Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

Expanding the donor pool: Donation after circulatory death and living liver donation do not... Because of the shortfall between the number of patients listed for liver transplantation (LT) and the available grafts, strategies to expand the donor pool have been developed. Donation after circulatory death (DCD) and living donor (LD) grafts are not universally used because of the concerns of graft failure, biliary complications, and donor risks. In order to overcome the barriers for the implementation of using all 3 types of grafts, we compared outcomes after LT of DCD, LD, and donation after brain death (DBD) grafts. Patients who received a LD, DCD, or DBD liver graft at the University of Toronto were included. Between January 2009 through April 2017, 1054 patients received a LT at our center. Of these, 77 patients received a DCD graft (DCD group); 271 received a LD graft (LD group); and 706 received a DBD graft (DBD group). Overall biliary complications were higher in the LD group (11.8%) compared with the DCD group (5.2%) and the DBD group (4.8%; P < 0.001). The 1‐, 3‐, and 5‐year graft survival rates were similar between the groups with 88.3%, 83.2%, and 69.2% in the DCD group versus 92.6%, 85.4%, and 84.7% in the LD group versus 90.2%, 84.2%, and 79.9% in the DBD group (P = 0.24). Furthermore, the 1‐, 3‐, and 5‐year patient survival was comparable, with 92.2%, 85.4%, and 71.6% in the DCD group versus 95.2%, 88.8%, and 88.8% in the LD group versus 93.1%, 87.5%, and 83% in the DBD group (P = 0.14). Multivariate Cox regression analysis revealed that the type of graft did not impact graft survival. In conclusion, DCD, LD, and DBD grafts have similar longterm graft survival rates. Increasing the use of LD and DCD grafts may improve access to LT without affecting graft survival rates. Liver Transplantation 24 779–789 2018 AASLD. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

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Publisher
Wiley
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
DOI
10.1002/lt.25068
Publisher site
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Abstract

Because of the shortfall between the number of patients listed for liver transplantation (LT) and the available grafts, strategies to expand the donor pool have been developed. Donation after circulatory death (DCD) and living donor (LD) grafts are not universally used because of the concerns of graft failure, biliary complications, and donor risks. In order to overcome the barriers for the implementation of using all 3 types of grafts, we compared outcomes after LT of DCD, LD, and donation after brain death (DBD) grafts. Patients who received a LD, DCD, or DBD liver graft at the University of Toronto were included. Between January 2009 through April 2017, 1054 patients received a LT at our center. Of these, 77 patients received a DCD graft (DCD group); 271 received a LD graft (LD group); and 706 received a DBD graft (DBD group). Overall biliary complications were higher in the LD group (11.8%) compared with the DCD group (5.2%) and the DBD group (4.8%; P < 0.001). The 1‐, 3‐, and 5‐year graft survival rates were similar between the groups with 88.3%, 83.2%, and 69.2% in the DCD group versus 92.6%, 85.4%, and 84.7% in the LD group versus 90.2%, 84.2%, and 79.9% in the DBD group (P = 0.24). Furthermore, the 1‐, 3‐, and 5‐year patient survival was comparable, with 92.2%, 85.4%, and 71.6% in the DCD group versus 95.2%, 88.8%, and 88.8% in the LD group versus 93.1%, 87.5%, and 83% in the DBD group (P = 0.14). Multivariate Cox regression analysis revealed that the type of graft did not impact graft survival. In conclusion, DCD, LD, and DBD grafts have similar longterm graft survival rates. Increasing the use of LD and DCD grafts may improve access to LT without affecting graft survival rates. Liver Transplantation 24 779–789 2018 AASLD.

Journal

Liver Transplantation – Wiley

Published: Jan 1, 2018

References

  • OPTN/SRTR 2011 annual data report: liver
    Kim, WR; Stock, PG; Smith, JM; Heimbach, JK; Skeans, MA; Edwards, EB
  • Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End‐Stage Liver Disease (MELD) inflation
    Northup, PG; Intagliata, NM; Shah, NL; Pelletier, SJ; Berg, CL; Argo, CK
  • Surgical techniques and innovations in living related liver transplantation
    Tanaka, K; Uemoto, S; Tokunaga, Y; Fujita, S; Sano, K; Nishizawa, T
  • Donation after cardiac death liver transplantation: predictors of outcome
    Mathur, AK; Heimbach, J; Steffick, DE; Sonnenday, CJ; Goodrich, NP; Merion, RM
  • Liver transplantation from controlled non‐heart‐beating donors: an increased incidence of biliary complications
    Abt, P; Crawford, M; Desai, N; Markmann, J; Olthoff, K; Shaked, A
  • Hospital resource use with donation after cardiac death allografts in liver transplantation: a matched‐controlled analysis from 2007 to 2011
    Singhal, A; Wima, K; Hoehn, RS; Quillin, RC; Woodle, ES; Paquette, IM
  • Right lobe living‐donor hepatectomy‐the Toronto approach, tips and tricks
    Sapisochin, G; Goldaracena, N; Laurence, JM; Levy, GA; Grant, DR; Cattral, MS
  • Thrombolytic protocol minimizes ischemic‐type biliary complications in liver transplantation from donation after circulatory death donors
    Seal, JB; Bohorquez, H; Reichman, T; Kressel, A; Ghanekar, A; Cohen, A
  • New classification of donation after circulatory death donors definitions and terminology
    Thuong, M; Ruiz, A; Evrard, P; Kuiper, M; Boffa, C; Akhtar, MZ
  • Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors
    Hashimoto, K; Eghtesad, B; Gunasekaran, G; Fujiki, M; Uso, TD; Quintini, C
  • Living‐donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients
    Cattral, MS; Molinari, M; Vollmer, CM; McGilvray, I; Wei, A; Walsh, M
  • Live donor liver transplantation with older (≥50 years) versus younger (<50 years) donors: does age matter?
    Goldaracena, N; Sapisochin, G; Spetzler, V; Echeverri, J; Kaths, M; Cattral, MS
  • Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey
    Dindo, D; Demartines, N; Clavien, PA
  • The comprehensive complication index: a novel continuous scale to measure surgical morbidity
    Slankamenac, K; Graf, R; Barkun, J; Puhan, MA; Clavien, PA
  • The comprehensive complication index (CCI): added value and clinical perspectives 3 years “down the line
    Clavien, PA; Vetter, D; Staiger, RD; Slankamenac, K; Mehra, T; Graf, R; Puhan, MA
  • Comparison of postoperative outcomes between donation after circulatory death and donation after brain death liver transplantation using the comprehensive complication index
    Kalisvaart, M; Haan, JE; Polak, WG; Metselaar, HJ; Wijnhoven, BPL; IJzermans, JNM; Jonge, J
  • Comprehensive complication index predicts cancer‐specific survival after resection of colorectal metastases independent of RAS mutational status
    Yamashita, S; Sheth, RA; Niekamp, AS; Aloia, TA; Chun, YS; Lee, JE
  • OPTN/SRTR 2015 annual data report: liver
    Kim, WR; Lake, JR; Smith, JM; Skeans, MA; Schladt, DP; Edwards, EB
  • Ischemic cholangiopathy after controlled donation after cardiac death liver transplantation: a meta‐analysis
    Jay, CL; Lyuksemburg, V; Ladner, DP; Wang, E; Caicedo, JC; Holl, JL
  • Utilization, outcomes, and retransplantation of liver allografts from donation after cardiac death: implications for further expansion of the deceased‐donor pool
    Selck, FW; Grossman, EB; Ratner, LE; Renz, JF
  • Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single‐center experience
    Grewal, HP; Willingham, DL; Nguyen, J; Hewitt, WR; Taner, BC; Cornell, D
  • Liver transplantation using donation after cardiac death donors: long‐term follow‐up from a single center
    Vera, ME; Lopez‐Solis, R; Dvorchik, I; Campos, S; Morris, W; Demetris, AJ
  • The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story
    Skaro, AI; Jay, CL; Baker, TB; Wang, E; Pasricha, S; Lyuksemburg, V
  • Impact of donor age in liver transplantation from donation after circulatory death donors: a decade of experience at Cleveland Clinic
    Firl, DJ; Hashimoto, K; O'Rourke, C; Diago‐Uso, T; Fujiki, M; Aucejo, FN
  • Liver transplantation using grafts from donors after circulatory death: a propensity score‐matched study from a single center
    Laing, RW; Scalera, I; Isaac, J; Mergental, H; Mirza, DF; Hodson, J
  • Longterm results of liver transplantation from donation after circulatory death
    Blok, JJ; Detry, O; Putter, H; Rogiers, X; Porte, RJ; Hoek, B
  • Defining benchmarks in liver transplantation: a multicenter outcome analysis determining best achievable results
    Muller, X; Marcon, F; Sapisochin, G; Marquez, M; Dondero, F; Rayar, M
  • A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients
    Lee, SG
  • Defining long‐term outcomes with living donor liver transplantation in North America
    Olthoff, KM; Smith, AR; Abecassis, M; Baker, T; Emond, JC; Berg, CL
  • Long‐term follow‐up of biliary complications after adult right‐lobe living donor liver transplantation
    Kim, PT; Marquez, M; Jung, J; Cavallucci, D; Renner, EL; Cattral, M
  • Complications and their resolution in recipients of deceased and living donor liver transplants: findings from the A2ALL Cohort Study
    Samstein, B; Smith, AR; Freise, CE; Zimmerman, MA; Baker, T; Olthoff, KM
  • Risk factors and management for biliary complications following adult living‐donor liver transplantation
    Nakamura, T; Iida, T; Ushigome, H; Osaka, M; Masuda, K; Matsuyama, T
  • The right posterior bile duct anatomy of the donor is important in biliary complications of the recipients after living‐donor liver transplantation
    Jeon, YM; Lee, KW; Yi, NJ; Lee, JM; Hong, G; Choi, Y
  • Outcome of living donor liver transplantation using right liver allografts with multiple arterial supply
    Lee, KW; Lee, S; Huh, J; Cho, CW; Lee, N; Kim, HS
  • Long‐term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation
    Hwang, S; Lee, SG; Sung, KB; Park, KM; Kim, KH; Ahn, CS
  • Living versus deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case‐control study
    Goldaracena, N; Marquez, M; Selzner, N; Spetzler, VN; Cattral, MS; Greig, PD
  • Live donor liver transplantation: a valid alternative for critically ill patients suffering from acute liver failure
    Goldaracena, N; Spetzler, VN; Marquez, M; Selzner, N; Cattral, MS; Greig, PD
  • Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers
    Scalea, JR; Redfield, RR; Foley, DP
  • Impact of donor age in donation after cardiac death liver transplantation: Is the cutoff “60” still of relevance?
    Schlegel, A; Scalera, I; Perera, MTPR; Kalisvaart, M; Mergental, H; Mirza, DF
  • Liver transplantation using donation after cardiac death donors
    Monbaliu, D; Pirenne, J; Talbot, D
  • High serum aspartate transaminase levels on day 3 postliver transplantation correlates with graft and patient survival and would be a valid surrogate for outcome in liver transplantation clinical trials
    Robertson, FP; Bessell, PR; Diaz‐Nieto, R; Thomas, N; Rolando, N; Fuller, B; Davidson, BR
  • Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications
    Rahman, S; Davidson, BR; Mallett, SV
  • Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long‐term outcomes from a single center
    Foley, DP; Fernandez, LA; Leverson, G; Anderson, M; Mezrich, J; Sollinger, HW; D'Alessandro, A
  • Minimal hilar dissection prevents biliary anastomotic stricture after living donor liver transplantation
    Ikegami, T; Shirabe, K; Morita, K; Soejima, Y; Taketomi, A; Yoshizumi, T
  • Development, management, and resolution of biliary complications after living and deceased donor liver transplantation: a report from the adult‐to‐adult living donor liver transplantation cohort study consortium
    Zimmerman, MA; Baker, T; Goodrich, NP; Freise, C; Hong, JC; Kumer, S

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