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Longterm results of liver transplantation from donation after circulatory death.

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Blok, Joris J Detry, Olivier Putter, Hein Rogiers, Xavier Porte, Robert J Lerut, Jan [UCL] for the Eurotransplant Liver Intestine Advisory Committee

Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P < 0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2016
Language Anglais
Journal information "Liver Transplantation" - Vol. 22, no. 8, p. 1107-1114 (2016)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) Hoboken, NJ)
issn 1527-6465
e-issn 1527-6473
Publication status Publié
Affiliations UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - (SLuc) Service de chirurgie et transplantation abdominale
Links
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Bibliographic reference Blok, Joris J ; Detry, Olivier ; Putter, Hein ; Rogiers, Xavier ; Porte, Robert J ; et. al. Longterm results of liver transplantation from donation after circulatory death.. In: Liver Transplantation, Vol. 22, no. 8, p. 1107-1114 (2016)
Permanent URL http://hdl.handle.net/2078.1/175895