Long-term results of liver transplantation from donation after circulatory death
Blok, Joris × Detry, Olivier Putter, Hein Rogiers, Xavier Porte, Robert J van Hoek, Bart Pirenne, Jacques Metselaar, Herold J Lerut, Jan P Ysebaert, Dirk Lucidi, Valerio Troisi, Roberto I Samuel, Undine Claire den Dulk, A Ringers, Jan Braat, Andries E #
Wiley & Sons
Liver Transplantation vol:22 issue:8
Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by post-transplantation complications such as primary non-function or ischemic-type biliary lesions. However, similar survival for DCD and donation after brain death (DBD) LT has been reported. Objective of this study is to determine long-term outcome of DCD LT in the Eurotransplant region corrected for Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and The Netherlands (1.1.2003 - 31.12.2007) in adult recipients were included. Graft failure was defined as either date of recipient death or retransplantation; death un-censured graft survival. Mean follow-up was 7.2 years. In total 126 DCD and 1264 DBD LT's were performed. Kaplan-Meier survival analyses showed different graft survival for respectively DBD and DCD at one (78% vs. 75%, p=0.71), five (66% vs. 54%, p=0.02) and ten (47% vs. 44%, p=0.55) years (Log Rank p=0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, most probably caused by lower other risk factors in DCD livers. Patient survival was not significantly different (p=0.59). Multivariate Cox-regression analysis showed a HR 1.7 (p<0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (1(st) WIT) over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (p=0.002).