Is It Time to Extend Liver Acceptance Criteria for Controlled Donors After Cardiac Death?

Donation after cardiac death (DCD) has reemerged as potential way to increase donor liver availability. Earlier, programs with DCD liver transplantation used conservative donor criteria to allow safe results. Successful initial outcomes allowed extended DCD criteria to address transplant demand. A t...

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Bibliographic Details
Published in:	Transplantation Vol. 92; no. 10; pp. 1140 - 1146
Main Authors:	TARICIOTTI, Laura, ROEHA, Chiara, THAMARA PR PERERA, M, GUNSON, Bridget K, BRAMHALL, Simon R, ISAAE, John, BUCKELS, John A. C, DAVID MAYER, A, MUIESAN, Paolo, MIRZA, Darius F
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 27-11-2011
Subjects:	Adult Age Biological and medical sciences Body mass index Cell survival Cholangiopancreatography, Endoscopic Retrograde Death Donors Fundamental and applied biological sciences. Psychology Fundamental immunology Heart Humans Ischemia Liver transplantation Liver Transplantation - adverse effects Liver Transplantation - mortality Medical sciences Middle Aged Reoperation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissue and Organ Procurement Tissue Donors Tissue, organ and graft immunology Heart Suboptimal donor Human Acceptance Digestive system Criterion Liver Mortality Graft Death Circulatory system
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Summary:	Donation after cardiac death (DCD) has reemerged as potential way to increase donor liver availability. Earlier, programs with DCD liver transplantation used conservative donor criteria to allow safe results. Successful initial outcomes allowed extended DCD criteria to address transplant demand. A total of 63 DCD liver grafts were used during the study period in carefully selected recipients. These were divided into two groups: "Standard" DCD within conservative criteria (n=33; age ≤60 years, body mass index <30 kg/m(2), donor warm ischemia time ≤30 min, and cold ischemia time ≤8 hr) and "Extended" DCD beyond these criteria (n=30). We compared donor and recipient characteristics and postoperative outcomes, including patient and graft survival. Both groups had satisfactory initial function; liver graft function at 1, 7, and 30 days after liver transplantation were similar. Median follow-up period was 25 and 18.5 months for Standard and Extended criteria DCD grafts, respectively, with 1-year patient and graft survival of 88% and 82% for the Standard group vs. 90% and 90% for the Extended. Overall, 8 of 63 (13%) patients developed biliary complications; however, the incidence was not different between the Standard and Extended groups. Seven early deaths occurred, four and three in the Standard and Extended groups, respectively. Recipients of DCDs beyond conventional acceptance criteria have equivalent early outcomes to standard DCD grafts. With careful selection of donors and recipients, these grafts can be safely used to expand the donor pool.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0041-1337 1534-6080
DOI:	10.1097/TP.0b013e318232babe