A comprehensive risk assessment of mortality following donation after cardiac death liver transplant - An analysis of the national registry

Colleen Jay, Daniela Ladner, Edward Wang, Vadim Lyuksemburg, Raymond Kang, Yaojen Chang, Joseph Feinglass, Jane L. Holl, Michael Abecassis, Anton I. Skaro*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

106 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)808-813
Number of pages6
JournalJournal of Hepatology
Volume55
Issue number4
DOIs
StatePublished - Oct 2011

Keywords

  • Donation after brain death
  • Donation after cardiac death
  • Liver transplantation
  • Patient survival

ASJC Scopus subject areas

  • Hepatology

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