Liver Transplantation with Grafts from Controlled Donors after Cardiac Death: A 20‐Year Follow‐up at a Single Center

• Published in: American journal of transplantation Vol. 10; no. 3; pp. 602 - 611
• Main Authors: Yamamoto, S., Wilczek, H. E., Duraj, F. F., Groth, C.‐G., Ericzon, B.‐G.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-03-2010; Wiley
• Subjects: Adult; Biological and medical sciences; Complications; Death; deceased donor organs; Female; Follow-Up Studies; Graft Survival; Hepatic Artery - pathology; Humans; Infant; liver transplantation; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Multivariate Analysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; survival; Thrombosis - pathology; Tissue Donors; Treatment Outcome; Heart; Suboptimal donor; Human; Center; Prognosis; Digestive system; Complications; Liver; Mortality; Homograft; Homotransplantation; Survival; deceased donor organs; Treatment; Surveillance; Follow up study; Surgery; Graft; Complication; Death; Circulatory system; Cadaver; Organ; Liver transplantation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02965.x

The first liver transplantation (LTx) in Sweden was performed in 1984, but brain death as a legal death criterion was not accepted until 1988. Between November 1984 and May 1988, we performed 40 consecutive LTxs in 32 patients. Twenty‐four grafts were from donors after cardiac death (DCD) and 16 grafts from heart‐beating donors (HBD). Significantly, more hepatic artery thrombosis and biliary complications occurred in the DCD group (p < 0.01 and p < 0.05, respectively). Graft and patient survival did not differ between the groups. In the total group, there was a significant difference in graft survival between first‐time LTx grafts and grafts used for retransplantation. There was better graft survival in nonmalignant than malignant patients, although this did not reach statistical significance. Multivariate analysis revealed cold ischemia time and post‐LTx peak ALT to be independent predictive factors for graft survival in the DCD group. In the 11 livers surviving 20 years or more, follow‐up biopsies were performed 18–20 years post‐LTx (n = 10) and 6 years post‐LTx (n = 1). Signs of chronic rejection were seen in three cases, with no difference between DCD and HBD. Our analysis with a 20‐year follow‐up suggests that controlled DCD liver grafts might be a feasible option to increase the donor pool.
This 20‐year follow‐up, single‐center analysis indicates that the use of liver grafts from controlled donors after cardiac death may be a realizable option to expand the donor liver pool and reduce the existing liver organ shortage.