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

2011; Elsevier BV; Volume: 55; Issue: 4 Linguagem: Inglês

10.1016/j.jhep.2011.01.040

1600-0641

Colleen L. Jay, Daniela P. Ladner, Edward Wang, Vadim Lyuksemburg, Raymond Kang, Yao-Jen Chang, Joseph Feinglass, Jane L. Holl, Michaël Abécassis, Anton Skaro,

Renal Transplantation Outcomes and Treatments

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 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. 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. 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. 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 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). 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.