TY - JOUR
T1 - A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation
AU - DCD Collaborator Group
AU - Schlegel, Andrea
AU - van Reeven, Marjolein
AU - Croome, Kristopher
AU - Parente, Alessandro
AU - Dolcet, Annalisa
AU - Widmer, Jeannette
AU - Meurisse, Nicolas
AU - De Carlis, Riccardo
AU - Hessheimer, Amelia
AU - Jochmans, Ina
AU - Mueller, Matteo
AU - van Leeuwen, Otto B.
AU - Nair, Amit
AU - Tomiyama, Koji
AU - Sherif, Ahmed
AU - Elsharif, Mohamed
AU - Kron, Philipp
AU - van der Helm, Danny
AU - Borja-Cacho, Daniel
AU - Bohorquez, Humberto
AU - Germanova, Desislava
AU - Dondossola, Daniele
AU - Olivieri, Tiziana
AU - Camagni, Stefania
AU - Gorgen, Andre
AU - Patrono, Damiano
AU - Cescon, Matteo
AU - Croome, Sarah
AU - Panconesi, Rebecca
AU - Carvalho, Mauricio Flores
AU - Ravaioli, Matteo
AU - Caicedo, Juan Carlos
AU - Loss, George
AU - Lucidi, Valerio
AU - Sapisochin, Gonzalo
AU - Romagnoli, Renato
AU - Jassem, Wayel
AU - Colledan, Michele
AU - De Carlis, Luciano
AU - Rossi, Giorgio
AU - Di Benedetto, Fabrizio
AU - Miller, Charles M.
AU - van Hoek, Bart
AU - Attia, Magdy
AU - Lodge, Peter
AU - Hernandez-Alejandro, Roberto
AU - Detry, Olivier
AU - Quintini, Cristiano
AU - Oniscu, Gabriel C.
AU - Daud, Amna
N1 - Funding Information:
No financial support was specifically dedicated to the benchmark study. The research on hypothermic oxygenated liver perfusion is funded by the Swiss National Science Foundation grant no 320030_189055, dedicated to P.D. and A.S. Additionally, P.M. and A.S. are further supported by the University of Florence through grant n° 90-2020/PR. None of the funding sources were involved in study design, in the collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Funding Information:
Authors are very grateful for the support by the following student researchers from University Hospitals Leuven, Belgium: Rutger Den Abt, Andrea Karlovic, Zhen Qian, Jef Van den Eynde, Melisa Garip, Tom Lauwers, Chimene Coudré, Maarten Claes, Florence Bourgeois, Lennert Fransen, Victor Van Lishout and Thomas Willems.
Publisher Copyright:
© 2021 European Association for the Study of the Liver
PY - 2022/2
Y1 - 2022/2
N2 - Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials. Lay summary: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort.
AB - Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials. Lay summary: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort.
KW - Donation after circulatory death
KW - benchmarking
KW - liver transplantation
KW - morbidity
KW - organ perfusion
KW - risk analysis
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U2 - 10.1016/j.jhep.2021.10.004
DO - 10.1016/j.jhep.2021.10.004
M3 - Article
C2 - 34655663
AN - SCOPUS:85121654852
SN - 0168-8278
VL - 76
SP - 371
EP - 382
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -