., Shenoy, S., Nalbantoglu, I., Byrnes, K., Garonzik-Wang, J., Wellen, J., Lin, Y., & Chapman, W. C. (2015). Outcomes using grafts from donors after cardiac death. Journal of the American College of Surgeons, 221(1), 142-152. https://doi.org/10.1016/j.jamcollsurg.2015.03.053