PTU-064 The use of non-heart-beating donor grafts increases perioperative resource utilisation in liver transplantation

• Published in: Gut Vol. 59; no. Suppl 1; p. A74
• Main Authors: Broomhead, R, Patel, S, Burroughs, A K, Fernando, B S, Mallet, S, O'Beirne, J P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2010
• Subjects: Clinical outcomes; Hypotension; Liver transplantation; Liver transplants; Lysis; Mechanical ventilation; Patients; Renal replacement therapy; Reperfusion; Survival
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2009.209056x

IntroductionThe use of NHBD donor grafts for liver transplantation (LT) is increasing. Large series suggest that patient outcomes are equivalent to heart beating donor (HBD) graft recipients but there is currently scarce literature on the impact on the increasing use of NHBD on perioperative resource utilisation.MethodsWe analysed patients undergoing NHDB LT in our centre over a 2-year period and compared perioperative variables to a similar number of HBD recipients (matched for age, disease severity and indication) to determine if the use of NHBD donor livers increased resource utilisation.Results16 NHBD recipients were matched to 16 patients undergoing HBD LT. There were no differences in indication, MELD, age or sex between the groups. NHBD LT was associated with more frequent post reperfusion hypotension and clinically significant lysis requiring tranexamic acid. Post operative stay on ITU was longer and there was a more frequent need for vasopressors, ventilation and renal replacement therapy in NHBD recipients (Abstract 064). 2 patients (both from the NHBD group) had primary non-function and underwent emergency regrafting. 90-day survival was 100% in both groups. Abstract PTU-064HBD (n=16)NHBD (n=16)p ValueAge52 (43–57)54 (41–62)NSMELD16.5 (13–20)18 (13.5–21)NSCold ischaemic time (mins)488 (431–589)397 (361–423)0.015Time with systolic BP <100 (mins)045 (30–64)0.0001Tranexamic acid (%)0430.003Total ITU vasopressor requirement (h)9.5 (5–16)20.5 (12–37)0.002Total ITU ventilator hours11 (7–19)22 (10–113)0.02ITU length of stay (days)2 (1.5–3.5)3.75 (2.5–6.5)0.021Renal replacement therapy (n)030.01Data presented as median and IQR unless otherwise stated. ConclusionThe use of NHBD grafts in LT results in acceptable patient and graft survival however there appears to be increased severity of reperfusion syndrome and more requirement for post operative organ support. These data suggest that though patient outcomes may not be significantly affected, increasing use of NHBD grafts may lead to significantly impact on the resources and costs associated with liver transplantation.