Long-term Outcomes Using Uncontrolled Donors after Circulatory Death (uDCD) for Liver Transplantation. A 10-Year Single Center Experience

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Abstract

Introduction

The good results obtained along the years with liver transplantation (LT) have led to an increasing number of candidates on the waiting list, while the number of liver grafts is not enough to attend all patients who need an OLT. That is because many LT teams have proposed to expand the number of available grafts using livers from donors after circulatory death (DCD). The aim of this study is to analyse the use of liver grafts from type 2 uDCD donors for LT, comparing post-OLT complications and recipient outcome at 10-year follow-up with a group of patients who received liver grafts from donors after brain death (DBD). To our knowledge this series represents the largest experience using this kind of donors.

Materials and Methods

Between January 2006 and December 2016 we performed 783 LT in adult recipients. Seventy-five LT were performed using grafts from uDCD (Maastricht type 2), and 265 LT using livers from DBD donors. We compared the results using uDCD donors vs. DBD donors in adult recipients.

Results

The mean age of recipients of uDCD donors was 58.8±8 years vs. 54.7±10 (p=0.000) in DBD donors. Comparing both groups of recipients, there were no statistically significant differences in relation with gender, body mass index, Child-Pugh, MELD score, LT indication, and pre-LT laboratory tests.

Results

Mean age of uDCD donors was 41.7±10 years vs. 47.8±15 of DBD donors (p=0.001), with a higher frequency use of vasopressors in uDCD group (100%) vs. 48.3% in DBD (p=0.001), and higher significantly levels of AST prior to donation. No differences were found with respect to the presence of esteatosis, preservation injury, and cold ischemia time. Mean warm ischemia time was significantly lower in recipients of uDCD donors: 62±14 min in uDCD vs 70 ±36 in DBD (p=0.010). The units of transfused hemoderivates (packed red blood cells, fresh frozen plasma, platelets and fibrinogen) was significantly higher in recipients of uDCD than in recipients of DBD donors.

Results

Primary non-function of liver graft was significantly higher in uDCD group: 8.1% vs 2.1% in DBD group (p=0.031). Retransplant rate was also higher in recipients of uDCD donors: 12% vs. 4.6% in DBD (0.028). Moreover, ischemic cholangiopathy was significantly more frequent in uDCD: 31.1% vs. 5.6% in recipients of DBD liver donors (p=0.000).

Results

Patient survival at 1, 3 and 5-year was in recipients of uDCD donors was 81.3%, 70.2% and 68.6%, respectively, while in recipients of DBD donors was 89%, 83.7% and 78.8% (p=0.070). Graft survival at 1, 3 and 5-year in uDCD group was 72%, 62.2% and 60.7%, vs 87.1%, 81.9% and 76.5%, in DBD (p=0.003).

Conclusion

Even with the associated higher risk of primary non-function of liver graft and higher risk of ischemic cholangiopathy, liver grafts from uDCD donors type 2 constitute a safe source of grafts for LT.

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