IMPROVING NATIONAL RESULTS IN LIVER TRANSPLANTATION USING GRAFTS FROM DONATION AFTER CARDIAC DEATH DONORS

• Published in: Transplantation
• Main Authors: Croome, Kristopher P, Lee, David D, Keaveny, Andrew P, Burcin Taner, C
• Format: Journal Article
• Language: English
• Published: United States 01.12.2016
• DOI: 10.1097/TP.0000000000001483

Published reports describing the national experience with liver grafts from donation after cardiac death(DCD) donors have resulted in reservations with their widespread utilization. The present study aimed to investigate if temporal improvements in outcomes have been observed on a national level and to determine if donor and recipient selection have been modified in a fashion consistent with published data on DCD use in liver transplantation(LT). Patients undergoing DCD LT between 2003-2014 were obtained from the UNOS STAR file and divided into 3 equal eras based on the date of DCD LT: Era 1(2003-2006), Era 2(2007-2010) and Era 3(2011-2014). Improvement in graft survival was seen between Era 1 and Era 2(p=0.001) and between Era 2 and Era 3(p<0.001). Concurrently, an increase in the proportion of patients with HCC and a decrease in critically ill patients, re-transplant recipients, donor age, warm ischemia time >30min and cold ischemic time(CIT) also occurred over the same time period. On multivariate analysis, significant predictors of graft survival included: recipient age, biologic MELD score, recipient on ventilator, recipient HCV+serology, donor age and CIT. In addition, even after adjustment for all of the aforementioned variables, both Era 2(HR: 0.81,CI:0.69-0.94;p=0.007), and Era 3(HR 0.61,CI:0.5-0.73;p<0.001) had a protective effect compared to Era 1. The national outcomes for DCD LT have improved over the last 12 years. This change was associated with modifications in both recipient and donor selection. Furthermore, an era effect was observed, even after adjustment for all recipient and donor variables on multivariate analysis.