Donation after Cardiac Death Liver Transplantation: Predictors of Outcome

• Published in: American journal of transplantation Vol. 10; no. 11; pp. 2512 - 2519
• Main Authors: Mathur, A. K., Heimbach, J., Steffick, D. E., Sonnenday, C. J., Goodrich, N. P., Merion, R. M.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2010; Wiley
• Subjects: Adolescent; Adult; Biological and medical sciences; Cold Ischemia; DCD liver transplant; Death; Epidemiology; Female; General aspects; graft failure; Graft Rejection - epidemiology; Hepatitis C virus; Humans; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; outcomes; prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue and Organ Procurement - methods; Tissue Donors; Treatment Outcome; United States - epidemiology; Warm Ischemia; United States; Heart; risk factors; Prognosis; Digestive system; Liver; Mortality; Prediction; DCD liver transplant; Homotransplantation; Epidemiology; Graft failure; Treatment; outcomes; Surgery; Donation; Risk factor; Graft; Evolution; Death; Circulatory system; Predictive factor; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2010.03293.x

We aimed to identify recipient, donor and transplant risk factors associated with graft failure and patient mortality following donation after cardiac death (DCD) liver transplantation. These estimates were derived from Scientific Registry of Transplant Recipients data from all US liver‐only DCD recipients between September 1, 2001 and April 30, 2009 (n = 1567) and Cox regression techniques. Three years post‐DCD liver transplant, 64.9% of recipients were alive with functioning grafts, 13.6% required retransplant and 21.6% died. Significant recipient factors predictive of graft failure included: age ≥ 55 years, male sex, African–American race, HCV positivity, metabolic liver disorder, transplant MELD ≥ 35, hospitalization at transplant and the need for life support at transplant (all, p ≤ 0.05). Donor characteristics included age ≥ 50 years and weight >100 kg (all, p ≤ 0.005). Each hour increase in cold ischemia time (CIT) was associated with 6% higher graft failure rate (HR 1.06, p < 0.001). Donor warm ischemia time ≥ 35 min significantly increased graft failure rates (HR 1.84, p = 0.002). Recipient predictors of mortality were age ≥ 55 years, hospitalization at transplant and retransplantation (all, p ≤ 0.006). Donor weight >100 kg and CIT also increased patient mortality (all, p ≤ 0.035). These findings are useful for transplant surgeons creating DCD liver acceptance protocols. Several recipient, donor, and transplant‐related factors are associated with increased graft failure and mortality risk following DCD liver transplant, but this study found that donor warm ischemia time greater than 35 minutes was particularly noteworthy.