Risk Factors of Primary Non-Function Using Uncontrolled Donors After Cardiac Arrest (uDCD)

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Abstract

Introduction

The acceptance of liver grafts from donors after cardiac arrest (uDCD) emerges as a consequence of the shortage of organs and increased mortality in the waiting list. The use of these grafts implies a higher risk of primary non-function (PNF) and ischemic cholangiopathy (IC). Classically, liver function tests (LFT) (AST-ALT) and ischemia times, as well as the macroscopic aspect of the liver are used as determining factors for accepting these livers.

Materials and Methods

Between January 2006 and December 2016 we performed 783 liver transplants (LT) in adult recipients. Seventy-five of these transplants were performed using livers from uDCD donors (Maastricht type II). We analyze factors related to LFT and the times of donors in ECMO.

Results

Seventy-five patients underwent LT using livers from uDCD donors. Six (8%) of these patients developed PNF, with a mean age of 54.2±7 years vs. 59.2±8 in group of normal function (p=0.128). The mean age of donor with PNF was 43.3±13 years vs. 41.6±9 in normal function (p=0.673). Indications for LT were: hepatocarcinoma (66.7% in PNF vs 47.8% in normal function; p=0.430); VHC cirrhosis 16.7% in PNF vs 63.8% in normal function; p=0.035)

Results

In relation to predictive risk factors for PNF, no statistical differences were found with respect to the mean values of cold ischemia and warm ischemia times in both groups. We also did not find statistical differences with respect to times in ECMO, fluid flow in ECMO, transfusion of red blood cells and plasma in ECMO. No statistical differences were seen with respect to time of cardiac arrest, even it was higher in PNF (6±7 vs 3.8±3.6; p=0.521), who also presented longer time of cardiopulmonary resuscitation (CPR), and out-of-hospital CPR (54.4±10 vs 43.9±1; p=0.320). We did not observed statistical significant differences with respect to LFT: AST at start of ECMO: 469±731 IU/L vs 132±137 (p=0.310); ALT at the start of ECMO 462±600 vs 130±157 (p=0.200); in final AST 342±153 vs 189±107 (p= 0.561); and final ALT 372±222 vs 140±102 (p=0.606). In univariable study the most important data was the median pump flow: 3394±287 vs 3825±421 (p=0.018). No differences were observed with respect to total bilirubin levels, prothrombin time (PT), activated partial thromboplastin time (aPTT) and blood pH.

Results

Differences were observed with respect to a higher necessity of packed red blood cells in ECMO in patients who developed PNF, although without statistical significance. Multiple logistic regression model has shown significant statistically difference in ALT final value over 4 times normal value (OR 1.06; CI 95%; 1.01-1.11; p= 0.012)

Conclusion

Taking into consideration these results, the LFT have not predictive value for PNF of implanted liver grafts from uDCD donors. Thus new parameters should be considered in the future for the evaluation of these livers.

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