Livers from donors after cardiac death offer alternative

Last Updated: 2015-04-22

By David Douglas

NEW YORK (Reuters Health) - Although caution is required, successful liver transplants can be made following donation after cardiac death (DCD), according to Missouri-based researchers.

"DCD donor grafts are an excellent way to increase the donor pool in this era of liver donation shortage but these grafts need careful selection to be used for liver transplantation," said Dr. Majella Doyle from Washington University School of Medicine in St. Louis.

In an email, she told Reuters Health that using these grafts can raise the risk of renal failure in the short term and ischemic cholangiopathy in the long term.

Unlike donation after brain death (DBD), DCD results in a period of organ warm ischemia prior to perfusion with the cold preservation solution, Dr. Doyle and colleagues note in the Journal of the American College of Surgeons, online April 8. But the impact of warm ischemia time and accompanying physiologic stresses is not fully understood.

The researchers retrospectively examined data on 866 patients who underwent liver transplantation at their institution between 2005 and 2014. They identified 49 patients who underwent DCD. They then compared outcome to all recipients of DBD grafts and to a donor and recipient age- and size-matched cohort.

Mean cold and warm ischemia time was similar. In both groups median ICU time was 2 days and the hospital stay was 7.5 days. Median follow-up was 4.0 years in the DCD group and 3.4 years in the DBD group.

Outcomes were similar between groups at up to five years. However, kidney injury and need for dialysis was significantly more common in the DCD group (16.3% versus 4.1%). Ischemic cholangiopathy occurred in four DCD patients (8.5%), three of whom required retransplantation, and in none of the controls.

Differences in the survival rates were not significant after controlling for propensity score and donor body mass index in a multivariate model. This was also true of the risk of death and/or graft failure.

"Careful selection of DCD donors," the researchers conclude, "can provide suitable donors with results of liver transplantation comparable to standard brain dead donors."

SOURCE: http://bit.ly/1OenXzg

J Am Coll Surg 2015.