TY - JOUR
T1 - A comprehensive risk assessment of mortality following donation after cardiac death liver transplant - An analysis of the national registry
AU - Jay, Colleen
AU - Ladner, Daniela
AU - Wang, Edward
AU - Lyuksemburg, Vadim
AU - Kang, Raymond
AU - Chang, Yaojen
AU - Feinglass, Joseph
AU - Holl, Jane L.
AU - Abecassis, Michael
AU - Skaro, Anton I.
N1 - Funding Information:
Research for this paper was done in part while the lead author was a National Research Service Award postdoctoral fellow with the Division of Organ Transplantation at Northwestern University, Feinberg School of Medicine under an institutional award from the National Institute of Diabetes and Digestive and Kidney Diseases, 5 T32 DK077662–02 (PI: Michael Abecassis).
PY - 2011/10
Y1 - 2011/10
N2 - Background & Aims: Organ scarcity has resulted in increased utilization of donation after cardiac death (DCD) donors. Prior analysis of patient survival following DCD liver transplantation has been restricted to single institution cohorts and a limited national experience. We compared the current national experience with DCD and DBD livers to better understand survival after transplantation. Methods: We compared 1113 DCD and 42,254 DBD recipients from the Scientific Registry of Transplant Recipients database between 1996 and 2007. Patient survival was analyzed using the Kaplan-Meier methodology and Cox regression. Results: DCD recipients experienced worse patient survival compared to DBD recipients (p <0.001). One and 3 year survival was 82% and 71% for DCD compared to 86% and 77% for DBD recipients. Moreover, DCD recipients required re-transplantation more frequently (DCD 14.7% vs. DBD 6.8%, p <0.001), and re-transplantation survival was markedly inferior to survival after primary transplant irrespective of graft type. Amplification of mortality risk was observed when DCD was combined with cold ischemia time >12 h (HR = 1.81), shared organs (HR = 1.69), recipient hepatocellular carcinoma (HR = 1.80), recipient age >60 years (HR = 1.92), and recipient renal insufficiency (HR = 1.82). Conclusions: DCD recipients experience significantly worse patient survival after transplantation. This increased risk of mortality is comparable in magnitude to, but often exacerbated by other well-established risk predictors. Utilization decisions should carefully consider DCD graft risks in combination with these other factors.
AB - Background & Aims: Organ scarcity has resulted in increased utilization of donation after cardiac death (DCD) donors. Prior analysis of patient survival following DCD liver transplantation has been restricted to single institution cohorts and a limited national experience. We compared the current national experience with DCD and DBD livers to better understand survival after transplantation. Methods: We compared 1113 DCD and 42,254 DBD recipients from the Scientific Registry of Transplant Recipients database between 1996 and 2007. Patient survival was analyzed using the Kaplan-Meier methodology and Cox regression. Results: DCD recipients experienced worse patient survival compared to DBD recipients (p <0.001). One and 3 year survival was 82% and 71% for DCD compared to 86% and 77% for DBD recipients. Moreover, DCD recipients required re-transplantation more frequently (DCD 14.7% vs. DBD 6.8%, p <0.001), and re-transplantation survival was markedly inferior to survival after primary transplant irrespective of graft type. Amplification of mortality risk was observed when DCD was combined with cold ischemia time >12 h (HR = 1.81), shared organs (HR = 1.69), recipient hepatocellular carcinoma (HR = 1.80), recipient age >60 years (HR = 1.92), and recipient renal insufficiency (HR = 1.82). Conclusions: DCD recipients experience significantly worse patient survival after transplantation. This increased risk of mortality is comparable in magnitude to, but often exacerbated by other well-established risk predictors. Utilization decisions should carefully consider DCD graft risks in combination with these other factors.
KW - Donation after brain death
KW - Donation after cardiac death
KW - Liver transplantation
KW - Patient survival
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U2 - 10.1016/j.jhep.2011.01.040
DO - 10.1016/j.jhep.2011.01.040
M3 - Article
C2 - 21338639
AN - SCOPUS:80052935055
SN - 0168-8278
VL - 55
SP - 808
EP - 813
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 4
ER -